Menopause is a fearful word to many, similar to the words aging, irritable. What symptoms can one expect after menopause? There are some disease that are effected by menopause, how can these be dealt with? What are the benefits and risk to the "treatments" for menopause? I will discuss my philosophy of medicine and how it applies when considering these and other related issues.

Hypothalamus- The part of the brain that regulates the pituitary

Pituitary- The "master gland" that produces hormones that stimulate other endocrine glands to produce hormones (thyroid, adrenal, ovaries, testis, etc.)

Ovaries- Female organs that produce eggs and hormones (mainly estrogen and Progesterone)

Immature follicle ÷ growing follicle ÷ mature follicle ÷ ruptured follicle (ovulation) ÷Corpus Luteum ÷Degeneration of Corpus Luteum

Hormone levels during Reproductive years (about ages 12 to 49).

Estrogen
There always is some estrogen produced. The level rises as the follicle matures and falls as the Corpus Luteum degenerates.

Physiologic Estrogen
  Estriol 60-80%
  Estradiol 10-20%
  Estrone 10-20%

Progesterone
There are minimal levels until the follicle mature about day 14, and falls to near 0 as the Corpus Luteum degenerates triggering menstruation.

FSH - Follicle Stimulation Hormone. Maximum level on Day 1 when estrogen is the lowest. There is a feed back mechanism with estrogen levels

LH - Luteinizing Hormone. Stimulates maturation of the Corpus Luteum. The Hypothalamus triggers a spike in LH at ovulation (and also a rise in temperature).

Hormone levels post menopausal

After menopause very little progesterone is secreted, and the level of estrogen are about 1/4 to 1/3 of the pre menopausal levels.
Ovaries produce some androgens a small amount is converted to estrogen.
Adrenal produce some estrone.
Fat produces some estrogen compounds.
FSH and LH are high.

Symptoms of Menopause

1. The cervix reduces its mucus production.  Vaginal dryness.
2. Hot flushes and night sweats.
3. Urinary disorders, there may be an increased urge to pass urine, or recurring urinary tract infections.
4. Insomnia, Mood disorders.
5. Sexual dysfunction.

Diseases common in western society effected by menopause.

1. Osteoporosis
2. Arteriosclerotic heart and vascular diseases
3. Urinary tract infection
4. Alzheimer's dementia

The best remedies and the heart of any treatment program are the eight nature remedies.  They should always be used and will be sufficient alone for healing in the majority of illnesses.  Pure air, sunlight, avoiding harmful substances, rest, exercise, proper diet, the use of water, trust in divine power,--these are true remedies. Every person should have a knowledge of nature's remedial agencies and how to apply them. It is essential understand these principles involved in the treatment of the sick.

The cause of the illness should sought for and treated.  If for example you are a Diabetic whose diabetes is caused by obesity the proper treatment is weight loss, exercise and a proper diet.  If your diabetes is caused by an immunological destruction of your pancreas and you no longer produce insulin, you also require insulin injections.

I find it useful to follow a  hierarchy of remedies when considering a treatment approach. Using only #2 when #1 has been considered/tried first etc..

1. Rational remedies without toxicity
2. Rational remedies with infrequent mild toxicity
3. Rational remedies with infrequent but serious toxicity
4. Rational remedies with predictable toxicity
5. Relief of Pain and Suffering.

Let us briefly review this.
1. Rational remedies without toxicity, These would be the eight natural remedies.
2. Rational remedies with infrequent mild toxicity such as thyroid hormones, charcoal, water soluble vitamins, progesterone cream, certain herbs, etc.
3 . Rational remedies with potential toxicity: antibiotics, insulin, diuretics, Digoxin, antihypertensive medications, estrogen hormone etc.
4. Rational remedies with serious predictable toxicity ; Prednisone,  Interferon, etc..
5. Relief of Pain and Suffering.

Most illnesses can be treated with rational remedies without toxicity but because of the effects of disease/age/heredity we will need to make use of the other rational remedies at times.  We must always weigh the potential risk against the likely benefits. It must also be pointed out that if a remedy is given for a inappropriate illness it becomes irrational, not a remedy and probably harmful.  (Antibiotics for a non bacterial infection i.e. a cold.)  Also if a effective remedy is withheld for irrational emotional reasons and a ineffective remedy is given without knowledge of it effectiveness it become irrational and generally harmful.

The simpler remedies are less harmful in proportion to their simplicity; but in very many cases these are used when not at all necessary.  Even though simpler remedies( thyroid medication, ulcer medication, minerals, herbs and vitamins, etc.) do not carry the risk of addicting drugs, their use should be considered only when there is;

1. A rational base for believing it might help
2. A knowledge of the potential risk. 
3. Evidence for its stated benefit.

Your body was design to handle natural substance.  When possible avoid ingesting altered substances. 

In summary,  let us consider thoughtfully the cause of the illness, elimination the cause when possible.  Let us strive to do no harm.  We need to become knowledgeable in methods of assisting the natural processes of healing created by God.  We are to consider the risk vs. expected benefit in any remedy proposed.  We need evidence for a proposed remedy's benefit not just a testimony or theory.

The most common Hormone Replacement Therapy in the USA is Premarin (Conjugated estrogens) or Prempro [Premarin and Provera (a progesterone like hormone)].    If one has had a hysterectomy usual Premarin (a estrogen) is used alone.  If the uterus is still present then Provera (medroxyprogesterone)  is added to protect the uterus from proliferation and possible cancer.

Other physician prescribe estrogens include:
Ethinyl estradiol (Estinyl)
Piperazine estrone sulfate (Ogen, Orthoest)
Esterified estrone (Estratab)
Micronized estradiol (Estrace) 0.5, 1, 2 mg
Estradiol transdermal patch (alora) (Climara) (Estraderm) (Fempatch) (Vivelle)
Tri-Est (80% Estriol, 10% Estadiol, 10 % Estrone)

Other physician prescribe progesterones include:
Micronized progesterone,
Norgestrel
Norethinedrone

Benefits
Improves lipid profile.
Reduced the occurrence of fractures related to Osteoporosis by 80%.
Reduce the risk of Hemorrhagic Strokes.

Risk
Increase the incidents of Breast Cancer. 
Increase the tendency for clotting. (see comment)
Increase the  incidence of Gall Bladder disease.
Increased risk for hypertension.
Estrogen creates proliferative endometrium -Progesterone is required to counteract this.
Causes breast stimulation - Pain or cyst formation incidence is higher with HRT.
Salt and fluid retention.

Comments
  The greatest benefits from estrogen are seen in those population groups at osteoporosis.  These would be non vegetarians, smokers, sedentary and those who choose other detrimental lifestyle practices.
  The first 1 to 2 years of HRT there is an increases risk of heart attacks.  This is because the increased tendency for clotting.  After 3 to 4 years of HRT the incidence of heart attacks is the same in the HRT group as the non-HRT group.  
  Most but not all studies show an increase incidence (occurrence) of breast cancer in those taking estrogen replacement.
  The only currently accepted reason for estrogen therapy is for symptomatic relief of menopausal symptoms.   

Eight natural Remedies

1. Proper diet
   Plant sterol molecules that act on the human estrogen receptors have been termed Phytoestrogens.  They may exert effects similar to estrogen. The common types of phytoestrogens are flavones, lignans, Coumestans and isoflavones, with the latter being the most potent.

 Lignans and flavones are found in most cereals and fruits and vegetables. Isoflavones, however, are only found in legumes such as, soy, lentils, chickpeas, and beans. Most American women will have modest levels of lignans and flavones in their blood but very low levels of isoflavones. 

Due to a much higher consumption of legumes (especial soy) in Asia, blood levels of the isoflavone phytoestrogens are 20-30 times greater than those of American women. In China and Japan, women have few menopausal symptoms and have a low incidence of breast cancer.

  Sunflower seeds contain Coumestans that have steroidlike activity and have phytoestrogen properties.

There are four isoflavones (the most potent phytoestrogens) that have been studied: Biochanin, Formononetin, Genistein, and Daidzein. 

The isoflavones	Soy products	chickpeas	Green split peas
Biochanin
Formononetin
Genistein
Daidzein

As you can see a combination of legumes provides a variety of isoflavones with phytoestrogen properties.

Other dietary recommendations are:
 1. Low fat diet, no hydrogenated oils, or fried foods.
 2. Include some omega 3 oils in the diet (i.e. Walnut, flax seed).
 3. Eat a plant-based diet, include whole gains, fruits, vegetables, legumes, and nuts.

2. Exercise
Regular exercise improves circulation and reduces stress.  Studies have shown exercise prolongs life and prevent depression.

3. Water
Plenty of water will help prevent urinary tract infection that are more frequent after menopause.  Avoid sodas.

4. Sunlight
Vitamin D Help prevent osteoporosis

5. Avoiding harmful substances
Avoid foods that may trigger hot flashes, such as caffeine, alcohol, sweets and spicy foods.  Stop tobacco.

6. Pure air
Helps with the mental effect of a hormonal change

7. Rest
Stress reduction techniques, Regular sleep times, Sabbath rest.

8. Trust in divine power

Herbal Remedies

Phytoestrogens (from Soy) See "Eight natural -diet"

Licorice  (This is not the candy type licorice).   The Herbal Licorice  "Facilitate natural estrogen synthesis in the body".
It was  used as a mineralocorticoid in the treatment of Addison's disease before more potent agents (i.e. cortisone etc.) were available.  Large amounts should be avoided because it lowers potassium and raises blood pressure.

Black Cohosh  Studies on rats suggest estrogen receptor activity.

Dong Quai  Modulate estrogen balance and progesterone synthesis. Little research or evidence exists for the claims made about Dong Quai, other than "the Chinese have used it for centuries."  The  typically recommend doses of between 300 and 500 mg three times a day. It is contraindicated in pregnancy.

Vitex  Establish hormone balance and suppress excess prolactin  Scientific literature or documentation could not be found.

Red raspberry,   Offers little medicinal  value.

Red Clover   Contains phenols and tannins. When sheep graze on large amounts, the steroidlike effects induce sterility. Humans would be hard pressed to consume enough to have any impact on their endocrine functions.  "Promensil" is derived from red clover delivers all four isoflavones (a Phytoestrogen).

Progesterone Creams

Compounding pharmacies make progesterone creams, capsules, tabs, oils, and gels.  They are unusually  purchase in bulk from Pharmacia Upjohn.  The are derived from plant sources, as is provera.  Over the counter Progesterone creams are promoted, by Dr. John R. Lee as substitutes for hormone replacement therapy and claim to have estrogenic, progestation and androgenic effects.   No data exist documenting that over the counter topical progesterone can prevent the endometrial proliferative changes induced by oral or transdermal estrogen.  They should therefore be used with caution if used in place of provera alone with a estrogen.

If you decide to use Progesterone cream:
1. Use 3% by volume, 400 to 500 mg per ounce, usually a 2 ounce jar.
2. 1/8 to 1/2 teaspoon for 3 weeks a month,  2 weeks before menses if not menopausal.

Disease specific Rx

Fosamax and Miacalcin for osteoporosis

Lipitor for hyperlipoproteinema

Evista for the estrogen benefit without the effects on the breast or uterus.  It however offers no symptomatic relief.

Conclusion

One remedy is not right for all situations. What common disease that effect post menopausal women are you at risk to develop. Are you have any bothersome menopausal symptoms? What lifestyle changes are you willing to make?
Remember treatment begins with the eight natural remedies.

References

1. Dr . John Lee, "What your Doctor may not tell you about Menopause"

2. Lee JR. Osteoporosis reversal: the role of progesterone. Int Clin Nutr Rev. 1990:10:384-391.