Nature determines our sex and in doing so whether we are going to face the menopause and the life changing period that it is. Even if we don’t fit the criteria sexually, many of us are still dramatically affected by the end of ovulation. Husbands, children and workmates see the effect that flushes, lack of sleep and bouts of depression can have and for those closest to the person suffering, it can be a real torment.

Estimates put nearly 9 million of us in the position of either, suffering directly with the devastation the menopause can cause or looking on dismayed, wondering why in this day and age there is no ready solution.

Most women of 50 can tell you what a hot flush feels like. For most of the rest of us, it is usually only associated with jokes about red faced harpies. This gulf in understanding and about how to help, is half of our problem. There are solutions, in fact a number of them are simple, effective and do not need to be approached with great caution.

If you or a loved one is suffering, take five minutes to explore the options presented here. I would not guarantee that this covers every approach to menopause management but these choices should give most of you a way to bring back the well being you felt and the feeling of family that is so important to all of us.

Dr Chris Steele, MBE

Dr. Chris Steele, MBE, is a British medical doctor well known for his many media appearances.
He is the "resident" doctor on ITV's This Morning daytime magazine show. He appeared on the very first show in 1988 and still appears on the show every week.



Key: Wellbeing Rating.

The Wellbeing Rating score is provided as a guide to how effective the majority of users find a particular therapy. The Rating is not intended to quantify the efficacy of any specific product.

- Suggested for severe problems.

- Suggested for moderate to severe problems.

- Suggested for mild to moderate problems.

- Suggested for mild problems.

- Not recommended. No better than placebo.




“What are the options?”

Simply stated, there are four approaches to the menopause years and beyond, and the choice of approach is as applicable to a woman, proactive about her health, who experiences no symptoms, as to one who suffers the worst of symptoms.

Starting with the facts: the body is not designed to exist in perpetuity, for most people, bodily systems run as intended while younger and able to create a family, and then start to slow down. Somewhere in this for women is that period in life called the menopause, and beyond is a gentle decline in bodily function with increased risk of ill health.

The menopause represents that time in a woman’s life when her ovaries stop producing sex hormones and her menstrual cycles end. Notwithstanding, that for the many women that suffer no symptoms this can be a welcome change, other things happen as well. These so called sex hormones have had a major job to do throughout the body. This list of jobs is very long and many of the things that happen are little understood.

For example, collagen production, which is critically important throughout life for healthy bones and skin, is triggered by hormones. Other areas of a woman’s body are equally dependent upon a healthy hormone system; cerebral function and the central nervous system, the maintenance of a good blood flow and functioning of the cardiovascular system. Even the eyes appear on the list, and incidence of cataracts.

But let’s not be too bleak about this. It is relatively easy to live a long, healthy and active life after menopause; many woman do and many more will do so in the future. The menopause years and beyond need not be a slow decline as they used to be, but more akin to a ‘Duracell battery’ where bodily function, and hence lifestyle, remain firmly in the ‘life zone’. Yes, of course we don’t live forever, but living a full life is a lot more attractive than the alternative, hence the need to do something about the menopause.


Hot flushes and night sweats.

The actual physiological process that causes a hot flush or night sweat remains little understood, but clearly involves the Hypothalamus. Flushes start in the Hypothalamus where low levels of oestrogen stimulate the production of gonadotropin releasing hormone (GnRH). Subsequently the GnRH stimulates the pituitary to increase levels of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). At the Ovaries, FSH and LH try to stimulate oestrogen production. With no eggs, the ovaries are unable to respond. Receiving feed-back that the level of oestrogens remains low, the hypothalamus again produces GnRH. This cycle continues until Catecholamine sensitive neurons in the autonomic nervous system become activated by the increased level of GnRH and subsequently, substances that cause dilation of peripheral blood vessels are secreted and the hot flush begins.

However caused, hot flushes or night sweats represent the most common and often most distressing symptom of the menopause, typically lasting between a few seconds and a few minutes and can be felt for a period of up to 15 years from the onset of the peri-menopause. Flushes and sweats tend to peak within 2 to 3 years after the menopause, and lessen thereafter, but the range of patterns among menopausal women is quite diverse. Experienced by more than 75 per cent of perimenopausal women, flushes and sweats vary in frequency from an occasional flush to up to 20 a day or more. The severity of hot flushes also varies: some women may just feel a sensation of heat flooding from breast to head. For others, the hot flush may begin with a feeling of nausea or a headache, then turning bright red, they perspire profusely, afterwards feeling cold and shivery. During a flush, women may also suffer with other symptoms such as palpitations, giddiness, weakness and skin prickliness or feel as if they are suffocating. Night sweats are severe hot flushes, and can cause women to wake, often drenched in sweat. In some cases a woman has to get up several times during the night to wash and change. By impairing the dream-time sleep (REM phases), a woman is always left feel tired and worn out in the morning. Night sweats can also cause serious stress in a relationship, if a partner also suffers from disturbed sleep.




“So what can we do?”

Approach 1 - Traditional Hormone Replacement Therapy.

See your GP. Ask about a menopause test. Discuss the help available. Don’t be afraid to voice your concerns, your GP wants to help. Discuss the benefits, risks and potential long-term problems.

Facts: Proven treatment option for reducing menopausal symptoms. May be used for a few months or several years.

Issue: Long term use brings a small increased risk of ill health substantiated by many large scale trials.
Please see The facts and risks of using HRT?

In the past, if you felt you needed help, your medical practitioner would probably have prescribed a traditional oestrogen therapy.

HRT or ERT (Oestrogen only) as it is often referred to, is a proven treatment option for reducing menopausal symptoms and has until recently also been considered the first line treatment for osteoporosis in menopausal women.

Most women will be advised to take an oestrogen and a progestogen. If you have had a hysterectomy you will only need to take oestrogen, but if you still have your uterus, you need to protect yourself from the increased risk of endometrial cancer that taking oestrogen alone will confer.

If you are within a year of your last period (perimenopause) you may be prescribed progestogens cyclically, this means you will take them for 12 to 14 days each four weeks and when you stop taking them you will bleed for a few days. This way you will appear to have a regular period but you will probably not know when your natural menopause occurs.

HRT is available in tablet and skin patch forms, with a test of oestrogen level determining the best method for your personal metabolism. High doses are achieved by having an implant. For short term (3-6 months) use at low doses, vaginal cream or pessaries may be recommended. Most people in the U.K. take HRT by tablet, making it easy to change if there is a problem. Patches are also convenient to use and are popular. Matrix patches give less skin irritation than the older type, which have higher alcohol content. Implants are often prescribed at the time of hysterectomy and ovarian removal. They give gradually decreasing levels of oestrogen over a few months and need periodically replacing. Implants tend to need replacing earlier each time and you may become less responsive to the hormones. A recent addition is a nasal spray giving symptom relief for 24 hours, but some women have reported problems with a sore and blocked nose. Transdermal gels / creams are popular in Europe but it can be difficult to maintain the exact dose needed.

Don't be afraid to go back to your GP if you develop side effects or unusual bleeding. There are many types of HRT and you may achieve up to 95 % reduction in menopausal symptoms.

Wellbeing Rating:




Approach 2 - Dietary Supplements.

Not happy with taking HRT? There are some equally effective supplements available.

Fact: Only 2% of Japanese women take HRT.

Concerns: How can a supplement help?

In many Asian countries, women in menopause don’t find it necessary to turn to HRT. This is attributed to the high levels of phytoestrogens consumed in their diets. Phytoestrogens are found in virtually everything we eat - grains, beans, nuts, seeds, seed oils, berries, fruits, vegetables, and roots - and have been shown to have both oestrogenic and antioestrogenic properties (over a 1000 are known).

For Japanese women, a wide range of commonly consumed foods contain amounts of these different phytoestrogens. For example, Coumestans, a class of phytoestrogen, which are over 30 times more potent than the widely regarded Soy isoflavones, can be found in high concentration in bean sprouts. Unfortunately the average western diet offers a much lower intake of phytoestrogens, hence the need to use a dietary supplement.

Phytoestrogens were first identified in the early 1930s. Today, we now know from human clinical trials and molecular and cellular biology experiments that certain phytoestrogens can confer notable health benefits related to cardiovascular diseases, including lowering levels of blood cholesterol, inhibiting several stages of cancer initiation and progression, preventing osteoporosis via stimulating osteoblasts, suppressing menopausal symptoms and maintaining prostate health in men. These facts are in part validated by the epidemiological evidence that the rates of these conditions are more favourable in both men and women among populations that consume diets containing a higher proportion of phytoestrogen rich foods.

For healthy women, soy protein and soy isoflavones are considered safe to consume and can be helpful in the alleviation of mild menopausal symptoms. Studies have indicated that a 55% improvement (average) can be seen in Hot Flushes.

For those looking for a broader range of benefits including increased energy and sense of wellbeing, look to the more recently introduced green bean phytoestrogens which can offer up to 95% improvement in menopause wellbeing.

Ongoing research into the use of phytoestrogens as supplements and nutraceuticals (not as the basis for pharmaceutical products) continues to discover beneficial dietary therapies that can be readily acquired in health stores.

Pop into your local chemist and ask for Estroven if you want to try Soy.

Wellbeing Rating:

If you are looking for green bean phytoestrogens try fxmenopause.

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Approach 3 - Other Medicines.

If you are suffering with hormone related illness, making HRT unsuitable, your GP may prescribe another type of medicine.

Fact: New medicines exist that target hormonal related health problems, concurrently giving significant levels of symptom relief without the health risk of traditional HRT.

Worry: Is it safe to keep taking such medicine?

Some women should not take HRT, though not as many as was once thought. Here are a few reasons.

Unexplained vaginal bleeding until you know there is no serious cause.
Active breast cancer.
Severe or active liver disease.
Some women have medical conditions that should be taken into account but do not absolutely preclude taking oestrogen*. br /> Endometriosis - may be reactivated by HRT*.
Fibroids - may enlarge and cause troublesome bleeding*.
Women with a past problem with blood clots in veins (thromboembolism) need to be tested to make sure they are not at risk of developing further clots, which are slightly more common on HRT*.

Tibolone is a synthetic steroid, which treats menopausal symptoms, prevents bone loss and improves mood at the same time as not affecting the breast or uterus; SERMs are Selective Estrogen Receptor Modulators that mimic the action of oestrogen in some tissues while blocking it in others. One of these, Raloxifene, is licensed in the UK for the treatment of osteoporosis.

Wellbeing Rating:

*You may also be able to use dietary supplements to manage your menopausal symptoms but are advised to do this under medical supervision.




Approach 4 - Herbal Supplements.

Properly handled, medicinal herbs may help with the management of menopausal symptoms.

Facts: Plants are efficient chemical factories that produce a wide variety of chemical compounds. In many cases these can be used to gain relief from a wide variety of problems.

Concern: The term "Natural" does not mean “Safe”.


Black Cohosh.

Black Cohosh has a long history of use by women suffering with menopausal symptoms. Native to North America, this member of the buttercup family is also known as bugbane. However, its most common American nickname, black snakeroot, describes its gnarled black root, the part of the plant that is used medicinally. Contained in the root is a complex mixture of natural chemicals, many as powerful as modern pharmaceuticals.

Even though Black Cohosh has been in use for many years and is clearly, for many women, an effective way of managing symptoms, its mechanism of action remains unclear and repeatedly, scientific studies provide contradictory results.

In use it is considered moderately effective at managing hot flushes and night sweats. Black cohosh cannot help support cardiac or bone health, and is normally recommended for short term use (to 6 months) by healthy women.

Caution is advised for those with Liver and Breast conditions.

Wellbeing Rating: (Flushes & sweats)


Sage.

Sage may give relief by reducing the excessive perspiration associated with hot flushes and night sweats. It is believed this is because Sage directly decreases production of sweat. This is based on traditional herbal prescribing and has not been evaluated in clinical studies.

Wellbeing Rating: (For sweating)


Agnus Castus.

Agnus Castus has been used for thousands of years for its beneficial affect on the female hormonal system. Modern research confirms this use. The berries of this plant modify the hormonal balance between oestrogen and progesterone. Thus it has value in malfunctions of the feminine reproductive system and has been used with great effect in restoring absent menstruation, regulating heavy periods, restoring fertility when this is caused by hormonal imbalance, relieving pre-menstrual tension and easing the change of the menopause.

Caution is advised since excessive intake can cause a nervous disorder known as formication, which manifests as a sensation of insects crawling over the skin.

Wellbeing Rating:


St. John’s Wort.

Scientific trials (15) encompassing 1,757 individuals found that St. John's Wort in doses less than 1.2 mg per day produced a 61% improvement in mild to moderate depression, while doses up to 2.7 mg per day produced a 75% improvement. St. John's Wort efficacy in the treatment of severe depression is not documented, but it presents its self as a credible alternative compared to prescription antidepressants and in use has a low incidence of side effects.

Caution is advised as St. John's Wort can cause light sensitivity so exposure to sun should be avoided. Not to be taken together with the contraceptive pill, anti-epilepsy treatments and a number of other medications including anti-depressants. If you are taking any medication consult your doctor before starting St John's Wort. Also should not be taken together with foods that contain tyramine i.e. cheese, red wine, preserved meats and yeast extracts.

Wellbeing Rating: (If feeling depressed)


Dong Quai.

Also known as dang-gui in Traditional Chinese Medicine (TCM), dong quai is sometimes referred to as the female ginseng. In Traditional Chinese Medicine, dong quai is often included in herbal combinations for abnormal menstruation but is not used in TCM for treating symptoms associated with menopause, such as hot flashes.

Wellbeing Rating: (no better than placebo)


Wild Yam.

Contrary to popular claims, wild yam roots do not contain and are not converted into progesterone or dehydroepiandrosterone (DHEA) in the body. Pharmaceutical progesterone is made from wild yam using a chemical conversion process. This can lead to confusion - while wild yam can be a source of progesterone, it cannot be used without this pharmaceutical conversion, which cannot be duplicated by the body.

Women who require progesterone are advised to consult with their Health Professional and not rely on either Wild Yam supplements or other non prescription progesterone creams.

Wellbeing Rating: (no better than placebo)




Please keep in mind.

Herbal medicines are derived from natural sources. Many prescription and over-the-counter medications are, too. Each of these should be treated with caution. If you do use herbal supplements you are advised to keep your doctor informed.

Your doctor can tell you whether:

Any herbs you take or are interested in taking have potentially dangerous side effects.
Specific herbal medicines are appropriate for you given your overall health status.
Any herbal medicines can interact with other medications you currently use.
You could achieve the same results you desire from herbal supplements by changing your lifestyle — for example, your diet or exercise program.

Your doctor may be cautious about endorsing or embracing most herbal supplements. This is most often because relatively few controlled studies have been done on herbal supplements. However, a growing number of doctors are working to better understand herbal therapies so that they can help you make informed decisions about your health care.


Lifestyle – Your body, your choice.

Diet and exercise, find time for yourself and your family.

There are several simple ways of helping to reduce the impact of hot flushes and night sweats; many women can help reduce the number of night sweats by dropping the evening bedroom temperature a few degrees cooler and avoiding food, alcohol or caffeine within 3 hours of going to bed. Women with hot flushes should avoid caffeine, alcohol, cayenne, occlusive clothing and heat. Wearing clothing made of natural (i.e., cotton) materials and if possible taking exercise each day for 30 plus minutes (not within 3 hours of bedtime) is also recommended, as is the use of long term herbal deodorants.

Hot flushes and night sweats are often mistakenly accepted as the only major problem caused by the menopause, not a symptom of the more significant health issues brought about by living in an “oestrogen-deficient” state for up to a third of a lifespan. Due to this, many women go through the menopause without taking adequate measures to reduce the risk of problems later in life, such as heart disease and osteoporosis.

To more fully manage hot flushes and night sweats, a woman has to manage her reduced ability to produce oestrogen. Hence proactive health maintenance is vital for any women looking to ensure a good quality of life, now and in the future.


Not forgetting.

Women being treated for oestrogen dependent cancers and, most importantly breast cancer should not assume that Herbal or Dietary supplements are safe to use. Although often mild in action when compared to conventional HRT, phytoestrogens function physiologically by binding at the oestrogen receptors found in many cells, including both breast and endometrial tissue, promoting or moderating estrogenic activity and have the potential, by doing so, to block the activity of therapies design to stop oestrogenic activity e.g. Tamoxifen.

Flushes although commonly associated with the menopause may also be caused by other medical conditions such as under-active Thyroid. Do consult your GP if you are unsure of the cause.

Many prescription drugs such as anti-hypertensives and mood altering drugs such as anti-depressants can also cause hot flushes. Over-the-counter medications and supplements should also be examined for their side effects at this time of life.