CHAPTER 1: PERIMENOPAUSE
Menopause occurs when the ovaries stop releasing eggs and menstruation ceases. The period of a woman’s life called premenopause
can begin eight to ten years before complete menopause; it occurs when the normal monthly cycle of ovulation and menstruation becomes less regular. This entire period of transition is also known as the climacteric
because the reproductive phase of life is reaching its climax
. The formal term is perimenopause
–literally, the time surrounding menopausal changes.
The changes that accompany menopause are no less dramatic than those we experienced at puberty. Our bodies change, and with this comes new, strange feelings. The first part of this chapter discusses what is happening in the body at the cellular level. So that you can adapt to your own particular changes, the second part of the chapter provides practical, effective guidance that you can apply during the perimenopausal period and throughout this new stage of life.The Reproductive Process and Perimenopause
Our reproductive systems undergo natural, predictable changes from puberty to menopause. Each month, throughout the years between puberty and menopause, a woman’s ovaries normally produce one egg, and the lining of the uterus thickens to prepare for a developing fetus should conception occur. If conception does not occur, this uterine lining (the endometrium) is discarded and released as menstrual blood.
Our endocrine systems produce hormones that circulate in our bodies and stimulate different functional activities at the cellular level. Estrogen, the hormone produced by the theca cells in the ovarian follicle, is key to the functions and changes in a woman’s reproductive system. Women enter puberty when the body begins to produce significant levels of estrogen, and enter menopause when estrogen production declines.
When we are still having menstrual cycles, we are low in estrogen just before menstruation begins, especially on the first day. This is true whether you are twenty-two or forty-two. The brain senses low levels of estrogen circulating in the blood and sends a message to the pituitary gland in the brain to release follicle-stimulating hormone
(FSH) into the bloodstream. FSH reaches the ovaries and stimulates development of an egg within its surrounding cavity (follicle). As the egg develops, the follicle makes estrogen, so levels in the bloodstream start to rise. This signals the brain that it can stop firing off such a strong message to the pituitary.
Meanwhile, back in the ovary, the developing egg keeps maturing while several others die off. The FSH decreases as the egg’s secretion of estrogen signals the brain not to send so much FSH, but the FSH that is still being sent to the ovaries keeps the one egg growing, which ensures that the level of estrogen keeps rising for a time. The egg creates enough estrogen by about day fourteen to trigger a release of leuteinizing hormone
(LH) from the pituitary. LH causes more blood to circulate into the ovaries, bringing about two important changes. First, more cholesterol (a normal sterol found in the blood) is broken down in the ovaries and eventually changed into even more estrogen. A sterol is any one of a large group of plant or animal compounds related to both fats and alcohol. Second, enzymes help liberate the fully mature egg from its follicle for ovulation. The empty follicle now folds in on itself to form a soft lump, called the corpus luteum
(yellow body)–it is yellow because of its fatty sterols, which are now made into a different female sex hormone: progesterone, the pro-gestation
hormone that acts to prepare the uterus for implantation of the egg, to maintain pregnancy, and to promote milk production in the breasts. If there is no fertilization of the egg, the corpus luteum learns this through the chemistry of the blood. In turn, the corpus luteum stops making progesterone.
In perimenopause, there are fewer viable eggs than in past years and the ovaries become less responsive to FSH and LH. The hypothalamus in the brain sharply increases production of FSH and LH levels to stimulate the ovaries to produce estrogen. Some cycles never have enough estrogen built up for ovulation, although menstrual flow may still occur. Our bodies begin to need much less estrogen than was required for menstruation, conception, pregnancy, and lactation. But we do not completely lose all estrogen in menopause. If there is a healthy cushion of body fat, this provides raw material for estrogen production, and the adrenal glands also make a little. A lower level of estrogen may even have important advantages. As cycles become more irregular, estrogen-dependent symptoms such as painful cramps, tender breasts, menstrual migraines, and heavy bleeding from fibroids tend to improve. On the other hand, symptoms of low estrogen may potentially create new problems–at least until our bodies reach a new balance. Because estrogen is only one of many hormones whose levels are changing during this time, herbs that promote progesterone have also helped Òlow estrogenÓ symptoms of menopause, presumably by supporting our bodies in reaching that new balance.The Onset of Perimenopause
Perimenopause is usually a gradual process, so women may not know exactly when it begins. If you are reasonably healthy and are older than thirty-six, a change from a fairly regular cycle to an irregular one may be an early sign of perimenopause.
Perimenopause commonly begins in the fifth decade of life but may start as early as the thirties or even the twenties. Menopause beginning in the twenties is not really menopause–it is premature ovarian failure. High-stress lifestyles, heightened economic and social worries, global pollution, a rise in gynecological surgeries, and other twenty-first-century factors may contribute to early onset of perimenopause, even among healthy women. It was thought until fairly recently that the earlier your first period (an event called the menarche
) occurred, the earlier menopause was likely to occur. Now researchers are not certain.
Yet even if the experience of other women in your family turns out not to be an exact predictor of your age at menopause, talking with our elders about their histories can be invaluable. Our reproductive experiences are often similar. Listening to stories from mother, sisters, cousins, and aunts can encourage intimacy and a wealth of detail. Other factors to consider are personal health history, nutrition, ethnicity, climate, economic status, and social setting, all of which influence one another. For example, women who smoke or make a habit of eating fast food are more likely to have some degree of nutrient imbalance when menopause arrives, and therefore to have more severe symptoms such as hot flashes, depression, and dry skin. A history of health problems is associated with an earlier menopause. Health factors other than perimenopause can also make the menstrual cycle erratic–for example, traveling, illness, malnourishment, or rigorous athletic training. In this case, women may have unpredictable menstrual cycles, or more symptoms such as mood changes or hot flashes.A New Stage of Life
For many women, perimenopause is a time of emotional ups and downs. Entering a new stage of life as well as coping with changing hormonal levels naturally make this a time for reevaluating life goals–assessing past accomplishments and defining or redefining the future.
You may wonder why, when you have been perfectly content with your beliefs up until now, you are suddenly questioning everything about your purpose in life and the way you have chosen to conduct it. And you may feel quite alone in your observations: You may feel you are the only one to notice that the weather is all wrong, that your favorite dish doesn’t taste quite right. You catch your loved ones looking at you funny, which naturally makes you want to send them to summer camp, though they are far too old for that now. Meanwhile, you are worrying about aging, and on top of that, you have other challenges to face: family difficulties that tax your resources, career and financial choices to be assessed. When Tuesday’s ÒI’m proud I did the best I couldÓ clashes with Friday’s ÒI’ve been on the planet for almost half a century and what have I got to show for it?Ó–stop and take a deep breath. These and myriad variations on having the emotional rug pulled out from under you are not necessarily signs of disease. Your mood swings could well be the opening stanza of perimenopause.
There is no healthy way to suppress strong emotions during this period. The best you can do is take a mental health break, even for five or ten minutes during a hectic schedule. Recognize your need for time to cool off, reflect, and get some space–and then find a way to do just that. By tuning in to what you are feeling, you will come to identify the known (and unknown) triggers that bring out these perhaps unwelcome feelings. Delve beneath the surface of your deeper unease. If you can take the time to muse on things until an insight rings true, you may even come to see the wisdom in this seeming madness. The process may be helped along with a relaxing cup of herb tea, a counseling session, or ten minutes locked in a bathroom stall breathing slowly and evenly. Perimenopause does not make women ÒcrazyÓ; it makes us look inside. If we don’t look inside, we will soon feel
crazy. This is a time to deepen into your wisdom and begin to make the changes you have always wanted to make.
At any stage of perimenopause, the herbal self-care outlined in this chapter can help realign your essential, unchanging self with your emerging self. Less ideally, you can use megadoses of herbal supplements as natural drugs to ÒfixÓ a perimenopausal symptom, whether it is a mood change or an irregular cycle. The herb-as-drug approach can work for some women. But if we embrace the rite of passage that menopause is, we can take advantage of this special opportunity for deep transformation. Drugs, natural or pharmaceutical, are fine for short-term fixes, but, as you might guess, they have hidden costs, such as side effects needing still more treatment. Many of these are discussed in chapter 3.
The rest of this chapter explores common challenges faced during perimenopause. Some symptoms alarm women; some are more general signs of physical change you can observe in yourself. Still other challenges are nonphysical: emotional or mental self-doubts. All kinds of health changes may make a woman wonder whether she has entered menopause. Hot flashes, weight gain, and episodes of depression may occur in either perimenopause or menopause; these are covered in chapter 2.Mood Swings
When women speak of mood swings, they often mean depression, anxiety, or irritability, not upward swings of elation or joy. But you can experience both extremes under the biochemical influence of fluctuating hormones. If you want to fully experience your changing feelings without suppressing them or being run ragged by your emotions when they surface, try the nonaggressive herbal remedies in this section. The key to their effectiveness is consistency: Over time, these gentle herbal allies can help restore balance to your nervous system and hormonal cycle.
Whether a gentle herbal approach works depends on four factors: how long your stress level has driven your mood swings up and down, how troubling these emotional changes feel to you, how quickly or slowly your unique chemistry responds to the herbs, and what other steps you take to complement the healing herbs. As soon as all symptoms feel better or are almost gone (usually after two to three months), continue the same combination and dose for an extra three weeks, then reduce the dose by half for another three weeks. If you feel just as well after reducing the amount this way, simply keep a little extra on hand for future times when an occasional week back on the herbs will help you cope with a rough spell. If you should have any lingering symptoms after four or five months, continue taking the herbs at a half dose five days a week. When you feel ready, try reducing the dose again. Watch how well you respond, and skip the tea when your moods feel stable to you.Nutrition
Review the following suggestions for whole foods that provide vitamins and minerals to address your mood, as well as the list of natural supplements.Wise Food Choices
• Choose foods high in vitamin C: red, green, yellow bell peppers; fresh broccoli; citrus fruits; rosehip jam (although vitamin C is lost in cooking except in some high-quality brands, natural fruit pectins and bioflavonoids offer other benefits); baked potatoes.
• For healthy nerves, eat foods high in B vitamin complex: dark green leafy vegetables and whole grains such as brown rice, polenta, buckwheat, whole wheat with bran, and wheat germ.
• Eat one clove of raw or lightly steamed garlic in food daily to protect the heart from long-term stress. Fresh garlic provides zinc, chromium, and other nutrients, and it kills off microbes. Cooked garlic and deodorized garlic capsules benefit the heart but have fewer immune benefits. Aged garlic extracts have also been shown by medical research to reduce cancer risk. For all these reasons, adding some form of garlic in a mix of whole foods on a daily or weekly basis is an all-around beneficial practice.
• Reduce animal fats and excess protein. Calcium from dairy foods and iron from meat is not well used when a woman is under chronic stress, so eating more doesn’t add energy.
• Replace chicken or red meat with tofu, tempeh, or other soy protein one or two times a week.
• Occasionally add 1 teaspoon to 1 tablespoon sesame seeds or tahini (the delicious paste of ground sesame seeds) to salads; use tahini on crackers instead of margarine or butter. For a vegetable dip or satisfying nondairy sandwich spread, mix 1/3 cup tahini with 1 tablespoon water and 1 to 2 teaspoons miso (rice, barley, or soybean paste) to taste with a spoon, fork, or whisk, until smooth and creamy. Sesame seeds are high in calcium and other nutrients, and the oil provides essential fatty acids; though women concerned with weight gain and heart health are well advised to lower dietary fats, we all require some healthy oils for good nerve function and immunity. When we feel nourished and eat small amounts of these concentrated, healthy plant oils, our craving for inappropriate fats lessens. For those who are interested, the use of sesame seed has ancient spiritual reverberations associated with physical protection.
Excerpted from The Natural Menopause Handbook by Amanda Mcquade Crawford. Copyright © 2009 by Amanda Mcquade Crawford. Excerpted by permission of Crossing Press, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.