Which menopause treatment is right for you?

Source: Best Health Magazine, March/April 2012

For Diana Barkley, a public relations consultant in Vancouver, menopause meant a loss of control over her life. It began at age 50 with insomnia and night sweats’waves of heat that struck several times a night, leaving her drenched and clammy’and the inevitable fatigue that followed the next day. Daytime hot flashes became a fact of life, too, striking her unawares, including at work. Barkley, a person who normally had her professional life under control, found herself surreptitiously reaching for ice cubes from the water jug during client meetings and rubbing them onto the back ‘of her neck.

‘You feel like you are heating up from the inside. It’s a flash of heat, like the sun beating down. It makes you red and flushed,’ she says. ‘You hear crazy stories of women rolling in the snow. When you’re going through it, that doesn’t seem so far-fetched.

She also felt more emotional and stressed than usual. ‘Emotions’whatever they were before menopause’are at a heightened level,’ she explains.

What is menopause?

It occurs on average around age 51, and all women go through it to varying degrees. By 2026, 21 percent of the Canadian population will be women 50 and over, according to Statistics Canada (so for those who are in their 30s right now, it certainly won’t be a lonesome path!). For about 65 percent of us, menopause could be called megapause’a transition so uncomfortable we need medical help to get through it.

The Society of Obstetricians and Gynaecologists of Canada defines menopause as beginning at the moment when a woman hasn’t had a period for one year. The start of menopause tends to be the worst for symptoms, which can include night sweats, hot flashes, fatigue, aches and pains, vaginal dryness, decreased libido, heightened emotions, weight gain, mild depression and changes to the texture and appearance of skin.

‘Hot flashes are the most obvious and disturbing symptom,’ says Dr. Donna Fedorkow, a professor of obstetrics and gynecology at McMaster University. How long do they last? ‘We do know that about 95 percent of women will stop having symptoms within five years of their last period.‘ For the other five percent, menopause may be more chronic. Fedorkow has a patient in her 80s who is still having hot flashes.

A holistic approach to treating menopause

The fact is that there are as many different experiences of menopause and ways to tackle it as there are women going through it. When Barkley wanted to get her symptoms’and her life’back under control, she went to the Westcoast Women’s Clinic, a private clinic in Vancouver run by medical doctors Bal Pawa and Nishi Dhawan. (Pawa believes the Westcoast Clinic is the only MD-based clinic in Canada that is doing holistic, integrated health care for hormonal health. There are numerous holistic clinics led by naturopaths, but not all naturopaths are licensed to prescribe hormones.)

Staff at the clinic conducted an evaluation that included assessing Barkley’s lifestyle; rating her risk factors for breast cancer, osteoporosis, heart disease and diabetes; and checking hormone levels in her blood and urine. They then created an ongoing treatment plan for her. She now takes low-dose bioidentical estrogen through a patch, as well as progesterone tablets and dietary supplements. The clinic found her levels of the stress hormone cortisol were elevated, so they helped her with stress management, teaching her meditation and other relaxation methods. Barkley didn’t need encouragement to exercise: In her spare time, she’s an international-level competitive ice dancer.

The treatment has made a big impact. ‘I feel great,’ says Barkley. ‘My sleep is fine. I have more energy. I’m more emotionally calm.’

According to Pawa, creating harmony in your changing menopausal body begins with a healthy lifestyle: eating well, getting the proper vitamins and minerals, cutting down on coffee and alcohol, exercising regularly, getting enough sleep, de-stressing and surrounding yourself with positive relationships. ‘It’s very powerful,’ she says. ‘When we optimize these things, we really can alleviate a lot of symptoms and have a tremendously positive effect on the body for long-term anti-aging solutions.’

Doctors at the Westcoast Women’s Clinic prescribe bioidentical hormones, and only recommend estrogen taken transdermally. ‘When estrogens are taken by mouth, they are broken down by the liver and can produce some by-products that are carcinogenic,’ says Pawa. ‘Also, hormones taken orally can alter some proteins in the liver, causing the blood to thicken, creating a higher risk of blood clots. When you administer drugs via the skin, you can use a lower dose and also lower the risk of stroke and heart disease.’

Bioidentical hormones are often misconstrued to be 100 percent safe, says Pawa, so it’s important to get a medical opinion you trust. ‘It’s not just that hormones are bad or good. It’s that you have to know if they’re good for that patient. Just because your friend got hormones doesn’t mean they’re right for you.’

Naturopathic treatment for menopause

Ann Lawrence, a naturopathic doctor at Dragonfly Naturopathic Clinic in Ottawa, regularly treats women going through menopause. She uses a combination of acupuncture, homeopathy, herbs and supplements (some patients benefit from Siberian ginseng and royal jelly), lifestyle and nutrition counselling, and a technique that gently works the muscles and connective tissues, called Bowen therapy. ‘Naturopathy can be extremely useful in menopause,’ she says. ‘Women have to be willing to do some work. But it will not only help with menopause, they’ll feel better overall.’

Evidence is accumulating that eating plants such as soy and ground flaxseeds, which are high in the phytoestrogens isoflavones and lignans, helps to alleviate menopause symptoms and assists with bone and heart health, says Barbara Weiss, a naturopathic doctor with offices in Port Hope, Ont., and Toronto. A 2000 randomized trial involving 177 women found that soy isoflavone extract was effective in reducing hot flashes.

Acupuncture has also been shown in some small studies to alleviate hot flashes. A 2011 Turkish study involving 53 menopausal women found that traditional Chinese acupuncture twice a week for 10 weeks decreased hot flashes. Another small 2006 study by Stanford and Harvard university researchers, involving 29 women, showed that seven weeks of acupuncture helped decrease nocturnal hot flashes. A larger 2009 Norwegian study, with 267 female subjects, found that acupuncture plus self-care can alleviate ‘hot flashes better than self-care alone. (Self-care meant resting, reducing stress, exercising, eating healthy food, and limiting alcohol and smoking.)

Gosia Pacyna, an acupuncturist and doctor of traditional Chinese medicine at the AllOne holistic clinic in Toronto, has had great success treating menopausal women using acupuncture, Chinese herbs and acupressure/Tuina massage. She believes menopause is a time of rebirth, peace and wisdom. Pacyna just went through the transition herself and got through it using natural methods. ‘I do practise what I preach,’ she says. She deliberately slowed the pace of her life. ‘I’m 53. It’s artificial to pretend I’m in my 20s or 30s.’

Hormone therapy

If lifestyle changes and natural therapies don’t work and symptoms persist, ‘by far the most effective treatment is hormone therapy [HT],’ says Fedorkow, who has a special interest in mature women’s health. (She points out that the word ‘replacement’ in ‘hormone replacement therapy’ is no longer used.)

Her patients are often quite desperate for relief by the time they get to see her. ‘They’ve been suffering for a while. They’ve tried a lot of other things. I support their decision to take hormones.’

Hormones can be taken several different ways: pills, gels, creams and patches. There are conventional hormones and bioidentical hormones, which are identical in molecular structure to your own hormones. Conventional HT consists of Premarin (made from the urine of pregnant mares) and Provera (a synthetic progestin). Bioidentical hormones are made from soybeans and yams, which are synthetically modified in a lab. ‘There are more and more options, and we tailor treatment to the woman and what she’s going through,’ says Fedorkow.

In 2002, the Women’s Health Initiative assessed the risks and benefits of using HT in preventing certain chronic diseases. Early results from this landmark study showed women taking Premarin plus Provera were found to have higher rates of heart attack, stroke, and blood clots in their lungs and legs. The medical community now believes that while HT is not recommended in women with a history of breast cancer or blood clots in deep veins, low-dose, short-term HT is safe if it’s prescribed early in menopause. ‘Our recommendation is to start as close to the onset of symptoms as possible,’ says Fedorkow. But sometimes women don’t go to their doctor until a year or so after symptoms show up and they are fed up. ‘In this case, as long as they are less than 70 years of age, it is okay as far as heart disease is concerned,’ says Fedorkow. ‘The general pharmacological principle is to give the lowest possible dose for the shortest possible amount of time.’

This article was originally titled “Menopause driving you crazy?” in the March/April 2012 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!