A gradual cessation of menstruation or a lengthening of the time between each period is the main signal for menopausal onset. It naturally occurs anywhere between the mid-thirties to mid-fifties, but typically between the ages of 45-55. Clinical confirmation that a woman is experiencing menopause is achieved through the results of hormone assays. Postmenopausal women have elevated levels of serum follicle stimulating hormone (FSH) and serum luteinizing hormone (LH).
FSH and LH are important hormones in the female reproductive system helping to regulate and stimulate ovarian cycles through feedback mechanisms to the ovaries and the hypothalamus. Peri-menopausal women are women who have begun to move from the reproductive stage to the non-reproductive and are experiencing menstrual irregularity and symptoms such as hot flushes and sweating. During this stage, levels of FSH have increased. As the menopause continues to progress in the peri-menopausal stage, FSH levels continue to rise and LH also begins to rise until both hormone levels are well elevated past their normal values.
The end result is low oestrogen and progesterone levels which can have the effect of causing the uncomfortable symptoms of menopause.
Serious health conditions affect postmenopausal women who show a rapid loss of bone density (osteoporosis) in the ten years following menopause and no longer have the pre-menopausal protection from ischaemic heart disease due to hormonal changes.
The alteration in the hormonal balance often results symptoms such as
- Hot flushes
- Night sweats
- Vaginal dryness
- Lowered libido
- Emotional disturbance
- Ischaemic heart disease
Conventional treatment strategies
In conventional medicine, the menopause is treated as a disease with the intervention of synthetic Hormone Replacement Therapy (HRT). The trend of prescribing HRT has been reduced due to clinical research on the potentially negative health effects of HRT on women. In 2002, the Women’s Health Initiative (WHI) Study released a report stating that HRT in comparison to a placebo group increased the risk of cardiovascular disease, breast cancer, stroke and thromboembolic disease. Continued research from WHI has shown that HRT does not elevate the quality of life nor does it have any beneficial affect on the incidence of dementia or mild cognitive impairment in postmenopausal women. Findings from another study on the cardio protective effects of HRT have caused doubt on its intended protective action on the cardiovascular system which is one of the alleged benefits for its administration.
The Ayurvedic view of the Menopause
Interestingly, the menopause is not actually mentioned in any of the Ayurvedic classical texts which leads to the assumption that Indian women living a natural lifestyle did not suffer from such symptoms in earlier times.
However, Ayurveda has very successful treatments for the alleviation of menopausal symptoms. The Ayurvedic perspective on menopause centres around changes in the two Ayurvedic dosha known as pitta and vata. The pitta phase associated with ambition, family rearing and drive evolving into the vata phase of wisdom, maturity and insight. This also has physiological affects and in individuals where the constitution is destabilised there can be some uncomfortable symptoms.
- The main symptoms of vata are: nervousness, dryness, depression, anxiety, irregular cycles, missed menses, mood swings, sleep disturbances, lowered libido, hot and cold flushes.
- The main symptoms of pitta are: hot flushes, heat sensations causing headaches and hot flushes, irritability, anger, change in menstrual flow, night sweats, digestive upset.
- It is also common for some women to put on weight during menopause, especially if they have disturbed digestion or are taking HRT. This is often seen as a reflection of the kapha dosha.
Alternative treatment strategies
The primary treatment strategy is to strengthen the deficiency caused by the sudden change in hormonal balance and to try and restore a sense of harmony to the whole system.
- Have regular massage to help tone the skin, clear toxins and calm the nervous system.
- Fully engage with exploring paths to deep inner peace.
Natural ways of balancing oestrogen
Oestrogen is a catabolic sex hormone that has a large array of roles and influences including including reproduction, digestion, mood, fat-balance, fluid ratios, skin pigmentation, breaking down muscle mass that leads to an increase in body fat and aromatase. Testosterone, and to a slight degree progesterone, are anabolic sex hormones that promote lean body mass.
Aromatase is an enzyme that is found in estrogen-producing cells located in the adrenal glands, ovaries, placenta, testicles, brain and fat tissue. Higher levels of aromatase in the body convert more testosterone and progesterone into estrogen. With the increased prevalence of Environmental Endocrine Disruptors, we are exposed to multiple triggers for endocrine disruption.
Elevated aromatase activity and oestrogen dominance are some of the most common factors associated with breast, uterine and ovarian cancers in women. Prostate, colon and breast cancer in men are associated with oestrogen dominance. Other symptoms include PMS symptoms, cervical dysplasia, uterine fibroids, endometriosis, decreased libido, fatigue, fibrocystic breasts, headaches, infertility and weight gain.
Foods and herbs that balance oestrogen:
1. Cruciferous veggies: Cruciferous vegetables such as broccoli, cauliflower Brussel sprouts and cabbage contain several powerful nutrients that help metabolise oestrogenic molecules. These nutrients include Indole-3 Acetate, Indole-3 Carbonyl and Diindolylmethane. These cruciferous veggies also contain sulfur containing nutrients such as Sulfurophane and Phenyl Isothiocyanates that enhance liver detoxification processes and destroy cancer cell formation.Broccoli sprouts 50-100g/day are a good way to get this.
2. Healthy fat-rich foods: These are foods that are rich in saturated and omega-3 fatty acids. It includes plant based fats such as coconut oil, hemp seed oil, extra virgin olive oil and avocados. Raw nuts (other than peanuts) and seeds contain oestrogen balancing plant sterols. Organic poultry, wild-caught salmon, wild game and 100% grass-fed beef are the best animal-fats for healthy hormone function.
3. Allium family: The alliums include garlic, onions, scallions, chives and leeks. These are all rich in sulfur-containing amino acids and the powerful flavone anti-oxidant quercetin that both help the liver detoxify and reduce the production of oestrogen.
4. Flavone rich herbs: Dietary flavones and flavonones have been demonstrated to be the most potent aromatase-inhibitory flavonoids. The most powerful flavones include chrysin which is found in passionflower and apigenine which is found in chamomile.
5. Flavonones: These are found in citrus fruits and in particular lemons and limes. They are classically called citrus bioflavonoids and they include diosmin, hesperidin, rutin, naringin, tangeretin, diosmetin, narirutin, neohesperidin, nobiletin and quercetin.
6. Antioxidant-rich herbs: Herbs such as oregano, thyme, rosemary, sage and turmeric are loaded with volatile oils that promote liver detoxification. Turmeric has a potent ability to destroy oestrogen receptor positive cancer cells which are the most commonly found cells in breast, uterine, ovarian and prostate cancer.
7. Chlorophyll: One of the most powerful life-giving substances on the planet is chlorophyll. This is the pigment that gives green foods their color. Chlorophyll-rich foods have a very deep green color and they are extraordinarily useful in purifying the body of toxins.
8. Fermented foods: These contain organic acids, anti-oxidants, enzymes and probiotics that enhance gut function and eliminatory channels. Fermented veggies include sauerkraut, kimchi and fermented soy.
9. Lignans: Using 2 tablespoons of freshly-ground flaxseed everyday helps to establish a healthy oestrogen balance.
10. Herbal Teas: Green tea and Licorice specifically balance oestrogen levels.
11. Mushrooms: All mushrooms regulate aromatase and regulate oestrogen levels. Use shitake, maitake, button, cep.
12. Lentils: All lentils contain appreciable amounts of phyto-oestrogens that help to balance oestrogen-progesterone levels. Soy is well known for this but all pulses are helpful.
13. And a few things to avoid:
- Avoid hot spices, greasy food, very cold foods
- Avoid coffee as this increases blood pressure, heart rate and dilates the peripheral skin vessels and hence encourages sweating
- Avoid alcohol as this dilates the peripheral skin vessels and encourages sweating
Core herbs of managing the menopause
- Aloe Vera, Aloe barabadensis, Is cooling, nourishing and anti-inflammatory. It is a sweet bitter that helps to nourish dry mucus membranes and also to clear inflammatory heat from the body.
- Ashoka, Saraca ashoka, The legend of the Ashoka tree is that it flowers when a beautiful woman touches it. It literally means ‘remover of sorrow’, attesting to its ability to remove pain and discomfort. Its potent rakta stambhana haemostatic quality make it my first port of call for any excessive uterine bleeding, or other forms of discharge. Its bitter and astringent flavour point to its cooling and dry qualities that can help tone the uterus, treat prolapse, giving strength and form where that has been lost. It is a renowned garbhashaya rasayana, rejuvenating the uterus and reproductive system. Its ability to stop spasms make it useful in recurrent miscarriage, dysmenorrhoea and pain. Its ability to clear ama congestion from arthava srotas make Ashoka potentially useful in the treatment of cysts, fibroids and endometriosis as well. Of course, like all reproductive plants, it is not only beneficial for the reproductive system. It can also treat cystitis and painful urination, heal intestinal bleeding and strengthen the heart. It contains B-sitosterol. Use 1-9g/day as a powder, although it is very effective as a decoction as well. As a 1:3 tincture use 3-15ml/day. Higher doses for more acute symptoms of bleeding.
- Gokshura, Tribulus terrestris, This mild, sweet and bitter seed is a gently tridoshic herb and balances the whole system. It has a rather special ability to remove stagnant fluids and also moisten dryness at the same time. Its spiky thorns symbolise its ability to scrape out obstructions, so use it whenever vata, pitta or kapha are blocking the pelvis and interfering with the smooth flow of the period. I use it when there is dysmenorrhoea, amenorrhoea or irregularity in the cycle. This quality is also useful in prostate problems with high vata. Gokshura, whether you are considering its potent steroidal saponins or its sweet rasayanic quality, is a remarkable tonic, bringing strength, rejuvenation and replenishing the sexual appetite. Use 3-5g/day as a powder or 3-15ml of a 1:3 tincture.
- Hemp Seed Oil, Cannabis sativa, Is full of Omega 3-6-9 essential fatty acids and nourishes all the body’s mucous membranes. Omega 3 also helps to create prostaglandins which can reduce water retention and normalise hormone levels.
- Shatavari, Asparagus racemosus, This sweet and slightly bitter root nourishes the reproductive system and restores a healthy balance to the hormonal levels through its steroidal saponin content. Energetically, it is sweet, bitter, moistening and cooling. This means that it nourishes dry tissue and also clears aggravating heat and sweats. It has the ability to increase prolactin levels and hence increase progesterone levels. This helps to support the body to achieve a natural balance. Asparagus racemosus contains steroidal saponins and isoflavones as chemical constituents. Steroidal saponins and isoflavones have been found to mimic hormones in the body due to the chemical structure of the constituents resembling hormones and attaching to hormone receptors. These constituents are called phytoestrogens.
Phytoestrogens are weaker than natural oestrogen in action, however they compete with oestrogen for oestrogen receptors. In the presence of excess oestrogen in the body, phytoestrogens take up some of the receptor sites and, buffer the effect of excess oestrogen. When there is a depletion of oestrogen, the phytoestrogens engage vacant receptor sites to stimulate an oestrogen reaction within the body.
The symptoms of menopause are due to the body experiencing a withdrawal in oestrogen. Due to low levels of oestrogen being produced in the body, the numerous oestrogen receptors are not engaged due to the low oestrogen concentration. As these oestrogen receptors are not engaged, the reaction from the presence of oestrogen on the receptors is not triggered and results in the breakdown of feedback mechanisms that the endocrine system is reliant on to function efficiently. Asparagus racemosus, having known phytoestrogen properties,acts to engage vacant oestrogen receptors completing the stimulus required in order for the oestrogen required reaction to take place.
- A new isoflavone from the roots of Asparagus racemosus. Saxena VK, Chourasia S.Fitoterapia. 2001 Mar;72(3):307-9. Natural Products Laboratory, Department of Chemistry, Dr Harisingh Gour University, -470003 (M.P.), Sagar, India.