MENOPAUSE

SOME WOMEN SPEAK OF MENOPAUSE with an ominous tone of dread as a time of hot flushes, uncontrollable moods and dwindling desires. Other women embrace The Change' with a relentlessly upbeat attitude, heralding it as a glamorous, even fascinating time of life to be greeted wearing running shoes and a sexy smile.

Regardless of how you feel about menopause, if you're female, you will go through it, which also means you'll have plenty of company. If you're among those women experiencing menopause between 2000 and 2020, the chances are that at least 25 years of your life will be post-menopausal. Now there's a reason for positive thinking: 25 years of being period-free.

Menopause occurs when the ovaries' production of the hormones oestrogen and progesterone greatly decreases. This dwindling hormone supply can occur suddenly or it can take several months. Although it can cause a variety of physical and emotional symptoms, there are some things it does not do: it does not redistribute fat, contribute to a loss of muscle tone or cause wrinkles to appear. If you're experiencing these phenomena, blame other causes.

The first phase of menopause is sometimes called perimenopause. It is characterised by the fluctuation of oestrogen levels, which can begin as early as age 35 in some women. Common symptoms of perimenopause include erratic periods, both in terms of length and amount of flow, breast tenderness, headaches, food cravings, irritability, forgetfulness, and mood swings.

Some women describe perimenopause as nothing more than a bad case of PMT, or premenstrual syndrome. So if you've always experienced PMT, you're probably wondering how to tell when those trials end and the trials of perimenopause begin.

Whatever symptoms you may have, the important thing is to anticipate menopause as a natural event and prepare for it. Exercise and proper nutrition can ease the passage through the menopausal years, diminishing many symptoms to the point where drugs are unnecessary.

Hormone replacement therapy (HRT) is the most common drug treatment prescribed for symptoms of menopause. But it's also the subject of some controversy. Oestrogen is thought to help slow osteoporosis and reduce a woman's risk for heart attack and heart disease, two of the leading killers of postmenopausal women. But some data challenge the notion that oestrogen protects the heart.

What's more, HRT is not without its risks, including the increased risk of development of ovarian, uterine and breast cancer. It has even been linked to autoimmune disorders such as lupus. A safer technique might he to boost the intake of natural oestrogen-like compounds called phytoestrogens in your diet.

In addition to HRT, tranquillisers, antidepressants and sleeping pills are sometimes prescribed for specific menopausal symptoms. These drugs have their own attendant side effects.
Several herbs can act as hormonal precursors - that is, they help the body build oestrogen molecules when the hormone is running low. Other herbs help ease or even eliminate hot flushes, the anxiety and depression that may accompany menopause, and other symptoms associated with hormone fluctuation and dysfunction.

VITAMINS AND SUPPLEMENTS FOR MENOPAUSE
Mounting evidence suggests that getting enough of certain vitamins and other nutrients can make menopause a breeze.
* Vitamin E. Tests dramatically support its use for hot flushes and other symptoms of menopause. In some tests, vitamin E worked better than barbiturates to calm anxiety, cool hot flushes, protect against heart disease and ease vaginal dryness. Typical dosage: 200 to 800 IU per day.
* Vitamin C with bioflavonoids. Clinical studies of women in menopause found that half experienced relief from discomfort by using vitamin C with the bioflavonoid hesperidin. Leg cramps, bruising and hot flushes significantly decreased. Typical dosage: 500 to 5,000 milligrams per day.
* Calcium/magnesium. This dynamic duo of minerals helps prevent osteoporosis and ease mental stress and anxiety. In fact, adding supplemental calcium to the diet as early as age 20 can increase bone density, which puts you ahead in the race against bone loss after menopause. Use absorbable forms such as calcium citrate, gluconate or carbonate. Typical dosage: 1,000 to 1,500 milligrams of calcium per day in a 2:1 ratio with magnesium. So if you take 1,000 milligrams of calcium, take 500 milligrams of magnesium, too.
* B-complex vitamins. These nutrients help to reduce water retention, combat fatigue, and prevent nervous and mental disorders. In fact, vitamin B6 injections have been used to reduce hot flushes and treat mood disorders. Take a good daily B-complex supplement that provides at least 25 to 50 milligrams of vitamin B6, 50 to 100 micrograms of B12 and 400 to 1,000 micrograms of folic acid.
* Selenium. This mineral helps to maintain normal hormone function; some research suggests it may also brighten moods and help fend off heart disease. Typical dosage: 200 micrograms per day.
* Acidophilus. These beneficial bacteria work to prevent vaginitis, yeast infections and cystitis, problems that can crop up more frequently after menopause. Typical dosage: 2 to 6 capsules daily; or 1 teaspoon of liquid one to three times daily.
* Evening primrose oil. This oil contributes to oestrogen production and works as a sedative and a diuretic. It has also helped some women control shot flushes. Using flaxseed oil with evening primrose oil can help you maintain a healthy cardiovascular system. Typical dosage: 800 to 1,200 milligrams standardised to 20 per cent gamma-linolenic acid, or GLA, per day. To help your heart, supplement your evening primrose oil with 1 to 2 tablespoons of flaxseed oil per day.

DANGER SIGNS AND SYMPTOMS
Bleeding between periods or prolonged or excessive menstrual bleeding may indicate the presence of a uterine tumour. Bleeding after menopause is not normal; if this happens, contact your doctor for an evaluation.

DRUG TREATMENT

Hormone Replacement Drugs
Estradiol (Climaval, others). Function: adds oestrogen to alleviate hot
flushes, decrease bone loss and protect the heart. Side effects: nausea, bloating, weight gain, breast tenderness.

Conjugated oestrogens (Premarin, others). Function: alleviate symptoms associated with menopause. Side effects: nausea, bloating, weight gain, breast tenderness, increased chance of blood clots.

Other Drugs
Raloxifene (Evista). Function: guards against bone loss without increasing risk of breast and uterine cancer. Side effects: hot flushes, nausea, bloating, weight gain, breast tenderness.

Testosterone (Estratest). Function: sometimes given to decrease menopausal symptoms. Side effects: nausea, breakthrough bleeding, swelling, increased hair growth on body and face.

WORKING UP A SWEAT TO COOL HOT FLUSHES
Clinical studies have found that women who engage in regular physical activity are half as likely to experience menopausal hot flushes as women who don't. Exercise is also one of the most important weapons against the increased risk of osteoporosis and heart disease that women are exposed to after menopause. And working up a sweat marshals endorphins, the body's own mood-menders and painkillers.

Most experts recommend an aerobic, weight-bearing workout three to five times per week for 35 to 45 minutes. There are lots of exercise options out there: cycling, brisk walking, tai chi, in-line skating. But if it's not weight-bearing, it doesn't strengthen bones (so swimming, while it does burn
calories and boost aerobic capacity, isn't as helpful). Whether your exercise is social or solo, start slowly and check with your doctor or other health practitioner before taking up a new routine. Injuries, even minor ones, can derail good habits before they're ingrained.

HERBAL REMEDIES

Black Cohosh (Cimicifuga racemosa)
This herb has proven to be such an effective remedy for menopausal and premenstrual complaints that it has received official recognition in Germany. Studies have confirmed that black cohosh root can mimic oestrogen in the body. It also possesses antispasmodic and diuretic properties. It is useful for hot flushes, vaginal dryness and even the depression sometimes associated with menopause. Typical
dosage: one to three 500-milligram capsules standardised to 2 per cent triterpene glycosides per day; or 10 to 25 drops of tincture up to every four hours. Caution: do not exceed recommended dosage. Do not use if you are pregnant or breastfeeding.

Dang Gui (Angelica sinensis)
A staple of traditional Chinese medicine, this herb helps relieve a number of unpleasant symptoms associated with menopause. No other herb in Chinese medicine is as widely used for treating gynaecological ailments. Dang gui acts as a phytoestrogen - in other words, it has similar, but milder, effects on the body to actual oestrogen. Dang gui is traditionally believed to have pain-relieving properties, but this is probably due, in part, to its ability to calm spasms. It also boosts elimination and supports the cardiovascular system, valuable actions for women in menopause. Typical dosage: up to six 500- to 600-milligram capsules ppr day; or 5 to 20 drops of tincture up to three times per day. Caution: this herb should not be used if you are pregnant or breastfeeding or when you have the flu. It has made some people more sun-sensitive.

Agnus Castus (Vitex agnus-castes)
Compounds in the berries act on the pituitary gland to stabilise hormone fluctuations. Clinical evidence bears out the use of agnus castus in treating menopausal symptoms. Typical dosage: 200 milligrams
of product standardised to 0.5 per cent agnuside, one to three times daily. Caution: avoid if you're pregnant or trying to become pregnant.


Raspberry (Rubus idaeus)
Long used for various discomforts during pregnancy and childbirth, raspberry also strengthens the uterus, stops haemorrhages, decreases excess menstrual flow and increases deficient flow. It also relieves painful menstruation by relaxing the smooth muscles. Typical dosage: 1 to 2 cups of tea per day (steep 1 teaspoon of dried leaves in 1/2 litre of hot water for 10 to 15 minutes). Caution: consult a qualified practitioner to use raspberry during pregnancy.

Liquorice (Glycyrrhiza glabra)
You'll find this root as an ingredient in about a third of all Chinese herbal formulas and in a majority of the formulas prescribed for female reproductive problems. Liquorice works to control water retention, breast tenderness and carbohydrate cravings. It also adjusts and boosts oestrogen metabolism, helping to decrease the symptoms associated with hormone fluctuation. Liquorice is believed to enhance the action of other herbs when taken in a formula.
Typical dosage: up to six 400- to 500-milligram capsules per day; or 20 to 30 drops of tincture up to three times per day. Caution: avoid liquorice if you're pregnant or breastfeeding, have high blood pressure, heart rhythm irregularities or kidney disease, or if you are taking digitalis-based drugs, unless supervised by a doctor. Taking liquorice for extended periods of time can raise blood pressure. Taking potassium supplements with liquorice is advised. Deglycyrrhizinated or DGL liquorice avoids the side effects of this herb.

Saw Palmetto (Serenoa repens)
This shrub yields berries that were used for hundreds of years by Native Americans. Today saw palmetto has been scientifically and clinically proven effective for both prostate conditions in men and hormonal conditions in women. Typical dosage: 320 milligrams of capsules standardised to 85 to 95 per cent fatty acids per day.

St John's Wort (Hypericum perforatum)
This well-known mood-lifter and antiviral herb helps boost brain function, and fight the anxiety and depression sometimes associated with menopause. It works by increasing blood supply to brain tissue
..,and naturally raising serotonin, a mood-controlling brain chemical. It can help to control mood swings. Typical dosage: 300 milligrams of capsules standardised to 0.3 per cent hypericum three times per day. Caution: may cause increased sun sensitivity. Don't take St John's wort in combination with prescription antidepressants or with L-dopa, a drug for Parkinson's disease, unless advised to do so by your doctor.

NUTRITION FOR A SMOOTHER PASSAGE
Smart eating, begun in the years that precede menopause, may help to decrease unwanted symptoms.
Vegetables from the cruciferous family - broccoli, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, swedes and turnips-may help the body make substances called indoles. Indoles may help protect women from the dangerous effects of excess oestrogen, among them breast cancer. Plus
they're all good sources of vitamins and fibre. If you eat them without cheese sauce, they're all low-fat.

Here are more foods to seek out.
Whole grains • Garlic
Sesame seeds • Whole-grain pastas
Sunflower seeds • Flaxseed oil
Almonds • Dates
Fresh vegetables • Pomegranates
Fresh fruits

Here are foods and substances to avoid.
Rich dairy products
Sugar
Fried foods
Red meats
Caffeine
Alcohol
Cigarettes
Nicotine

THE POWER OF ISOFLAVONES
One reason Asian women tend to sail through menopause with few symptoms and lower incidences of hormone-related cancers is that they eat large amounts of soya products, such as tofu, tempeh and miso. Most soyabean products contain isoflavones, whose chemical structure closely resembles that of oestrogen. More than a thousand clinical studies indicate that soya compounds act as weak oestrogens in the body - filling in for `real' oestrogen when there isn't enough, but blocking the body's own hormone when there's too much.

Phytoestrogens can also protect the heart against postmenopausal heart disease just as well as hormone replacement therapy; help protect against bone-mineral loss, the leading cause of osteoporosis; and help protect against breast and uterine cancer and postmenopausal psychological symptoms. Although no dietary guidelines have been established for soya, studies show that even small amounts of soya products, eaten twice a day, can improve women's health during menopause.

If you want to get isoflavones but you just hate soyabeans no matter how cleverly they're disguised, try incorporating other beans into your diet. Most legumes - including adzuki, black, broad, butter, kidney and mung beans, red and yellow lentils, and black-eyed peas - either come close to or surpass soyabeans' level of genistein, one of the key isoflavones. In addition, they're low-fat, high-fibre protein, perfect heart-healthy foods.

It's not cheating to get your isoflavones from a capsule, but you won't reap the side benefits of bringing a low-fat, high-fibre food to your table. Typical dosage of supplemental isoflavone: 6 to 20 milligrams of genistein, or total isoflavone consumption of 40 to 80 milligrams daily.