MENOPAUSE

However, what has clearly emerged is the number of Well Woman medical problems. Therefore, as a result of the many questions on my programmes, Jan has embarked on the Well Woman series, starting with premenstrual and menopausal conditions, to be followed with books on the subjects of childbirth and pregnancy, mother and child, skin and hair conditions, and women’s cancers. These books will answer in depth the many queries that we have had on the programmes and I do hope that this series of books will be of help with many of the presently common conditions.

The menopause is mostly associated with a period of time when women may experience diverse complaints such as hot flushes, night sweats, tiredness, anxiety, lack of energy, depression, lack of confidence, vaginal dryness, changes of mood, and other less specific symptoms. However, should the menopausal period constitute a problem, much can be achieved by understanding the physiological changes that take place in the female body during this time of life, while at the same time realising that much can be done to minimise the problems.

For some women the first signs of the onset of the menopause, which occurs mostly during the mid-forties, are uncertainty and a lack of purpose about the future. The menstrual cycle becomes irregular, the production of the oestrogen hormone slowly wanes and they become aware of some of the symptoms already mentioned.

The word menopause describes the moment when a woman’s fertile period approaches the end. The stage is reached when the ovaries are losing or have lost the ability to perform the major part of their function. The menopause therefore signifies the end of an extremely important stage in the life of women. However, never doubt that the post-menopausal period holds much in store and should be regarded as a new phase in your life.

Let me remind you of the fact that in earlier centuries the life expectancy was such that women rarely reached the age of 40 and therefore hardly anything was known about the menopause. At the beginning of the nineteenth century the expected lifespan for women was 48 years. Since then better health care and diet have combined to create a much longer life expectancy. Statistics show that at present in the western world the average age reached by a woman is around 78 and, bearing in mind that the menopause occurs in one’s late forties or early fifties, this indicates that a third of a woman’s life is still ahead of her after the menopause.

How the menopausal period is experienced by individual women depends a great deal on the measure of balance achieved during the years of menstruation. Are you a stressful person by nature? Do you receive support from your husband, family and friends? Are you comfortable discussing your problems with your doctor? Contrary to popular belief most women pass through the menopause without any significant problems, although fully aware of the physiological changes. Other women require general or expert help and guidance in order to be able to accept and cope with the changes that take place in the body during this stage. Hot flushes and night sweats can result in lack of sleep and general tiredness, making a woman irritable and nervous. She is therefore less capable of concentrating and as a result lacks decisiveness. It is an unfortunate fact that men often also pass through a period of increased uncertainty at this stage of their lives, and therefore neither partner may be able to offer the level of support that is sought and expected.

At this stage it is often decided to seek medical advice and frequently a supplementary oestrogen preparation is prescribed. I wonder if this is always necessary. Although HRT (Hormone Replacement Therapy) has benefits, I fear that the body is often not given the time to find a new balance in the way that nature would, if given the chance. Nature will run its own course and will readily establish its own levels for compensation of physiological shortages and changes. It is often not recognised that naturopathy offers an alternative and less aggressive approach. It may require no more than a change in dietary habits to counteract a calcium deficiency or lack of vitamin absorption, all of which can be easily overcome.

A lack of confidence at this stage in a woman’s life is often caused because they feel they are losing their appeal to the opposite sex and if nothing else a substitute hormone supplement may at least slow down the development of wrinkles and delay the possible onset of osteoporosis. However, it has not been proved beyond any doubt that these preparations are free of side effects. If it is at all possible, why shouldn’t we give nature a chance first? Having said this, I must immediately refute the idea that women of this age are less attractive to men. It is widely recognised that they often exert a greater appeal because of their maturity and wisdom. It is a great pity that the term menopause or change of life is so often misinterpreted. Admittedly, it is the end of a woman’s reproductive years, but during the next stage of life women have so many other gifts to offer. Psychologically, the more positive a woman is about the change of life, the better she will cope with this period. How well she copes largely depends on her own approach and the understanding of her husband and her immediate family. If a husband’s or family’s understanding is lacking or withheld, emotional and erratic moodiness may occur and it is not unusual that during this stage of her life a woman may feel emotionally deserted and therefore experience greater physical menopause problems than would have been the case if she has received solid support.

For all concerned it is important to understand the primary hormonal functions. The production of hormones is all-important in the reproductive process, but they are also active in other bodily functions. Hormones are substances that are produced by the body and have the role of messengers. The word ‘hormone’ is derived from Greek and means ‘’to excite’. Every form of life produces hormones – humans, animals and plants alike – although biologically the hormonal messengers produce different results, depending upon the species. Each hormone stimulates organs, tissue or body functions in its own specific way.

One of the better known hormones, the oestrogen hormone belongs to a group of several female sex hormones, while testosterone is a male sex hormone, and progesterone is a steroid hormone that prepares the uterus for the fertilised ovum and the mammary glands for milk secretion. The ovaries produce both oestrogen and progesterone, which in differing quantities are deposited in the bloodstream during the monthly cycle. The ovaries also produce a small quantity of testosterone. On average, once every four weeks an egg (or ovum) is released after ovulation and by way of the oviduct or Fallopian tube this egg reaches the womb. When sperm enters the womb via the cervix, impregnation may take place. The womb is an organ with a length of about 8cm where the fertilised egg can develop into a foetus. The lining of the womb, where the fertilised egg will settle, is called the endometrium. However, when the egg has not been fertilised, it will be disposed of during the monthly menstruation when the lining of the womb is discarded.

There are two organs that are capable of hormone production which are utilised in the reproduction system.

The first is the pituitary gland at the base of the brain, which produces two hormones that are influential in the procreative cycle. These are referred to as FSH and LH (follicle stimulating is hormone and luteinising hormone). The adrenals, one of which found just above each of the kidneys, produce hormones during one’s entire life, which are converted into oestrogen and testosterone. This source of oestrogen is especially important during the post-menopausal period, because the ovaries are no longer capable of producing oestrogen.

Second is the hypothalamus, a gland placed just above the pituitary gland, which acts as the control centre for the production of FSH and LH by way of the pituitary.

On average a woman’s fertility begins to wane in her early forties when ovulation may start to become slightly irregular. During this stage unplanned pregnancies are not unheard of because ovulation still takes place, although in an irregular pattern. Remember that at this point one is ill advised to practise the natural rhythm method, because the regularity of ovulation may have disappeared and it would therefore be wise to take extra care in contraceptive methods. The actual production of oestrogen during the years of the menopause differs considerably among individuals. When ovulation stops, progesterone is no longer produced, which results in reduced oestrogen production. This can lead to a thickening of the lining of the womb, slightly increasing the risk of cancer. When unusual blood loss is experienced the doctor is therefore likely to advise a minor surgical performance commonly called ‘D and C’ (dilatation and curettage) or a course of supplementary progesterone.

The monthly menstruation cycle may well have stopped yet, due to the continual production of oestrogen, the symptoms one has come to associate with the monthly cycle may still be experienced, e.g. swelling of the breasts and a tendency to retain fluids. These symptoms can be controlled by dietary changes, diuretics or indeed by a low progesterone supplement in order to slow down oestrogen production. Then a new cycle begins which shows itself as a blood loss that resembles menstruation. It is also possible that the doctor would advise a combination of oestrogen and progesterone in order to control the blood loss.

When ovulation no longer takes place and menstruation stops, the following menopausal symptoms are frequently experienced:

Remember, I am not saying that one should ignore or misinterpret the physical messages emitted by the body. In some of my books, e.g. Body Energy or Cancer and Leukaemia, I have mentioned external signs where the body tries to draw our attention to something. Although a positive outlook is always essential, there are certain messages, which you simply must not ignore. In this category I would again mention heavy and prolonged blood loss, because this may be overcome easily by a minor surgical operation and much discomfort may be avoided. If this is brought to the doctor’s attention and timely action is taken, it may severely reduce the risk of cancer of the womb or the cervix (the neck of the womb). I would also strongly advise self-examination of the breasts and please take advantage of the opportunity for regular smear tests. Much recrimination may be avoided by an awareness of these facts and a sensible and responsible attitude to one’s own health.

The post-menopausal period is not necessarily like a second youth. During the menopause the body becomes accustomed to a reduced oestrogen concentration, but some of the effects of this may not become apparent until after the menopause. One example of this is that the previously regular oestrogen production ensured that the vaginal wall remained strong and elastic, producing sufficient vaginal fluids. However, due to the reduced oestrogen supply, changes will take place in the vagina. This will gradually become narrower and less elastic, and also produce less moisture. In medical terms this is referred to as ‘vaginal atrophy’. Depending upon the oestrogen concentration, these effects will become more noticeable over a number of years following the menopause. This can be the cause of some embarrassment, discomfort or pain during sexual intercourse, and also increase the risk of vaginal infections. Do not suffer, but ask your doctor or practitioner for advice.

Another problem frequently experienced is reduced bladder control. Again, as a result of the reduced oestrogen concentration the muscles and connective tissue in the pelvic area grow less elastic. A weak bladder is more prone to infection and because of muscle weakness in the intestinal area bowel movements may be less frequent. The walls of the urethra become weaker and this is the reason why women could experience slight incontinence problems when laughing, sneezing or coughing. Consult your doctor if you experience frequent urges to pass water or cannot control your bladder, because this may point to a form of urinary infection. Because of general weakening of the muscles the womb may have dropped to an uncomfortable position where it is pressing on the bladder and if that is the case, your doctor may advise the use of a vaginal pessary to relieve the pressure or it may be suggested that you undergo a surgical operation, depending on the severity of the situation.