The Wisdom of Menopause

by Christiane Northrup

  After reading your article on the benefits of keeping your ovaries and uterus, I wept. I was only forty-five when I had my hysterectomy for a fibroid that wasn’t really bothering me at all. They took my ovaries, too. But that was twenty years ago. I didn’t know that I had any other choice. And I also realized that I had never fully grieved for the loss of my pelvic organs. I have now completed that process, and I can let it go and move on.

  The first step to healing after hysterectomy is to appreciate any benefits you’ve experienced from having the surgery. In a landmark study here in Maine, it was found that hysterectomy for noncancerous conditions of the uterus, such as bleeding and pain, was positively associated with improving the woman’s quality of life in the vast majority of cases.19 I want to stress that in this particular study, all of the women were given a choice: to have the surgery or to not have it and be followed. I referred many women to this study and even performed some of the hysterectomies that were included in the data. Many of the women who chose surgery were convinced that they’d be better off with a hysterectomy. Some had lived with pelvic discomfort or heavy bleeding for years that was cured by the surgery. Others actually had an improvement in their sex lives following the surgery. The moral is this: hysterectomy can be a healing surgery under the right circumstances.

  Yes, your uterus and ovaries are important, but always remember that you are more than the sum of your organs. Your spiritual body, the field of electromagnetic energy that surrounds and nourishes your physical body, is always whole and intact. You cannot destroy this essential part of yourself, no matter what happens to your physical body.

  Appreciate the fact that your body has the ability to rebalance your hormones and maintain its health if you follow a healthy diet, exercise regularly, and use bioidentical hormone therapies that match as nearly as possible what your body normally produces.

  If you had a hysterectomy that you now regret, realize that you probably made the best decision you could have under the circumstances at the time. Give yourself credit for that. Our medical care system and its beliefs simply reflect those of the culture we’re all a part of. And we can’t help but be affected by these beliefs, at least to some degree. Maybe you would have avoided your hysterectomy if you had known more—but you didn’t have that knowledge. Let any emotions you have around this issue come to the surface, even if they aren’t pleasant ones. (One of my patients had a recurrent fantasy that she wanted to injure or even kill the surgeon who did her surgery. When she allowed herself to feel these unladylike revenge fantasies fully and express them out loud, she was able to release herself from the past and get on with her life, eventually forgiving herself and the surgeon.)

  You can heal from anything—even events as life-changing as losing some body parts to surgery. And when you heal, your story can help someone else on her journey toward health. One of the most helpful things you can do to improve your health right now is to look back on the events leading up to your hysterectomy and see if you had any issues with boundaries or creative drive at the time. Making this link can be very empowering and will also give you greater appreciation for the wisdom of your body. Remember, too, that your second-emotional-center power and passion are still there. They don’t get removed with your uterus.

  MASTER PROGRAM FOR CREATING

  PELVIC HEALTH

  The following program is effective for a host of pelvic health issues, including hormonal imbalance, menstrual cramps, pelvic pain, and pelvic floor disorders (including urinary health, discussed later in this chapter). Any dietary or alternative program such as this one that works to balance excess estrogen or enhance the flow of chi through the pelvis often works for treating fibroids and heavy bleeding, as well. However, let me repeat that before you start any treatment program for heavy bleeding, I recommend that you get a physical exam and a Pap smear if you haven’t already had one within the year. Though the vast majority of cases of heavy bleeding are benign and can be treated with the advice below, you want to be sure that you don’t have some other condition that is contributing to your problem.

  Diet, Nutritional Supplements, and Herbal Suppor

  ~ FOLLOW A HORMONE-BALANCING FOOD PLAN. (See chapter 7 for detailed instructions.)

  ~ ELIMINATE ALL DAIRY FOODS (CHEESE, ICE CREAM, CREAM, MILK, YOGURT) FOR TWO MONTHS AND TOTALLY ELIMINATE RED MEAT if you suffer from menstrual pain. Though I do not have any statistics on this, I’ve seen many women get rid of their menstrual pain altogether (even in cases of severe endometriosis) by eliminating dairy foods from their diets. Some are able to prevent cramps by avoiding dairy just for the two weeks before their periods. During perimenopause, when periods so often become irregular, you may need to stop dairy altogether for a few months to experience the benefits.

  Red meat, like dairy foods, is high in an eicosanoid precursor known as arachidonic acid, which results in symptoms such as cramps and arthritis in susceptible individuals. Eliminating it from your diet can cut down on the inflammatory eicosanoids associated with cramping and endometriosis pain.

  ~ TAKE ADDITIONAL SUPPLEMENTS. Follow the supplement program outlined on pages 261–262, with special attention to the following:

  Magnesium: 100 mg taken as frequently as every two hours during times of actual pain has been shown to help relax smooth muscle tissue and therefore decrease cramping. Do not exceed 1,000 mg per day, otherwise stools may become too loose.

  Omega-3 fatty acids: Omega-3 fats are precursors for series 1 and 3 eicosanoids. Take the recommended levels of fish oil (DHA and EPA) outlined on page 218, or commit to eating one serving of fatty fish (3–4 oz) three or four times per week or taking either 4 tbsp ground fresh whole organic flaxseed or 1 tbsp fresh flaxseed oil daily.

  Vitamin C: Take the recommended level of 1,000–5,000 mg per day, but increase to bowel tolerance (when tissues are saturated with Ascorbic acid, loose stools result) when cramping occurs.

  B complex and vitamins A, C, and E: These vitamins are especially important for pelvic health because they help strengthen your blood vessel walls as well as help neutralize excess estrogen. Take the mid-to-high range of the B vitamins on pages 261–262.

  Vitamin D: Higher vitamin D levels are linked to a lower risk for female pelvic floor disorders, according to the results from the National Health and Nutrition Examination Survey (NHANES).20 Researchers reported that vitamin D levels were significantly lower in women with at least one pelvic floor disorder and for women of all ages who specifically reported having urinary incontinence. On the other hand, women age fifty and older whose vitamin D levels were 30 ng/ml or higher had a significantly reduced risk for incontinence.

  Supplemental iron: In many women with heavy bleeding, the primary symptom is fatigue from iron deficiency anemia. Get your blood count checked. If it’s low, take iron. The recommended daily allowance is 15 mg per day. You may need to take three to four times this amount until iron levels are restored. (Iron supplementation itself has been shown to decrease menstrual flow in some women.) The best iron supplement I’ve found is ANR Iron 27+. (See Resources.) It is time-released, doesn’t cause stomach upset or constipation, and is easily and readily absorbed. It has helped many women in my practice keep their blood counts normal—something they were previously unable to do with other iron supplements. It has even saved some women from needing surgery.

  ~ REDUCE CAFFEINE INTAKE if you tend to have urinary problems. Caffeine is a bladder irritant. Eliminate it completely for two weeks and then reintroduce to see if symptoms recur. (Even decaffeinated coffee and tea still retain a small amount of caffeine.)

  ~ DRINK PLENTY OF WATER AND CRANBERRY JUICE AND TAKE CRANBERRY CAPSULES if you have frequent urinary infections. Drinking copious amounts of water or unsweetened (or artificially sweetened) cranberry juice the minute you feel any bladder symptoms is helpful. The extra liquid helps encourage frequent urination, which tends to flush out any bacteria lurking in the system, and cranberries contain a substance that prevents bacteria
from sticking to the bladder wall, thus decreasing the risk for recurrent infection. You can also try taking cranberry capsules, available at natural food stores; take as directed.

  ~ TAKE PROBIOTICS REGULARLY to help recolonize your gut with “friendly” bacteria. The anus and urethra are so close anatomically that encouraging the growth of favorable bacteria in one area of the body also helps the other. Two probiotic strains in particular, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 (formerly known as Lactobacillus fermentum RC-14), have been shown in numerous studies to be helpful in both preventing and treating genitourinary infections when taken as an oral dietary supplement.21 These strains are commercially available in Fem-Dophilus from Jarrow Formulas (see www.jarrow.com), which is perfect for women on birth control pills as well as women with diabetes who get recurrent yeast or urinary tract infections.

  Such approaches are always worth a try, as this letter from a newsletter subscriber attests.

  I have been suffering for years with multiple uterine fibroid tumors, approximately twenty-five to thirty in number, in the wall of my uterus. For two weeks out of every month I had excruciating, unbearable pain. I was unable to sleep, would lie down curled up in a ball, and literally sweat in agony. I have had laser surgery through the laparoscope twice, and the surgeon was only able to remove three or four of the larger fibroids. Then I read your book and have been religiously following your advice to cut out dairy products and take B complex vitamins as well as 800 mg of magnesium. As a result, if I could, I would give you my firstborn child in gratitude! My pain is gone! Though I was planning reconstructive surgery, I changed my mind when I realized that your suggestions were working. I feel like a completely new woman—reborn, revitalized, and empowered.

  Acupuncture and Chinese Herbs

  Acupuncture has been scientifically shown to alleviate menstrual cramps and pelvic pain.22 I have seen its benefits hundreds of times in my practice, and I personally found it extremely helpful for severe cramping in my early forties. I also took individually prescribed Chinese herbs for about a year. If you cannot locate a trained practitioner of Traditional Chinese Medicine near you, it is safe to try Bupleurum (Xiao Yao Wan, also known as Hsiao Yao Wan). This patent medicine is widely available, and many of my patients have done very well with it. (See Resources.) Take four or five of the tiny tablets four times per day during the two weeks before your period is due, and continue through the first day of bleeding. It may take two to three months to see full results. Yunnan Bai Yao is a traditional Chinese medicine that can stop heavy bleeding within one to two weeks, sometimes sooner. Take one to two capsules four times daily. This treatment works very well for recurrent UTIs.

  Topical Treatments

  ~ TRY HOMEOPATHIC REMEDIES, such as Menastil, which is available over the counter. The active ingredient is calendula oil—an essential oil extracted from marigold petals. The U.S. Food and Drug Administration and the Homeopathic Pharmacopoeia of the United States recognize this pure grade of essential oil for the temporary relief of menstrual pain. This all-natural product, which comes in a small roll-on applicator bottle, relaxes the uterine muscle and increases the flow of blood and oxygen, which in turn reduces pain. Claire Ellen Products manufactures and distributes Menastil; for information, call the company at 800-MENASTIL or 508-366-6311, or visit http://mediapilot360.com/Menastil/website/shop.

  ~ CONSIDER CASTOR OIL PACKS. Lying down with a castor oil pack on your lower abdomen for sixty minutes two to four times per week is often very helpful for both treatment and prevention of cramps and pelvic pain. Edgar Cayce, the renowned medical intuitive of the early to mid-1900s, recommended this immune-system-enhancing treatment for all kinds of conditions. (See Resources.) Note: Do not use these if they increase your pain or if you are bleeding heavily.

  ~ CONSIDER PROGESTERONE CREAM. Progesterone skin cream helps to counter estrogen dominance and can be used to decrease heavy bleeding, among other symptoms. It is available over the counter in a 2 percent strength (trade names Pro-Gest, PhytoGest). The usual dose is ¼ tsp (20mg) rubbed into your palms or the soft areas of your skin once or twice per day, three weeks on and one week off. If you are having regular periods, time the application so that your week off corresponds to the week of your period. If your periods are irregular, I suggest coordinating use of the progesterone cream with the phases of the moon, to which every human life is attuned. Plan to be off the progesterone during the dark of the moon—the time when women were most apt to have their periods before the advent of artificial lighting. Some women do best using the cream every day, with no week off.

  For some women, 2 percent natural progesterone isn’t strong enough to counteract their own estrogen. In this case, ask your doctor for a prescription for a stronger, natural progesterone cream, available from a formulary pharmacy, or for a prescription for a stronger vaginal gel, such as Crinone, which comes in 4 percent and 8 percent strengths. Micronized oral progesterone (brand name Prometrium) is another option if the creams are not effective. The dose is 100–200 mg once or twice per day for the two weeks before your period is due, although some women need to take it daily. Because oral preparations must be metabolized by the liver and the resulting breakdown products can cause excessive sleepiness or even depression in susceptible women, some women prefer the creams, which are absorbed into the bloodstream directly.

  Strengthen Your Pelvic Floor

  Getting in touch with your pelvic floor can be a most enjoyable experience. Remember that your pelvic floor is the seat of your life force and sexual energy. Since energy follows awareness, just placing your awareness in your pelvis can begin to change your experience of this area—you will probably notice a pleasant tingling sensation. After all, in addition to your pelvic organs and pelvic floor, the pelvis has a great deal of erectile erogenous tissue within it. (See chapter 9, “Sex and Menopause.”) So when you do your pelvic strengthening exercises, make the experience as fun and juicy as possible!

  Becoming aware of your pelvic floor and exercising it regularly—through either Kegels, vaginal weights, or the use of a jade egg—not only strengthens the pelvic floor, but also increases blood flow to the vagina, bladder, and urethra, making the tissue more resilient. This will greatly improve both your sex life and your bladder control.

  But as important as Kegels are, they can backfire. They work well in the short term for strengthening the pelvic floor, but a truth that has more recently come to light is that over time, doing Kegels can actually make your pelvic floor muscles weaker—unless you also develop strong gluteus muscles (the muscles in your butt). This is the central idea in the pelvic strengthening program developed by biomechanical scientist Katy Bowman, director of the Restorative Exercise Institute in Ventura, California. When I first read what she had to say about how Kegels have been overemphasized and why concentrating on your glutes is key for a strong pelvic floor for women and men, her explanation made an enormous amount of sense to me—even though it was the complete opposite of what most experts have been preaching for decades.

  Bowman, also the creator of the Aligned and Well DVD program (www.alignedandwell.com) and the author of the popular Katy Says blog about body alignment (www.katysays.com), explains that Kegels keep the pelvic floor muscles short and tight, which actually makes them weak, not strong. Here’s why: doing lots of Kegels certainly tightens your pelvic floor muscles initially, but over time it also pulls your sacrum (the large triangular bone at the base of the spine) forward, out of its natural alignment. (The first sign of this, she says, is not having a lumbar curve—that little curve in your lower back.) This creates slack in your pelvic floor muscles, which run from your tailbone to your pubic bone. Continuing to do more Kegels then tightens the slackened pelvic floor, but because your tailbone is still curling under, the tight pelvic floor muscles are now shorter. And shorter muscles are weaker because they have less range of motion.

  To illustrate this, Bowman suggests thinking about curling your biceps with
a weight. If you started in a curled position with your elbow bent but then lowered your arm only a little before bringing it back up, you wouldn’t be getting much of a workout. To have proper form for such an exercise, you’d lower your arm the whole way, almost straightening your elbow, before bending your arm back up into the curled position. It’s the same way with your pelvic floor muscles—for proper toning, they have to be able to stretch and relax the whole way instead of staying tight. Toning requires both strength and length.

  On the other hand, maintaining strong gluteal muscles (the butt muscles you use when you squat) keeps the tailbone pulled back in its natural position. This in turn keeps the pelvic floor muscles long and taut. In this position, the pelvic floor is much better able to hold up the pelvic organs and open and close what Bowman refers to as your “bathroom muscles” to keep you from leaking urine. The most effective and natural way to strengthen your glutes, she says, is by doing two to three daily sets of squats, using proper form. (Bonus—it’s also good for your hips and knees.)

  Because many people who live in third-world countries use squat toilets (which look something like drains in the floor, sometimes with places for your feet on either side of the hole) instead of the “throne”-style toilet Westerners sit down on, they naturally have stronger glute muscles, Bowman adds. Not surprisingly, women from these cultures have stronger pelvic floor muscles and often have an easier time giving birth because with their tailbone untucked and in proper alignment, their birthing space is bigger and they put less pressure on their pelvic floor, resulting in less tearing of muscles and tendons and less damage to ligaments.