Change of Life: Menopause
In ancient times, pubescent boys were hunters and warriors. Adolescent girls were mothers -- mothers who knew the phases of their bodies their bodies and birthed and cared for children in the context of extended family. Fertility cycles were known to be of the moon, and the signs of the moon’s reflection in the body were understood. “From before I had the body of a woman” a kahuna once told me, “the knowledge of my body’s fertility cycles was mine.” Life was lived in rhythm with nature. Foods were of the earth and of the sea. Movement was essential to life, running and swimming, dancing in celebration. The air was pure, and so were the waters. We lived to younger ages then, and as we did grow older, our youngers took on our work. We slowed and accepted inner responsibilities. In menopause, we were grandmothers, even great grandmothers. We were elders; we were keepers of wisdom. There was an innate intelligence to the flow, and a place for us to be in every stage of life.
As we have advanced through time, we’ve gained a certain freedom, but lost the context. Birth control pills allow us to choose when and with whom we bear children, yet they disrupt the delicate communications between brain and ovaries. Free to follow our career choices, some of us may face infertility for the first time as we enter menopause. Suddenly alone, or new parents in mid-life, we rebirth ourselves in order to survive. Who is it we are supposed to be? Where are the role models? What is the cycle in which we find ourselves? We wish to prevail over our physiology that we might remain in a cycle of youthful energy long past our time. But our bodies betray us. For a number of years, conventional medicine claimed to triumph over nature. Irregular cycles? Hot flashes? Mood swings? Insomnia? Swallow a few pills and stay young, beautiful and content, heart healthy and bone strong. How much easier could it be to ignore the biological rhythms of aging and the ensuing life changes?
The chilling conclusions of the 2002 Women’s Health Initiative Study on the realities of hormone replacement therapy dispelled the notions of ease and rightness. Somewhere in the neighborhood of 6 million American women have taken the most common conventional hormone replacement therapy, a combination of Premarin (0.625 mg of conjugated equine estrogens) and Provera (2.5 mg of medroxyprogesterone acetate). These drugs did not protect them as was promised, but rather increased the risk for breast cancer, heart attacks, strokes, and blood clots in the lungs and legs. This risk outweighed the benefits of fewer hip fractures and reduced risk of colon cancer. The widely promoted benefit of heart disease prevention was not substantiated.
Physicians all over the country, having previously insisted that their patients pop those palliative pills, now urgently recommended stopping them -- cold turkey. Thus, a cadre of flashing, sweating, panicking women revisited old questions and sought new solutions.
The findings of the Women's Health Initiative are no surprise in the world of naturopathy, as they are no surprise to many of our patients. We have long held that conventional hormone replacement therapy is one of our time’s scarier examples of widespread medical experimentation on human subjects. We are of course pleased to see that questions are being asked, and that the situation has come to the attention of the public.
A fundamental question is the relevance of Premarin and Provera to hormone replacement therapy in general. Premarin and Provera are not bio-identical hormones. They are synthesized to be different than those hormones your body produces, in order that they might be patented and sold. Premarin, the estrogen replacement, comes from a hormone produced by pregnant mares and excreted in their urine. Provera is a progestin, not true progesterone. One would expect that these substances, foreign to our bodies, would differ in their bodily interractions from natural hormones -- and they do.
Many women are now aware that we have more than one estrogen in our bodies. Estrone (E1) is the predominant post menopausal estrogen. Estradiol (E2) is the predominant pre menopausal estrogen. Estriol (E3) is a less potent, possibly protective end stage metabolite. Conventional hormone replacement therapy is based on estrone or estradiol, but not necessarily in the forms in which they exist in in the human body. Hormone replacement therapy in Europe is based on estriol. Hormone replacement therapy in complementary medicine is based on bio-identical bi and tri estrogen combinations, always balancing the estrogen with bio-identical progesterone. (The term “natural” is somewhat of a misnomer when applied to these hormones, as all are synthesized, whether from a wild yam or from some other source. The issue is whether they are synthesized to be identical to (“bio-identical”) or different from that which could normally be found in your body.
It is not known, as it has not been studied, what the consequences are of long-term hormone replacement with bio-identical hormones. One could reasonably assume that these hormones would be more user-friendly. Still, there is the issue of overriding the natural cycles of the body to force a “forever young” state. Yet when those menopausal symptoms are overwhelming, we need pathways to follow in order to stay sane.
Often we can address menopausal symptoms through dietary change, nutritional supplements, plant medicine and energy medicine. When symptoms are incapacitating and cannot be treated in other ways, we may use low dose combinations of bio-identical hormones. Through detailed case histories and salivary hormonal testing, you can look at your unique hormonal profile to find what treatment best suits you. If you are taking any estrogen for any reason, you can test whether your body metabolizes estrogen to protective forms or to potentially problematic forms, and supplement to shift your metabolism to favor protection.
In addition to working with obvious menopausal symptoms such as hot flashes, vaginal dryness, mood swings and menopausal arthritis, you can ascertain individual risk factors for silent conditions which often occur in menopause, such as cardiovascular disease and osteoporosis. A new form of lab test called “genomics profiles” allows a look at genetic variations which would predispose you toward one condition or another and offer the treatment option best suited to you. For example, you can determine whether your risk for osteoporosis would be more likely to respond to an increase in calcium supplementation, or to optimizing Vitamin D metabolism. The success of your treatment protocol can be monitored with cardiovascular profiles, bone density testing, urinary tests for bone loss, or other indicators. Using these approaches as a basis for establishing a personally-tailored treatment plans, most naturopathic physicians are able to help you address the physical symptoms of this energetic change of life which we call menopause.
What of the change itself? As our hair silvers or falls out, do we celebrate the molting and re-examine our defination of beauty? Or do we brighten the dimming color to appear more youthful? Or have a little fun and rinse our hair purple just for the heck of it? Do we shave our heads to see what that would be like?
As we grapple for lost words and lost memories, is the terror we experience because we are dropping off past definitions of ourselves, when we don’t really have new ones? That belly rounding… is it to accommodate the power building in the solar plexus energy center? Or is it a call to attend to the food we’re taking in and nourish ourselves with health giving choices? If we tire more easily, do we balance our work with play, our activity with meditation, or do we exhaust ourselves and tank up with stimulants to just keep it all going? Is there a passion that calls us to re-prioritize our lives and live in daring, different, creative ways? If we’re not sleeping, is there a way to be with that? Do we need a pill to diminish the discomfort of being alone with ourselves through those lonely nights? Or is there something to be learned, a new rhythm to develop?
Do we sink or do we swim? Menopause can be a crisis, a dangerous opportunity. Energy is available for dramatic, uniquely individual transformation.