Tuesday, 15 March 2011

My take on hormones and 'The Menopause'

So this is the talk I gave at Circle Health Hospital last night. My delivery was pretty piss poor as the time I had was very short and I had to rush and then got nervous and had a dreadful dry mouth and I had to miss loads out.
I think they got the gist though.
It starts with my usual rant about understanding why your body does stuff. I always do this to try and reassure people that their bodies aren't going wrong or letting them down.

I'm sure it's full of typos and grammatical errors but hey ho the plants don't mind my complete inability to spell and sentence structure correctly.

The body is constantly adapting to environment it finds itself in. It monitors everything going on around it and being put in it and then it changes it’s function in response to that – it’s primary goal is to stay alive.

The nervous system is the primary sensor – and you can simplify the understanding of the way the nervous sytem works by thinking about what its initial role was in our evolving ancestors- basically to look out for sabre tooth tigers and then activate all the tools it has to enable you to run away or fight as hard as possible. So your heart beats faster, the breathing increases, blood and the oxygen it carries gets pumped around to the running muscles, the pupils dilate so you see better and everything that isn’t essential for saving your life at that moment is stopped;  like digestion=dry mouth.
Needle Felted Tiger - good relaxation therapy

When the saber tooth has gone away the body sets about repairing and restoring everything that was worn or damaged. It needs to consume, digest, absorb and distribute all the materials it needs to do that and it also deals the elimination of waste products or rubbish created by all this activity. So the appetite returns, digestion commences, urine production resumes, the bowels open and pertinent to this discussion, the ability to reproduce itself commences. Everything is balanced out and is deliberately intended by the body.

What happens in modern day living is that there is a fairly perpetual sabre tooth on all our tails – got to earn money, to buy food, to feed the kids, pay the bills, keep a clean house, washing, school time, holiday time, depressing media reports, eat this don’t eat that, lists lists lists information overload.
This means that our bodies are in a constant state of burning energy, running away and the rest and restore never has a proper chance to readdress the balance required to keep us alive.

You might notice that you can’t sleep properly – your brain is going round like a broken record or that you sleep for a few hours and then startle awake, your heart is pounding –especially when you finally sit down or go to bed, you can’t open your bowels( “cos you can’t poo when there’s a sabre tooth on your tail – ‘scuse me mr Sabre tooth would you mind just waiting there for a minute while I pop behind this bush)
You might get woken to wee in the night- because your body is using the rest time to make urine rather than during the day or first thing in the morning, your periods become very quick and heavy flow – can’t be bleeding for long when there is a sabre tooth around he might sniff you out.
You crave sugar and carbohydrate because it’s quick energy for running muscles and when there is a constant high blood sugar because of all the carbs the body sense that and thinks I’ll store that as fat around your middle because there might be a famine soon. A clue to what your hormones are doing is to know that fat distributed above the umbilicus indicates high cortisol levels(Treat the liver and adrenals). Fat below the umbilicus and on the hips shows high oestrogen(Treat the liver)

So everything that the body is doing is deliberate and for a reason. It is just doing the best it can in the situation it finds itself in. Everyones body adapts in its own unique way, which is why different people have slighty different dis’eases.
Pilewort roots - Ranunculus ficaria
As a herbalist I am looking for the root of the problem – and there is often more than one because the body can cope admirably with no symptoms, a few long term inbalances.
 I then advise on strategies to enable the body to regain balance again – using lifestyle changes, nutrition and herbs which I see as good sharp sticks to fight off sabre tooths or they can provide the body with the materials it needs to help it rest and restore when life throw you those curved balls that you cannot avoid and sometimes have soldier on through for a bit.
They also help the body adapt when it is going through natural progressive age changes until it gets used to the new status quo, like in menopause.
Herbalists generally don’t see menopause as a disease or something to be cured, they see it as a natural transition into a new phase of life.
 Ladies Mantle - Alchemilla vulgaris
What is menopause?
Menopause literally means cessation of menstruation. But unless the ovaries are surgically or chemically removed, the natural decline of the reproductive capabilities of the body often begins years before the periods actually stop.

Once the periods start to become irregular or ceased then on average most womens symptoms should have ceased within 2 years.
The hormones that control menstruation are all released on feedback systems that either turn production of each other up or down.

As simply as I can describe it the monthly cycle goes like this:
An egg matures in the ovary each month stimulated by follical stimulating hormone sent from the brain.
The little egg sac produces oestrogen that makes the lining of the womb build up so there is a nice bed for a fertilized egg to nest down into.
When the oestrogen level gets high enough it messages back to the brain to produce lutenizing hormone to make the egg pop out and travel down the fallopian tube where it hopes to meet it’s boyfriend, the sperm, coming the other way.
 The left over empty sac then produces progesterone as well as oestrogen that keeps the womb lining in place . It only does this for 10 or so days when it finally shrivels up and ceases production.
 If the egg got busy with it’s boyfriend and has nested down nicely in the lining of the womb then the placenta takes over the progesterone job. If ithere has been no fertilization then the womb lining sheds as a period because there are no hormones keeping there.

The low levels of progesterone and oestrogen then stimulate the brain to start producing more follicle stimulating hormone to get another egg ready and the cycle begins again.
As you age the number and quality of eggs starts to decline and the normal levels of FSH might not stimulate one to mature, so the level of oestrogen doesn’t begin to rise.
 The brain senses this and releases more FSH to try and stimulate an egg. It also increases LH but more slowly. These hormones are released on 60-90 minute surges. These surges co incide with hot flushes(think about the sabre tooth again – heart pumping, blood surging around, nerves on high alert, sweaty palms etc the mechanisms are the same as the emergency adrenaline system)
And so the periods cease.
However many problems can start to emerge before this point. Women in the perimenopausal years often suffer with symptoms that are more often associated with high oestrogen – breast tenderness, heavy periods, fibroid growth, mood swings, bloating, digestive problems, headaches  Etc

What is though to happen in perimenopause is that the ovaries are already tiring and they sort of go to sleep on the job at the beginning of the cycle.
 The oestrogen levels are low so the brain senses that and stimulates them with lots of FSH– they then startle awake, late to work and suddenly produce lots of oestrogen in response to the extra stimulation from the brain
– then the womb lining builds up more than usual. When the rest of the cycle catches up the period is late and heavy because of the excess oestrogen. High oestrogen also stimulates fibroid growth, breast tenderness and all the other symptoms.
 So in perimenopause sometimes your estrogen levels are high and your progesterone is low, and you might get symptoms of PMS. At other times, your estrogen levels remain low and you get hot flashes. Then for several months you're back to normal. Your symptoms are actually caused by fluctuations of high and low estrogen.
The symptoms of menopause can include:
Hot flushes or night sweats
Skin and vaginal dryness
Mood swings
Poor Libido
Poor memory and slow thinking
Depression and anxiety

The role of the liver

 I see the liver as the central shipping unit in the body. It takes nutrients in and manipulates them into usable forms and it gathers up wastes and breaks them up into less toxic units and ships them out via various routes.
Its roles are so vast and complex it doesn’t take a huge amount of extra work load to become overwhelmed and begin to neglect some jobs in favour of others that is sees as more important.
Every bodies liver prioritises jobs in different ways.

At menopause it has extra hormones to deal with. It has to process and make the cholesterol that is the building block for those hormones. It then has to break down the hormones and eliminate them. If you pour a bit of stress into the mix and the large chardonnay or chocolate bar/cake/packet of biscuits/junk food then the liver becomes overloaded and you get worse symptoms of hormone inbalance and symptoms from all the other jobs that are getting neglected – like IBS because the digestion is neglected and effected by the hormones or joint inflammation because irritating wastes are being dumped there rather than being flushed out. If you are having heavy bleeding then it has to use its iron stores to replenish the blood.
Vitamin B6 and magnesium are necessary for the liver to neutralize estrogen. Increased sugar intake will also use up magnesium and interfere with its ability to breakdown estrogen.  Alcohol and caffeine will significantly aggravate hot flushes and slow up liver function.

Why diet and lifestyle are essential

Stress – if menopausal hot flushes, night sweats or insomnia have been going on for more than 2 years and are particulary frequent or debilitating then there is usually a high level of chronic stress going on.
The mechanisms of chronic stress and the symptoms are very similar to the effects of the natural hormone changes at menopause. In most people experiencing real difficulties with menopause then there is likely to be stress increasing the severity of the hormone fluctuations.
It is really important to reduce stress levels as much as possible in whatever way works best for you – but not by reaching for that glass of pinot or the carb fix but by doing some kind of relaxing activity and finding some space for you.

Yoga is particularly good it increases flexibility and bone strength but also relaxes the nervous system – you get to lay down a lot between postures, which works for me.

A daily walk in nature, breathing gently in and out through the nose will also reduce stress hormones. Getting out into the fresh air and natural surroundings is well documented to promote feelings of well being.

Meditation and breath work has been show to reduce anxiety and stress. If you breath in and out of the nose. A particularly useful breathing exercise is to count in breath for 7 and the out breath for 11. You can actually feel the calming effects in a few minutes and they are measurable with heart and oxygen monitors. 7:11 breathing can stop a panic attack. It is also useful during the night if you suffer with insomnia- everytime the mind wanders off onto it’s busy work pull it back to the breath again and again and you will fall back to sleep much quicker. The more you practice the quicker it works.

Exogenous oestrogens and diet
Plant oestrogens which are often called phyto oestrogens are interesting – they have an effect of hormone receptors in the body but are thought to be about 10,000 times weaker than those your body produces. They still have an effect on your hormone levels tho because they fit in the receptor sites and make your body think the oestrogen levels are normal. If you have too much oestrogen they compete for receptor spaces – elbowing out your own excess ones. If you have low levels they fit in and replace what you are lacking. It is well observed in cultures where high levels of phyto oestrogens are consumed in the diet the level of menstrual and menopausal problems is very
There are three types of phyto-oestrogens: Isoflavones, Lignans and Coumestans.
Phyto-oestrogen rich foods:
Soya: Have traditional style fermented soy products. Avoid soy if you have low thyroid function as it inhibits thyroid hormone.
Soya yoghurt can be easily made with Soya milk and a dessert spoon of a starter culture. I reuse my old yoghurt pots and fill them with Soya milk and a dessertspoon of Soya yoghurt (yofu) Put in a box or freezer bag with a jar of boiling water for warmth, leave overnight and it should have set by morning. Refresh the starter culture every 4-6 weeks with a new pot of yofu.
           Tofu is Soya bean curd, try smoked or marinated for better flavour. It's great in stir-fries or on salad or roasted with vegetables.
            Miso paste is fermented Soya beans and can be used as stock for soups and casseroles.
90g of soya a day has been shown to alleviate menopausal symptoms – I think that is quite a lot but a cup of miso soup and a dollop of soya yoghurt on your breakfast everyday goes a good way plus add in a few other things and you will notice the difference.
Linseeds: A very cheap, rich source of essential fatty acids and lignans. Buy them in bulk and grind them in a coffee grinder. Store in a plastic bag in the freezer to prevent the oils from going rancid. Sprinkle one dessert spoon on breakfast and dinner.
Pumpkin, sunflower and sesame seeds: These are all rich in essential fatty acids and Isoflavones.
Lentils and Chickpeas are rich in isoflavones as well as canellini, kidney, flageolet and butter beans.
Grains: Rice, oats, barley, cous cous, polenta and buckwheat are high in lignans. I encourage people to vary their carbohydrate intake from wheat, wheat, and wheat to include other sources like these.
Mung beans and alf alfa sprouts are rich in comestans and good in salads and sandwiches.

Calcium and Vitamin D Sources: Cheese, kale, almonds, brewers yeast, dandelion greens, brazils, watercress, sardines, pilchards, mackerel, tofu and an apparently very rich source of vitamin D, according to the Rheumatologist who was also at the talk - wine gums!
High in blood vessel protective bioflavonoids: Cranberries, blackberries, red and blackcurrants, blueberries and red grapes. (Including juice and red wine) All citrus, melon, cherries and plums, red onions, beetroot, greenbeans, sweet peppers, garlic, broccoli, tomatoes.

Try to eat all your food as close to natural as possible and avoid additives and artificial flavourings as much as possible to prevent putting strain on the liver.
                                          PHYTO OESTROGEN CAKE.
4oz/100gm Soya flour
4oz/100gm wholemeal flour
4oz/100gm rolled oats
4oz/100gm  ground linseeds
2oz/50gm sunflower seeds (grind if preferred)
2oz/50gm pumpkin seeds (grind if preferred)
2oz/50gm sesame seeds (grind if preferred)
2oz/50gm flaked almonds
2 pieces stem ginger finely chopped
8oz/200gm raisins
Half tsp. each of nutmeg, cinnamon and ground ginger.
15 fl oz/425mls Soya milk
1tbsp malt extract
Mix all the dry ingredients well, add the Soya milk and malt extract and soak for 30 mins.
Line and grease a small loaf tin. The mixture should be a dropping consistency, add more Soya milk if needed. Bake at 190c 375f gas mark 5 for 90mins. A slice a day keeps the flushes at bay!

 A usuful tip to know now is that it won’t hurt your husband or partner to have a slice a day either. Phyto oestrogens have been shown to protect against prostate problems!

Limeflowers - Tilia spp 
There are lots of herbs and herbal pills that are touted about for being good for menopause. As a herbalist my persective is that herbs treat people not ailments. So as you understand how uniquely different we all are and how our bodies all function and adapt in slightly different ways you can see that one herb doesn’t fit all. There is also a lot of misinformation out there about herbal and natural fixes for menopause.
Lots of the products that are sold are untested and unfounded in their claims. Taking a herbal pill or potion might not be enough to address all of the changes your body is going through and help it adapt to a new phase of life. Especially if there has been lots of adaptations happening to help your body survive in the lead up to the menopause. 
 Severe symptoms are your body waving a great big red flag at you say “there’s something wrong here in my environment and I can’t cope anymore without this happening” You cannot take a pill to put that right. You need to identify the problems and then put into place supportive measures.
 It might seem really difficult to leave the lid on the bottle of wine, or not eat the sweet fix or drag yourself out after a long day to yoga or a walk. It is a matter of reframing the situation – you aren’t denying yourself, you are doing it to make yourself feel better – it doesn’t take too long of feeling better to impliment the changes keenly rather than feeling like you are denying yourself something!

There are some simple herbal remedies that grow locally and commonly in gardens you can try yourself at home along side the diet stuff to help with particular symptoms:
Sage herb is a drying herb that has good levels of phytooestrogens in it. You can make a cup of it with 6-10 fresh  leaves. Put them in a mug, cover them with boiling water and cover the mug. Leave to infuse and cool. Drink up to 3 times a day. Or  an hour before retiring if night sweats are a problem. Leave a mug by the bedside to drink in the night if you wake.
There are lots of herbs that reduce stress and promote sleep.
 Chamomile, lemon balm and limeflower are all pleasant simple herb teas. Lavender is particularly good at reducing the flight or fight response of stress – diluted essential oil in the bath, or in a moisturizing oil or a few drops on the pillow at bedtime. You can drink lavender herb as a tea.
St Johns Wort is a popular herb which has particular benefits in menopause because it also supports the liver function. You shouldn’t take it if you are using prescribed medication however as it helps the liver metabolise drugs and eliminate them. It works particularly well together with lavender.
A simple for this is raspberry leaf or Ladies Mantle herb as a tea. Add nettles in for their ability to stop bleeding and for the vitamins and minerals they contain – including iron.

Anything that tastes bitter encourages and supports liver function.
Dandelion root coffee
Bitter salad leaves, endive, chicory.

OK - that's it. I know it needs work but you know what - I'm off for a relaxing walk instead. You can figure it out.

1 comment:

  1. What a lovely lot of great information, Zoe!! I am past that change, and used some of the herbals in this post, but friends entering this phase of life are always asking for ideas, and I will direct them straight here! That cake recipe sounds as delicious as I am sure supportive:) I love the added bit about how many cultures women,that use phyto oestrogen rich foods, have so many fewer problems. I had read somewhere that there is no word for hot flashes in the Japanese language, and so had upped my intact of these foods and greatly helped my flashes during the change. Don't know if that is true or not, the bit about the Japanese language, but I took it to heart at the time, and it helped me;-) You make excellent sense, and btw, I adore your little tiger! xxxx