Menopause, long ignored or brushed aside by mainstream medicine, has finally hit the CBC news and will be a major topic for discussion in 2023.
Especially considering the rise of qualified women to key positions in government, finance, health services and every other sphere of life, it is time (truly, past time) to acknowledge women’s importance to our society and to agree that these prime contributors to our civilization should no longer suffer silently in the background.
Menopause is now easily, safely and inexpensively treatable, and it is time for a paradigm shift.
Menopause is that stage of life in which woman’s ovaries cease producing eggs, estrogen and progesterone.
It usually begins naturally, between 45 and 55 years of age, but may start earlier due to natural causes, or to destruction of functioning ovarian tissue by surgical excision, chemotherapy or radiation.
Its onset is usually gradual, with intermittent symptoms due to fluctuating hormone production, but may be sudden.
When intermittent, it is termed “premenopause” and by consensus, medical professionals deem menopause to be in effect when menstrual cycling has been absent for one year.
Early Premenopausal/Menopausal symptoms
Often, the first indication of approaching menopause is irregularity of the menstrual cycle, with variability of menstrual flow.
Classical early symptoms include hot flashes (with or without flushing), nocturnal sweating, joint pain and stiffness, instability of mood, irritability, variable insomnia, vaginal dryness, fatigue, reduced libido and “fuzzy thinking”.
Any and all of these symptoms may, or may not, be severe.
Often, they so interfere with thought as to render complicated work impossible.
For most women, the transition to established menopause is marked by an increase in the severity and frequency of symptoms, but discomforts may be mild, or absent.
The hot flashes, night sweats, irritability, mood swings and insomnia tend to settle down within 3 to 4 years, but symptoms and disabilities due to hormonal loss continue indefinitely.
For a full list of menopausal symptoms, see the graphics at https://en.wikipedia.org/wiki/Menopause#/media/File:Symptoms_of_menopause_(vector).sv
From a practical standpoint, irregularity of menstrual cycling in the fifth or sixth decade indicates the onset of menopause: the presence of symptoms confirms it.
But since it sometimes takes quite a while for menstruation to stop completely, the doctor should confirm the diagnosis of menopause with blood tests.
The laboratory tests will show very low estradiol and progesterone levels.
However, more importantly, there will be high levels of the ovary-stimulating hormones, LH (“Luteinising hormone”) and FSH (“Follicle-stimulating hormone”), which the pituitary gland secretes in an effort to get the ovaries working again.
Once low progesterone and estrogen and high LH and FSH have been documented, the doctor will be secure in the diagnosis and can prescribe in good conscience, to relieve the symptoms.
Later Menopausal effects
In the absence of estrogen, a number of body functions deteriorate, over time.
There may be:
(1) Slow bone loss, leading to osteoporosis, “Dowager’s hump,” and the risk of fracture,
(2) Reduced collagen and elastin in the skin, with wrinkling and an “aging” appearance,
(3) Increased fat, both inside and around the abdomen in the early days,
(4) Increase of breast, hip and buttock fat later on, due to Estrone made by lipocytes.
(5) Impaired glucose and cholesterol management, which may lead to diabetes or cardiovascular disease,
(6) Reduced libido, often with unpleasant effects on relationships.
(7) Atrophy (shrinking) of the vaginal lining, with dryness and painful intercourse.
(8) Atrophy of the tissue supporting the urethra (the urinary tube below the bladder), with embarrassing urine leaks and the discomfort of wearing pads, or diapers.
(9) Hair loss, inconfidence, anxiety and confusion, intensified by stress and by the effects of other hormone deficiencies, including DHEA, Progesterone, Allopregnanolone, Testosterone, Thyroid Hormone, Melatonin and others.
All these hormones begin a slow decline at age 26 and by the time menopause begins, all are seriously depleted or frankly, absent.
(10) Depression, due to altered bodily characteristics, hormone loss, stress, anxiety, confusion, fatigue, and reduced self-confidence.
(11) Stress-related reduction of T3 levels inside the cells (intracellular hypothyroidism, a.k.a. “chronic fatigue syndrome”, “nonthyroidal disease”, “low T3 syndrome” or “euthyroid sick syndrome”) with additional debilitating symptoms of true hypothyroidism. *
SOCIOECONOMIC CONSIDERATIONS IN MENOPAUSE
Women’s socioeconomic status has improved considerably over the last 3 decades; but the situation is still inequitable.
Women now represent 46.6 % of the workforce, 40% of managers, and 8.8% of Fortune 500 CEOs. They comprise 27% of the US House of Representatives and boast 28 heads of state, worldwide.
It is a travesty that these indispensable workers and leaders, even now in the 3rd decade of the 21st century, are required to maintain normal executive function while hamstrung by a natural condition, menopause.
A ROUGH ESTIMATE OF THE COST OF MENOPAUSE
Let’s arbitrailry assume that our most efficient worklife lies between age 30 and 60.
Let’s visualize the effect on productivity, of the metabolic and psychological upheaval caused by menopause, beginning at age 45 and lasting through half of the worklife; to age 60.
Let’s calculate the worldwide loss to society from reduction in efficiency, involving 46.6% of the workforce, 40% of managers, more than 8.8% of CEOs, 27% of the US House of Representatives and 28 heads of state.
Factor in the certainty that 100% of these people will be severely affected for some years, and perhaps, for a full half of their most efficient, most productive worktime.
Include the irony that the disruption under consideration is due to a natural metabolic and psychological, condition which can be treated very easily and safely.
Reiterate that the “trouble” begins at age 45 and
Finally, let us admit that for decades, we have had simple, safe, inexpensive treatments to alleviate menopausal symptoms.
RATIONALE FOR UNIVERSAL THERAPY FOR MENOPAUSE
It is in everyone’s interest, to keep women as healthy as possible.
Surely, all agree that therapy is necessary, for the individual and for our entire society.
Let our nation provide, gratis to the citizen,
– Personal care for the individual woman (complete relief from symptoms is possible).
– Assurance and support for her family.
– Maintenance of her abilities in the interest of her coworkers.
– Stability of her leadership, in the interest of her workplace.
– Ensured efficiency, for society at large.
THERAPEUTIC SUPPORT IN MENOPAUSE
Much has been written about prescribing
Clonidine, gabapentin, SSRIs, or “sleeping naked in a cool room”, for hot flashes,
Exercise for sleep,
Phytoestrogens and avoiding nicotine, caffeine and alcohol, for mood swings, Alendronate or Risendronate for rebuilding bone,
Sleeping pills, acetaminophen or Advil for joint pain,
Collagen and wrinkle creams for the skin,
Weight loss programs,
etc. etc. etc.
However, all of these therapeutic manoeuvres are designed
to alleviate individual symptoms
without addressing the cause of the problem.
Menopausal symptoms result from absence of estrogen and progesterone, but are magnified by the effects of deficiency of many other hormones, including DHEA, Allopregnanolone, Melatonin, Testosterone and Vitamin D.
In addition, stress produced by the symptoms themselves, or by the effect of menopausal symptoms on professional function, results in increased cortisol production and consequent intracellular T3 deficiency.
The diagnosis of menopause is easily confirmed by blood tests.
Treatment using bioidentical hormones is simple and safe.
Therefore, we should inform everyone of the scientific facts and we should make diagnostic testing, counselling and individualized treatment easily available to any menopausal person who needs it and wants it.
CORRECTION OF HORMONE DEFICIENCY BY SUPPLEMENTATION:
A cream containing 2, of 3, natural human estrogens, estradiol and estriol, in a 20/80 ratio, is applied to the skin if there are no vaginal symptoms, or to the vagina, if there are.
The dose is adjusted according to its effect on symptoms and validated by checking the serum estradiol level.
Progesterone (Prometrium, a compounded capsule, or a cream) is taken at bedtime, to improve sleep, to assist memory and cognition and to counter the tendency of estradiol to produce weight gain.
The starting dose is 200 mg: dosage is adjusted up, or down according to change in symptoms, the progesterone and estradiol serum levels and the progesterone/estradiol ratio.
The Vitamin D level is assessed via blood test: vitamin D3, at a minimum dose of 2000 IU daily is started if the level is low, as it usually is (added vitamin K is a good idea).
The dose is adjusted according to the serum level of Vitamin D.
Melatonin is prescribed for its protean antioxidant and supportive effects, not specifically as a sleep aid.
The preferred dose for this purpose is 10 mg at bedtime.
DHEA improves the libido, self-confidence and cognition by elevating testosterone and other “downstream” hormones.
It reduces stress, thereby lowering cortisol and improving intracellular T3 levels.
It is the raw material for the “micro-hormones” which our cells need, to function.
Thus DHEA protects the heart and enhances skin, muscle, hair and fingernail quality.
It also helps with vaginal dryness and urine loss (incontinence).
It is available OTC, as a capsule, as a skin cream or as a vaginal cream, in the USA.
The cream is particularly helpful for vaginal atrophy and urine loss.
Most women need 50 mg, with breakfast.
Some need a lower dose, to avoid testosterone-related side effects.
A few individuals need more: a few experience such improvement that they demand a higher dose.
The dose is adjusted according to symptomatic response, testosterone side effects and the on-treatment serum free testosterone level.
The main threat to well-being in menopause is stress, with intracellular hypothyroidism (low T3 inside the cells), resulting from increased cortisol secretion as a response to perceived stress. A variety of hypothyroid symptoms are reported.
Diagnosis is via assessment of the T3/rT3 ratio (normal = >20).
Secure, safe and proven therapy with slow-release, oral T3 produces immediate improvement in mood, energy, cognition and anxiety level.
The dose is adjusted depending on serum T3, rT3 and T3/rT3, ratio.
Occasionally, T3 therapy can be stopped when the individual’s stress level improves.
Allopregnanolone, under the trade-name “Zulresso” is now available for the treatment of depression, but is inordinately expensive.
However, progesterone, available as a commercial product (Prometrium), or compounded progesterone, is inexpensive and is reliably converted into Allopregnanolone by the brain.
Allopregnanolone’s effects can be induced by 2-300 mg of progesterone, at bedtime.
ADDITIONAL ADVANTAGES OF ROUTINE THERAPY FOR MENOPAUSE
Hormonal deficiency and imbalance is the root cause of a majority of debilitating noncommunicable diseases, in both genders.
Therefore many of our most problematic conditions, including cardiovascular disease, some “autoimmune” conditions and (probably) Alzheimer’s disease, can be prevented or slowed by hormone balancing.
THE BOTTOM LINE
Investigation and management of menopause is in the interest of the individual.
However it is even more important to society at large, since dispelling the symptoms of menopause will increase efficiency and reduce costs, for everyone.
Links are provided in lieu of references, but one deserves special mention: see below.
Fact Sheet (a declaration):
Women & Socioeconomic Status,
by the American Psychological Association,