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The Menopause — Naturally

The menopause is a significant change in a woman's life, but it is not an illness. The changes of the menopause are normal — natural. This does not mean, however, that the menopause is always easy. Hot flushes, vaginal dryness, aches and pains and signs of ageing can be difficult to adjust to. Women seeking help around the menopause are often given information only about hormone replacement therapy (HRT). This online booklet looks at natural and complementary approaches to the menopause.

During the menopause, a woman's body begins to slow its production of oestrogen. This change in hormone levels can cause irregular periods, hot flushes, night sweats and vaginal dryness. Some women also experience aches and pains, mood swings, anxiety and insomnia (difficulty sleeping).

To relieve these symptoms, many women are advised by their doctors to take hormone replacement therapy (HRT). But HRT may not be right for every woman. Some women feel the risks that come with HRT are greater than the benefits. For example: if a woman takes HRT for more than five years, her risk of developing breast cancer increases. There are also higher risks of developing blood clots.

Other women simply do not want to use chemical treatments for what is a natural, normal stage in life.

A natural approach

The treatments, therapies and approaches in this leaflet acknowledge that the menopause is a natural change in every woman's life. They take a holistic approach to relieving symptoms. That is, they focus on the whole body, the whole person. They do not involve surgery or the use of pharmaceutical drugs.

This leaflet introduces the main natural approaches to the menopause:

• Homoeopathy
• Herbalism
• Aromatherapy
• Nutrition and supplements
• Exercise
• Acupuncture and acupressure

This is followed by a look at how each approach can help to ease specific symptoms of the menopause.

Some of the treatments and approaches in this article have limited clinical research to back them up. This does not mean they do not work. Unlike conventional medical treatments, natural therapies are personalised. This can make them more difficult to study in a controlled environment. They are, however, supported by the personal experiences of thousands of women who have tried them. We have chosen approaches with the most evidence to support them.

Note: Many women use natural progesterone cream as an alternative to HRT. This leaflet does not look at natural progesterone because, although part of it comes from a wild yam, it is chemically created.

Women's Health does not endorse one health care approach over another. We believe all women should have the information they need to make informed choices about their own health and well-being.

The Menopause — Some natural therapies to consider

Homeopathy

Homoeopathy aims to kick-start the body's own system into healing itself. It is based on the principle that like can cure like. For example, a homoeopath may treat hay fever with allium cepa, made from onions. In a healthy person, onions can cause stinging and watering eyes, but homoeopathy believes an onion-based treatment can reduce stinging and watering in a person who is already suffering from these symptoms.

There are approximately 100 homoeopathic remedies that may be useful for treating symptoms of the menopause. In 1999, a survey by the Women's Nutritional Advisory Service found that 76% of women who had used homoeopathy at the time of the menopause found it helpful.

There are a number of books available that can be used as guides to self-treatment, and many homoeopathic remedies can be bought from health food stores and pharmacies. Unless you know a lot about homoeopathy, however, the best treatment will be through a registered homoeopath. Some GPs are trained in homoeopathy and in some areas it is available on the NHS.

Herbalism

Herbs have been used for centuries to aid healing. The herbalist, like other holistic practitioners, will consider each woman's symptoms and health background before creating a treatment plan. Herb doses and combinations will vary from woman to woman. Some of the herbs used to ease symptoms of the menopause include:

Aromatherapy

Aromatherapy treats symptoms by using essential oils from plants and flowers. A small amount of oil is mixed either with a massage oil for the skin, or in water to be used as a compress or to be inhaled. Some of the key oils used with women at the menopause include:

Geranium: a hormone stabiliser that is often used for relaxation.

Cypress: thought to be helpful in reducing hot flushes.

Clary sage: used as an anti-depressant.

Bergamot: for its uplifting effects.

Lavender: to aid sleep and ease aches and pains.

Roman chamomile: to soothe and calm, and relieve dull pain.

Caution: Massage can be dangerous for people who have certain conditions such as inflammatory arthritis or those at risk of deep vein thrombosis (blood clots in the vein). For the most effective and safe use of aromatherapy, it is best to consult a registered aromatherapist.

Contact the Aromatherapy Organisations Council for more information. See Resources and links.

Nutrition and Supplements

Food can affect hormones in the body and it is best to avoid drastic changes in diet around the menopause. Gradual and lasting changes, however, can make the menopause easier and improve overall health.

A diet low in saturated fats (meat, cheese, eggs) and high in unsaturated fats (nuts, seeds, oily fish and some vegetables) can help reduce some symptoms of the menopause. Unsaturated fats have essential fatty acids which help the body adjust to new hormone levels. Women at the menopause should also get plenty of calcium, vitamins E, D and B, and magnesium (see the vitamin table in the Menopausal symptoms section.

Oestrogen in food

Some plants have small amounts of natural oestrogens called phyto-oestrogens ('phyto' means 'plant' in Greek). Phyto-oestrogens are similar to the oestrogen in women's bodies. Research shows that eating foods high in phyto-oestrogens may help relieve symptoms, such as hot flushes, that result from falling oestrogen.

Foods high in phyto-oestrogens:

Tofu: add to salads or just about any dish. Marinated tofu is also available from supermarkets and health food stores.

Exercise

Exercise is important for good health at all life stages, but is especially important around the menopause. Thirty minutes of activity every other day (or as often as you can manage) can benefit the body and the mind.

Keep active by joining a gym, walking with a friend, cycling to the shops, playing tennis in the park or exercising with videos at home. Do what feels right for you. The benefits of exercise will begin as soon as you start, but it may take a couple of months to notice improvement.

Regular exercise:

• encourages sleep
• increases energy levels
• improves strength, flexibility and balance
• strengthens the heart and reduces blood pressure
• improves emotional stability
• builds strong bones

Acupuncture and Acupressure

Acupuncture and acupressure are based on the idea of a universal energy made up of yin and yang. These must be in balance for a healthy body and soul. Acupuncture and acupressure are used to restore this balance and promote health.

Acupressure may help relieve minor symptoms of the menopause. It involves applying pressure to points on the body which match up with energy channels.

Acupuncture is used for more severe symptoms. An acupuncturist will use needles rather than pressure to redirect energy. Tiny needles are inserted into points on the body and are left in place for about 20 minutes. The needles tingle or feel warm more than hurt. It generally takes eight to ten treatments to feel an improvement.

To find a registered acupuncturist or acupressurist near you, see the Resources and links section.

The Menopause — Symptoms

This section contains information about a natural approach to dealing with the following menopausal symptoms:

• Hot flushes and night sweats
• Vaginal dryness
• Stress incontinence
• Aching joints
• Anxiety and irritability

Hot flushes and night sweats

Hot flushes and night sweats are the most common symptoms of the menopause. They usually occur over a period of a few months, but for some women they can go on for a number of years. Hot flushes are not caused by a lack of oestrogen, but by a sudden drop in oestrogen. This is why flushes usually stop once the level of oestrogen stabilises.

Women can have hot flushes on the neck and face, upper arms, torso or the entire body. Hot flushes may last a few seconds or a few minutes and they can be strong or mild. Increased blood flow to the area raises the skin temperature and this creates a flush, i.e. red, blotchy skin. Sweating is the body's way of trying to cool down.

Hot flushes may be triggered by heavy blankets, hot-water bottles, coffee, tea and spicy foods — just about anything hot.

Night sweats can be more upsetting than daytime flushes because they disrupt sleep. Some women find that as a result they suffer from insomnia, which leads to irritability, tiredness and forgetfulness.

Dealing with hot flushes and night sweats:

Hot flushes

• Wear natural fabrics that breathe.
• Wear layers.
• Carry a foldable fan with you to help cool down.
• Don't fight the flush — try to relax if you can.
• Carry moist tissues to freshen up after a flush.

Night sweats

• Use cotton sheets and keep spares close to the bed in case you need to change them in the night.
• Wear lightweight cotton or silk to bed — or don't wear anything at all.
• Drink less coffee and alcohol, especially late at night as they can make flushes and sweats worse.

Homeopathy

Lachesis is often used to help reduce hot flushes. Other remedies include graphites, silver nitrate, sepia and sulphur.

Herbalism

Some herbs increase adrenalin and may increase oestrogen. This would help to reduce hot flushes. These herbs include: siberian ginseng, nettle, borage and liquorice. Cypress (Cupressus sempervirens) and sage may also help reduce flushes.

Aromatherapy

Roman (not German) chamomile is used to help the body regulate hormones and reduce flushes. It can be blended with a massage oil and massaged into the skin. Or drops can be placed on a tissue and inhaled as and when necessary.

Nutrition and Supplements

Some research suggests that eating foods high in phyto-oestrogens may reduce hot flushes. Japanese women, for example, report fewer hot flushes than western women and this may be related to the amount of soya they eat.

These tips may help reduce hot flushes:

• Eat foods rich in phyto-oestrogens, such as tofu or soya bread.
• Cut down on sugar, caffeine and alcohol.
• Eat foods rich in vitamin B6. Many breakfast cereals are high in B vitamins.
• Eat foods with vitamin E, such as hazelnuts, almonds, sweet potato and avocado.
• Avoid hot spicy foods.
• Take supplements of Evening Primrose.
• Eat foods high in magnesium and calcium. See table below.

Acupuncture and Acupressure

To relieve hot flushes, acupuncture and acupressure focus on the kidneys and the heart. Related pressure points are on the inside of the wrist (along the line of the little finger) and along the kidney channel of each foot.

Acupressure books and classes will provide more information about pressure points and energy lines. If flushes and sweats are severe, consult a registered acupuncturist or acupressurist. See the Resources and links section.

Vaginal dryness

Low hormone levels at the menopause can cause the walls of the vagina to become thinner. There is also less natural lubrication. These changes can make penetrative sex uncomfortable for some women.

Some studies have shown that phyto-oestrogens may improve cells of the vagina. A study published in the British Medical Journal (1993), found that women who ate 45g of phyto-oestrogen rich foods each day (clover sprouts, linseed oil and soya flour) had relief in vaginal dryness after only a few weeks. For foods with phyto-oestrogens, see the Natural Therapies section.

Foods high in vitamin E may also help reduce dryness. Some women feel that inserting a capsule of vitamin E directly into the vagina every night for a few weeks makes a difference.

Exercise

Do regular pelvic floor exercises, known as Kegel exercises. Designed to strengthen pelvic floor muscles, they also work the vagina and help to keep it healthy. They are easy to do just about anywhere and other people can't tell you're doing them. See Kegel exercises information below right.

Acupressure

Acupressure focuses on the kidneys, as these are considered to be the centre of sexual energy. Pressure is put on key points along the foot and ankle.

Kegel Exercises to strengthen the pelvic muscles:

Pelvic floor exercises strengthening the muscles that support the pelvic organs. The exercises are easy and quick to do but it's important to do them correctly, and many women benefit from guidance from a physiotherapist.

Start by locating the muscles you need to exercise. There are a few different ways to do this:

1. Place one or two fingers in your vagina and squeeze your muscles until you can feel your vagina tighten around your fingers. These are your pelvic muscles.
2. Imagine you're trying to stop the flow of urine mid-stream. The muscles you tighten (contract) are your pelvic floor muscles.
3. Another way to identify the correct muscles is to imagine you are trying to stop yourself from passing gas. The muscles you squeeze to do this are your pelvic muscles.

Once you've identified the correct muscles you're ready to begin. The exercises can be done while lying down, sitting or standing, with your knees together or slightly apart.

Set 1: Slowly tighten your pelvic floor muscles and count to four, then let the muscles relax for a count of four. As your muscles get stronger gradually increase the count to 10. Try to repeat this 10 to 15 times.

Check that you're not tightening the muscles in your legs, abdomen or buttocks, as it's important to use only your pelvic muscles. Remember to keep breathing.

Set 2: Now tighten and relax your pelvic muscles as quickly as you can, again 10 to 15 times.

As a preventive measure, try to do the exercises two or three times a day.

Stress Incontinence

Oestrogen helps to keep the muscles at the base of the bladder tight and strong. These muscles restrict and release the flow of urine. Low levels of oestrogen at the menopause increases the risk of stress incontinence — small amounts of urine leaking out when you cough, sneeze or laugh. More than 50% of women experience occasional stress incontinence after the menopause.

Homeopathy

Homeopathic remedies for stress incontinence include causticum, pulsatilla or sepia.

Herbalism

Herbs with phyto-oestrogens may help. These include ginseng, hops, sage and red clover.

Aromatherapy

There is little information available about aromatherapy and stress incontinence. If you would like to try aromatherapy, do Kegel exercises and consult an aromatherapist.

Nutrition and Supplements

The tissues of the bladder are sensitive to oestrogen. Eating foods rich in phyto-oestrogens may help. Avoid tea and coffee. They increase the rate at which fluid passes through the body. Vitamin C helps the body produce collagen and collagen strengthens tissue and muscles. Blackcurrants, strawberries, kiwi, brussels sprouts and oranges are rich in vitamin C. Supplements are also available.

Exercise

Do Kegel exercises regularly. They are the most effective self-help method to prevent stress incontinence.

Exercise

To deal with stress incontinence, acupressurists may put pressure on points along the foot which correspond to the bladder.

Aching joints

Many women suffer from general aches and pains during the menopause. It is unclear whether they are caused by the menopause, but they often occur along with it.

Anxiety and irritability

Some women feel more anxious and irritable around the menopause. Change can be stressful and, at this time in life, women may experience physical changes, life changes and anxiety about growing older.

Mood is also affected by blood sugar levels, and swings between high and low levels can cause stress within the body.

Stimulants, such as tea, coffee and sugar, produce a quick rise in blood sugar levels. This is followed by a rapid drop in blood sugar that stimulates the release of adrenalin. Adrenalin is the hormone released under severely stressful situations and can cause feelings of anxiety.

When the body goes without food for more than three hours, it also triggers the release of adrenalin. To keep blood sugar levels stable, eat little and often.

Homeopathy

There are a number of homoeopathic remedies to help ease stress and irritability, including sepia and nux vomica.

Herbalism

Herbs that relieve anxiety are called nervines. One of the most common nervines is Valerian. It is often used to help reduce irritability and stress. Ginseng may also be useful in reducing stress.

Aromatherapy

Essential oils of geranium, clary sage and roman chamomile can aid relaxation and calm nerves. Aromatherapy with massage can also help. Studies have shown that regular therapeutic massage reduces anxiety.

Nutrition and Supplements

The B vitamins have positive effects which can reduce stress and balance mood. Eat bananas, avocados, nuts and taramasalata.

Magnesium helps to metabolise (break down) sugar, to keep blood sugar at healthy levels. Snack on nuts, oat cakes or fruit. Avoid sweets, coffee and alcohol.

Exercise

Many studies show that exercise helps to reduce anxiety, tension and stress. Try stretching, walking or any exercise you enjoy.

Acupressure and Acupuncture

Acupuncture and acupressure have been used successfully to treat anxiety. Consult a registered therapist for more details.

After the Menopause

Osteoporosis

Women start to lose calcium from their bones from the age of about 35. During the five years just after the menopause, women lose bone mass at the highest rate in their lives. This can lead to osteoporosis, a serious condition that results in bones breaking very easily.

To prevent bone loss:

• Don't smoke.
• Exercise regularly. Weight-bearing exercise is best, such as running, tennis, weight-training, or even a brisk walk.
• Get plenty of calcium.

The National Osteoporosis Society suggests women over 40 should get 1500mg of calcium each day. Vitamin D helps the body absorb calcium, and sunlight on the skin stimulates the body's own production of vitamin D. It is also in some cereals, cheddar cheese and margarine.

Calcium in food

• half-pint semi-skimmed milk = 365mg
• Cheddar cheese (5 slices) = 360mg
• Cup of almonds = 300mg
• Cup of low fat yogurt = 190mg
• Prawns (100g boiled) = 150mg
• Spinach (100g boiled) = 150mg

Heart disease

Before the menopause, oestrogen helps to protect women from heart disease. With the drop in oestrogen, by the time a woman reaches 65, her risk of a heart attack equals that of a man.

To help prevent heart disease:

• Avoid saturated fat — the fat in meat, dairy and hydrogenated oils used in packaged foods.
• Don't smoke.
• Eat garlic. Garlic can reduce cholesterol by 15%.
• Exercise. It lowers both blood pressure and cholesterol.
• Use less salt.
• Avoid processed foods.

A recent study suggests that women who take daily supplements of fish oil can reduce their risk of heart disease by 27% after the menopause.

The Menopause — Resources and links

Organisations

Aromatherapy Organisations Council
PO Box 19834
London SE25 6WF
tel: 020 8251 7912
web: www.aocuk.net
Publishes a list of registered practitioners.

British Acupuncture Council
63 Jeddo Road
London W12 9HQ
tel: 020 8735 0400
email: info@acupuncture.org.uk
web: www.acupuncture.org.uk
Provides a list of qualified practitioners. Members are insured and bound by a code of ethics, practice and professional conduct.

British Medical Acupuncture Society
12 Marbury House
Higher Whitley
Warrington WA4 4QW
tel: 01925 730 727
web: www.medical-acupuncture.co.uk
Provides a list of registered practitioners.

British Homeopathic Association
27a Devonshire Street
London W1N 1RJ
tel: 020 7566 7800
web: www.trusthomeopathy.org/trust/tru_over.html
Publishes a bi-monthly magazine.

Society of Homoeopaths
11 Brookfield
Duncan Close
Moulton Park
Northampton NN3 6WL
tel: 0845 450 6611
email: info@homeopathy-soh.org
web: www.homeopathy-soh.org
Publishes register of homoeopaths who are trained, insured and abide by the Society's Code of Ethics.

National Institute of Medical Herbalists
56 Longbrook Street
Exeter
Devon EX4 6AH
tel: 01392 426 022
web: www.nimh.org.uk
Members have completed four years of training. Members adhere to a professional code of practice.

Royal London Homoeopathic Hospital NHS Trust
Great Ormond Street
London WC1N 3HR
tel: 020 7837 8833
Provides homoeopathy and other complementary therapies. Runs a specialist women's clinic.

Society of Homoeopaths
11 Brookfield
Duncan Close
Moulton Park
Northampton NN3 6WL
tel: 0845 450 6611
email: info@homeopathy-soh.org
web: www.homeopathy-soh.org
Publishes register of homoeopaths who are trained, insured and abide by the Society's Code of Ethics.

Women's Nutritional Advisory Service
PO Box 268
Lewes
East Sussex BN7 2QN
tel: 01273 487 366
web: www.wnas.org.uk
Provides a diet-based advisory service for women.

Books

The New Natural Alternatives to HRT by Marilyn Glenville (Kyle Cathie Limited, 2002)

Cruising Through the Menopause - managing your menopause successfully without HRT by Maryon Stewart (Vermilion, 2000)

Menopause Naturally by Kitty Campion (Newleaf/Gill & Macmillan Ltd, 1998)

Ten Steps to a Natural Menopause by Leslie Kenton (Vermilion, 1999)

The Which? Guide to Complementary Medicine by Barbara Rowlands (Which? Books[Consumer Association], 1997)

Menopause - what you really need to know by Dr Sarah Brewer (Robinson, 2003)

More about Soya

The Guardian/Observer has published a number of interesting articles. Go to:
www.guardianunlimited.co.uk/Archive and search on ' soya'.

Written by Tamara Beus and published in printed format (2000) by Women's Health

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