Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

‍

The great majority of women require no treatment at menopause whatsoever, as the symptoms are minor and will pass without any particular treatment in a few weeks or months, or at the most two or three years. Since the use of hormones from an outside source has been associated with serious problems, it is recommended that the administration of hormones be avoided, if at all possible. An increase in breast, ovarian, and endometrial cancer has been associated with the use of estrogens, as well as fibroid tumors of the uterus, depression, and liver or gallbladder disease.

After hysterectomy, even though the ovaries were saved when the uterus was removed, they may be damaged by surgery, the tying off of blood vessels, and mechanical trauma to the glands, so that they function poorly.

Osteoporosis is a major health concern in menopause. It is a condition of five, ten, even forty years in the making, and at the time of menopause, usually has no recognizable symptoms. The major unpleasant symptom in menopause is the hot flash.

Common Symptoms Ascribed to Menopause

Cardiovascular system

• palpitations
• high blood pressure
• hot flashes

Musculoskeletal

• aches and pains
• osteoporosis is usually without symptoms

Genital

• irregular bleeding
• decreased libido
• vaginal dryness

General

• dryness of skin
• wrinkling of the skin

Neurological

• nausea
• dizziness
• mood changes
• irritability
• depression
• insomnia
• numbness
• tingling‍

Cause of Hot Flashes

‍An experiment was done measuring the tightening of blood vessels in the skin after applications of ice. Women with hot flashes tended to lack the normal tightening of blood vessels, whereas women who had no flashes, or very mild flashes, tended to have a more brisk tightening of the blood vessels. There was a significant relationship between the degree of tightening and the severity of the symptoms.

Improper breathing may be one cause of hot flashes. At about age 50, women tend to relax the shoulders and soft palate. Snoring and shallow breathing often occur then. Poor cooling of the blood as it passes on its way up to the brain causes the thermostat to perceive the body as being hot.

‍Avenues Available for Treatments

1. Hormones‍

The following are organs we can stimulate in order to optimize the physiological processes:

• The adrenal glands secrete in women small amounts of male hormones, some of which are converted to estrogens in the body's fat cells. To stimulate the adrenals, give vigorous tapping over them with the fingertips for two minutes, or administer alternating very hot water applications and very cold water applications, one minute each for six minutes, ending with cold. Repeat daily. Locate the adrenals by measuring about two inches above the waist, one on each side of the spine.
• The liver has a system for the breakdown of the estrogens. Relieve the liver by one day of fasting each week, ending the fast with breakfast, never with supper.
• The thyroid has an effect on metabolism. Stimulate by a cool shower each morning followed by a brisk but brief cold mitten friction for three minutes. Until the hot flashes pass, avoid thiourea foods:
• ~~cabbage
• ~~carrots
• ~~kale
• ~~peaches
• ~~peanuts
• ~~soybeans
• ~~spinach
• ~~strawberries
• ~~turnips
• ~~rutabaga
• The hypothalamus produces luteinizing hormone. Stimulate by starting a new intellectual program, such as initiating a Bible study group in your home, or organizing a group ministry for a prison or an orphan's home.
• The anterior pituitary produces its FSH and LH. Stimulate by being regular to bed and to rise, regular with meals, and regular with an hour or more of exercise daily.‍

2. Botanical Remedies

‍‍‍Herbs: Use one cup of the following formula three times daily.

• 4 c. boiling water
• 1 t. alfalfa leaf
• 1 t. catnip tea
• 1 t. black cohosh
• 1 t. red raspberry leaf
• 1/4 t. licorice powder

Directions: Put the cohosh and licorice to boil gently for 30 minutes in one quart of water. Pour it all into a container with one tablespoon of the mixed leaves. Steep for half an hour. Use one cup four times a day. Dong quai is also useful and is high in iron & vitamin E.

Licorice root assists in balancing the estrogen-progesterone ratio and is a good source of chromium and niacin. Chaste tree is used for a wide variety of menopausal discomforts.

Other herbs that have estrogen and progesterone precursors are hops and ginseng. All ginsengs have a lot of saponins in them, which stimulate the nerves and bowels.

Vaginal itching may be helped by mixing angelica and alfalfa (if not already a powder, pulverize in a seed mill or blender) in glycerin from the pharmacy and using topically.

Damiana tea is very helpful for dryness and itching. Use one cup four times a day.

For itching around the vagina, use a perineal pour: one quart of hot or cold water into which you put one to four tablespoons of vinegar, poured slowly through the low part of the pubic hair and encouraged with the fingers to touch all parts of the vulva by opening all the folds. The perineal pour should be done with every bathroom use.

Also puncture a vitamin E or vitamin A capsule and insert it high as a suppository in the vagina each night for dryness of the vagina. The vitamin A or E suppositories have to be used daily for six weeks to get relief. In six weeks drop back to about once or twice a week. Itching can also be helped by vitamin E oil rubbed on the vulva.‍

3. Physical Activity‍

Exercise: Exercise is not just a healthful thing to do; in menopause it is one of the main treatments women need. We recommend that a woman obtain three to five hours of outdoor labor daily to stimulate the ovaries and other endocrine glands. Weight bearing exercise is the ideal, as it protects against osteoporosis. Swimming one hour three times per week has been shown to increase bone mineral content.

To prevent humpback, several times a day (at least four) raise up from your work, stand or sit tall, hold the elbows at shoulder height, and try to touch the elbows together, both in front and behind. All day maintain the good position you achieve with this exercise.

A deep breathing exercise will often stop a hot flash in a few seconds. Simply breathe in deeply through the nose and out through the mouth, repeatedly, until the flash stops.‍

4. Habits of Life‍

Smoking: Stopping smoking is a treatment for menopause. Smoking itself leads to a decrease in estrogen levels and increased bone loss at an early age. Smoking a pack per day causes the loss of one percent of the bone calcium per year after menopause.

Alcohol: It suppresses the growth of bone, is toxic to the ovaries, can cause infrequent ovulation and menstrual irregularities.

Coffee: Coffee interferes with many metabolic processes, including those concerned with normalizing the menopausal process. Most damaging is the loss of 1.4 percent of bone calcium per year after menopause from drinking just one cup of coffee per day.‍

5. Mental Health‍

Emotional Aspects: Improving one's interpersonal relationships not only makes one more at ease, but actually lessens women's hot flashes. Learn that God is the great Healer. Decide you want to work for your healing through prayer and the physical means God has provided in nature. Confidently expect healing in God's own time. Start a new study program in the Bible. God will give you help and comfort.

‍6. Nutrition‍

Diet for Hot Flashes: Hot drinks, hot meals, and hot spices can aggravate hot flashes. So can sugar or simple refined carbohydrates. Do not be disappointed if you must go through months and months trying to improve hot flashes. Use a vegetarian diet without sugar, and often the hot flashes will stop promptly.

The following foods have been found to be high in naturally occurring plant sterols similar in chemical formula to estrogens. Some of these should be eaten daily in liberal quantities, if you do not have sensitivities to them:

• Almonds
• Apples
• Anise seed
• Barley
• Carrots
• Cashews
• Cherries
• Coconut: 1T/day
• Corn
• Food yeast
• Garlic
• Oats
• Olives
• Parsley
• Peanuts
• Plums
• Rice
• Sage
• Soybeans
• Wheat
• Wheat germ: 1T/day
• Whole grains
• Yams
• Alfalfa leaf tea
• Licorice root tea
• Foods of the nightshade family (bell pepper, paprika, pimentos, eggplant, potatoes, tomatoes)

Diet for Osteoporosis

Eat a low protein diet, as the kidneys excrete large amounts of calcium through the urine to make up for the high sulfuric acid from the protein. A significant treatment for osteoporosis, as well as preventive maintenance for any person, is a low protein diet. Many clinical nutritionists are now recommending the low protein diet for problems other than osteoporosis. Eliminate free-fat almost entirely, or completely if the weight demands it, such as margarine, mayonnaise, fried foods, salad oils, cooking fats, and nut butters. This diet is most helpful in menopause, both for the hot flashes and preventing osteoporosis. Low-fat consuming Seventh-day Adventist women, who have no animal protein or animal fat whatsoever, do not have evidence of essential fatty acid deficiency and have a very low rate of osteoporosis.

Some Other Diet Issues in Osteoporosis

If a calcium supplement is taken, it may decrease the availability of copper and zinc and increase cholesterol. Zinc is considered to be as important in bone strength as calcium. Calcium supplement also decreases iron retention, increasing risk of iron deficiency anemia.

Flaxseed, two tablespoons ground, at each meal has benefits in the menopausal years in terms of stroke and blood fats. Too much salt causes the kidneys to excrete more calcium in the urine. Caffeinated drinks (even after decaffeinating) can cause increased calcium loss. Women should eat a low phosphate diet, which is another benefit of a no-animal protein diet, as animal products are generally high in phosphates. Soft drinks and baking powder are also high in phosphates. Vitamin E by mouth can be used for the management of hot flashes.

Boron supplements have been used by some to increase the deposition of calcium in the bones. It also stimulates the production of very tiny amounts of estrogen, even in women who have gone through the menopause or who have had a hysterectomy. Although the estrogen production is in small amounts, its sedative effects may be sufficient to avoid the most severe symptoms of menopause. Take three milligrams per day.‍

7. Water Treatments‍

A cool or tepid shower every morning (about 95 degrees water temperature) slows down hot flashes. Hydrotherapy is useful in osteoporosis to improve absorption and assimilation of nutrients: hot compresses to the abdomen for 20 minutes four or five times a week, or hot sitz baths for 20 minutes five times a week for three to four weeks to stimulate the ovaries.

An attempt should be made to avoid irritation of all mucous membranes, as these surfaces become quite thin following the menopause. When the vaginal opening is cleansed, the hands should be first washed and then the hands used to thoroughly wash the area. Then plain, clear water is used to meticulously rinse the area, being gentle and using no abrasive cloths. Drying of the non-hairy portions is done by blotting rather than rubbing. Douching is to be discouraged, as the surfaces are washed free of the light covering of shed cells. Never use soaps on the genital area. Two tablespoons of vinegar (or more) in a quart of water, poured over the perineum each morning after the shower, makes the most favorable acid condition for the vulva.‍

8. Clothing‍

The clothing should be checked carefully for healthfulness. Girdles are taboo. There must be no band tight enough to leave a red mark on the skin. Perhaps the most important, yet most difficult to attain, is warm clothing for the extremities. Even though there is no sense of chilliness the extremities should be clothed. The blood loses much latent heat from a bare skin area. Experimentally, there is alteration of the blood flow in the pelvic organs, if only one hand or one foot is chilled for over five minutes.

‍9. Why Not Use Hormones

‍To give estrogen treatment in menopause treats menopause as a disease, not a normal physiologic process. That there are symptoms associated with it in a certain percentage of people should bring us to search for physiologic and natural remedies, rather than pharmacologic.

If a woman takes estrogen for 5 years, she increases her risk of getting cancer of the breast measurably, and if she takes it for 15 years the risk of breast cancer increases by 35 percent.—Center for Disease Control, 1992. Taking Progesterone also increases her risk of getting cancer of the breast .—Dr. John McDougal. Taking Progesterone also increases the likelihood of getting gallstones, hypertension, and intravascular blood clotting.—Annals of Internal Medicine, May 1, 1992.

Additional Notes

1. ‍‍Often the time of menopause is a time when a woman loses confidence in herself and her role in life, her usefulness, and her acceptance by others. Instruction should be given on the changing of the body, which occurs before menopause: signs and symptoms, which begin before the periods stop. The body is getting ready to begin to change, which involves much more than simply a cessation of menstrual periods. Attitudes change, physiologic processes change, mental and emotional portions change, and a woman can begin to question even her sanity.
2. Stresses play a role in exacerbating the problem. At the time of menopause is also the time when there may be deaths in the family, when older children's behavior can cause a lot of stresses, when there may be the loss of a job, the illness of a spouse, the presence of major repairs necessary on one's home or one's automobile. Instruction should be given in the awareness of the stress such losses can deliver. Instruction should also be given in hopefulness and expectation that very ordinary and natural things can bring about relief, and that drugs and surgery are not at all a part of normal and natural menopause. Instruction should be given that natural means actually carry much more power than medicine to take one through this time, and the end result is far better. Demonstrations should be made and case histories should be given to substantiate and verify this matter.
3. Food, herbs, exercise, etc., are a practical support for this time of life. The foods, herbs, and exercise should address hot flashes, night sweats, sleep disruption, vaginal dryness, lack of sex drive, hair changes (scalp, face, secondary sex hair), mood depression and elevation, nervousness, easy tears, and concerns about a late life pregnancy.
4. Instruct in such a way as to defuse fear and enhance self-reliance. Instruct a woman to assume a role of "the wise woman," which many cultures try to continue to have, selecting those women who have reached a certain age and responsibility.
5. Address the freedom with which many doctors remove "spare organs" from women just because they are now past menopause. What is the function of these organs past menopause? What represents disease sufficient to warrant surgery?
6. Address the problem of women who are now hooked on "patches, pills, and potions."
7. Discuss various fears: cancer, degeneration of the mind, osteoporosis, and various diseases of old age.
8. An understanding of the various stages of life each with its own set of handicaps, duties and privileges, will assist in the understanding that the change of life is not for the worst, but actually for the better. A woman should pass through menopause recognizing that the change is good, and that we have the ability to harness that which is good in order to capitalize on the challenges and rewards. Women should be taught that there is beauty in every age of life, and that she need not retain the Barbie doll idea of what she should look like. She should understand that her tears require no apology. A woman in the change of life has unusually tender sensitivity to the feelings of others.
9. Advise for the husband: Understand that your wife needs extra help during this time. Participate with her in her programs, such as exercise, weight loss, and stress control. Understand that she may at times be inconsistent in her feelings. She may tell you to call before you come home, if you are going to be late, and then when you call she scolds you for interrupting her program. Understand that she may not know quite who she is since she is not needed to be a mother anymore, she is not pretty as she once was, she is no longer physically up to the same amount of work, and other physical feats she once did easily. Remember to give her your kindly looks, words, and touch. Never comment in a derogatory way about any of the changes she is making. Try to recapture the time, attitudes, and good times together, working, planning, and preparing, which you had before the children came. Reassure her of her worth and strength. Be patient. Be compassionate. Believe she will come through this and not be a dependent person. Learn to apologize and to repeat often the words, "Open mouth, insert foot." "A harsh word stirs up anger; a mild word turns away wrath." A woman in menopause is unsure of herself. She looks to her husband as a mirror.

June 2007