In keeping with the traditions of my practice, the first thing I tell patients is that menopause, the cessation of ovulation, is not a disease, and it should be welcomed rather than feared.  It is a liberating life transition, a normal slowing of hormone production after passing the childbearing years.  By the way, don't think for a minute that men don’t go through their own menopausal stage, called andropause.  They are usually just unaware of it until they develop erectile dysfunction.  Menopause can last as long as ten years for some women.  Taking artificial hormones as a form of treatment, unless specifically needed, is a much less attractive choice than increasing foods and herbs to help move the process along.  Healthy diet and exercise are the best medicine, and when understood can accomplish all the things hormone replacement is supposed to do with much less risk.

When ovulation ceases there is a quick drop in the production of progesterone, as well as a 40-80% reduction in estrogen production.  As a result, the following problems may gradually develop in some women:

• atrophy of vagina, cervix, uterus and ovaries
• weakening of muscle control in the bladder, rectum and sphincter muscles
• vaginal dryness
• redistribution of body fat
• loss of bone mass
• hot flashes
• fatigue and loss of sex drive

It is common knowledge that Oriental women experience fewer menopausal symptoms than their Western counterparts.  The most popular current explanation is that Asian populations consume much more soy, which is high in phyto-estrogens.  While I do not necessarily disagree, I think this perspective is too narrow and not fully proven.  I think it more likely that this is due to much larger cultural, dietary and environmental issues.

Weight Gain and Menopause

During the long period of time during which women go through menopause, they experience changes in body fat distribution.  Often seen as an entirely negative and undesirable occurrence, I believe this redistribution may have some functional value.  We have known for a long time that mortality rates are higher for obese people than for lean people.  However, we have also learned more recently that unfit lean men have a higher risk of all-cause mortality than men who are fit and obese (Lee et al 1999).  In addition, we have learned that slight increases in weight may be beneficial for both men and women. How are we to understand these findings, and how does it relate to the weight gain that so often occurs as women enter menopause?

First of all, in broad general terms, nature usually does what it does for a good reason. A simple fact is that fat storage has survival value if you live in a primitive society where there are periods of famine, and as you age, your hunting skills and physical mobility decline. On the other hand, we have the seemingly opposing epidemiological studies that show (1) a clear correlation between large increases in body fat and mortality, but (2) lowered mortality for moderate increases.

To make sense of it all, consider recent scientific evidence demonstrating that fat tissue is a very active tissue, almost like an endocrine gland, secreting a variety of peptides (such as leptin), cytokines (such as tumor necrosis factor), and complement factors.  In addition, fat cells store and release several chemical substrates, such as glycerol and FFA (Barzilai and Gupta 1999). 

Although I cannot currently prove it in a laboratory (unless someone gives me a few million dollars and lots of rats), it makes sense to me that a healthy diet throughout life, similar to the one followed by most residents of China-- In that country, gaining some weight as you age is considered beneficial, and being too skinny is considered bad for you--creates moderate fatty stores of healthy substrates, including phyto-estrogens. At menopause, moderate increases in fat distribution allow for increased levels of substrates.  Slight increases in weight are not problematic because they make up for the estrogen losses resulting from decreased production.  Hot flashes are the body’s attempts to mobilize its fat stores to release stored estrogens, but if the stores are not there, the flashes will increase in intensity and frequency until estrogen is supplied externally or fatty stores are increased.  If the fat stores remain insufficient, the body will actively seek out and store any available fat as it enters the body, eventually leading to obesity.

In short, mild increased stores of fat in an aging healthy person with a good diet may be of benefit, because those stores may contain things that are needed to survive, including both calories and hormones. But in an aging person with poor diet or living in a toxic environment, fat stores may contain unhealthy substances or fat storage may increase to the point where it causes increased mortality and disease.

Focus on Exercise

Forgetting fat, one thing science is telling us for sure is to get out there and exercise. I often council people to bypass the fat debate and proceed on to the super beneficial plan to get into good shape.  Exercise directly reduces the risk of cardiovascular disease and bone loss.

Therefore, in our clinic we implement the following lifestyle measures in our treatment approach to menopause symptoms:

• A healthy diet, with an emphasis on soy foods, fruits and vegetables to increase body levels and stores of both phyto-estrogens and phyto-progesterones.

• Regular exercise to sustain metabolic rate and reduce risks of cardiovascular disease and bone loss (for more detailed information about preventing and treating bone loss, refer to our discussion of osteoporosis).

Treatment of Menopausal Symptoms

Lifestyle changes may not always be sufficient to handle many troubling menopausal symptoms, and herbs and nutrients can help here. I have found that it often takes several months of herbal treatment to relieve symptoms.  The herb choices depend on the situation, and although herbs with phyto-estrogenic activity are important, they are not the only choices.  The idea here is to keep a free-flowing cycle of intake and elimination of hormones and hormone-like plants, allowing your body to choose the necessary amount to keep in circulation and to store.  A healthy liver also has the ability to get rid of xenoestrogens, artificial estrogen-like chemicals that are the by-products of environmental pollution. One additional clinical fact - I have noticed at my clinic that women treated in the past with HRT (hormone replacement therapy), already subject to numerous problems may have the additional problem that milder herbal therapies for hot flashes do not work as well for them.

•  Nai-shing's basic formula for hot flashes is lycium bark (which is very effective in some cases), phellodendron bark, lugustrum fruit (nu zhen zi or L.  lucidum), shou wu root, raw rehmannia root, cornus fruit (shan zhu yu or C.  officinalis) and moutan bark (mu dan pi or Paeonia suffruticosa).  TAM doctors use white and red sandalwood together in equal proportions.

• Black cohosh is a primary herbal medicine for menopausal symptoms, and a first line treatment for hot flashes. More info on black cohosh research can be found here

• Use herbs with phyto-estrogenic activity to build up your available stores over several months.  Many extracts made from soybeans, red clover blossoms, black cohosh root and alfalfa are now commercially available.  Do not use excessive doses, and alternate different types and change doses until you find what works best for you.

• Use pomegranates on a semi-regular basis, because they contain small amounts of estrone, a weak but true estrogen.  You can eat the ripe fruit, dried seed or juice as desired. Ayurvedic doctors classify pomegranate rind (dadima) as a blood nourishing tonic

• Use liver herbs such as dandelion root, bupleurum root, burdock root and white peony root to improve liver conjugation of estrogen to enhance its elimination from the body.  These are also useful for mood swings.
• Use schisandra berries for menopausal night sweats.

• Follow the recommendations in our article on osteoporosis to keep the bones healthy, and read the section on keeping your heart strong and healthy as well.

• The supplement DHEA is reported in numerous studies to benefit reduction in sex drive, as well as improving mood, protecting bones and supporting weight loss. It combines well with the Chinese herbs mentioned above.

• I have noticed that women who have taken estrogen replacement therapy (ERT), and then stopped due to concerns about side effects, may develop a severe hot flashes that cannot be relieved with the normal herbal remedies. I think this is because the body has adjusted to the ERT hormones which are dozens of times too strong. In these cases we have been able to achieve results using a complex set of herbal protocols (contact the clinic for more info).