Читать книгу Hormone Replacement: How to Balance Your Hormones Naturally - Dr. Cabot Sandra - Страница 9
ОглавлениеThe average age of the start of the menopause is 51; however, some women will go through the menopause many years earlier than this. Fertility starts to decline after the age of 35, due to the gradual reduction in the number of healthy follicles (eggs) in the ovaries. The incidence of hormonal imbalances is more common after the age of 35, simply because the ovarian follicles are ageing.
You are more likely to experience Premenstrual Syndrome (PMS) during the years from age 35 up to the menopause. This is because, after ovulation, the ovaries may not always produce adequate amounts of the female hormones called oestrogen and progesterone.
During the peri-menopause it is more common for progesterone production to be inadequate, which can result in symptoms of relative oestrogen excess such as:
heavy and/or painful menstrual bleeding
growth of fibroids and uterine polyps
growth of endometriosis
irregular menstrual cycles
premenstrual depression and mood disorders
premenstrual headaches
fluid retention
abdominal bloating
breast tenderness and lumpiness
hair loss
The Peri-menopause
This phase of a woman’s life is defined as the several years before and after the menopause. Hormonal imbalances are common during the peri-menopausal years.
The menopause is said to have occurred when menstrual bleeding has been absent for 12 consecutive months. Because the age of the menopause varies considerably, the time of onset of the peri-menopause also varies. The majority of women will go through the menopause between the ages of 45 and 55.
The years following the menopause are called the post-menopause. During the post-menopause, the production of sex hormones from the ovaries continues to decline, and may eventually become non-existent.
What Causes the Menopause?
The human female is the only creature known to live much longer than her sex glands and reproductive capacity. We could ask ‘Why us and not men?’ or ‘Did Mother Nature have a design fault?’
These questions are valid, however the fact remains that our ovaries simply run out of follicles (eggs). It is the follicles that produce the vast majority of the female sex hormones, and thus we are no longer able to produce these hormones in adequate quantities. The age at which the supply of ovarian follicles becomes exhausted varies between women; this is why we see such a large variation in the age at which the menopause occurs.
IS THERE A TEST FOR THE MENOPAUSE?
The menopausal ovary being devoid of follicles is unable to manufacture significant amounts of the female sex hormones. If a blood test is done to measure the levels of oestrogen and progesterone, they will be found to be at very low levels. In menopausal and post-menopausal women, blood oestrogen levels (which are measured in the form of oestradiol) are generally less than 160pmol/L. The term pmol/L means picomoles per litre, and is a standard laboratory measurement.
Typical Results of the Hormone Levels in Menopausal and Post-menopausal Women
| HORMONE | BLOOD LEVEL | |
| FSH | greater than 30U/L | |
| Oestradiol | less than 160pmol/L | |
| Progesterone | less than 3nmol/L |
Oestradiol is the most potent form of oestrogen produced by the ovary. Other types of oestrogen produced by the ovary and the fat tissue are weaker, and consist of oestrone and oestriol.
The function of the ovaries is under the control of the pituitary gland, which is situated at the base of the brain and acts as a master-controller for the most of the hormonal glands in the body. The glands which produce hormones are known as endocrine glands, and the medical speciality of hormones is called endocrinology.
The pituitary gland is very sensitive to the hormonal output of the ovaries, and it begins to react when the ovaries fail to pump oestrogen and progesterone into the bloodstream. Indeed, the pituitary gland is not at all ‘happy’ with the failure of the menopausal woman’s ovaries. The pituitary gland quickly responds by pumping out large amounts of a hormonal messenger called Follicle Stimulating Hormone (FSH).
FSH travels from the pituitary gland, via the bloodstream, to the failing ovaries to try to stimulate them back into action.
Alas, this does not work; the ovaries have ‘closed up shop’ forever, and despite the hormonal pleas and wooing from the pituitary gland the ovaries remain inactive. Meanwhile, the pituitary gland cannot comprehend that the ovaries are unable to respond to its advances, and in a futile attempt to reawaken them it continues to pump ever-increasing amounts of FSH into the bloodstream. This achieves nothing as far as the ovaries are concerned, but it does provide a useful diagnostic test for your doctor to determine if you are menopausal. Typically the blood FSH levels are quite high if you are menopausal, and will be greater than 30 U/L, and may reach up to 300 U/L. In other words, you will have continually elevated levels of FSH, and this is the most accurate test for the menopause. Obviously all women who are wondering if they are menopausal will want to know what their FSH level is, because if they are truly menopausal they no longer have to worry about contraception. They will also know if it is the failure of their ovaries that could be responsible for any unpleasant symptoms that they may be suffering with.
If you are on the oral contraceptive pill, you will need to stop taking it for several months before having a blood test; otherwise your blood tests for the menopause will be inaccurate. The oral contraceptive pill makes the results of blood tests for hormone levels totally meaningless. Women on the Pill will always show very low levels of both FSH and their own naturally-produced hormones, because the Pill suppresses the production of hormones from the pituitary gland and the ovaries. I am often amazed that women are sent for testing of their hormonal levels while they are still taking the Pill!
Symptoms of the Menopause
Some women will not experience any menopausal symptoms and may get a shock to discover that their blood tests show menopausal levels of hormones!
Other women may experience unpleasant symptoms, ranging from mild to severe, such as:
Hot flushes
Aches and pains – sometimes called fibromyalgia
Vaginal dryness and discomfort
Vaginal shrinkage
Painful sexual intercourse
Bladder problems such as urgency and incontinence
Loss of sex drive
Shrinkage of the breasts
Mood changes, which may be severe enough to result in a clinical depression
Low self esteem
Anxiety and panic attacks
Memory problems
Poor concentration
Dry and ageing skin
Hair loss
Sleep disorders
These symptoms may come on gradually during the perimenopausal years, or may come on quite suddenly. Understandably they can be very distressing, especially if you do not understand what is causing them.
To assess your level of oestrogen and progesterone deficiency, blood tests and/or salivary tests are very accurate.
You can also take a minute to fill in the questionnaire below, which is known as ‘Your Oestrogen Level Score Chart’.
If your total score for all of these symptoms is 15 or more, then it is likely that you are suffering from a deficiency of oestrogen.
If your score is 30, your body is probably crying out for oestrogen. This can be confirmed or refuted by a simple blood test to check your levels of oestrogen and follicle-stimulating hormone (FSH).
It is an interesting exercise to score your symptoms of oestrogen deficiency before and after starting HRT. Computing your score every three to four months provides a useful self-check to see whether your hormone replacement therapy is adequate. However, you should not decide to alter your dosage based on the results of this questionnaire without first consulting your doctor.
OESTROGEN LEVEL SCORE CHART
| Symptom | Your Score | |
| Depression and/or mood changes | _________ | |
| Anxiety and/or irritability | _________ | |
| Feelings of being unloved or unwanted | _________ | |
| Poor memory or concentration | _________ | |
| Poor sleeping patterns | _________ | |
| Fatigue | _________ | |
| Backache | _________ | |
| Joint pains, arthritis | _________ | |
| Muscle pains | _________ | |
| Increase in facial hair | _________ | |
| Dry skin and/or sudden development of wrinkles | _________ | |
| Crawling, itching and/or burning sensations in the skin | _________ | |
| Reduction in the sexual desire | _________ | |
| Frequency of or burning sensation with urination | _________ | |
| Discomfort during sexual intercourse | _________ | |
| Vaginal dryness | _________ | |
| Hot flushes and/or excessive sweating | _________ | |
| Lightheadedness or dizziness | _________ | |
| Headaches | _________ | |
| TOTAL SCORE | _________ |
The symptoms that are characteristic of oestrogen deficiency can be grouped together in the chart above, and scored according to the following scale:
Absent = 0 Mild = 1 Moderate = 2 Severe = 3
How Long Does the Menopause Last?
The word ‘menopause’ means the cessation of menstrual bleeding – that is, the last menstrual period. When this occurs your ovaries no longer contain any viable eggs (follicles), and so they can no longer produce significant amounts of sex hormones. So no more eggs means no more hormones, and technically we could say that once the menopause has arrived, it is here to stay.
However, the menopause is not a disease – it is merely a state of relative sex hormone deficiency; we do not want women to think that now they are menopausal, they have incurred a permanent disease that requires long-term medical intervention.
During the early 1980s I worked in a missionary hospital in India, which I found a fascinating anthropological and spiritual experience. Luckily I spoke some Hindi and had a solid training in Obstetrics and Gynaecology, as we were presented with all sorts of female emergencies that are no longer common in Western countries. I was in my early 30s at the time, and although I knew how to deliver babies and treat gynaecological problems, I was still very naive about the ways of the world and about cultural differences. I was quite surprised to find that Indian women saw the menopause as a completely different experience to the majority of my patients in Australia. Indian women welcomed the menopause and saw it as a liberating time in their lives; they no longer had to worry about unwanted pregnancy, continual anaemia from menstrual bleeding and childbirth, and the load of a big family. However, their liberation was not due to the loss of fertility alone, it was also because they were now free to be themselves. I found that many of the older Indian women, even up to their late 70s, were still sexually active, notwithstanding their lack of HRT. They were pleased to be able to have their vaginal and bladder repairs done, not just to overcome urinary incontinence but also to feel good about themselves as women, and also so they could have a better sex life. So this experience taught me a lot – the way we see the menopause has a lot to do with the expectations that have been brainwashed into our subconscious minds. The menopause is just a new phase of life, and really we are lucky to be able to live long enough to experience it!
Some women will have very few menopausal symptoms, and so the time that the menopause lasts becomes quite insignificant. In those women who continue to experience symptoms of hormonal deficiency right up into their late years, we can use either nutritional medicine or a combination of natural HRT and nutritional medicine to relieve their symptoms completely. So although the menopause is a permanent stage of your life, any unpleasant symptoms do not have to be permanent.
HRT can be taken for a short period of time, or for many years. We now know that oral forms of oestrogen and/or progestogens are not safe to take for more than several years, due to the increased risk of breast cancer and blood clots. They can be taken for one to two years, if you prefer to take oral forms of HRT.
If HRT is to be used for many years to relieve unpleasant symptoms in older women (over 55), then I personally believe that the natural forms of oestrogen, progesterone and testosterone, administered in the form of creams, patches or low-dose lozenges (troches) are a very safe alternative. As a woman ages, she will generally need smaller doses of HRT, and the amount of hormones in the creams can be easily adjusted accordingly. In many cases it is only necessary to use the creams in the vaginal area, making the amount of hormones absorbed into the bloodstream much lower.
What Are the Myths Surrounding the Menopause?
Many women are reluctant to consider HRT anymore, because of sensational media coverage, or books they may have read. However, many of these things are nothing more than hormonal myths. Below we look at some of these common misconceptions, as well as the true facts about HRT.
| MYTH | TRUTH |
| If I start on HRT, I will never be able to come off it. | Not true,HRT is not addictive. |
| Homoeopathic hormones such as DHEA and melatonin will relieve my symptoms as well as real hormones do. | Homoeopathic hormones do not work like real hormones, as they are present in infinitesimal doses. |
| Herbal preparations are converted into real hormones in my body. | There is no proof that herbal hormones can be converted in the body into real hormones. |
| Natural HRT is the same as herbal hormones (phytoestrogens). | Not true, natural hormones are human hormones and some require a doctor’s prescription. |
| HRT should always be taken for the shortest possible time. | If we use small doses of natural hormones that are administered via the skin or vulva, they can be used for long periods of time. |
| HRT never causes weight gain. | If potent hormones are given orally, they may cause weight gain in some women. |
| Menopause is a short phase of my life. | Menopause is a permanent state of relative sex hormone deficiency. |
| Blood tests are not an accurate way to tell if I have become menopausal. | It is necessary to check the FSH levels. |
| I will not need any HRT until after my periods have finished completely. | Some women need natural progesterone to help balance their hormones, well before the menopause arrives. |
| Once I lose my sex drive, there is nothing I can do about it. | Wrong, natural HRT, used in the correct way, can make you sexually young again. |
| All HRT will definitely increase my risk of breast cancer. | Small doses of natural hormones in the form of creams or patches have not been shown to increase the risk of cancer. Natural progesterone and oestriol may exert anti-cancer effects. |
| All HRT will definitely increase my risk of blood clots and strokes. | Natural HRT given in a way that bypasses the liver, such as in patches or creams, has not been shown to increase blood clots or strokes. |
| I am too old to take HRT. | Possible benefit from HRT has little to do with your age, but rather your lifestyle, sexual needs and symptoms. |
| If I take HRT, I do not need to take a calcium and mineral supplement. | It is always vital to take a good calcium-mineral tablet, as this will improve bone density and will reduce your risk of osteoporosis. HRT alone is not adequate to protect against osteoporosis. |
What Tests Should I Have During the Menopause?
Every peri-menopausal woman should have a Dexa Bone Mineral Density test to determine her risk of osteoporosis. If bone density is abnormally low, the test should be repeated regularly, either annually or biannually.
She should see her doctor every 12 months for a breast examination and a vaginal and pelvic examination.
A mammogram and pap smear should be done every two years.
Blood pressure measurement, weight, urine and cholesterol testing should be done annually.
A Menopause Examination Checklist
This table provides you with a general checklist of important tests that are often performed at the menopause, together with what the doctor is looking for when doing them. Your doctor will decide if any special tests, such as blood tests or pelvic ultrasound, are needed in your individual case.
| EXAMINATION | WHAT THE DOCTOR LOOKS FOR |
| THE PHYSICAL EXAMINATION | |
| Heart, blood pressure, blood vessels | High or low blood pressure; signs of cardiovascular disease; varicose veins. |
| Weight | Underweight; obesity. |
| Thyroid gland | Enlargement; lumps. Under or overactivity can be confirmed with a blood test for thyroid function. |
| Breasts | Lumps; thickening; skin or nipple changes. |
| Abdomen | Swelling; tenderness. |
| Pelvic examination | Size of pelvic organs; condition of ovaries; signs of cancer, prolapse of uterus or bladder, vaginal atrophy. |
| SPECIAL TESTS | |
| Pap smear | Cancerous or precancerous cells in the cervix. |
| Mammogram | Very early signs of breast cancer. |
| Bone mineral density test (BMD) | Signs of osteoporosis. |
| Blood count; blood tests for oestrogen, follicle-stimulating hormone (FSH), blood sugar, liver function, cholesterol level | Blood oestrogen level; signs of metabolic disorders. |
| Urinalysis | Signs of infection, kidney disease. |
| Pelvic ultrasound | Signs of disease of the uterus and/or ovaries. Pelvic ultrasound is useful for women in whom pelvic examination is difficult, uncomfortable, or inconclusive. |
