Menopause and The Menstrual Cycle
- The Normal Menstrual Cycle
- What is Menopause ?
- What Changes During Menopause ?
- What are the Symptoms of Menopause ?
- What are Hot Flashes ?
- Vaginal Lubrication
- HRT - False Promises
- HRT - The Reality
- Side Effects of HRT
- Long Term Risks of HRT
- The Supposed Benefits of HRT
- Stopping HRT
- Progesterone Cream
- The Alternative, A Natural Menopause
- MenoGlow, The Natural Alternative to HRT
1. The Normal Menstrual CycleThere are 4 key hormones associated with the normal menstrual cycle. These are:
- Follicle Stimulating Hormone (FSH) - causes follicles in your ovaries to mature.
- Luteinising Hormone (LH) - causes ovulation.
We look at a typical 28 day menstrual cycle, considering the changes in hormone levels and the associated changes to your body.
Days 1 to 4: MenstruationThis is your period, when the lining of your womb breaks down and is expelled. This happens when the egg has not been fertilized and corresponds to a sudden and dramatic fall in the levels of estrogen and progesterone.
Days 5 to 14: Proceeding to OvulationOvulation, the release of one (or sometimes more than one) mature egg, occurs midway through the menstrual cycle, on day 14.
FSH stimulates follicles on the surface of your ovaries causing them to grow and mature. The ovarian follicles produce estrogen as they grow, causing the lining of your womb to thicken in preparation for the possible reception of a fertilized egg.
Ovulation is triggered by a sudden rise in LH levels secreted by the pituitary.
Days 15 to 28:After ovulation the empty follicle develops into a "corpus luteum". The corpus luteum secretes mainly progesterone (but also some estrogen). The result is that estrogen levels fall from their peak at ovulation, whereas progesterone levels rise.
The increasing levels of progesterone cause further changes to the lining of the womb to prepare it for reception of a fertilized ovum. It also causes a fertile alkaline mucus to be produced to help keep sperm alive and to help transport them through the cervix and up towards the fallopian tubes where fertilization can take place.
The egg released at ovulation may only be fertile for as little as 8 hours. Although sperm may survive for several days they may be capable of fertilizing the egg for only 24 hours. In this time they must travel from the vagina, through the cervix and into the fallopian tubes to fertilize the egg. The window of opportunity for fertilization is therefore relatively short.
If fertilization does not occur falling levels of estrogen and progesterone trigger menstruation and the cycle begins once more.
2. What is Menopause ?A woman’s store of eggs are already in place when she is born. By puberty over half the eggs may have already died, still leaving over a million healthy eggs ! By your mid-forties you may only have 10,000 left. Menopause occurs when your store of eggs runs out.
By definition "menopause" is your very last period. What most people call the menopause is the transition period which can last up to 20 years. This can be split into three phases:
- Pre-menopause: Regular periods but the first symptoms such as hot flushes and mood changes.
- Peri-menopause: Periods start to become irregular and symptoms increase.
- Post-menopause: No more periods.
3. What Changes During Menopause ?As we have seen in the normal menstrual cycle follicles in the ovaries produce the hormone estrogen as they mature. The estrogen levels peak at ovulation then decline until menstruation.
During menopause, as the ovaries run out of follicles to produce eggs the amount of estrogen produced gradually falls. It is mainly this reduction in estrogen levels that causes the symptoms of menopause.
Some women adapt better than others to falling levels of estrogen. Approximately one quarter of women experience very mild or no symptoms from menopause, about half notice mild to moderate symptoms and the remaining quarter can suffer quite severe symptoms.
4. What are the Symptoms of Menopause ?The short term symptoms of estrogen withdrawal include hot flashes (hot flushes), night sweats, headaches, tiredness and mood swings. Longer term symptoms include vaginal dryness and declining libido, urinary problems, loss in skin elasticity and thickness, hair loss and changes in hair quality.
However it is important not to automatically blame menopause for all negative physical and mental problems during the menopause years. The forties and fifties can be challenging years irrespective of menopause. Be wary of your GP immediately attributing problems to menopause and as a subsequent knee-jerk reaction offering you pharmaceutical HRT.
5. What are Hot Flashes ?Hot flashes (also known as "hot flushes") are experienced by over three quarters of women around the menopause. They are one of the normal symptoms of estrogen withdrawal during menopause.
During a hot flash your body reacts as it would to cool you off on a hot day. Your arteries near the surface of your skin increase in diameter allowing more blood to enter the capillaries in the skin surface. This accounts for the redness accompanying hot flashes. With more blood at the surface your skin temperature rises. This triggers and increase in the amount of sweat produced to help cool you down. With increased skin temperature heat is also lost through increased conduction, convection and radiation.
Hot flashes can be triggered by heat, increased humidity, alcohol, caffeine and spicy foods. If you can pinpoint a particular trigger for your own hot flashes you may be able to reduce the frequency by simply avoiding those trigger situations.
Hot flashes and night sweats both start as a feeling of heat in the face, neck or body that spreads. Some women show no signs of the hot flash, but others may go very red and sweat profusely. Some hot flashes may be accompanied by palpitations. The hot flash may pass in a few seconds or could last up to half an hour.
When the hot flash recedes you may feel cold as the sweat produced during the flash evaporates. If your hot flash occurs during the night we call it a night sweat. You may awaken to find your night clothes drenched in sweat and have to get up to dry yourself down and change your clothes. If this happens several times a night it can play havoc with your sleeping patterns and as a result you may feel tired out during the day. This can often affect your ability to perform to your usual standard and so can lead to irritability, anxiety and depression.
6. Vaginal LubricationAs estrogen levels fall during menopause the vaginal walls become thinner. This can cause a lowered blood flow and a subsequent lack of lubrication. This can lead to some women finding penetration painful without the aid of a lubricant.
However the good news is that this is less of a problem if you stay sexually active. Sex or masturbation stimulates blood flow to the vaginal area reducing dryness whilst muscle contractions during orgasm help keep the vagina elastic.
7. HRT - False PromisesIt is perhaps not suprising that it was men that postulated that nature intended women to quietly expire after their child-bearing years were over. Looking at historical figures for life expectancy they presumed that menopause was being reached simply because of the extended life expectancy in the modern western world. They postulated that menopause was therefore an unnatural condition and as such it needed treating.
However this was simply bad science, or in truth no science whatsoever. The figures for female life expectancy in the past were skewed due to the number of women dying during childbirth. Many women in past times lived long healthy lives without HRT.
The perceived need to treat menopause was perhaps also cultural. Whereas older women are respected for their knowledge and wisdom in many cultures, in the west with its emphasis on youth, looks and materialism the role of mature women is seen in a more negative light.
In the 1930s scientists decided that as estrogen drops during menopause the simple solution is to replace it. However it was in the 1960s that hormone replacement really took off. The gynaecologist Robert Wilson wrote a book promoting estrogen replacement for women reaching menopause. He talked about menopause as a "living decay" and suggested that menopausal women were a misery to themselves and to all others. He promoted estrogen replacement as a panacea that would abolish all symptoms of menopause and keep women "Feminine Forever" (the title of his book).
Later promises were made for beneficial effects of HRT on the heart and on reducing the risk of fractures. This is no longer considered to be the case.
8. HRT - The Reality
First Cancer ProblemsIn the 1970s it became clear that replacing estrogen on its own increased the risk of breast cancer and cancer of the womb. Estrogen triggers the thickening of the womb lining in preparation to receive a fertilized egg. Without progesterone to trigger the breakdown of the womb lining it was discovered that cells in the lining were mutating. Womb cancer risks for women taking estrogen-only HRT were discovered to be up to 7 times greater than women not on HRT.
As a result a synthetic version of progesterone was added to HRT, thus preventing the build up of the womb lining. Nowadays only women that have undergone a hysterectomy are given estrogen only HRT.
Horse Urine!Some so called "natural estrogens" are in fact taken from the urine of pregnant mares. These unfortunate horses are often kept in appalling conditions for the duration of their pregnancy. They are kept is small stalls with harnesses attached to their hind quarters designed to collect their urine. The horse estrogens extracted from the urine have a different chemical structure from human estrogen and you can be sure that your body will never have encountered these chemicals before. They certainly are not natural for women.
As for the mares pregnancy, the foals are often unwanted byproducts and slaughtered. After a 6 month pregnancy the mare is impregnated as soon as possible for the whole process to start again.
Your Liver - Just Doing Its JobPills are the most common method of taking prescribed HRT. Unfortunately the hormones ingested must first be processed by the intestines and liver, both of which try to deactivate the sex hormones. It is simply these organs doing their job!
As a result you need to take a much higher dose than if the hormones go through the skin. There are consequences to the massive amount of estrogen passing through the digestive system. There is an increased risk of gallstones and an increase in the levels of fats in the blood leading to an increased risk of blood clots. This has led to some experts believing that there is an associated increased risk of heart disease. Women that chose prescribed HRT should investigate the use of patches.
PMS into your 80s!Taking estrogen in HRT increases the risk of breast and womb cancer. The increased womb cancer risk (up to 7x more likely) is due to the lining of the womb being constantly thickened in a readiness to receive a fertilized egg (despite the fact that you may no longer be producing any eggs). To decrease the risk of cancer of the womb a synthetic progesterone cream is given to cause a bleed similar to your period.
Most pharmaceutical HRT triggers a monthly bleed. Some are designed to trigger a 3-monthly bleed and some pills include a daily dose of progesterone to try to prevent a build up in womb lining altogether. However some bleeding may still occur even with the continuous combined pills.
One of the main blessings of menopause for many women is their freedom from periods. So the option to have them continue for further decades is not appealing to many. A significant minority of women on pharmaceutical HRT experience PMS symptoms as a result of the synthetic progesterone required to counter the build up of the womb lining. These symptoms include mood swings and irritability, depression, bloating and weight gain and breast tenderness.
Sorry, Is It Mr or Mrs ?Some pharmaceutical HRT (some no-bleed pills and some subcutaneous implants) contain either testosterone, the male sex hormone, or contain some synthetic compound that has male hormone qualities. Possible upsetting side-effects include an increase in facial hair, a loss of head hair and a deepening of the voice.
ImplantsSome women taking subcutaneous estrogen implants find that they need to increasing amounts in order to relieve their menopause symptoms. Often these women find that hot flashes return despite very high levels of estrogen in their body. Further even after discontinuing use of implants these women can find that it can take many years for the estrogen to be eliminated from their body.
This has led to concerns that women discontinuing implants should be given synthetic progesterone for a period afterwards and should have their wombs checked for abnormalities.
Prescribed HRT - Not For Me!Despite the pressure to continue with prescribed HRT almost 40% of women stop taking it within 8 months. Women exercising their right to control what chemicals are put into their own body is proving to be quite an irritation to the industry. This has led to the pharmaceutical companies producing many reports on how to increase "compliancy". Do not doubt that getting and keeping you on prescribed HRT is a lucrative money-maker for the industry. As such they devote a great deal of their resources to increase the take up of prescribed HRT and to keep women on it for as long as possible.
9. Side Effects of HRTThe Physician's Desk Reference used by doctors in the USA provides the following list of possible side-effects from prescribed HRT:
- Weight Gain/Weight Loss
- Breast Tenderness/Breast Enlargement
- Increased Blood Pressure
- Reduction in Carbohydrate Tolerance
- Skin Rashes
- Hair Loss
- Abdominal Cramps
- Vaginal Thrush
- Cystitis-like problems
10. Long Term Risks of HRT
Breast CancerNumerous studies have confirmed a link between pharmaceutical HRT and an increased incidence of breast cancer. Despite 30 years of evidence it took until 2002 for the dangers of HRT to be highlighted.
In 2002 a major research program undertaken by the Women's Health Initiative was abandoned as the dangers became clear. A follow up survey after 5 years had shown that women taking HRT had a 26% increase in their chances of getting breast cancer, a 41% increased risk of stroke and a 29% increased chance of heart problems.
Further evidence has shown that the increased risk of breast cancer is immediate and increases the longer you take it. The risk reduces quickly once you stop taking prescribed HRT.
HRT can also trigger the development of breast cysts and enlarge existing benign tumours. Some HRT increases the density of breast tissue making small tumours harder to spot.
Womb CancerA study in 1975 showed women on HRT had a seven-fold increase in the risk of developing womb cancer. Since this study women have been given synthetic progesterone to help avoid prolonged thickening of the lining of the womb. Even so the risk is still estimated to be double that of a woman never having taken HRT.
Blood Clots and StrokesHRT can increase the risk of blood clots thereby increasing the risk of heart attacks and strokes. Research has shown the risk is greatest in the first year where a woman taking HRT has double or treble the risk of a woman not taking HRT.
Heart DiseaseNaturally occurring estrogen from a woman's ovaries protects her from heart disease. Pre-menopause a woman's risk of heart disease is considerably lower than that of a man of the same age. Post menopause a woman's risk rises to about the same as for a man.
It seemed reasonable therefore to assume that the estrogen in HRT would be protective in the same way as naturally occurring estrogen. However new research actually shows that rather than lowering the risk, pharmaceutical HRT actually increases the risk. The benefit of heart health proposed by pharmaceutical companies as a reason to put up with the side-effects of HRT turned out to be false.
Liver and Gall Bladder ProblemsThe liver tries to deactivate estrogen in oral HRT. As a result very large doses are required to ensure that enough makes it through. The high levels of estrogen can cause metabolic changes in the liver and lead to and increased risk of gall bladder disease including a threefold increase in the risk of gallstones. The risk rises the longer you are on HRT.
Ovarian CancerMore recent research has suggested a link to ovarian cancer for women on HRT.
11. The Supposed Benefits of HRTWe have already seen that current thinking has turned on its head the supposed protective effect of HRT on heart disease. What about the other supposed benefits you may have heard suggested ?
OsteoporosisMany women are worried about the possibility of osteoporosis and have heard that HRT may protect against it. The body is extremely sensitive to levels of calcium in the blood and should calcium levels drop the body will take calcium from your bones. Too many calcium withdrawals over a long period of time can lead to a weakening of the bone and an increased risk of fractures.
Research however is less than convinced that HRT plays a protective role against osteoporosis. Bone density and the propensity to fracture do not go hand in hand. The US Food and Drug Administration withdrew approval for the oldest and most popular form of HRT (made from the urine of pregnant horses) to be used as a treatment for osteoporosis.
Alzheimer's DiseaseIt was once believed that estrogen might play a role in slowing the progression of Alzheimer's Disease. However research has failed to show this and indeed there is some concern that HRT may actually speed up the disease.
DepressionHRT may help reduce depression in menopausal women, but only if the depression has been brought about by the hot flashes, night sweats and sleep disturbances that accompany menopause.
IncontinenceA study has shown that contrary to popular belief not only does HRT not help urinary incontinence but that it may actually make the problem worse.
Bowel CancerStudies are still showing that HRT can reduce the incidence of bowel cancer by over a third, however changes in diet can also have a significant effect in reducing bowel cancer. It is pointless to take HRT to reduce the risk of bowel cancer whilst increasing the risk of breast, womb cancer and ovarian cancer.
12. Stopping HRTDo not simply stop taking HRT without consulting your doctor. Sudden estrogen withdrawal can cause its own problems including ironically hot flashes. In fact you can end up with worse hot flashes than you had when you decided to take HRT.
The best way to stop is to slowly reduce the amount of estrogen you are taking over a period of several months. Women taking oral HRT could discuss with their doctor the possibility of switching to patches. Skin patches deliver estrogen through the skin and because the estrogen isn't first broken down by the liver much smaller doses are required.
If you are on a type of HRT that simulates a withdrawal bleed it is important that this is allowed to happen. This means that any synthetic progesterone taken to facilitate a bleed must not be altered until estrogen has been stopped.
If you are taking subcutaneous estrogen levels may remain high for some time and should be measured by your doctor.
13. Progesterone CreamProgesterone Cream was touted by some as a natural and superior alternative to conventional pharmaceutical HRT. However it turns out to be not so natural and has plenty of problems just like conventional HRT.
Some women believe that because progesterone can be made from Wild Yam, a natural plant with many healing properties, that this progesterone is in some way natural and holistic. The truth is that although the process starts with the diosgenin (found in Wild Yam) it is synthesized by chemical processes into progesterone. The end product is therefore not natural. Despite the many benefits of Wild Yam it does not contain progesterone, neither would your own body be able to convert it into progesterone, for this you need a chemist in a laboratory.
Because progesterone cream contains such a powerful hormone the United Kingdom medicines control agency, the MHRA, have correctly limited supply to prescription only. In the USA the FDA do not allow medical claims to be made for the product but do allow its sale without prescription as if it were a cosmetic.
A herb with a tradition of healing such as Wild Yam relies on the synergy of a multitude of compounds. It does not follow that just because the multitude of natural compounds making up Wild Yam are know to have anti-spasmodic and anti-inflammatory properties that one single compound diosgenin, chemically altered will have the same effect. Many women have been duped into believing they are taking a natural product. Women are in effect simply replacing the sex hormones estrogen and progestin of HRT with progesterone.
NOTE: Progestin is different to progesterone. Progesterone is converted by the liver and so cannot be taken by mouth. Progestin however can be taken by mouth. The downside is that the body has difficulties recognizing and coping with Progestin because it is not a natural hormone. This leads to well known side-effects such as mood-swings and depression.
Looking at the decades it took for evidence to come to public attention of the long-term risks of estrogen in HRT, you may consider that taking progesterone in a cream is a gamble too far.
A big worry with progesterone cream for women on estrogen from HRT is that the amount of progesterone absorbed may not be enough to protect the womb lining from the thickening caused by the estrogen. If this is the case you can get an excessive build-up of womb lining, endometrial hyperplasia, and the risk is that if not treated the cells could become cancerous.
14. The Alternative, A Natural MenopauseAll the side-effects and long-term risks associated with HRT can be avoided by refusing to jump on the HRT money-go-round.
HRT - Not Natural and Not Clever
What if you are one of the lucky women who would have no major symptoms of menopause? You may naturally breeze through your menopause. Why rush to your doctor simply because your periods stop ? The latest research shows little or no proven benefit for HRT besides reducing hot flashes and night sweats. If you don't get these symptoms then why accept the numerous side-effects and risks for no benefit?
If you do suffer from the symptoms of menopause then why jump to such a side-effect and risk-laden partial solution as HRT. A huge volume of research exists to show that natural herbs can act powerfully to reduce the symptoms of menopause whilst at the same time being extremely gentle on your body. It may also be time to take stock of your lifestyle and perhaps improve your nutrition and fitness. If you consider HRT to be the natural course once you approach menopause then you have been listening to too much pharmaceutical company propaganda.
If you are approaching or experiencing menopause then avoid the temptation to blame all mental, emotional and physical ills on menopause.
Menopause Symptoms and DietMenopause is not just about hormone levels. If it were this could not explain why up to 85% of western women suffer from hot flashes whilst in some Asian countries this falls to as low as 15%. Further the percentage of women suffering from hot flashes within a single country differs considerably depending on lifestyle and diet. Indeed when women move from a country with a naturally low incidence of menopause symptoms to the west their symptoms inevitably increase. As the diets of traditional Asian countries become more Western so the incidence of menopause symptoms increases.
All this is strong evidence for the role of diet in the incidence and severity of menopause symptoms. This should not come as a suprise. The nutrients you ingest from your food are the resources for all the processes taking place in your body. Supply your body with the nutrients it needs and it will run optimally. A continued lack of the nutrients your body needs and problems will arise.
The balanced diet is a myth in the Western world. We have become so conditioned over generations to accept the food advertised and promoted as being "normal" that we are effectively being force-fed over-processed nutrient-poor food. More and more people are putting effort into trying to improve their diets. However the epidemic of obesity in both adults and children is a sign that overall we are failing.
Not only are we fighting against the limitless imagination and advertising budgets of the junk-food industry, we are also finding problems with our healthy fruit and vegetables. Much of our fruit and vegetables are lacking in the vital nutrients that we expect as modern intensive farming methods strip the soil of its minerals. A lot of our fruit and vegetables are picked before they are ripe and shipped across the world to us. Some fruit and vegetables are stored for months before being shipped and artificially ripened.
We have the crazy scenario that despite consuming far too many calories the average American is actually deficient in many key nutrients. This is a good case for nutritional supplements, even for those of us who try to maintain a healthy diet.
15. MenoGlow, The Natural Alternative to HRTMenoGlow Natural HRT contains a balanced combination of quality concentrated extracts of the the leading six menopause herbs. By using top quality concentrated extracts of these plants we are able to deliver our powerful menopause formulation in a single one-a-day capsule. This can be equivalent to a handful of capsules of cheap plant powder formulations.
Phytestrogens, IsoflavonesNatural HRT contains substantial amounts of phytestrogens, estrogen-like plant hormones. Phytestrogens have a similar structure to human estrogens but are 500-1000 times less active. They can take the place of human estrogen at estrogen receptor sites within the body.
Isoflavones are the most widely researched phytestrogen. Isoflavones alone can reduce the number of hot flushes by 50% within 3 months. Isoflavones also benefit the circulation to reduce the risk of heart disease and increase the density of bone in the lumbar spine to help protect against spinal osteoporosis. It is possible that isoflavones may also play a role in reducing the risk of breast cancer. Phytestrogens levels in Japanese women are as much as 110 times higher as those found in women in the West and do not appear to produce any long-term ill effects. Because phytestrogens are so much weaker than normal human estrogen they do not need to be balanced by progesterone.
PhytochemicalsPhytochemicals are naturally occurring chemicals found in plants that are biologically active in the human body. There has recently been a great amount of interest generated by research into their health benefits.
As well as numerous antibacterial, antiviral and antioxidant properties phytochemicals also:
- Help regulate hormone metabolism,
- Help the liver to remove toxins from the body,
- Reduce the danger of blood clots,
- Stimulate the immune system,
- Help reduce blood pressure,
- Help lower cholesterol levels.
Our Natural Herbal HRT is brimming with powerful phytochemicals which can help dramatically reduce the symptoms of menopause.