The Wisdom of Menopause

by Christiane Northrup

  ~ KEEP YOUR VEIN WALLS SLIPPERY. Research has shown that individuals with varicose veins have a decreased ability to break down fibrin in their vein walls. Fibrin is a protein in blood that is involved in clotting. When it isn’t metabolized properly by an enzyme known as plasminogen activator, it coats the inside of the vein, causing it and the surrounding skin to become hard and lumpy. Normally veins have enough plasminogen activator already in their walls to keep fibrin from building up. But when they become varicose, the levels of plasminogen activator decrease.36 So you have to import your own.

  A substance known as bromelain, found in pineapple, has been shown to act in a manner similar to plasminogen activator to cause fibrin breakdown.37 In supplement form, it can be used to improve varicose veins that already exist or, in smaller amounts, to prevent them.

  The usual dose of bromelain is 125–450 mg three times per day on an empty stomach. Use the smallest amount as general prevention, and the larger amount to treat veins that are already present. Bromelain is readily available at health food stores. You can also get bromelain by eating pineapple.

  ~ MAKE SURE YOU’RE GETTING ADEQUATE AMOUNTS OF VITAMIN E. Since vitamin E deficiency has been associated with the exacerbation of varicose veins, you’ll want to be sure to get enough of this vitamin every day. An adequate dosage is 100–400 IU per day, the amount I’ve already recommended for your daily multivitamin/ mineral combination.

  When to Consider Treatment—Either EVLT

  or Sclerotherapy

  If your varicose veins are causing you pain of any kind that doesn’t respond to the measures I’ve outlined (and pain includes feeling too embarrassed to wear shorts or a bathing suit), I’d recommend that you look into a relatively quick, simple, and effective treatment called endovenous laser therapy (EVLT), performed by interventional radiologists (specialists who use ultrasound technology to help diagnose and treat).

  EVLT has a 98 percent success rate and typically requires only one procedure (although you will need an initial consultation so the specialist can evaluate your veins using ultrasound). Here’s how it works: after administering a local anesthetic (usually to the ankle or knee), the doctor makes a very tiny cut and inserts a thin catheter into the damaged vein. A laser fiber is threaded through the catheter and is guided to the end of the problem vein. Additional anesthetic then numbs the whole leg and causes the blood to leave the vein. When the doctor fires the laser, it heats the inside of the vein wall, causing it to collapse and seal shut. The laser is then withdrawn back down the length of the vein to treat the entire problem area.

  The doctor checks the vein with ultrasound to make sure it is completely closed, after which the catheter is removed and the leg is bandaged. The patient leaves wearing a waist-high compression stocking to be left in place for seven to ten days. The whole procedure usually takes only ninety minutes, and the patient can resume most activities right away—although lifting anything more than five pounds is discouraged for the first week or so.

  The most common side effects are mild swelling and bruising or minor pain, which may worsen during the first week after treatment. Over-the-counter medications such as Motrin or Tylenol easily take care of such problems, and some patients even report that their postop pain is less than the pain they experienced before surgery! The incision site also occasionally becomes infected, which is treated with antibiotics. Patients typically return for a follow-up exam after two weeks and again after two or three months to make sure that the vein remains closed.

  Richard Baum, M.D., an interventional radiologist at Brigham and Women’s Hospital in Boston, told me that of all the procedures he does, which include life-saving hemorrhage control, the patients who are the most grateful are those who have this procedure! (For more information, visit www.evlt.com. Also, if you are thinking about having this therapy, consider the Comprehensive Vein Care Center at Brigham and Women’s Hospital, one of the best clinics in the country; for more information, visit www.bostonveins.com.)

  On the other hand, if your problem is unsightly but painless spider veins, chances are all you need is a simple office procedure known as sclerotherapy—which has been safely used in Europe for the last fifty years and is finally catching on in the United States. After an ultrasound evaluation, the physician (typically a dermatologist) injects the veins with a solution designed to irritate the wall of the vein, causing it to swell and cut off the blood supply. No anesthesia is necessary, although several procedures may be required.

  Should you decide to go through with a vein procedure, I recommend that you follow all my suggestions for maintaining healthy veins before and after your treatment. Doing so will lower your chances of having any recurrent problems.

  Despite our best efforts to appear youthful, life is full of challenges that sooner or later etch themselves on our faces and bodies. Happily, at midlife most of us are far better equipped to handle this than we were at twenty, when we still believed that our lives would be perfect if we could just lose that final five to ten pounds or if our noses looked different. We can still be beautiful—especially since the crucible of perimenopause removes some of our self-consciousness. We’ve had enough life experience to be happy that our legs still work, even if they don’t look perfect, happy that there are amusing things to laugh at, even if doing so creates crinkles around our eyes. What a relief!

  12

  Standing Tall for Life:

  Building Healthy Bones

  During the summer before I wrote the first edition of this book, I had the privilege of seeing rock-and-roll legend Tina Turner live in concert. At an age (then sixty-plus) when the majority of women have resigned themselves to slowing down and taking it easy, Tina tore up the stage in her towering heels (an athletic feat in itself), belting out her signature high-energy music for two solid hours while outshining dancers less than half her age. Her aweinspiring performance laid to rest any notion about the inherent limitations in physical stamina that are supposed to come with growing older. I was thrilled that my two then-teenage daughters were with me, so that they, too, could internalize this icon of female power and health. Watching Tina Turner that night, I was reminded anew that we midlife women can hone our physical strength and skills for years to come if we are willing to continue to move, to work our muscles regularly—and, of course, to unload any Ikes who are holding us back.

  My own mother is a perfect example of this. At the age of eighty-four, she fulfilled a lifelong dream of climbing to a Mt. Everest base camp, which is at an elevation of about 17,800 feet—where the air has half the oxygen it does at sea level. Mom had completed the Appalachian Trail in her late sixties, then climbed the one hundred highest peaks in New England in her seventies, all with her friend Anne, who is four years older. But two years before the Everest trek, she fell on some black ice on the steps of the log cabin where she lives, landing on her midback. She was alone at the time and couldn’t move her arm. Thanks to her fitness level and bone strength, she didn’t sustain a fracture in the fall (or in any of a few other falls she’s taken while hiking and one particularly bad spill she took down a set of stairs at Christmas when her socks slipped on the polished wood floor).

  Even though my mother hadn’t broken any bones, she was in such pain for the next three months that she couldn’t sleep lying down. It took her quite a while to fully recover. During that time, she was unable to participate in her active lifestyle of skiing and hiking—activities she had always taken for granted—and for a while there, she had to face her mortality and make peace with the fact that she might not be able to continue to do some of the things that had been such a huge part of her life. So her injury was not only physical, it was also emotional.

  When she had pretty much given up on her Everest dream, she got a call from Werner Berger, a man who had climbed Everest in his seventies and was taking a group to base camp. He invited my mother. At first she said no. But then my sister, Penny, and her husband decided to go on the trek and support my mother. A
s a teenager, my sister had formed a very strong bond with our mother when our mother drove her to countless ski races (my sister made the U.S. Alpine Ski Team and the World Cup circuit at the age of sixteen). On all their drives up the New York State Thruway, my mother had talked about her Himalayan dream. In addition, she had previously been asked to help out with base camp operations for a professional mountain climber named Julie whom she had joined earlier on a skiing trip around the base of Mt. McKinley in Alaska. Julie and her husband were planning to climb K2 the following year, but Julie was killed in an avalanche soon thereafter, and my mother never got to go.

  So when our mother turned down Werner’s invitation, my sister was determined to change her mind. Penny decided that she would “stand” for my mother and be there for her as she met the incredible challenges of this trek. And that’s exactly what happened—they made it to the base camp and back. (When I saw their slide show after they returned, I was stunned. I’ve never seen anything so rigorous in my life. And I was very glad that I didn’t have to do it!) My mother’s biggest obstacle turned out to be the willingness to accept help in the form of getting on a horse for part of the route. (Staying on the horse on that terrain was also a huge challenge. As Mom said, “Every muscle that I didn’t use for climbing, I had to use to stay on the horse.”)

  What I found equally fascinating was that my mother returned from the climb feeling stronger than when she left. She was also more flexible and more surefooted. In other words, by meeting the challenge of the climb, she actually developed better coordination and stamina—proof positive that the body has the ability to grow and develop throughout our entire lives. My colleague Louise Hay, who turned eighty-four this year, recently wrote to me and said, “This has been the best year of my life so far.” Talk about a winning attitude!

  Tina Turner, my mother, and thousands of other older women who stand tall in their lives offer a clear alternative to the realities of inactivity and osteoporosis. You don’t have to look very far to see women who are bent over or otherwise crippled by this devastating disease. Osteoporosis begins in earnest at perimenopause in susceptible women, but its effects may not appear until twenty or more years later, often when it is too late to do much about it. When it comes to bone health, prevention is absolutely essential. And that prevention needs to start as soon as possible. Perimenopause is an ideal time to shore up your bones—the part of you that is your foundation for moving forward in your life.

  OSTEOPOROSIS: THE SCOPE OF THE PROBLEM

  Bone loss starts silently, asymptomatically. In the early stages it is called osteopenia. As it progresses to osteoporosis, the bones become increasingly porous, brittle, and subject to fracture. The National Institutes of Health Consensus Conference defined osteoporosis as a disease of increased skeletal fragility, accompanied by low bone density (a T-score for bone mineral density below –2.5) and microarchitecture deterioration.1 Make no mistake: this is a potentially fatal disease.

  Currently, ten million people (including eight million women) in the United States have osteoporosis and thirty-four million have osteopenia. This accounts for 55 percent of the population who are at least fifty years old. Half the women in this age group will have an osteoporosis-related fracture in their remaining lifetime, with the number of such fractures expected to pass the three million mark by 2025. Hip fractures are especially problematic, because after six months, only 15 percent of patients are able to walk across a room unaided. Even worse, 24 percent of Americans fifty and older who fracture their hip will die within a year. (Vertebral fractures are also linked to an increased risk of death.) Women who fracture a hip have a fourfold greater risk of sustaining a second such fracture.

  Osteoporosis also increases the risk for wrist and vertebral crush fractures, which can result in pain, disability, and disfigurement. It is the vertebral crush fractures, in which the bone in the spine collapses, that result in the shrunken, hunched-over posture—complete with dowager’s hump and pot belly—that is often seen in elderly women. If your mother or grandmother looks like this, you may be seeing your future—unless you act now.

  By the age of eighty-five the majority of Caucasian women in the United States will have at least one partial deformity in their spine.2 The risk for African American women is less, while the risk for Asian American women falls somewhere in between. This difference is related, in part, to the fact that women with more pigment in their skin also have a thicker collagen matrix upon which their bones are built. Men also have thicker, stronger bones than women, partly for genetic reasons and partly because of their higher levels of bone-building testosterone. Though men, too, may get osteoporosis, it’s often related to alcohol intake or steroid use and shows up at a later age than in women. Osteoporosis-related fractures currently cost the health care system some $19 billion per year, a figure that is estimated to reach $25.3 billion in 2025. Hip fractures represent 80 percent of the total expense, averaging $35,000 per patient.3

  FIGURE 16: FEMALE VERTEBRAE

  Given these discouraging statistics, it is little wonder that so many doctors are quick to prescribe drugs such as alendronate (Fosamax). Please remember, however, that statistics are derived from entire populations and may not have anything to do with you personally. In my practice I have seen eighty-year-old women with the bone density measurements of an average twenty-five-year-old. I have also seen twenty-five-year-olds with the bones of an average eighty-year-old. And today there are many safe and natural options available to help you either maintain the bone you have or build it to new, healthier levels.

  WE’RE DESIGNED FOR LIFETIME STURDINESS

  There is nothing inherent in the human condition in general, or the postmenopausal woman in particular, that causes our bones to weaken and break as we age. We were designed to live on this planet well supported by sturdy bones from youth to old age. Like other degenerative diseases so common in Western civilization, such as coronary artery disease, hypertension, and obesity, osteoporosis is either unknown or very rare among indigenous peoples living time honored, hunter-gatherer lifestyles characterized by a strong connection with the wisdom of the earth as well as regular exercise and a whole-food diet. A deep sense of connection to the earth shores up the health of our first emotional center—the part of our emotional anatomy that is associated with a sense of belonging, and with our basic sense of safety, security, and belonging in the world. This sense of safety and belonging affects our bones, blood, and immune systems.

  When an entire culture teaches us to regard our bodies as uncontrollable and unreliable, it is not surprising that so many women have lost their sense of connection and support—with resulting first-emotional-center disease such as osteoporosis. It is also not surprising that so many are beginning to lose bone at earlier and earlier ages, a side effect of a refined-food diet, poor nutrient intake, and a sedentary lifestyle.

  The gravity of the earth itself (weight-bearing exercise) and sunlight are two of the keys to bone health, as we will see in this chapter.

  HOW HEALTHY BONE IS MADE

  If you want to keep your bones strong and healthy, you need to understand the dynamic and effortless way in which your body is designed to build and remodel bone throughout your life. The process that results in osteoporosis is actually a survival mechanism created over millions of years of evolution to help your body maintain biochemical balance. Once you begin to work with that essential body wisdom, even bones that have already weakened can regain strength.

  Bone metabolism is a complex process in which construction and demolition crews work side by side. Each of our 206 bones harbors cells that continually deposit a protein framework made from collagen. Minerals from the blood then attach to this matrix and harden into bone. Those same bones also contain cells that can break down that structure. In childhood, as we grow, the bone builders keep ahead of the bone destroyers. But the balance can shift as we get older. A wide variety of conditions—including depression, deficiencies of vitamin D and bone-
building minerals, a high-acid diet, and steroid use—can allow the osteoblasts, the cells that make bone, to be outpaced by the osteoclasts, the cells that break down bone. The result is weakened bones.

  Bones Are Storehouses for Essential Minerals

  Bones are the major storehouses for calcium, phosphorous, and magnesium, as well as other minerals, all of which are necessary for the healthy functioning of every cell in the body. Calcium, for example, regulates processes ranging from the beating of the heart and the clotting of blood to the firing of nerve cells. When blood calcium levels become low, a series of complex and interrelated biological reactions is activated.

  ~ The parathyroid gland (in the neck) releases parathyroid hormone (PTH).

  ~ PTH stimulates the kidneys to convert the body’s stores of vitamin D into an active form and release calcium from the surface of the bone. It also slows down the mineralization of bone, which uses calcium.

  ~ Activated vitamin D acts on the intestine to increase the absorption of calcium from food, encourages the kidneys to retain calcium that would otherwise be lost in the urine, and facilitates the release of more calcium from the bone.

  As soon as calcium levels in the blood are restored to an acceptable level, all these feedback mechanisms are reversed. Similarly, complex feedback loops are involved in the metabolism of the other essential minerals.4

  It is the job of the osteoclasts to break down microscopic bits of bone, thus releasing minerals into the blood. Each day more than 300 mg of calcium is dissolved from our bones. Over a year’s time 20 percent of our adult bone mass is recycled and replaced as our bones continually undergo breakdown and renewal in response to the overall needs of our bodies. If more minerals are taken out than are replaced, the end result is low bone mass.