Entering menopause naturally

Hormonally speaking, a woman's life has three important stages: the beginning of menstruation or menarche, the reproductive period and pregnancy, and the termination of the childbearing period with the end of the menstrual cycle, or menopause.

Usually the first two stages are pleasant and exciting, with ample social and family support, and high self esteem because of young age. But menopause can be trying for some women, both because of physical symptoms and psychological issues.

During menopause, several hormonal changes occur. Many signals go from tiny areas in the brain called the hypothalamus and the pituitary gland to the ovaries, and quite abruptly they stop secreting the female sex hormone, estrogen. This gives rise to distressful physical symptoms like hot flashes -- a sudden rise in body temperature followed by profuse sweating -- vaginal irritation and increased susceptibility to urinary infections, decreased ability to hold back urine, painful intercourse, joint pains, insomnia, irritability, forgetfulness and depression.

Lack of estrogen also raises levels of the bad fat triglycerides, lowers levels of the good fat HDL, affects elasticity of blood vessels and raises blood pressure. All this coupled with increased weight spells an increased risk of heart diseases for menopausal women.

Withdrawal of estrogen affects bone metabolism and makes bones more brittle and fragile and prone to fractures, a condition called osteoporosis.

To counteract these effects of estrogen deficiency after menopause, many physicians suggested replenishing the hormone through hormone replacement therapy, or HRT. But scientists have noted that giving estrogen increased the risk of cancer of the uterus. So the hormone progesterone was added to the therapy.

Small studies have found that HRT did relieve distressing symptoms, especially hot flashes and sexual dysfunctions, and it became very popular in the West during the past few decades. Women felt like they had found a panacea for youth. Practitioners started advocating it for long-term use after menopause, to alleviate symptoms and protect women from fragile bones and heart diseases.

But a large trial on more than 16,000 post-menopausal women was halted in July 2002, five years after it started, because doctors noticed that HRT comprising estrogen and progesterone markedly increased the risk of heart diseases, blood clots, strokes and breast cancers. The study, called the Women's Health Initiative, was sponsored by the National Institutes of Health and National Heart, Lung, and Blood Institute of the United States.

Experts Peter H. Gann, MD, ScD, and Monica Morrow, MD, from the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, refer to HRT as "a single-edged sword." They note that "alteration of a woman's basic hormonal physiology over decades in the interest of long-term disease prevention is fraught with hazard."

Last week Journal Watch General Medicine published an article stating that today, nearly six years after stopping the trial, women who took the medication most regularly during the trial are still at a high risk of dying from breast cancer, strokes and heart diseases.

The results of this study caused panic among women on HRT in the United States, Europe and Australia. Many stopped the medication without consulting their doctors. Some other ongoing trials on HRT were also prematurely closed after the results of the WHI trial.

Surveys reveal that most women turned to HRT because of troublesome physical symptoms like hot flashes, urinary irritation and painful intercourse. Many were not even aware of the risks of osteoporosis and heart diseases after menopause.

Most women acquire information on this topic from television programs, women's magazines and newspapers rather than authentic sources like their general practitioner or obstetrician. It appears their knowledge is limited by these resources and their attitude toward menopause is also shaped by these media.

Scientists observe that this attitude differs from culture to culture and it determines the severity of menopausal symptoms that women experience. "Women complain of symptoms that they have heard of. Nothing seems to happen to uneducated women from lower classes, because they don't know such complaints are related with menopause," notes senior obstetrician and gynecologist Dr. Sumedha Dabke, from Pune in India.

In July 1996, a study on the menopausal experience of rural women in a south Indian fishing village was published in Health Care Women International. These women, who lived in quite harsh economic and environmental conditions, did not look upon menopause as a disease needing any remedy but rather as a natural and positive development, that allowed them to continue working as fish sellers without any hindrance or worries about periods and personal hygiene. They had a clear sense of identity as fish sellers and not redundant housewives. While they did suffer from hot flashes and physical symptoms, these did not require medical treatment in their opinion.

Several other studies on Taiwanese, Indian, Pakistani and African women reveal similar observations. Women who are physically active, gainfully employed and socially dynamic have a good self image, are less depressed and less bothered by the physical symptoms. Women in stable relationships with understanding partners feel more secure and are more in harmony with their physical changes.

Some cultures in developing countries equate menopause with stopping intercourse. This belief indirectly protects women from menopause-related sexual problems.

Psychiatrists believe that women should look upon themselves as more mature and more experienced with age and look upon menopause as a symbol of achievement and a time to start enjoying life rather than feeling "not young" and old and worrying about the change in their sexuality.

The important consideration after menopause is the prevention of fractures and heart diseases. It is imperative to adopt some sort of physical exercise, like walking, and eat the right food to keep weight gain under control to prevent heart diseases. Besides, slim women suffer less from hot flashes.

Exercise strengthens muscles and improves body balance. This gives the triple benefit of preventing falls, maintaining bone density and preventing osteoporosis. Supplementation with vitamin D and calcium under medical supervision is also essential to maintain good bone health.

A woman's body is an intricate and finely coordinated orchestra of multiple hormones that are interdependent and influence her physical and psychological attributes. It produces a unique music in every stage of her life. The menopause is the crescendo of the symphony and should be enjoyed as such.

Source: http://www.upiasiaonline.com/Society_Culture/2008/03/11/health_watch_entering_menopause_naturally/9928/