The Nature of the Menopause
The menopause is a very obvious key point in a woman’s life. It is a time when ovulation and menstruation ceases, indicating the end of fertility. This natural progression which can occur anywhere between the ages of forty-five to fifty-five is not a disease, but simply a ‘change of life’. Unfortunately, unwillingness to accept the change when the time comes hurts only the woman concerned, for the change is inevitable. At the other end of the scale, women who are more willing to accept their own position are much more likely to accept the changes of the menopause, recognizing them as a necessary part of life’s pattern. Indeed, such a woman may be able to look forward positively to the postmenopausal period.
Adverse Symptoms of the Menopause
It is unfortunate that in societies with a “Western” lifestyle, and to a lesser extent elsewhere, the onset and continuation of the menopause are often accompanied by undesirable symptoms. This inevitably reinforces the negative view of the menopause. This however is not a fair and balanced view if one considers that by adjusting one’s lifestyle, these adverse symptoms may be largely overcome.
The best known of these negative symptoms is osteoporosis; a condition in which the bones lose a substantial proportion of the calcium phosphate mineral substance that hardens them. The result is a loss of strength in the bones and hence a tendency to fracture. A section across bone that has been affected in this way shows it to be porous – full of tiny holes. The condition may well be symptom-free until a fracture occurs. Whilst fractures may occur in anybody, given a severe enough blow, the characteristic of osteoporosis is the occurrence of fractures even with fairly light stress to the bones. An example of this was a woman who broke her ankle merely by pulling up sharply in her car. The pressure of applying the brakes rather harder than usual produced the fracture, which would never have happened to a person with normal bone structure. Diagnostic tests exist within orthodox medicine for measuring bone density, but unless there is reason to suspect some problem, these measurements are unlikely to be applied. Hence a fracture may be the first indication of trouble.
Osteoporosis is the most definitive and measurable symptom of the menopause. There are many others, however. Hot flushes, vaginal dryness, night sweats and palpitations are additional physical symptoms. Fatigue, insomnia, poor stamina, feelings of weakness, stress symptoms, night leg cramps, easy bruising and spontaneous nosebleeds are also prominent, but less specific, general symptoms. Mental symptoms include anxiety, irritability, mood swings, depression, excessive worrying and memory loss. Although these symptoms are often worse at the time of the menopause, they are obviously not specific to it and may occur at any time throughout life. It is clear that the prime triggering causes of these problems are related to the withdrawal of oestrogens and/or progesterone. In the case of the hot flushes, the excess of circulating LH has been implicated, but this too would be corrected by increasing the concentrations of circulating oestrogen and progesterone towards the premenopausal levels. Because the whole condition appears to be completely geared to the body’s availability of steroid hormones, it is not surprising that orthodox medicine came up with hormone replacement therapy (HRT) as a treatment.
Hormone Replacement Therapy
The contrast between orthodox and alternative medical solutions lies in some quite deep aspects of medical philosophy. In thyroid gland insufficiency orthodoxy administers thyroxine, a thyroid hormone. Alternative medicine methods seek instead to regenerate the body’s own production of thyroxine. In diabetes mellitus, orthodoxy quite straight-forwardly prescribes insulin; this represents once again a simple replacement of the missing hormone. Alternative medicine methods seek instead to regenerate the body’s own production of insulin from the pancreas. In the eyes of alternative practitioners, orthodoxy stands for direct intervention to provide whatever is shown to be missing, ignoring any effects which that might have upon the patient’s own glands. Obviously, such an approach is far better than no answer, since it saves lives once an emergency has been allowed to develop, but this approach is insensitive to the needs of the body to return to normal function. Instead, it traps the patient into a position of permanent dependence upon the prescribed hormone.
Therefore, the orthodox medical solution to adverse symptoms of the menopause is to prescribe oestrogens and progesterone. Such a prescription constitutes HRT. Depending upon circumstances, supplementary calcium and vitamin D may also be advised. One review by Heaney (1) concentrates upon such an orthodox viewpoint, it is a very simple and direct approach, lacking subtlety and ignoring the fact that women have undergone the menopause since our species first evolved. In another review given by Prentice (2), they come to the conclusion that the link between intakes of any dietary component and fracture risk to the individual is not sufficiently secure to make firm recommendations on their intake. They do however give the exception of calcium and vitamin D in this case.
Admittedly, the number of women reaching menopausal age was modest before the 20th Century, but have women always had a bad experience of it? Is HRT the only way out? Did the species evolve over aeons of time with a dependence upon a medical treatment that would only become available in the 20th Century? Before attempting to answer these important questions, it is worth looking at HRT and assessing whether the benefits outweigh the dangers and disadvantages.
