The Wisdom of Menopause

by Christiane Northrup

  TREATING THE SURFACE—MINOXIDIL AND TRETINOIN SPRAY: Minoxidil is currently the only drug approved by the FDA for its beneficial effect on hair growth. Minoxidil is a potent antihypertensive medication that when taken by mouth lowers blood pressure by dilating blood vessels. It was discovered by accident that it increases hair growth. Though it is not clear how it enhances hair growth when applied topically, it may increase the size of the hair follicle, prolong the growth phase of a hair follicle, increase blood flow to the skin, or enhance DNA synthesis. Side effects are rare but may include skin irritation and a short-lived increase in heart rate. In one study, a 2 percent solution of minoxidil increased the total weight of hair by over 40 percent over a forty-week period of use.30 When researchers combined a 2 percent solution of minoxidil with 0.025 percent tretinoin (Retin-A) and used it four times per day as a scalp spray, 90 percent of the women in the study showed visible and cosmetically significant improvement in hair quality after six months.31

  PRESCRIPTION MEDICATIONS FOR HORMONAL HAIR LOSS: The drugs doctors prescribe to rebalance systemic hormonal imbalances work well for some, though not all, women with hormoneassociated hair loss. However, too often they help the symptoms without really addressing the underlying cause—too much body fat, unhealthy diet, sedentary lifestyle, and so on—or helping you learn how to heal yourself by using the body’s own internal wisdom. If you use any of the following medications, complement them with appropriate diet and lifestyle changes.

  ~ Birth control pills with ethinyl estradiol, 30–40 mcg, for twenty days of the cycle. Birth control pills sometimes work to stop androgenic hair loss for the same reason they help acne—they reduce the body’s susceptibility to the effects of androgen on the hair follicle and its attached sebaceous gland.

  ~ Dexamethasone, 0.125–0.375 mg at bedtime. Dexamethasone is a powerful steroid that suppresses the production of androgens, thereby increasing the amount of hair on the head. It also treats the acne that accompanies male pattern hair loss in many women. Unfortunately, it has all the potential side effects of too much cortisol, such as an increase in insulin, thinning of the skin and bones, and an increased susceptibility to infection.

  ~ Spironolactone is an antiandrogen that can be taken orally or applied topically. Taken orally, it decreases total and free testosterone. Applied topically, it reduces the amount of androgen that directly affects the hair follicle.

  In some women, an individualized prescription for HT, such as the ones described in chapter 5 and above for skin, can help balance hormone levels and help alleviate androgen excess.

  Making the Most of the Hair You’ve Got

  While you’re working from the inside out—or the outside in—you’ll still want to look your best. Make the most of what you’ve got … and enhance it.

  Consult a professional who specializes in hairpieces, hair extensions, weaves, and body perms. You might even want to inquire about hair transplantation for women by a dermatologist or plastic surgeon.32

  Here are some more tips for making thin hair appear its best.

  ~ Use gentle shampoos, and don’t shampoo more than every other day.

  ~ Don’t brush your hair when it’s wet—this stretches out the hair.

  ~ Avoid teasing your hair—it can break the hair shaft.

  ~ Chlorine damages hair. Shower with pure water. If your water is chlorinated, use a shower filter that removes it.

  ~ Ask your hairdresser to recommend professional products for fine hair that will give you extra volume.

  WHEN GOOD SKIN CARE ISN’T ENOUGH:

  DECIDING ON COSMETIC PROCEDURES

  Sometimes the results you’re looking for will be unattainable with diet and good skin care alone. If you have a “fixable” aspect of your face that bothers you every time you look in the mirror, it may be time to consider getting outside help. Whether you want to enhance your smile with cosmetic dentistry or get rid of the bags under your eyes that always make you look tired even when you’re not, there’s no doubt that fixing an energy-draining “ding” in your appearance can improve the quality of life. That’s why so many women get braces at midlife, or have skin peels to give them a fresher look that simply can’t be achieved any other way. Cosmetic surgery of all kinds is growing by leaps and bounds because of vast improvements in technology and increasing demand.

  It seems to me that it is almost impossible to go through the normal process of facial aging in this culture and not wish that something could be done about certain parts of your face, especially the eyelids and jawline. If you’re one of the lucky ones who really aren’t at all bothered by sagging eyelids or jowls, bless you. If, however, you want an appearance-enhancing face-lift, eyelid surgery, skin peel, liposuction, laser surgery, or other cosmetic polishing of your exterior, then bless you, too. Through the years I’ve referred many patients for various plastic surgery or dermatological procedures. Just about 100 percent of them have been thrilled with the results.

  In addition to giving referrals for plastic surgery, while I was still at Women to Women I even took a course in how to do deep facial skin peels. We did the procedure at the office and then cared for the women at a private home for four days thereafter. I always thought of this service as a kind of “cocoon” experience in which the newly peeled and vulnerable women were kept safe, warm, and healthy while they shed their old skins and prepared to face the world with a renewed countenance. I must admit that the results were spectacular for the women (and one man) who went through with the procedure. I was always thrilled on the last day to witness the “unveiling” as we helped our patients remove their masks of powder and apply makeup to cover their renewed but very red skin. This was especially true for those whose difficult and painful past histories had lined their faces with expressions of anger and depression they had since worked through. Virtually all of the women I treated had done lots of inner work. Now they simply wanted their outsides to match their insides.

  One of my patients had her eyes done at the age of forty-one, about one year after a mastectomy. With the bags under her eyes surgically corrected, she looked brighter and fresher than she had in years. And her new look helped her outlook and possibly her immune system as well.

  Particularly Effective Cosmetic Procedures

  Led by the desires of baby boomers to look as young as possible for as long as possible, a whole new range of cosmetic and skin care solutions is now available to rejuvenate aging skin and keep it looking good for years. These include intermittent laser (called intense pulsed light, or IPL) treatments, which are very effective at reducing wrinkles, evening out skin tone, thickening the collagen layer, and removing spider veins. IPL is generally done as a series of five or so treatments followed by maintenance of once every six months. IPL treatments can be alternated with glycolic peels so that you are having a mini-rejuvenation procedure every three months or so. Fraxel is a laser procedure that thickens the collagen layer of the skin. It must be done monthly (after which the skin is quite red for several days) for about four months. But it’s effective. Other acid and laser peels are available that can help remove the effects of sun damage and give you a clean slate that is easier to maintain with a good skin care regimen. If you decide to consult a plastic surgeon or dermatologist or if you already have a procedure scheduled, I’d recommend the following.

  ~ Be sure that you’re having a cosmetic procedure because it makes you feel better. Don’t do it for your husband, boyfriend, or mother. Over the years I’ve seen that the results of surgeries are always much better when our motivation for having them is clear.

  ~ Choose the right doctor. When it comes to cosmetic surgery, especially laser techniques, there is a great deal of crossover between the profession of dermatology and plastic surgery. For example, laser skin peels that include the eyelid area (usually done in a doctor’s office) give a result that is often as good as a face-lift obtained with a surgeon’s knife. Look for a board-certified plastic surgeon or, in the case of laser procedures,
a dermatologist or other practitioner with extensive training in laser technology.

  ~ Don’t choose a doctor just because he or she offers the lowest prices. All surgical and laser procedures carry a certain amount of risk. This risk increases if doctors cut corners on care and safety to keep prices low.

  ~ Make sure you go to someone with whom you feel completely comfortable. (This same criterion goes for body workers or anyone else who will be working with your body in any way—including a dentist.) Ask yourself: “Does this person have the kind of clinical, objective, and healing touch that will allow me to feel comfortable even if I have to stand in my underwear and have him or her look at my body and take pictures as part of my care?” A good doctor will put you at ease even in this kind of situation. If there’s any feeling of discomfort, go elsewhere. That’s what happened with a friend of mine who went to see a plastic surgeon in order to have both her nose and her deviated septum fixed. (She had had a broken nose since childhood.) The surgeon kept staring at her breasts, which are relatively small, while she kept trying to get his attention back on her nose. She had no desire to have breast implants. Though this man had all the right credentials, had trained at the best places in the United States, and is perfectly competent technically, he also had what I’ve come to call the sleaze factor. His attitude made her uncomfortable. So she chose someone else to do her surgery. Her feeling of unease was confirmed when she later heard via the grapevine that he had told his wife, also a physician, about some of the surgeries he had done and upon whom. This information had made its way around the community. Such a breach of confidentiality is completely unacceptable, but it happens. You can avoid this kind of situation by trusting your gut as well as a surgeon’s credentials.

  ~ Keep your surgery decision to yourself as much as possible. You’d be amazed at the number of judgments your friends may have concerning cosmetic surgery, depending upon where you live. (The Rocky Mountain and Pacific regions are currently leaders in plastic surgeries.)33 Some of your friends won’t think you’re very spiritually evolved, for instance, if you want to remove the bags under your eyes. Frankly, how you look is none of their business.

  ~ If at all possible, go away to have your procedure done. Too many of my patients have had the experience of being home with a bruised face after plastic surgery, looking like battered women, and then having to answer the door for the plumber, the mail carrier, and everyone else who comes along.

  ~ Give yourself enough time. Recovery from eyelid or facial surgery usually takes a minimum of two weeks before you look presentable. So use this time for reading or taking a much-deserved retreat from your usual routine. It will speed your healing process and help the inside of you as much as the outside.

  ~ Make arrangements to be waited on for at least the first three days post-op. Though you may feel fine, you’re apt to be more tired than usual and perhaps a bit weepy and emotional during this vulnerable time. Give yourself the space you deserve.

  ~ Stock up on the Chinese patent herb Yannan Pei Yan and begin taking it, one tablet four times a day, as soon as you possibly can after surgery. This herb speeds healing and cuts way down on postoperative bruising. I also recommend taking at least 2,000 mg of vitamin C for two weeks pre-op and four weeks post-op to help build up collagen in your skin. You can also use skin cream containing vitamin C ester to speed up healing.

  ~ Use guided-imagery tapes before and during surgery, and ask your surgeon and anesthesiologist to work with you. (See Resources.)

  ~ Be realistic. Cosmetic surgery won’t change your life, despite what our culture would lead you to believe. If you are beautiful on the outside but ugly, depressed, or unhappy on the inside, your appeal will begin to fade within thirty seconds of walking into a room. I’m sure you’ve all had the experience of meeting people who become more and more attractive right in front of your eyes as you begin to know and appreciate the humor, joy, or fun they bring to every situation.

  VARICOSE VEINS

  Chances are you don’t like the look of prominent blue varicose veins and want to do whatever you can to prevent them or, if you already have a few, minimize them. Appearance isn’t the only problem with varicose veins, however. If they get bad enough, they are often associated with a painful, heavy feeling in the legs, especially at the end of the day. Happily, there are a number of strategies to help you prevent varicose veins in the first place, or keep them from getting worse if you already have a few.

  Let’s start by going over what varicose veins are and why they develop. The term varicose refers to a vein that is dilated, tortuous, and located just beneath the skin. Quite often the valves of these veins, which are designed to keep the blood from flowing backward, no longer work as they should. When a surface vein stretches and loses its elasticity, and the valves don’t shut properly, blood flows backward, pooling in the affected vein, which then enlarges into a mass of blue tissue beneath the skin. Varicose veins can be large, having the appearance of blue worms, or they can be very small and purplish blue in color. These small “spider” veins often occur in a fanlike pattern in the thigh area. Varicose veins, whether large or small, are the end result of poor circulation.

  Diet and Varicose Veins

  It is very clear that the fundamental cause of varicose veins is a diet high in refined carbohydrates and low in fiber—the same kind that is also associated with heart disease, breast cancer, and bad skin. Such a diet often results in subtle nutritional deficiencies, excess weight, and constipation, all of which increase intra-abdominal pressure, which over the years puts too much pressure on the veins in our legs.34 Chronic coughing does the same thing—and so does excess fat in the abdomen.

  Varicose veins are virtually nonexistent in rural Africa, where the diet tends to be high in fiber-rich whole foods and very low in refined foods. But thanks to our own very different diet, almost all of us in this country are at an increased risk for developing at least a few dilated veins in our legs. Varicose veins can also be aggravated by the hormonal changes that women experience during three specific times in our lives: at the onset of our menstrual periods, during pregnancy, and at the beginning of menopause. These are the times when we are most susceptible to subtle changes in our blood flow that put us at increased risk for damage to our vein walls. Because of these hormonal changes, varicose veins can show up as early as age twenty. In men, by contrast, varicose veins develop evenly throughout the life span up until the age of seventy and don’t appear to be hormonally related.

  Program for Preventing or Treating Varicose Veins

  Now that you know what you’re dealing with, let’s get down to the business of keeping your veins in top shape.

  ~ GIVE YOUR LEGS THE SUPPORT THEY DESERVE. If you already have varicose veins or if you have a family history of varicose veins, make sure that you wear compression or support stockings of some kind whenever you know you will be on your feet for a long time. And elevate your legs as much as possible. I have a family history of varicose veins, so when I was a resident in training, I always wore compression stockings when I was on call at night. Putting those stockings on always gave me a new lease on life. Though I was only in my twenties at the time, I found that when I didn’t wear them, my legs ached and my ankles got swollen after being on my feet all night. (I used Jobst brand stockings; another good brand is T.E.D.’s. These are available at your pharmacy. The cost is sometimes reimbursable from your insurance if you have a doctor’s prescription.) Avoid standard knee-highs and thigh-high stockings if you have varicose veins, because the elastic at the tops of these impedes venous blood flow and increases the pooling of blood in the veins that is the cause of the problem in the first place.

  ~ IF YOU TAKE ESTROGEN, MAKE SURE YOU’RE TAKING THE RIGHT DOSE. Low-dose estrogen replacement therapy does not appear to cause varicose veins in women, but occasionally a woman will notice that her legs ache and seem to swell more when she is on estrogen replacement, and existing varicose veins may seem to get worse. If you�
�ve noticed that your veins seem to be worse on estrogen replacement, consider lowering your dose.

  ~AVOID CONSTIPATION BY FOLLOWING A DIET THAT HAS ADEQUATE FIBER, PLENTY OF WATER, AND VERY FEW REFINED CARBOHYDRATES.

  ~ USE YOUR MUSCLES TO KEEP YOUR BLOOD MOVING. Rhythmic exercise such as walking, biking, running, or swimming keeps your blood moving and uses the mechanical action of your muscles to get the blood out of your veins and back to your heart. I’ve seen many women cure their symptomatic varicose veins and improve the cosmetic appearance of their legs by starting and staying with a regular exercise program. It’s worth noting that my mother had fairly severe varicose veins during her childbearing years. With all of her hiking and a good diet, they have resolved on their own!

  ~ NOURISH AND PROTECT YOUR VEIN LININGS. The herb bilberry (Vaccinium myrtillus) contains flavonoid compounds known as anthocyanosides, which are potent antioxidants that improve microcirculation and protect vein linings. Blueberries and currants do the same thing. These same substances also increase blood levels of a hormone known as prostacyclin (an eicosanoid), which prevents platelet aggregation, so blood flows more smoothly through the vessels. This herb has been successfully used to help prevent and treat varicose veins in pregnancy.35 The usual dose is 160 mg per day for general prevention of varicose veins, and up to 480 mg per day to treat varicose veins that already exist. The flavonoid compounds in berries, particularly blueberries, blackberries, and raspberries, are also very helpful for keeping veins healthy.