Menopause Health Dictionary

Symptoms. Not all present at once. Hot flushes, weight gain, depression, urinary frequency, headaches, backache, painful breasts, vaginal discomfort, cannot sleep or concentrate and gets irritable. Cries easily. Poor sexual response.

The hot sweats must not be misdiagnosed. They may be due to an over-worked thyroid gland which requires Kelp, Bugleweed. Palpitations may be due to tachycardia – see: CARDIO-VASCULAR AGENTS: Hawthorn, Lily of the Valley, Motherwort, etc. Tiredness often points to anaemia – see: ANAEMIA.

Oestrogen deficiency predisposes to osteoporosis (weakening and softening of the bones), height loss. Increased flow, or spotting, after an interval of 6 months should be investigated. Excessive blood loss may be due to fibroids.

Alternatives. Herbs to enable women to adjust naturally to the menopause are many and varied. In general use: Agnus Castus (ovarian hormone precurser), Black Haw (Uterine relaxant), Broom (gentle diuretic and heart restorative), Clivers, Goldenseal, Helonias (ovarian hormone precurser), Lady’s Mantle, Life root, Lime flowers, Marjoram, Motherwort, Nettles, Oats (nutrient), Parsley tea, Pennyroyal, Raspberry leaves, Skullcap (tension), St John’s Wort (anxiety), Valerian (nervous excitability).

For menopausal flooding, see: MENORRHAGIA.

Hot flushes: see entry.

With circulatory disorders, add Rosemary.

Alternative formulae. Teas. (1) Motherwort and Raspberry leaves. (2) Lady’s Mantle, Lime flowers, Yarrow. (3) Raspberry leaves, Broom, Clivers. Place 1 heaped teaspoon in each cup boiling water; infuse 15 minutes; 1 cup thrice daily. (4) Sage tea. (Chinese traditional)

Vitamin E. Hot flushes and circulatory distress.

Evening Primrose oil capsules.

Formula. Agnus Castus 2; Black Haw 1; Valerian half. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Diet. Infrequency of hot flushes and other menopausal symptoms in Japanese women are believed to be related to their Soya-rich diet, Soya containing isoflavonoids which are similar to human oestrogen. Avoid coffee. Reduce tea, Cola drinks, Alcohol.

Vitamins. The condition makes heavy demands upon the vitamin reserves. C, 1g morning and evening. E, 500iu morning and evening. B-complex, B6.

Minerals. Calcium helps reduce risk of fracture, particularly in menopausal women who may increase their intake to 800mg daily – calcium citrate malate being more effective than the carbonate. Dried milk powder contains high percentage of Calcium. 

Symptoms of menopause include hot flushes and night sweats; vaginal dryness caused by thinning of the vaginal skin; and a decrease in vaginal secretions. The vagina shrinks and loses elasticity, and becomes prone to minor infections. Vaginal dryness may also make sexual intercourse more difficult and painful (see vaginitis). The neck of the bladder and urethra undergo similar changes, which can result in a feeling of needing to urinate frequently.

Psychological symptoms, such as poor concentration, tearfulness, loss of interest in sex, and depression, are also often attributed to the menopause.

Changes in metabolism occur during the menopause but may not cause symptoms until later. Bones become thinner, and osteoporosis may develop. There is also an increased level of fats in the blood, which may cause an increase in atherosclerosis and a higher incidence of coronary artery disease and stroke.

Hormone replacement therapy (HRT) may relieve menopausal symptoms.

reduces the risk of fractures associated with osteoporosis.

However, it has been associated with a slightly increased risk of breast cancer.

For most women, treatment is recommended for a duration of around 10 years.

One of the major problems of the menopause which does not give rise to symptoms until many years later is osteoporosis (see BONE, DISORDERS OF). After the menopause, 1 per cent of the bone is lost per annum to the end of life. This is a factor in the frequency of fractures of the femur in elderly women as a result of osetoporosis, but it can be prevented by hormone replacement therapy (see below).

Hormone replacement therapy (HRT) This term has become synonymous with the scienti?cally correct term ‘OESTROGENS replacement therapy’ to signify the treatment of menopausal symptoms and signs with oestrogens, now usually combined with PROGESTOGEN. Oestrogen and combined treatment relieve the short-term symptoms such as hot ?ushes, sweats and vaginal dryness. Atrophic vaginitis and vulvitis (shrinking of the tissues of VULVA and VAGINA due to fall in natural oestrogen levels) also usually respond to treatment with oestrogens.

Cyclical therapy is necessary to avoid abnormal bleeding in women who have reached the menopause. If oestrogens are given alone, there is an increased risk of endometrial hyperplasia (overgrowth of the ENDOMETRIUM) which may lead to endometrial cancer, so these are restricted to women who have had a hysterectomy and are no longer at risk. Other women can be given oestrogen-progestogen combinations.

There is good evidence that oestrogen alone or in combination can prevent the bone-loss associated with the menopause by reducing the demineralisation of bone which normally occurs after the menopause; and, if it is started early and continued for years, it may prevent the development of osteoporosis. Oestrogen is far more e?ective than calcium supplements and has been shown greatly to reduce fractures affecting the spine, wrists and legs after the age of 50.

However, HRT is no longer licensed for ?rst-line treatment to prevent osteoporosis, as increased risk of stroke, breast cancer and coronary heart disease cannot justify treatment for long periods – unless the woman has severe menopausal symptoms. HRT is recommended for short-term use only in menopausal women whose lives are inconvenienced by vasomotor instability (severe ?ushes, etc.) or vaginal atrophy, although the latter may respond to local oestrogen treatment – creams or pessaries. In terms of oestrogenic activity, natural oestrogen such as oestradiol, oestrone and oestriol are more appropriate for HRT than synthetic oestrogens like ethinyloestradiol, mestranol and diethylstilboestrol.

Many experts believe that controversy surrounding the risks and bene?ts of HRT have been settled by a large randomised trial (the Women’s Health Initiative), published in 2003, which showed that combined treatment increases the risk of breast tumours, stroke and coronary heart disease (in the ?rst year). Oestrogen alone (given to women who have had a hysterectomy) also increases the risk of stroke. Five years of combined treatment may double the risk of breast cancer, and the heart-disease risk is nearly doubled during the ?rst year of use. This is in spite of the bene?cial effects of HRT on blood lipids. However, there are others who consider that di?erent dose combinations of di?erent hormones may one day prove bene?cial, so research continues.

HRT can also provoke minor adverse effects such as breast tenderness, ?uid retention, leg cramps and nausea. The risk of abnormal blood clotting means that HRT is not normally recommended for women who smoke heavily or have had THROMBOSIS, severe HYPERTENSION, stroke or liver disease. HRT has, however, brought symptomatic bene?ts to many menopausal women, who can then justify taking the other increased risks – only fully understood since the large trial results were published.

As the evidence stands at present, careful consideration of each woman’s medical history and the severity of her menopausal symptoms is necessary in deciding what combination of drugs should be given and for how long. In general, the indications should be severe menopausal symptoms that can be controlled by the lowest dose for the shortest time. Using HRT to alleviate mild symptoms, or to prevent future bone loss, is probably of insu?cient bene?t to counter the other risks described above.