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ALTERNATIVES TO HRT FOR MENOPAUSAL SYNDROMS: VAGINAL DRYNESS
As hormone levels change at the menopause, the vagina is affected. There is a tendency for the vagina walls to become narrower and thinner and for the level of natural secretions accompanying sexual arousal to fall, which can make intercourse uncomfortable. This is another one of those ‘use it or lose it’ situations. During lovemaking and orgasm, blood circulation is increased in the vagina and this can revive the vaginal tissues. It is important to keep up a good intake of essential fatty acids in your food and not to go on a ‘no fat’ diet as you need the lubrication from these oils.
A study in a gynecological journal showed that supplementing with vitamin E produced positive changes in the blood vessels in the vaginal walls after only four weeks. I have found insertion of vitamin E to be more successful than taking it orally, hence the recommendation below.
Nutritional therapy
Insert a vitamin E capsule inside your vagina every night for six weeks and after this time just use as you feel you need it.
Herbs
Herbs like agnus castus which help to normalize the hormones at the menopause will be useful here. Motherwort can help by restoring thickness and elasticity to the vaginal walls. The Chinese herb dong quai is also useful for vaginal dryness. If the dryness is affecting your relationship with your partner or making sex very uncomfortable, it may be better to seek professional help from a herbalist or a practitioner with a good working knowledge of herbs to obtain more detailed advice on how to cope with the hormone changes affecting your vagina.
*66/101/5*

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TESTS AT THE MENOPAUSE: HORMONE TESTS
There are a number of tests available that are worth having at the menopause. These tests can let you know what condition your body is in now. They can tell you what vitamin and mineral deficiencies and heavy toxic metal excesses you may have, and let you know the condition of your bones and how well your digestive system is functioning. They can also help you assess what you might need in the form of food supplements in order to bring your body back into balance and optimum health, helping to prevent future problems arising.
Hormone tests (blood and saliva)
A simple blood test can measure your hormone levels and determine whether you are in the menopause. Your FSH (follicle stimulating hormone) tends to rise dramatically during the menopause and if it appears high it would indicate that you are menopausal.
Another simple and very effective non-invasive test can be carried out on the saliva to measure the levels of the two major classes of ovarian hormones, oestrogen and progesterone, at the menopause. Using a specially designed kit, you collect a sample of your own saliva, seal it in the container supplied and send it off directly to the laboratory for analysis. The results include measurements of your current levels of oestriol, oestradiol, progestrone, DHEA and testosterone.
I feel that a hormone test is important if you arc considering HRT as one woman I saw who had been put on hormones now has a level of oestrogen which her hospital considers too high. She has been told to come off the drug and wait for the level to drop. It is possible and very likely that her oestrogen level was adequate before she was given the hormones and the additional hormones may well have caused an imbalance.
*85/101/5*

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ELISA IgG TEST AT MENOPAUSE
The ELISA test (enzyme linked immune system assay) is a very sensitive way of testing for food allergies.
This test measures the IgG antibody reaction to certain foods. When your food is not being digested properly, food particles can leak out into the bloodstream. Instead of your body seeing these particles as food, it views them as toxins and sends out IgG antibodies to cope with them. When there are too many, they clump together and get deposited in the soft tissues around the body in the joints, muscles, skin, brain, etc. This can cause symptoms such as weight gain, fatigue, water retention, pain and inflammation, to name but a few. By measuring the IgG antibody reaction to certain foods it is possible to find out which foods you should avoid in order to prevent any ‘allergic’ reactions you may be experiencing.
By using cither of the above two blood allergy tests first to identify and then to eliminate the foods your body is reacting to, you will start to remove the cause of the inflammatory conditions and are likely to notice an improvement that may be dramatic.
With these tests you are sent a special kit that enables your practice nurse or doctor to take a small quantity of blood. This is sent to the laboratory and after it has been analyzed you are sent an extensive personalized report showing:
Ђў A list of foods that are highly reactive for you and those that are borderline and also those hat are non-reactive for you.
Ђў Recommendations of how to implement food changes and how to reintroduce the reactive/borderline foods safely at a later date.
I have had excellent results with these tests. I am told one woman lost 6kgs (13 lb) in four weeks after taking a test and following the recommendations. Others have reported significant reductions in their symptoms.
Both types of test have been used to identify clinical problems and both of them have had scientific research published on them which supports these findings.
*90/101/5*

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PROTECTING AGAINST COMMON POISONS: OZONE AND NITROGEN DIOXIDE, LEAD
Ozone and nitrogen dioxide
These photochemical air pollutants are health-damaging constituents of smog. They can cause many respiratory and other disorders, notably emphysema.
Protection
1. Vitamin A. It protects your mucous membranes, including those of the lungs, against damage by ozone, nitrogen dioxide and other pollutants.
Dose: 50,000 units per day.
2. Vitamin E. It has been established that vitamin E affords definite protection against toxic effects of ozone and nitrogen dioxide. It also keeps the ozone from destroying vitamin A in the body.
Dose: up to 1,200 IU a day.
Lead
Lead is present in air, water and food in increasing amounts. It is one of the most toxic metal contaminants and can be fatal even in small amounts. It comes mostly from leaded gasolines, but also from lead-containing paint, ceramic glazes, and other industrial sources.
Lead is a cumulative poison. Early symptoms of lead poisoning can be hard to diagnose: lack of appetite, fatigue, nervousness. As the poison continues to accumulate, it damages the kidneys, liver, heart and nervous system. Eventually, paralysis of extremities, blindness, mental disturbances, mental retardation and even insanity may develop. Multiple sclerosis is believed by some researchers to be caused by lead poisoning. It can also cause anemia, reproductive disorders, decline in fertility, miscarriages, stillbirths and total sterility. Chronic lead poisoning can also cause sexual impotence in men.
Lead is particularly dangerous to expectant mothers. Children born to lead-poisoned women suffer growth retardation and nervous and mental disorders.
Protection
1. Calcium. It has both a preventive and curative effect on lead poisoning by helping the body to safely excrete lead from the system.
Dose: 5 to 10 tablets of bone meal or calcium lactate daily. Calcium gluconate (intravenously) helps to remove pain of acute lead-poisoning colic.
2. Vitamin D. In acute cases of lead poisoning, calcium and vitamin D, injected intravenously, have been successful in speeding the recovery.
3. Vitamin Ў. A powerful anti-toxin. Helps in neutralizing the toxic effect of lead. Protects muscle tissue from lead damage.
Dose: 1,000 mg. to 3,000 mg. a day. In acute condition, up to 10,000 mg. (1,000 mg. every hour, preferably intravenously).
4. Vitamin B1. It is of specific value in protecting against damaging effect of lead.
Dose: 25 mg. to 100 mg, together with one high potency B-complex tablet, each day.
5. Vitamin A. It helps activate enzymes which are involved in detoxifying lead poisons.
Dose: 25,000 units.
6. Lecithin. Lecithin is a “neutralizer” of poisons in the body. It also protects the myelin sheaths of nerve fibers from being damaged by lead.
Dose: 1 to 2 tbsp. a day in granular form.
7. Mineral and trace elements supplement, in tablet form or natural, like sea water. According to Dr. Henry Schroeder, a mineral-rich diet will help to resist harm caused by heavy metal contamination.
8. Potassium iodide. Combines with lead in the system and promotes its excretion from the body.
9. Avoid smoking. Smoking cigarettes can increase your daily intake of lead by 25 percent.
10. Legumes and beans, used generously in the diet help to excrete lead from the system.
11. Algin (made from brown Pacific kelp), or sodium alginate, has been shown to help excrete lead from the body. Algin is a chelating agent which moves through the intestinal tract without being absorbed. It attaches to the lead and carries it out as it leaves the body. Powdered algin can be mixed with drinks and foods.
*78/103/5*

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BENEFITS OF EXERCISE AND SEX AT MENOPAUSE: EMOTIONS, BONE HEALTH
It’s hard to exaggerate the benefits of regular exercise, it really is. And the older you get, the more important exercise is for your health. It has a direct impact on the way you feel and look as well as on your bone strength, your heart function and your hormones. Regular exercise appears to be linked to a lower risk of breast cancer and a higher tolerance of stress and it is absolutely vital for any woman who wants to keep a youthful figure, a good skin and a general zest for life.
Your emotions
Exercise releases brain chemicals called endorphins which help us to feel happier, more alert and calmer. Just exercise on its own has been shown to have a dramatic positive effect on people suffering from depression, stress, anxiety and insomnia and it is now often recommended as part of the treatment for these problems.
Your bone health
Weight bearing and weight training help maintain bone density through the menopause and prevent osteoporosis. Weight-bearing exercises include brisk walking, running, tennis, badminton, stair climbing and aerobics – any activity that puts stress on your bones. Women, who have allowed themselves to become inactive, are at risk of fractures later on in life. It is definitely a case of ‘use it or lose it’. Our bodily functions are very logical. Astronauts lose bone density in the weightlessness of space where there is no pressure on their bones. The same principle applies to the rest of us. If we make the demands on our body to provide us with good strong bones, bone density will be maintained or increased. When the bones are put under stress and their strength is in demand, the body will draw osteoblasts (bone builders) to those areas which need building up. If we become inactive and make no demands on our bones, we are compromising our bone health.
The impact of exercise on bone has been dramatically illustrated by research that examined the difference in bone density between the two arms of professional tennis players. The bones of the racket-holding arm which does most of the work can be over a third denser than the other one.1 Several studies have shown that weight-bearing exercise helps women maintain or increase their bone density through and beyond the menopause.2 At the same time we have to be careful about putting too much strain on our joints. A recent study reported in the Journal of Arthritis and Rheumatism compared former first-class athletes with a group of ordinary woman with an average age of fifty-two. The researchers, from St Thomas’s Hospital, London, were looking at the difference in osteoporosis between the two groups and the rate of osteoarthritis (wear and tear on the joints). The former athletes had 15 per cent stronger bones than the other women but a greater risk of osteoarthritis. Clearly the answer is to find forms of exercise that put demands on the bones but avoid too much pressure on joints. The recommendation of the St Thomas’s team was that we should have an hour’s weight-bearing exercise a week, or two hours of walking spread out over a week if we don’t want to go to the gym. The researchers felt there were benefits from short bursts of activity, such as running for ten minutes, as long as it was done every day.
Because our lifestyles have changed we need to make an effort to get enough of the right kind of exercise. In my mother’s generation, exercise came naturally as part of the everyday routine. Both my father and mother would walk a few miles to work and back each day. After my sister and I were born, my mother would walk to get fresh vegetables and groceries each day and carry them back. Washing was done weekly by hand and involved a lot of scrubbing and wringing out of clothes (strengthening the back and the wrists). Every job required more effort and was physically demanding. What do I do? I put the family’s clothes in the washing machine, turn it on and then take the clothes out. I drive the car to the shops once a week to pick up the shopping. In order for me to keep active, exercise needs to be a conscious part of my life. I deliberately choose to walk up stairs instead of taking the lift, I walk up escalators, I run up the stairs at home, I park the car further away from the shops and have to walk (except when doing the weekly shop!). None of us would want to go back to the days when the household jobs took so much more hard physical effort, but we have to find some way of making up for the lack of everyday exercise in our lives.
Exercise isn’t just important for our bone health. It also helps keep our reflexes sharp and improves our coordination. Many fractures happen because someone falls or misses a step. If you keep yourself flexible, have good reflexes and coordination, you may save yourself falling in the first place. As we get older our range of movement becomes limited unless we make the effort through exercise to maintain it. Exercise also helps build up our muscles – and strong muscles act as the first line of defence when we have an accident, shielding our bones from the impact.
*77/101/5*

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HEALTHY KIDNEYS: SALT AND SALT-FREE DIETS
If it were possible to list the more important ingredients in the body, certainly water would come first and probably salt second. Salt is so easy for us to get in this part of the world that we ignore it, but that is not so everywhere. I heard a young man tell of his experiences as an airplane observer in India, near the Himalayas. The local chieftain had no use for money, but the United States Air Force paid rent to him in salt. Some of the Roman legions took part of their pay in salt (sal, Latin for salt), that is why the white-collar worker is said to receive a salary.
The amount of salt that a normal healthy individual eats varies with his taste, and it seems perfectly safe to regulate it in this way when things are going along well. Dr. Oliver Wendell Holmes has been quoted, possibly apocryphally as wanting enough food on his salt to give it a flavor. In extremely hot weather or in places such as foundries it is advisable to take large amounts of salt to compensate for that lost in sweat. All the bodily excretions have much salt.
It has long been known that persons with dropsy, that is, swelling of the body with fluid, resulting from certain diseases of the kidneys or heart, cannot excrete enough sodium chloride. Therefore, salt-free diets have been used. One of the best known has been the rice diet. As this consists practically of rice, fruit, and sugar, it soon becomes monotonous to the point of disgust.
A friend told a story illustrating the difficulty of keeping a patient on a salt-free diet. At his place on Charlestown Pond he was visited one day by an elderly friend, accompanied by a trained nurse. After a bit the visitor prevailed on the nurse to let him gently paddle a skiff about in the shallow water. Soon the host noticed that the boat had drifted over to some rocks where the occupant seemed to find much of interest. There were oysters clinging here and there, and under the eyes of the unsuspecting nurse he was enjoying the most delicious salty snack that he had had in months.
In dropsy it is the sodium that is preventing the excretion of fluid. Of course the largest amount of sodium is in salt but many foods have some and other interesting parts of the ordinary diet are free of it. It also should be noted that potassium seems to favor the excretion of fluid as sodium inhibits it. Incidentally this is the first suggestion of an argument I have ever heard for the hard red corned beef prepared with saltpeter that is potassium nitrate, which has replaced the lovely brown succulent beef treated with common salt in better days.
The taking of a sodium-free diet is not simple, and not everybody with kidney or heart disease or high blood pressure is necessarily a candidate for this treatment. Nor is it a panacea; digitalis or drugs to promote the flow of urine are still valuable. In the last century and occasionally in this, patients with great accumulations of fluid in the tissues have been treated with Southey’s tubes. These are lovely little silver pipes stuck through the skin into the water-logged tissues. Perhaps Dr. Southey drove through the mountains in the days of horse and carriage when leisurely progress allowed an opportunity to observe the sides of the road. One might see a pipe stuck into the hillside and a steady stream of water flowing from it. In the same way actually gallons of fluid might pour from Southey’s tubes, relieving the kidneys of this work and certainly giving the patient great relief – temporarily at least.
*39/276/5*

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Other names: Abilify

EVENING PRIMROSE OIL IN THE TREATMENT OF SCHIZOPHRENIA
There was recently a double-blind trial on Efamol on abnormal movements, psychiatric status and memory on patients with tardive dyskinesia, which showed that evening primrose oil produced significant results in certain aspects of schizophrenia. Memory, and total psychopathology scores improved significantly, and there was a marginal improvement on involuntary abnormal movements.
Tardive dyskinesia (involuntary abnormal movements). Up to 60% of patients on neuroleptic drugs suffer from motor disorders such as tardive dyskinesia as a side-effect. These involuntary abnormal movements are severely disabling and intractable.
In a preliminary study by Dr Vaddadi, it was noticed that there was a sudden reduction in these involuntary movements in some of his schizophrenic patients while they were being treated with evening primrose oil and penicillin. These early findings have been backed up by further studies.
The success of Dr Vaddadi’s work led to a full-scale double-blind trial involving several centres1: the Department of Psychiatry at Crawley Hospital, West Sussex, St George’s Hospital Medical School, London, the Department of Psychology, Middle East Technical University, Ankara, Turkey, and the Efamol Research Institute in Kentville, Nova Scotia, Canada. As well as researching the effects of evening primrose oil on tardive dyskinesia, they also looked at the oil’s effects on psychiatric status, and on memory.
The trial involved 48 psychiatric patients with established movement disorders who had been on neuroleptic drugs over a long period of time. Thirty-nine of these patients were schizophrenic, four manic-depressive, and three had personality disorders. All of them had involuntary abnormal movements of at least mild severity. Patients were kept on their existing medication, and were matched against controls.
The patients were given either Efamol, or a placebo, for 16 weeks. The dose was 12 capsules of Efamol (or a placebo) divided up over the day. At the end of the 16 week period, there was a cross-over, so that the patients who had been on the Efamol received the placebo instead, and vice versa.
Assessments were made at the beginning of the trial and then at two-weekly intervals throughout the trial. Blood samples were also collected and analyzed.
The results of these blood tests showed that all psychiatric patients had below-normal levels of essential fatty acids. Patients with severe tardive dyskinesia had the lowest levels – significantly lower than both the patients without any movement disorder, and also those with only mild movement disorder.
This shows that there is an association between low levels of essential fatty acids, and the presence and severity of tardive dyskinesia. There is also a close association between low levels of essential fatty acids and psychosis. Giving supplements of essential fatty acids to these patients produced a move towards normal in their red cell membranes, but they did not reach normal levels.
The overall results of this trial on tardive dyskinesia showed a small but significant improvement with Efamol. However, this study on human psychiatric patients was not as convincing as previous animal experiments which had shown that essential fatty acids do have a noticeable effect on abnormal movements.
Perhaps the reason why this trial had slightly disappointing results was because there are irreversible structural changes to the brain in patients with severe and prolonged movement disorders; perhaps the dose was too low and the treatment period too short. There may also be a problem with absorbing essential fatty acids; it probably takes much longer to correct abnormal levels of essential fatty acids in the brain, than in red blood cells. Further research is planned to see whether the results could be more positive with a higher dose over a longer treatment period.
Even though the results of this trial were only marginally significant for the role of evening primrose oil in tardive dyskinesia, it is still worthwhile giving supplements of evening primrose oil, together with neuroleptic drugs, in the prevention and management of this disease.
Memory and psychiatric status. The effect of Efamol as an antipsychotic and as an improver of memory in tests was much more pronounced than its effects on tardive dyskinesia.
There was a mean improvement of 20% to 30% in the psychopathology scores at the end of the treatment with evening primrose oil. This improvement occurred in chronic patients with schizophrenia for whom orthodox neuroleptic therapy had little to offer. This related especially to the ‘negative’ symptoms of schizophrenia, such as ‘flat’ emotions and social withdrawal.
With memory, there was a clear deterioration when patients switched from active treatment to placebo. Other studies have shown that Efamol improves cerebral function to a significantly greater degree than a placebo.
*39/60/5*

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Other names: Apri

HEART AT MENOPAUSE: STUDIES AND RESEARCHES
Just where did the idea come from that HRT (Hormone Replacement Therapy) could prevent heart problems? The history of this rather dubious claim, which is incessantly repeated in media reports on the benefits of HRT, illustrates only too well an old adage of Winston Churchill’s that there are lies, damn lies and then there are statistics. The study that started all this off was reported in the New England Journal of Medicine in 1985, with a follow-up in 1991. It looked at data received from questionnaires sent out to 121,700 nurses every two years over a period often years. Eventually the study was reduced to 48,470 post-menopausal women. Every two years the questionnaires were sent out, and the nurses filled in the details of their food and alcohol intake over that two-year period. This required a great deal of motivation from the nurses to keep accurate records over such a long time.
More to the point was the way the research programme was structured. Normally one group of women is randomly split into two groups; one group would be given HRT and the other a placebo (dummy pill). Then the women’s progress would be followed over a number of years to study the comparative risk of heart disease. But this is not what happened with the nurses’ study. There was no random selection of the groups in this case. One group was selected because they were already taking HRT and the other group was selected because they were not taking HRT.
It is very likely that those nurses who were at ‘high risk’, who had a history of heart disease or knew it was in their family would probably not have been prescribed HRT in the first place. The researchers actually found that in the group not on HRT there were 29.5 per cent more cigarette smokers and 29.6 per cent more diabetics, who could be assumed to be at a higher risk of heart attacks anyway. So there was what researchers call a ’selection bias’. The results came out indicating that women on HRT had a lower risk of heart disease. In this experiment it is likely only the healthiest nurses with a low risk of heart disease would be in the group taking HRT. Those at a higher risk of heart attack would, by definition, not be taking HRT. This is not the same thing as demonstrating that HRT protects against heart disease. Not by a long way. But it is the simplistic message that makes the headlines. And the HRT industry is only too happy to reinforce it.
So we can’t draw any firm conclusions from this study at all. Nor from the results of other US studies which appear to show that women on HRT have a lower risk of heart disease. In the States, the women who take HRT arc usually middle class, health conscious and comfortably off. They are likely to have less heart disease anyway. In fact in the very same issue of the New England Journal of Medicine which featured the nurses’ study mentioned above were details of another study showing that use of oestrogen substantially increased both heart disease and strokes,” and a review of a number of separate studies in The Lancet in 1991 concluded that the evidence for the preventative role of HRT in heart disease was either biased or insubstantial.
It also emerged that of the 48,470 menopausal women taking part in the study only 112 died of heart disease. That was 0.2 per cent of the total – far too small a sample to yield any worthwhile conclusions as to the preventative effect of HRT. Yet it was claimed that taking oestrogen had more than halved the risk of dying from heart disease. In fact nine out often of the nurses who died during the study succumbed to something other than heart disease.
This then is the basis of the claim, endorsed by some authorities in this country over the last few years, that taking HRT might reduce heart disease by 50 per cent. Amazingly, this claim became common currency, despite the fact that up to 1991 published results of research (done mostly in America) were based on oestrogen only (unopposed HRT). From 1975 onwards, with the scare about womb cancer, women in the UK have been given oestrogen plus progestogen (opposed HRT). Nowadays opposed HRT is the most commonly prescribed form of HRT. Until the results of a follow-up survey were completed in 1992 and not published until the summer of 1996 no one knew what the impact of added progestogen would be. Yet the confident message broadcast for years before was that HRT could prevent heart disease. Here is the conclusion of the published results: ‘The addition of progestogen does not appear to attenuate the cardio-protective effects of post-menopausal oestrogen therapy.’ In plain English it is saying that adding progestogen to the oestrogen does not appear to weaken the protective effects the oestrogen has on the heart. But as we have seen from the above, it is far from conclusive that oestrogen has any such protective effects. In fact, there are studies which show the reverse is true. A letter published in the New England Journal of Medicine in 1992 cited sixteen references which negated the claim that oestrogen can be protective against cardiovascular disease.
*74/101/5*

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ENERGY NEEDS OF THE BODY: VOLUNTARY ACTIVITY
Our daily work may well vary from sitting at a desk to bedside nursing, active housework, or hard manual labor. In our leisure time we might choose to watch television, take a leisurely walk, or go swimming or dancing. The kind of physical activity in which we engage, and the amounts of time spent in each activity, determine the amount of energy the body uses. It is difficult to assign exact values to any activity because individuals vary widely in the efficiency with which they use their bodies. One can readily see why a typist, classed as sedentary, requires fewer calories than the moderately active home-maker who might be doing some gardening in addition to her housework.
Mental effort, as in studying, is a sedentary activity and the effort expended in solving a paper problem requires little caloric expenditure. If you arc studying and nibbling foods all the while, it is certain that you are consuming far more calories than are needed for your mental effort. Of course, if you are tense or move about quite a bit while you study, this would have some effect on increasing your caloric need.
*39/234/5*

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Other names: Mycelex-G

OSTEOPOROSIS AND THE MENOPAUSE
The popular theory is that women are at risk of developing brittle bones at the menopause because of lower oestrogen levels. Oestrogen, it is true, helps stimulate the liver to produce a protein which protects the bones against the harmful dissolving effects of adrenaline. But it’s clear that this is not the whole picture. If the oestrogen theory is correct, why do men, who have relatively small amounts of oestrogen in their bodies all their lives, not suffer more from osteoporosis than women? Men tend to have only a fraction of the bone density loss experienced by women. In tests it has been found that the male hormone testosterone triggers the bone-building osteoblasts, and this is accompanied by higher levels of the enzyme alkaline phosphatase which helps to form calcium crystals in the bone. As we reach the menopause, and our ovaries reduce their production of oestrogen, we then have proportionately more testosterone circulating in our system. It is possible that if we are in optimum health, our bodies provide fail-safe mechanisms to take over as one set of hormones reduces.
And bone density loss in women is not universal. Research has demonstrated that Asian and Caucasian women are more likely to suffer bone loss than African women, for instance. In Singapore more men than women get osteoporosis, while in Hong Kong they seem to be equally susceptible. And why does bone mass start to decline when we are in our thirties when oestrogen levels should still be high? Research demonstrates that bone loss starts well before the menopause and before any decreases in oestrogen levels. The anti-oestrogen drug Tamoxifen is given to women at risk of breast cancer. If lack of oestrogen is the prime cause of osteoporosis, it would be logical to expect that Tamoxifen would cause bone loss. But this does not seem to be a side effect.
A few years ago there was a fascinating article in The Lancet medical journal about tests done on eighteenth-century human bones discovered during the restoration of a London church.2 The rate of bone loss in modem women, both pre- and post-menopause was found to be far higher than that apparently experienced by our ancestors. All this suggests that oestrogen levels are not the only, nor the most important, factor in bone loss. It seems to indicate that differences in lifestyles, what we eat – or what we don’t eat – are a crucial element in the complex process of bone manufacture. This means that serious bone loss is not an inevitable part of the menopause, although the menopause may accelerate it. It is something that we ourselves can take positive action about without resorting to very powerful hormone drugs through fear. But first we need to understand a little more about what is going on.
*68/101/5*

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Other names: Prometrium
EXERCISE AT MENOPAUSE: WHAT KIND OF EXERCISE?
You need weight-building exercise for the bones, aerobic exercise for your heart and circulation and some kind of stretching exercise to keep you flexible and poised. My time is very limited so I have chosen a variety of exercises to give me all-round benefits. Some I can do at home and some I need to plan. I mix walking, running up the stairs, yoga, exercises from a video and a visit to my local leisure centre which has a gym. That way I get all the different kinds of exercise my body needs.
Many years ago I was taught a series of yoga movements called the Sun Salutation and they have stayed with me ever since. The Sun Salutation is taught as an exercise to start the day but you can do it at other times. I like it because there is a definite start and finish and also because of the variety of movements it offers in one simple sequence. The benefits are many, including posture, deep breathing, spine stretching, improved flexibility, increased circulation and relaxation.
Swimming is not weight-bearing. But if you enjoy it you should do it to increase stamina, improve your cardiovascular health and get a good stretch. There may be an aqua aerobics class at your local pool. That is an excellent way to get cardiovascular exercise and tone your muscles without putting pressure on your joints. And if you are on the plump side you will be more adept at it than thinner women whose lack of body fat means it is harder for them to float.
As with food you should try to introduce variety so that your body gets all the different kinds of exercise it needs. Start with thirty minutes of exercise once a week and gradually build up to one hour, three times per week, of various kinds of exercise. Whatever you do, be sure to first warm up properly by doing some stretching exercises. This reduces the risk of injury to your muscles and joints. If you join an exercise class, make sure the instructor is properly trained and that he or she teaches to do the exercises in the right way. It is all too easy to damage your back by pulling on the wrong muscles.
Because of limited time and wanting to fit in exercise whenever I can I have used an exercise video at home. There are some excellent exercise videos on the market, but also be aware that some should be treated with caution. I have found the videos by an American called Katy Smith to be particularly useful. These have a number of sections and I find that if I only have fifteen minutes to spare I can choose a complete section to follow.
Exercises for your breasts
Women’s Health1. Stand 60cm (2ft) away from a wall and place your hands flat against it, 30cm (1ft) wider than your shoulders. Breathe in, bend your elbows and lean towards the wall. Try to touch the wall with your nose, keeping your back flat and your legs straight as if you were doing a vertical press-up. Hold for a few seconds, then press away. Repeat five times.
2. Bend your elbows and press your palms together as if in a prayer position but with your elbows sticking out. Press your palms together as firmly as possible. Hold for a few seconds and then relax. Repeat five times.
*82/101/13*

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NATURAL ALTERNATIVES TO HRT FOR MENOPAUSAL SYNDROMS: MEMORY/CONCENTRATION
Poor memory, lack of concentration, impaired hearing and ringing in the ears are often caused by an obstructed blood supply to the brain. But this may be a problem to do with age rather than hormones. Our brain’s ‘food’ is the oxygen supplied by the blood. Logically, we can see that if the blood supply is deficient, our mental function can be impaired. Brain cells alone account for 25 per cent of the body’s total oxygen consumption. As we age we can also experience dizzy spells, as well as cold hands and feet, often a result of poor blood circulation.
With memory, as with the sexual side of our lives, it can be a case of Ђuse it or lose it’. It is important that you keep mentally active. Our brains have been likened to a container or pot which we can never fill up. It is similar to our muscles. If we were bedridden for a number of months without using our muscles, we would find it very difficult to walk when we finally got up and tried. It has been suggested that we use only about 10 per cent of our brain capacity. The more we use our brains, the more interconnections we make and the easier it is to remember and concentrate.
Nutritional therapy
Hardening of the arteries can be the cause of this reduced blood supply to the brain, so it is important that we keep the saturated fat content of our diet low. This hardening (arteriosclerosis) is caused by an accumulation of fats and the build-up of cholesterol in the arteries which causes them to narrow and so restrict blood flow. The process is similar to the furring-up of a pipe, with the opening becoming smaller and smaller as the deposits increase. Eat well as for the menopause and include plenty of fresh fruit and vegetables in your diet. Take:
Vitamin Ў – 1 000 mg twice per day
Vitamin B6 – 50mg per day
Vitamin E – 300ius once per day
Magnesium – 300mg per day
Selenium – 25mg per day.
Herbs
Ginkgo biloba tree leaf extract is now believed to have a rejuvenating effect on the brain. Several clinical trials have shown that it helps improve learning ability, concentration and memory. An article in The Lancet concluded that ginkgo biloba:
Ђў improves blood flow to the head
Ђў increases the supply of glucose and oxygen which the brain needs to create energy
Ђў prevents blood clots
Ђў protects the brain cells against damage
*60/101/5*

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Other names: Emulgel, Voltaren Xr, Voltarol

MIGRAINE HEADACHES: EVENTS AND CIRCUMSTANCES THAT TRIGGER AN ATTACK-HORMONES, HORMONAL CHANGES, AND PREGNANCY
Many women appear to experience migraine more intensely at times of hormonal
changeЂ”menstruation, ovulation, menopause, or at the beginning or just following pregnancy. It is known that female hormones, either those occurring naturally (endogenous) or those ingested (exogenous), have emotional as well as biological influences upon the body, and about half of the women patients who have migraine believe that their attacks occur most frequently just
before, during, or soon after their menstrual period.
Most women with migraine who take birth control pills or other female hormone preparations experience more frequent and more painful attacks of longer duration. When these agents are withdrawn, there is often a dramatic improvement in the patient’s condition. Occasionally women will experience an ameliorating effect from these drugs.
It is our opinion that women with migraine, particularly the classical form, should not use birth control pills or other female hormone preparations unless there is an extraordinary medical reason to do so. Stroke and other serious illnesses occur more frequently when these substances are taken. Accumulating evidence suggests that the inconvenience encountered by not taking the pill may be worthwhile. When advised to discontinue birth control pills, some of our patients state that this action will succeed only in creating one “headache” in place of another!
Pain Relief/Muscle Relaxant
Women’s Health
Healthy Bones There is an urgent need for additional scientific evidence regarding these issues. Learning a way to determine in advance which people are most apt to develop serious complications is particularly important, and until the evidence for or against the use of these hormones is conclusive, restraint is essential.
Pregnancy has a varying effect on migraine headache. There is a good chance that preexisting migraine will markedly improve after the first three months of pregnancy but return soon after delivery. However, some women with preexisting migraine experience a worsening throughout pregnancy, and still others say that at delivery, or the days immediately following delivery, their migraines first began.
*22/88/2*

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ALTERNATIVES TO HRT FOR MENOPAUSAL SYNDROMS: STRESS INCONTINENCE
Stress incontinence is the leaking of a small amount of urine when you laugh, cough or sneeze. It can be embarrassing and inconvenient and women often don’t want to tell even their doctors about it. It is thought to be linked to the menopause because oestrogen helps to keep the sphincter muscle at the base of the bladder tight. As oestrogen declines, the muscle can become weak.
Kegel exercises can strengthen the pelvic muscles including those of the vagina. These exercises can be done at any time because nobody knows you are doing them. All you do is draw the vaginal muscles firmly inwards and upwards, hold for a count of five and then relax. These are the same muscles that you would use to stop the flow of urine in midstream, when you have to give a sample. You may remember being urged to do these pelvic floor exercises when you were expecting a baby. They should be a part of every woman’s exercise programme, whatever her age. If stress incontinence becomes a real problem and you have tried a number of complementary practices including acupuncture to no avail, there are cones available on the market which can be inserted in the vagina to help strengthen the muscles.
Nutritional therapy
Eat well and follow the recommendations on nutrition so that you are making the most of your own circulating oestrogen to keep the muscles taut.
Vitamin Ў is important in stress incontinence because its major function is to produce collagen. Collagen is the most abundant protein in the body and gives strength to tissues. Take:
Vitamin Ў Ђ“ l000 mg three times per day
Herbs
Herbs for stress incontinence focus on strengthening the kidneys and include dandelion root, rehmannia, chickweed, marshmallow, ginkgo, astralagus and urva ursi.
*65/101/5*

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SEX AT THE MENOPAUSE: CONTRACEPTION, VAGINAL DRYNESS, SEXUAL SATISFACTION
Contraception
As a rule of thumb you should wait for two clear period-free years before abandoning contraception if your menopause starts before the age of fifty. If you were over fifty when it started, a year free of periods is considered safe.
Vaginal dryness
As well as the Kegel exercises and the vitamin E supplementation I have already recommended there are some lubricants available. One good one is a US product called Astroglide. It’s a gel that closely resembles our own body’s lubricant and is mildly acidic like our own secretions. Many vaginal lubricants sold over the counter alter the balance of the bacteria in the vagina designed to protect us from infection. But Astroglide, which is available in the UK, is water-soluble, non-hormonal and safe to use with condoms if you are still having periods and need a contraceptive.
Sexual satisfaction
There is no reason why sex should not be as satisfying now as at any other time of your life. And several good reasons why it should actually be better. Women have always taken longer to become aroused than men and when we are young the difference can be quite striking. A man in his twenties can achieve orgasm within two to five minutes whereas his partner may take twenty minutes. As a man gets older he needs longer to reach an orgasm, so the timing, in theory, becomes more compatible. Sex can take longer and intercourse may not necessarily be the main focus. You may have sex less often than in your twenties but it can be a deeper, more satisfying experience. The truth is that the ageing process has an effect on both men and women – and the so-called ‘male menopause’ may pose much more of a real problem in sexual terms for your partner. Women may worry about their attractiveness but many middle-aged men become very concerned about their sexual performance. Both partners may need to make adjustments at the menopause. Communication and honesty is the key and can prevent misunderstandings and resentment building up between you and your partner. By communicating honestly about what we like and don’t like, changing positions if one we have always used makes us uncomfortable, and taking the steps recommended to counteract any physical changes there is no reason why sex should not continue to be thoroughly enjoyable.
The biggest sexual problem for many women has nothing to do with hormones, vaginal dryness or anything else that can be explained medically. It is boredom. Many women have stayed in a relationship for the sake of their children. Other couples are happy enough but find that passion and excitement has just fizzled out. A patient once said to me that HRT was wonderful. Not Hormone Replacement Therapy, she said, but Husband Replacement Therapy. Once the children have grown up and left home a couple may find they just don’t have very much in common any more. This can expose weaknesses in a relationship. This is one reason why women feel they have reached an important turning point in their lives. Even if they are happy in a relationship they are conscious of the fact that they have put their children and husbands first for as far back as they can remember.
*84/101/5*

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THE RETURN OF INFECTIOUS DISEASE: POOR NUTRITION AND THE RISK OF INFECTION
Similarly, we are rapidly coming full circle in regard to the provision of food. It is clear that the reaction to an infectious disease is in large part determined by an individual’s overall state of health. The nutritional condition of a person at the time of exposure to an infectious disease is a key factor in his or her resistance to it.
According to the World Health Organisation, one-half to three-quarters of all statistically recorded deaths of infants and young children are attributed to a combination of malnutrition and infection. Don’t our children have enough to eat, you may ask? One can understand why the poor and hungry of other countries can succumb to infectious disease, but surely not American and Australian children?
Men’s Health
Women’s HealthTo preserve foods for the shelves of our supermarkets, we usually add something to them (i.e. chemical preservatives); or we take something out of them which is likely to spoil (i.e. wheatgerm oil in the processing of flour); or we precook or freeze them, thereby also diminishing their nutritional value. There are also more and more foods on the supermarket shelves which are less and less worth eating in the sense that they have little, if any, nutritional value. Randomly pick up a packet from the shelves to read the ingredients and you are almost certain to find that the number of artificial (i.e. chemical) additives outnumber the wholefood constituents of the product. The worse our diet, the more susceptible to disease we become.
Obviously, the destitute and homeless males of our society are far worse off in this regard than we are, so they are more likely to become more vulnerable to infectious disease. Make no mistake, however. Their problems are our problems. In the end, infectious diseases, and especially tuberculosis, will have no respect for class barriers, therefore we need to have respect for the health of people of every class.
*31/107/2*

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BREAST AT MENOPAUSE: BENEFITS AND RISKS OF MAMMOGRAPHY
A mammogram is a breast X-ray and although it is commonly recommended to detect breast cancer it has its negative side. First, X-rays can cause breast cancer, so ironically you could be exposing yourself to a test that can trigger the disease it is supposed to be detecting. Second, mammography can result in false readings. These false-positives mean women may be recalled to have another mammogram and another dose of X-rays, not to mention the emotional stress and anxiety the diagnosis causes.
There have been warnings about mammograms since the early 1980s when the late Dr Robert Mendelsohn published a book, Male Practice, How Doctors Manipulate Women. He warned that annual screening of women who had no symptoms might well produce more cancer than it detects. This unfortunately was borne out quite dramatically in a Canadian study in 1989 where the National Breast Screening Trial examined more than 89,000 women between the ages of forty and forty-nine over an eight-year period. Half the women in the group received mammograms every year. The researchers found that these women had a significantly higher death rate than those in the other half of the group, who had not been given a mammogram. The women who had the mammograms had a 52 per cent increase in deaths from breast cancer.
The excellent regular publication What Doctors Don’t Tell You (WDDTY) has published a guide to women’s screening tests which has a very informative section on mammograms. It suggests that if you decide to have a mammogram you should do some homework. It gives a four-point check list:
1. Is the equipment used specifically designed for mammograms? This is important because it means the equipment can give the best image with the least radiation.
2. How many mammograms are done at this facility? WDDTY quotes the American College of Radiology which recommends going to a lab or hospital where each radiologist reads at least ten mammograms a week. Obviously this will reduce the number of false readings.
3. When was the machine last inspected and calibrated to check it is giving out the intended dose of radiation? It should be checked once a year.
4. How old is the equipment?
Other safer tests in the pipeline are the transillumination test with infrared light scanning where a light is shone on the breast and lumps show up by blocking the light. The antimalignane antibody serum (AMAS) test measures serum levels of AMA, an antibody found in higher amounts in most patients in the early stages of active non-terminal malignancies.
*71/101/5*