Menopausal Issues

Menopausal Issues: Overview

Menopause didn't really come into vogue as a topic of concern for the medical profession until the 1960s.  In 1966 a New York gynecologist, Dr. Robert Wilson, wrote a best seller called Feminine Forever, extolling the virtues of estrogen replacement to save women from the "tragedy of menopause which often destroys her character as well as her health."  His book sold over 100,000 copies in the first year.  Wilson energetically promoted menopause as a condition of "living decay".

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According to him, estrogen replacement was a kind of long sought-after youth pill that would save poor, fading women from the horrors of age.  He popularized the erroneous belief that menopause is a deficiency disease.  Women's magazines eagerly seized upon his ideas and extensively promoted his concepts.  This pleased Wilson no end, since he had earlier set up The Wilson Foundation for the sole purpose of promoting the use of estrogen drugs.

The pharmaceutical industry generously contributed over US$1.3 million to his Foundation.  Each year he received funds from such companies as Searle, Wyeth-Ayerst Laboratories and Upjohn which made hormone products that Wilson claimed were effective in treating and preventing menopause.  Pharmaceutical companies jumped on the bandwagon with aggressive promotions and advertising campaigns.  His message hit a receptive chord: mid-life women need hormone drugs to be rescued from the inevitable horrors and decrepitude of this terrible deficiency disease called menopause.  Wilson pioneered the use of unopposed estrogen. [Nexus Magazine, Volume 3, #4 (June – July 1996)]

A clear distinction must be kept in mind, namely that non-human or artificial estrogens and progestins are more dangerous and less beneficial than using the natural forms.  The use of natural estrogens and progesterone is important in some women at menopause, when troubling symptoms continue.  The continued use of the appropriate natural hormone(s) for years can be without side-effects and provide ongoing significant health benefits.

Causes and Development

Surgical menopause involves the removal of the uterus and/or ovaries.  A hysterectomy usually indicates that part or all of the uterus was removed.  An oophorectomy means that one or both of the ovaries have been removed.  If the uterus is removed but one or more ovaries remain, then technically a person is in menopause since menopause means the end of having periods.  The symptoms usually associated with menopause are due to declining hormone production from the ovaries and may occur many years after surgical menopause, usually around age 50.

Treatment and Prevention

One study has suggested that dong quai, sometimes recommended in menopause, is no better than a placebo at relieving the symptoms of menopause.

References and Further Information

You can develop a clearer understanding of the nature of menopause and the interplay of female hormones by reading an informative book such as Natural Hormone Balance by Uzzi Reiss, MD, or What Your Doctor May Not Tell You About Menopause by John Lee, MD.

Conditions that suggest Menopausal Issues:




Symptoms - Reproductive - Female Cycle

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Menopausal Issues can lead to:


Syndrome X / Metabolic Syndrome

An Australian study tracked the metabolic health of 265 women aged 46-57 for five years as many of them progressed through menopause.  The study found that a surprisingly high percentage of these women – nearly 1 out of 6 – developed impaired fasting glucose levels during this time.

During the menopause transition, more fat often starts to accumulate around the stomach and insulin levels begin to inch upwards.  This subtle change can trigger a drop in levels of sex-hormone-binding-globulin (SHBG), the substance that attaches to sex hormones in the bloodstream and makes them inert.  With reduced SHBG levels, greater amounts of bioactive "male" sex hormones – androgens such as testosterone and DHEA – begin to circulate inside a woman's body.

Over time, this oversupply of active androgens can make women more male-like in appearance, fuel more obesity in the stomach region, and disrupt glycemic control.  Left unchecked, these imbalances often become self-perpetuating, thus stimulating further weight gain and metabolic dysfunction that eventually increases the risk of syndrome X, diabetes, cardiovascular disease, and certain cancers. [Obes Relat Metab Disord. 2001;25(5): pp.646-51]

Researchers in the U.S. found that among 949 women followed for nearly a decade, the risk of developing metabolic syndrome increased during perimenopause. [Archives of Internal Medicine, July 28, 2008]

Recommendations for Menopausal Issues:

Botanical / Herbal

Black Cohosh

Black Cohosh has been used successfully to control menopausal symptoms in a high percentage of women.  It may need to be taken for several weeks before benefits are noticed.  It is often found in an extract form called Remifemin, available from health food stores.

Vitex / Chasteberry

Low levels of progesterone are believed to contribute significantly to menopausal symptoms.  The ability of vitex to increase the secretion of luteinizing hormone which raises progesterone levels is the likely mode of action.  Physicians in Europe commonly recommend vitex for the treatment of hot flashes.


Dr. Malaspina, a respected cardiologist in Lima, has been using the maca root in his practice for a decade and reports finding maca to be effective for women with menopausal symptoms, including one who had already had her ovaries removed.  Maca is usually taken several months before symptoms subside.

Red Clover

Red clover extract (80mg per day of isoflavones for a 12-month period) reduced the number of hot flashes in a double-blind, placebo-controlled trial of 30 women who had not had a period for over 12 months and were experiencing more than five hot flashes per day. [North American Menopause Society 12th Annual Meeting, Oct 4-6, 2001, New Orleans, LA.]


Soy Isoflavones

The North American Menopause Society suggests that soy isoflavones can also be a natural alternative to estrogen replacement therapy for relief of mild menopausal symptoms.  It may help offset the drop in estrogen and regulate its fluctuations that occur at menopause.  Many women have reported a reduction in their hot flashes and night sweats when they regularly consume soy foods, such as tempeh or tofu.

Although study results are sometimes confusing on the issue of soy extracts and menopause, some studies have shown clear benefit.  One such study concluded that a particular soy product "...may be a safe and efficacious therapy for relief of hot flushes in women who refuse or have contraindications for hormone replacement therapy." [Menopause 2000;7: pp.105-111]

Another study found that consuming one capsule tid of a soy extract totaling 100mg of soy isoflavones per day effectively alleviated vasomotor symptoms, such as hot flashes associated with menopause, over a 4-month period compared with a placebo.  Total cholesterol and low-density lipoproteins were reduced also in the soy isoflavone group compared to placebo.  No difference in FSH and LH levels were observed between the placebo and the soy isoflavone group.  An increase in estrogen levels was observed only in the soy isoflavone group but this did not result in an increased endometrial thickness. [Obstet Gynecol 2002;99: pp.389-94]

Four months of treatment with a soy isoflavone product reduced the number of hot flashes and other menopausal symptoms in a study of 190 postmenopausal women in Spain. [Phytomedicine 2002;9(2): pp.85-92]


Natural Progesterone

Natural progesterone can protect against facial hair and male pattern baldness that some women have after menopause.  It can help with other symptoms as well, including hot flashes in some women.

Laboratory Testing

Test for Hormones

Checking primarily for estrogens and progesterone at this time of life, with subsequent hormone balancing, can provide both immediate and long-term benefit.


Vitamin E

Vitamin E, at a dose of 800 IU per day, is modestly effective in reducing hot flashes, on average cutting the number by one per day. [The Lancet Oncology 2001;2: pp.199-204]

Vitamin E is worth trying because it is safe, inexpensive, and has demonstrated efficacy.  Up to 3,000 IU per day is considered more effective by some doctors, but will have somewhat of a blood thinning effect.

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