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Menopausal Myths
By Glenn S. Rothfeld, M.D.
Myth #1: Menopause signals a time of declining function.
Menopause is a time of change, not of decline. Hormones don’t “stop,” but rather shift, with progesterone present throughout the cycle as estrogen is lowered, and the adrenal glands and fat tissues take up the slack of hormone production.
To some women, many menopausal symptoms are mere annoyances, while to others they are virtually disabling. One key factor here is adrenal health and general stress response. If a woman enters menopause in a depleted, stressed state, the adrenals are less able to make enough estrogen and other hormones to buffer the loss of production from the ovary. On the other hand, working on good health habits and stress management when younger can go a long way toward making the menopausal change simply that: a change rather than a downward slope.
Myth #2: Sexuality stops at menopause.
Sex, for men and women both, can mean something different after “a certain age.” It may be more about intimacy, less about fireworks. Some women experience a loss of sexual desire and sensitivity at menopause. Having testosterone and DHEA levels measured and replaced can lead to a return of sexual sensations. Many women find that sexual desire lessens temporarily during the few years of adjustment to menopause and then picks up again once they readjust.
Myth #3: Osteoporosis is a TUMS deficiency disease.
We look for simple answers in medicine, even though the human body is extraordinarily complex. So, calcium-containing antacids and synthetic estrogen replacement are touted as the appropriate treatment for osteoporosis.
This is only partially true. First, calcium is not the whole nutritional story. Magnesium, boron, vitamin K, zinc, B complex and vitamin C are all involved in the production of bone and the prevention of its loss. And of course, vitamin D, either oral or from natural sunlight, is critical for calcium use in the body.
Estrogen also is not the only hormone involved in bone health. Estrogens prevent the breakdown of bone (osteoclastic activity) but they don’t produce bone growth (osteoblastic activity). Other hormones, including progesterone, testosterone, and DHEA, all have osteoblastic activity, and these hormones should be assayed at menopause as well.
Of course, exercise has been strongly shown to prevent bone loss, and light weight training can be started at any age. But there’s another lifestyle factor that is overlooked in its contribution to bone health. Stress, and lack of sleep specifically, is probably the single-most contributing factor to bone loss.
Chronically elevated stress hormones block bone growth, and increase osteoclastic activity. This is why osteoporosis is a side effect of prednisone, a powerful synthetic version of the stress hormone cortisol. The proper hormonal rhythms that come with restful sleep reset our bone balance so that, the day after a restful sleep, new bone is produced significantly more. We can test cortisol, melatonin and other hormones on saliva samples to examine how the sleep-wake cycle is functioning.
Myth #4: Conjugated estrogens are the best (or only) options to respond to declining estrogen levels.
A common estrogen replacement is Premarin, which is made from the urine of a pregnant horse and then altered or conjugated. The body must convert this form of estrogen, called estradiol, to a recognizable form before it’s active. Other estrogen replacements (like the patch) contain estradiol in its natural form. More naturally-inclined physicians treat with all three estrogens that are natural to the body (estriol, estradiol, estrone).Whenever estrogen replacement is given, progesterone should accompany it. Progesterone helps to counter some of the heavy stimulation of estrogen receptors that can lead to uterine cancer, and perhaps other cancers as well.
The clearest reason to use Hormone Replacement Therapy (HRT) is to manage perimenopausal and menopausal symptoms. But here we need to access risk versus benefits. At our practice, we start with family history; any predisposition to breast cancer, blood clotting, or stroke generally rules out HRT. We also try to control symptoms in natural ways, including herbs, nutrients, acupuncture and Chinese medicine, as well as medications that address specific problems like sleep and depression. If HRT is an option, we limit its duration to 2-3 years, and usually prescribe a natural form of triple estrogen and progesterone. Meanwhile, we try to add the natural treatments so that when HRT is stopped, symptoms will be minimized.
Glenn S. Rothfeld, M.D.
Dr. Rothfeld, Beth Galan NP and Sarika Arora, M.D. are currently accepting new patients at The Rothfeld Center. Call Ann Kane at 781.641.1901 to make an appointment.
Glenn S. Rothfeld MD ~ Beth Galan NP ~ Sarika Arora, M.D.
Over 35 years’ experience in Integrative Medicine
The Rothfeld Center for Integrative Medicine
Arlington Plymouth
781.641.1901
www.rothfeldcenter.com
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