The Wisdom of Menopause

by Christiane Northrup

  The quotations that describe the symptoms below come from patients or my Women’s Wisdom Community subscribers. I have indicated the chapters in which symptoms and solutions are discussed in more detail.

  Hot Flashes

  “I’ve had to give up wearing sweaters because I can suddenly get so hot that I feel the need to open all the windows (even in the winter) and peel off as many layers as I can.”

  Hot flashes are the most common perimenopausal symptom in our culture, occurring in about 70 to 85 percent of all perimenopausal women.16 They can be very mild or so severe that they result in sleep deprivation and subsequent depression. They begin as a sudden, transient sensation of warmth that can then become intense heat over the face, scalp, and chest area; it may be accompanied by redness and perspiration. They are also sometimes accompanied by an increased heart rate, tingling in the hands, a crawling sensation under the skin, and/or nausea. They usually last from one to five minutes each, and in some cases the hot flash is followed by a feeling of being chilled. In the majority of women, hot flashes often start just before or during the menstrual periods during perimenopause. Triggered by falling estrogen and rising FSH, they tend to become more frequent as we approach our final period. That is the time when estrogen levels are lowest and FSH levels are highest. Hot flashes usually go away a year or two after actual menopause, although in some cases they may continue for many years, mostly because of a stressful lifestyle and adrenaline levels that are too high.

  Also known as vasomotor flushing, the hot flash occurs when blood vessels in the skin of the head and neck open more widely than usual, allowing more blood to shift into the area, creating heat and redness. Besides hormonal changes, external factors can influence the intensity and duration of a woman’s hot flashes. Anxiety and tension can magnify them, as can a diet high in simple sugars and refined carbohydrates such as those found in fruit juices, cakes, cookies, candy, white bread, wine and beer, and so on. Coffee—even decaf—also triggers them in some women. Excess weight and cigarette smoking have been identified as other risk factors.17

  There are many approaches to cooling hot flashes. Estrogen therapy is about 95 percent effective, and until the Women’s Health Initiative study, it was considered the gold standard for hot flash relief. A 2 percent progesterone skin cream also works in many perimenopausal women; as little as ¼ tsp (20mg) rubbed into the skin once per day may provide relief.18 (See chapter 5, “Hormone Therapy.”) Certain antidepressants have been shown to reduce hot flashes, although the side effects include nausea, dry mouth, drowsiness, decreased appetite, and insomnia.19 The drug clonidine, traditionally used for high blood pressure, reduces hot flashes up to 80 percent in transdermal form, but its side effects include low blood pressure, dry mouth, and sedation.20 A better option may be meditation and relaxation techniques, such as Herbert Benson, M.D.’s famous Relaxation Response or slow, deep, abdominal breathing started when each flash begins.21 Studies show meditation can cool hot flashes in 90 percent of women, without any hormonal therapy at all.22 This is because meditation lowers stress hormone levels.

  Many women also find relief when they improve their diets. (See chapter 7, “The Menopause Food Plan.”) Soy foods (a total of 45–160 mg of soy isoflavones per day) provide relief, as do many herbs, such as black cohosh, dong quai, chasteberry, maca, or Pueraria mirifica. Acupuncture can also be very effective. (These approaches are detailed in chapter 6, “Foods and Supplements to Support the Change.”)

  SEEING HOT FLASHES AS A CRUCIBLE, NOT A CURSE

  Here’s an incredibly empowering perspective on hot flashes from my good friend and colleague Deborah Kern, Ph.D., a health scientist and mind-body researcher, who originally wrote this account in her blog. (To read more of Dr. Kern’s inspiring wit and wisdom, visit her site at www.drdebkern.com.)

  It’s July and there are heat waves all over the country. I am no exception. I am a living heat wave. I am HOT! Since Sunday evening, I’ve been experiencing my first true waves of hot flashes—SIX the first night…. TWELVE the next day. This may sound crazy, but I’ve actually been awaiting this day with a sense of excited anticipation thanks to Joan Borysenko, Ph.D. While most women are afraid of hot flashes or complain about them, I’ve actually been looking forward to them. Why? Because in 1996 I read Dr. Borysenko’s book A Woman’s Book of Life: The Biology, Psychology, and Spirituality of the Feminine Life Cycle and I was captivated by a section about menopause and hot flashes. At the time I was in my late thirties and hadn’t even given birth to my first son, but there was something so powerful in the way she described hot flashes that I committed it to memory and I’ve been waiting for my turn to experience them.

  Here’s what she says on pages 164–165 of her book: At the age of forty-seven, a spunky Frenchwoman by the name of Alexandra David-Neel left her privileged, protected life. Leaving her husband behind in Paris, she shaved her head, dressed in saffron and crimson robes, traveled halfway around the world to the forbidden mountains of Tibet, and sneaked into a monastery by impersonating a male lama….

  During the full moon one February she attended a ritual in which monks stripped naked in the freezing temperatures of a Himalayan cave, wrapped themselves in wet sheets and proceeded to dry them when their bodies liberated prodigious amounts of heat during a meditation practice called tumo yoga. The monk who dried the most sheets was considered the highest adept. Tumo means “fierce woman” in Tibetan. It refers to the life-force energy of every human being (regardless of gender) that circulates in thousands of small channels called nadis, similar to the acupuncture meridians….

  Tumo yoga was practiced primarily for spiritual reasons, however, rather than for physical healing. Through a series of meticulous visualizations and the repetition of sacred sounds, the monks raised the lifeforce energy through the lower energy centers up to the highest chakra at the crown of the head. In the process, they believe that they are burning away mistakes, erroneous beliefs, and ego attachments that keep them from fully recognizing the nature of their True Self.

  What does tumo yoga have to do with my hot flashes? Well, as Dr. Borysenko points out in her book, menopausal women can use hot flashes in the same way the monks did: consciously thinking of their self-limiting beliefs, erroneous thoughts, stresses, and ego attachments and allowing them to be burned up in the inner fires of transformation. So six to twelve times a day (and night) I now have the chance to consciously burn off anything that might be blocking me from realizing my full potential. That thrills me! Am I still using my bioidentical hormones, following a healthy diet, exercising, meditating, and doing yoga in order to lessen the frequency, intensity, and severity of my hot flashes? You bet. But when they do come, I ride the heat wave with excited anticipation and I am grateful for all that is burning away.

  When she sent this to me, Dr. Kern added, “I can truly feel old bonds being released by this fire.” I suggest you try her strategy and see if it makes a powerful difference for you, too!

  Night Sweats

  “I sweat so much at night, I have to get up to change the sheets.”

  Night sweats are on a continuum with hot flashes. Traditional Chinese Medicine tells us, and many of my patients have confirmed, that 3:00 to 4:00 a.m. is the most common time for night sweats, which may wake you up drenched with perspiration. (This often happens postpartum as well. I like to think of it as the body’s way of detoxing.)

  Heart Palpitations

  “It’s like all of a sudden I’m aware of my heartbeat, whereas before my heart just did its job without me noticing it.”

  Like hot flashes, palpitations can range from mild to severe. They are rarely dangerous, though they can sometimes be very frightening. They are the result of imbalances between the sympathetic and parasympathetic nervous systems triggered by stress hormones and are often related to fear and anxiety. If they persist, see your doctor. (See chapter 14, “Living with Heart, Passion, and Joy.”)

  LESLIE: Power Surges at Menopause

&n
bsp; Leslie is an art teacher at a local high school and doubles as an unofficial counselor for her students, who uniformly respect and love her for her obvious devotion. “I’m one of those art teachers you can spot a mile away,” she wrote. “I look the part, I guess. I try to do more than just teach kids how to paint or sculpt—I mean, there’s art all around us in this world, and much of the joy of life is in appreciating it. I try to demonstrate that in the way I live.”

  Leslie likes the image of hot flashes as “power surges,” symbolizing a positive, transformative process, and she did not find her hot flashes or any of her other symptoms to be troublesome, nor did she want to mask or muffle them with medication. “My doctor wasn’t surprised when I told her I chose to forgo hormone replacement therapy. She knew I saw this as a way of honoring my body and the natural changes going on within me. At the same time, I did want to provide my body with support and help it adjust, so my symptoms wouldn’t be severe.” Leslie chose to provide that support through improved nutrition, herbs, and plant-based hormones (phytoestrogens). She takes black cohosh root, which softened her hot flashes within the first week and kept them mild enough that they were merely “interesting” rather than intrusive. She also drinks a glass of vanilla-flavored soy milk every morning and evening.

  Migraine Headaches

  “Ever since I turned forty, I’ve gotten a pounding headache the day or two before my period is due. This has never happened before.”

  Imbalanced hormone levels contribute to so-called menstrual migraine during perimenopause and menopause. This type of headache usually comes just before your period, when both estrogen and progesterone levels can fall dramatically. Hundreds of women have been able to completely recover from menstrual and menopausal migraines through the use of 2 percent progesterone cream. Apply ¼ tsp (20 mg) on your skin daily for the two weeks prior to your period, or three weeks out of every month if you’re no longer having periods. Or you can use progesterone capsules or vaginal gel, available by prescription in all conventional pharmacies. (For other headache remedies, see Resources.) Acupuncture and herbs (e.g., feverfew) also often help migraines.

  Breast Swelling and Tenderness

  “My breasts are sometimes so tender, it hurts to hug my children.”

  Many women have tender breasts just before their periods. This is often because of iodine deficiency. To remain healthy, the breasts require as much as 6 mg of iodine per day.23 During perimenopause, you may notice that your breasts feel tender or swollen much more often. This is far more common when a woman is experiencing estrogen dominance. Relief can often be achieved by following a hormone-balancing diet (see chapter 7, “The Menopause Food Plan”), ensuring an adequate intake of B vitamins, making sure you get enough omega-3 fats such as EPA and DHA (1,000 to 2,000 mg once or twice daily), stopping caffeine, and/or using 2 percent progesterone cream (¼ tsp—20 mg—twice per day). To add iodine to your diet safely, take several kelp tablets per day and eat several organic eggs per week. Iodine supplements are also available (see “What Everyone Should Know About Iodine,” earlier in this chapter). The addition of whole soy foods to the diet can also be very helpful. (See chapter 13, “Creating Breast Health.”)

  Heavy Menstrual Periods

  “My periods have become so heavy that I soak through a couple of tampons and an overnight maxi pad in fifteen minutes. Sometimes I even soak through my clothing at work.”

  When estrogen levels are high or even normal but progesterone levels are too low from lack of ovulation, the monthly estrogen-driven buildup of the uterine lining (the endometrium) continues unopposed. When it finally breaks down, the result can be erratic, heavy bleeding that can go on for days at a time.

  The problem can become so troublesome that some women resort to hysterectomy as a solution, but because heavy bleeding often resolves as a woman approaches menopause, hysterectomy is rarely necessary. The unopposed estrogen can often be treated with various types of progesterone or birth control pills. Since the problem is often worse in women who have too much body fat (fat produces estrogen), exercise and diet often help. Alternatives such as acupuncture and Traditional Chinese Medicine are also often helpful. In severe cases, the lining of the uterus can be cauterized via laser surgery in a procedure known as endometrial ablation. There are several different types, including ExAblate and NovaSure. (See chapter 8, “Creating Pelvic Health and Power.”)

  Irregular or Erratic Periods

  “I never know when I’m going to get a period. Sometimes I have a normal period. Then one week later I’ll have some spotting. Then I’ll go for three months before I have any bleeding again. I have to carry pads with me all the time, just in case.”

  When a woman is going through the hormonal changes of perimenopause, just about any kind of uterine bleeding is possible, ranging from periods that become very light and short to periods that space out to every three months or more. And some women have bleeding patterns that are so erratic, they don’t seem like periods at all.

  If you can live with erratic periods for a while, the problem will go away. It’s not really abnormal. But if you also have other symptoms, such as mood swings or headaches, or simply want more regular periods, a very wide variety of treatments are available, ranging from conventional birth control pills to effective alternatives such as natural progesterone skin cream or the herb chasteberry (Vitex agnus-castus), which helps regulate the hypothalamic-pituitary-ovarian axis to produce more progesterone. (See chapter 8, “Creating Pelvic Health and Power.”)

  Fibroids

  “I was having irregular bleeding, and when I went in for my annual visit with my gynecologist, she told me that I had a growth in my uterus that was a fibroid. An ultrasound confirmed my doctor’s diagnosis. My doctor tells me that we can just watch it.”

  About 40 percent of women develop benign fibroid growths in the uterus during perimenopause. Their growth is stimulated by estrogen, and they can become quite large. Fibroids shrink dramatically after menopause and, like heavy bleeding, do not usually require surgery or other treatment, especially if they don’t produce symptoms. Some fibroids, however, can cause heavy bleeding, depending upon their position in the pelvis. Small ones can be removed through lap-aroscopic surgery or sometimes by surgical removal through the vagina. Uterine artery embolization (UAE) or ultrasonic treatment (such as ExAblate) are other nonsurgical treatments. Weight loss, acupuncture, herbs, dietary change, and natural progesterone are all effective alternatives in many cases. (See chapter 8, “Creating Pelvic Health and Power.”) Many medical centers, such as the Cleveland Clinic and Johns Hopkins, now have fibroid treatment centers that offer women a wide range of different options that do not require hysterectomy.

  Loss of Sexual Desire

  “There’s nothing wrong with my marriage. I love my husband. But quite frankly, I don’t even get turned on by Matthew McConaughey anymore, let alone my husband.”

  There is nothing about a normal menopausal transition, per se, that lowers sex drive. But many women experience decreased libido as their attention turns inward toward themselves. Still, a healthy woman experiencing loss of sex drive should have her hormones checked. For reasons that aren’t clear, some women experience a drop in their testosterone levels during perimenopause; this can result in lack of sexual desire. Adrenal exhaustion can be another factor. If these levels are low, supplementation with small amounts of testosterone or its precursor, DHEA, will sometimes restore libido to normal levels. For some women, libido problems are related to lack of estrogen or thinning of the vaginal tissue. (See chapter 9, “Sex and Menopause.”) Women who’ve undergone removal of their ovaries surgically, or whose ovarian function has been compromised by illness, chemotherapy, or radiation, have lost a major source of their normal hormone production. A variety of safe alternatives, such as high-dose soy isoflavones, can often help in situations such as these.

  Vaginal Dryness and/or Painful Intercourse

  “I just don’t seem to be able to get lubric
ated during sex anymore. And when we do have intercourse, it hurts!”

  The lining of the outer one-third of the urethra and the lining of the vagina are estrogen-sensitive. Symptoms may arise from a lack of estrogen, as well as from decreases in muscle tone and subsequent blood supply in the urogenital area.

  For many women, the first sign of perimenopause is a decrease in normal vaginal discharge. This is a direct result of decreasing estrogen levels. Some may need to use a vaginal lubricant (e.g., K-Y Jelly) during intercourse because arousal and full lubrication take longer. Topical estrogen cream, vitamin E suppositories, systemic estrogen therapy, or increasing intake of phytoestrogens such as soy can be very helpful. Some of my patients have been able to increase vaginal lubrication through creative visualization. (See chapter 9, “Sex and Menopause.”)

  Urinary Symptoms

  “I keep getting symptoms that feel as though I have a urinary tract infection. I feel as though I have to urinate all the time, but my urine tests don’t show any evidence of infection.”

  “I got my first-ever UTI at age forty-five—as it turned out, the first of many.”

  “Sometimes I lose urine when I cough or sneeze. I’m worried that if this continues, I’m going to end up using adult diapers!”

  Recurrent urinary tract infections or urinary stress incontinence (the loss of urine with coughing, sneezing, laughing, etc.) may occur because of the thinning of the estrogen-dependent lining of the outer urethra. Urinary symptoms often resolve through the use of a small dab of estrogen cream applied locally. Kegel exercises can also increase blood flow to the area and help with stress incontinence. (See chapter 8, “Creating Pelvic Health and Power.”)