MENOPAUSE PATHOGENESIS: Menstruation is a normal, natural shedding process of the uterine lining that occurs monthly in all healthy

adult women after puberty. The parts of the body involved in the menstrual cycle include the brain, uterus, cervix, ovaries, fallopian tubes, and vagina. The ovaries are glands that produce certain hormones and contain tissue sacs in which eggs develop. In response to hormones from the brain an egg in one of the ovaries matures and travels through the fallopian tube to the uterus. If the egg is not fertilized by a sperm, the thickened lining of the uterus consisting of blood-filled uterine tissue is shed. This cycle happens every month. Menopause is the natural cessation of this cycle when the ovaries stop making hormones called estrogen. This typically occurs in women between the ages of 45 and 60. Menopause is based on the natural or surgical cessation of estradiol and progesterone production by the ovaries, which are a part of the body's endocrine system of hormone production, in this case the hormones which make reproduction possible and influence sexual behavior. After menopause, estrogen continues to be produced in other tissues, notably the ovaries, but also in bone, blood vessels and even in the brain. However the dramatic fall in circulating estradiol levels at menopause impacts many tissues, from brain to skin. In contrast to the sudden fall in estradiol during menopause, the levels of total and free testosterone, as well as dehydroepiandrosterone sulfate (DHEAS) and androstenedione appear to decline more or less steadily with age. An effect of natural menopause on circulating androgen levels has not been observed. Thus specific tissue effects of natural menopause cannot be attributed to loss of androgenic hormone production. Frequently menopause is characterized by hot flashes, sudden intense waves of heat and sweating. In the long term, some women experience problems linked to the low levels of estrogen found after menopause. These may include osteoporosis, increased risk for heart disease, mood changes and depression. Hormone Replacement Therapy - HRT is a treatment for these symptoms of menopause. As the name suggests, it 'puts back' some of the hormones that the ovaries have stopped producing. HRT can be administered in the form of pills, patches, gels, or implants and is individualized for each woman in consultation with her physician.

SIGNS AND SYMPTOMS: 1. Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling (related to increased activity in the autonomic / sympathetic nervous system). Without becoming too, technical, messages are sent to the hypothalamus because of declining estrogen production via neurons which result in vasodilation -- widening of the lumen of blood vessels (lumen being the cavity of a tubular organ, i.e., the lumen of a blood vessel,) which, in turn, causes flushing or hot flashes. 2. Bouts of rapid heartbeat (related to increased activity in the autonomic / sympathetic nervous system). Along with rapid heartbeat (palpitations), women can experience skipped heartbeats, irregular heartbeats. These are generally normal vasomotor responses experienced during menopause usually due to fluctuating hormone levels. However, if these problems continue, it's always a good idea to be checked by your health care practitioner. An echocardiogram is a common procedure to tell the doctor what he needs to know about your heart. 3. Heart Palpitations Some occasional heart palpitations or irregular beats can be normal during the time around menopause. But if they are happening frequently, or are accompanied with trouble breathing, fainting, chest pain, anxiety, or nausea they could be signs of heart disease or a heart attack. 4. Irritability Along with irritability, a host of "anger" problems can develop during menopause. Just as a perimenopausal woman can find herself suddenly crying for no apparent reason or provocation, so can she find herself reacting to given situations in an angrier manner than she normally does. This anger can sometimes feel like "rage." Again, this is hormone-induced, but for some women, the anger can become inappropriate and a woman can feel like she's out of control. 5. Mood swings Mood swings can include anything from mood shifts (happy one moment, depressed the next) to sudden bouts of crying when nothing overt has occurred to cause the crying. Mood swings can and have been misdiagnosed as bipolar disorder because one can feel such extremes of emotions due to hormone imbalance. Anxiety, depression, panic attacks and even feelings of

agoraphobia aren't uncommon during menopause. The panic attacks often can develop with the onset of hot flashes. For some women, hot flashes can be severe and quite frightening. 6. Insomnia Many women report a greater tendency to be wakeful. Sometimes this is due to night sweats and sometimes due to neurological excitability, both of which are more common during menopause. Once awake, they find it difficult to go back to sleep and can suffer from sleep deprivation as a result. 7. Irregular periods Characterized as shorter, lighter or heavier periods, flooding, and phantom periods. A phantom period is when you experience all the symptoms you're accustomed to having before you menstruate -- but... no period comes. This is a common experience during perimenopause before a woman's period actually stops. 8. Decreased libido (sex drive) Not every woman loses her libido entirely during perimenopause, although some may temporarily. Many women simply have a decreased interest in sex - often it's simply because they generally don't feel well and sex is the last thing on their mind. Also, bear in mind that there are many medications that can affect one's libido, including the anti-depressants some women take to cope with the depression and anxiety associated with menopause to anti-hypertensives. 9. Vaginal Dryness & Urinary Problems (results in painful intercourse) this symptom is also one for which women seek help. As estrogen is less available, the walls of the bladder, urethra and vagina become drier and less flexible. This makes the tissue more easily damaged and more prone to infections. 10. Fatigue Some women experience a profound fatigue during the menopause. It is usually temporary and is your bodys adjustment to lower estrogen. If it prevents you from doing your daily activities, or if it lasts more than two months, see a health care provider to rule out other causes of fatigue 11. Difficulty concentrating, disorientation, & mental confusion. Forgetfulness during perimenopause is often referred to lightly and humorously as "brain fog" but it's not always funny. 12. Incontinence

Especially upon sneezing, laughing: urge incontinence (reflects a general loss of smooth muscle tone). 13. Itchy, crawly skin (feeling of ants crawling under the skin, not just dry, itchy skin. The feeling of ants crawling on your skin is called "formication") 14. Aching, sore joints, muscles and tendons (may include such problems as carpal tunnel syndrome). Note: Osteoarthritis can develop during perimenopause - and those with existing arthritic and/or rheumatic pain may find it's exacerbated during the menopausal transition. 15. Increased tension in muscles 16. Breast tenderness Breast swelling, soreness, pain. 17. Headache change: increase or decrease. Many women develop migraine headaches during perimenopause. However, if one doesn't have a history of migraine headaches, they're generally a short-lived experience of perimenopause. 18. Gastrointestinal distress, indigestion, flatulence, gas pain, nausea For nausea, try some ginger or, boiling hot water with a few teaspoons of lemon or lemon juice concentrate in it. Many women also develop acid reflux (GERD). For some, it can be an uncomfortable feeling of severe burning sensations in the throat. If it persists, see your health care practitioner. 19. Sudden bouts of bloat Bloating, water retention are common complaints during perimenopause. Also, Acid reflux and heartburn are very common during perimenopause. 20. Depression (Has a quality from other depression, the inability to cope is overwhelming, there is a feeling of a loss of self. Natural hormone therapy, ameliorates the depression dramatically). Menopause is a time of changing moods and grief over lifes losses. If you are finding yourself sad most of the time, or if you feel hopeless, irritable, have lost pleasure in things you used to enjoy or think about dying or hurting yourself, make an appointment to see whether you are

clinically depressed. Some treatments for depression are also effective for other menopausal symptoms. 21. Increase in allergies Many women who suffer from allergies develop worse allergies during the menopausal years. Many women who've never had allergy or respiratory problems may develop them for the first time. Many people don't realize that histamine levels are affected by hormone levels. Women can develop wheezing, coughing and a host of respiratory problems. This generally disappears as the hormones level out once a woman becomes menopausal. 22. Weight gain (is often around the waist and thighs, resulting in "the disappearing waistline" and changes in body shape.) Your metabolism will slow with age, and weight gain is common in menopause. The combination of changing patterns of fat deposit, less muscle mass and a slower metabolism can give you a larger abdomen and flabby arms and legs that send you off to the gym for help. 23. Hair loss or thinning: head or whole body, increase in facial hair There is often a loss of pubic hair during menopause. Many women are more comfortable simply shaving their pubic area instead of having patches of hair. 24. Changes in body odor 25. Electric shock sensation under the skin & in the head ("take the feeling of a rubber band snapping against the skin, multiply it (exponentially, sometimes) radiate it & put it in the layer of tissues between skin & muscle & sometimes a precursor to a hot flash.")Those buzzing sensations, as though you've put your finger into a live electrical socket, can be frightening. They're all part of the hormones, nerve endings and electrical waves running through our bodies when our hormones are constantly fluctuating. Many women experience this during perimenopause, but it eventually passes. 26. Tingling in the extremities (can also be a symptom of B-12 deficiency, diabetes, or from an alteration in the flexibility of blood vessels in the extremities.) 27. Osteoporosis (after several years) 28. Brittle fingernails, which peel & break easily 29. Dry skin / skin changes 30. Dizziness

31. Ringing in the ears TREATMENT: NUTRITIONAL SUPPLEMENTS AND DRUGS FOR MENOPAUSE 1. Vitamin A needed for a healthy immune system but a lack of it is unlikely to affect most healthy menopausal women. However it is one of the Vitamins that can be harmful in excess doses especially in women of childbearing age. 2. B Vitamins During the menopausal years, the B vitamins are especially important. According to a study conducted at the Bastyr Center for Natural Health in 2003, folic acid may even act as a hormone replacement alternative and can help prevent changes in the cervix that may precede cancer. The B vitamins work together to maintain liver health, balance brain functions, and eliminate stress and depression. Consuming adequate amounts of vegetables, nuts, and grains can provide beneficial amounts of the B vitamins. Since hot flashes can deplete the body of these necessary vitamins, taking a sublingual B complex may also be necessary. 3. Vitamin C. Deficiency of Vitamin C is unlikely in a balanced diet containing fruit and vegetables. It is more likely in smokers and those not eating fresh produce. Some believe that it can fight off colds and flu in high doses. It works as an anti-oxidant. 4. Vitamin D is required to maintain bone health. It helps the body absorb calcium and is made in the skin due to sunlight action. Lack of sunlight due to poor climate, people being housebound, or being covered up when outside, often leads to lack of vitamin D, particularly in the elderly. Dietary sources include oily fish, dairy products and margarine and 2 main course portions of oily fish per week are recommended. 5. Vitamin E According to Dr. Gary Null the production of certain brain hormones such as FSH (follicle stimulating hormone) and LH (luteinizing hormone) are promoted by consuming vitamin E. Both are secreted by the pituitary gland and regulate ovulation processes. These hormones are also vital preventatives of hot flashes. Vaginal dryness can be reduced with

vitamin E, as well. Synthetic forms are not as effective as natural sources such as vegetable oil and mixed tocopherol forms. 5. Calcium With osteoporosis being an emerging problem during menopause, calcium is a very important mineral at this time. Dairy products are often hard to digest for women, so other sources may be needed such as calcium citrate and calcium carbonate. Non-dairy sources include tofu, collard greens, spinach, and salmon. The body requires at least 1300 mg of calcium daily and may need more if assimilation is difficult. 6. Phytoestrogens Also known as plant estrogens, phytoestrogens work in the body much like natural estrogen, only on a lesser scale. Isoflavone is a phytoestrogen that can be found in soybeans and can help to relieve vaginal dryness and hot flashes. Herbal sources include wild yam, which can also produce progesterone for better hormonal balancing. Alfalfa, blessed thistle and sarsaparilla can also serve as natural sources of both phytoestrogens and progesterone. Black cohosh and red clover are also rich in phytoestrogens. Dong quai is yet another herb that contains phytoestrogens, and has been proven effective in relieving menopausal symptoms within three menstrual cycles, according to Dr. Gary Null. 7. Low-dose antidepressants Venlafaxine (Effexor), an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), has been shown to decrease menopausal hot flashes. Other SSRIs can be helpful, including fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft). 8.Gabapentin (Neurontin) This drug is approved to treat seizures, but it also has been shown to significantly reduce hot flashes. 9. Clonidine (Catapres, others) Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but unpleasant side effects are common. 10. Bisphosphonates. Doctors may recommend these nonhormonal medications, which include alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva), to prevent or treat osteoporosis.

These medications effectively reduce both bone loss and your risk of fractures and have replaced estrogen as the main treatment for osteoporosis in women. 11. Selective estrogen receptor modulators (SERMs) SERMs are a group of drugs that includes raloxifene (Evista). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. 12.Vaginal estrogen To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms. 13. Hormone therapy Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. MANAGING MENOPAUSE SYMPTOMS THROUGH DIET (EDUCATIONAL VIDEO) Food Step 1: Eat More Tofu and Soy Soy may give relief from hot flashes, although that benefit is still being debated by researchers. However, we do know that soy may help protect our heart and arteries by lowering bad cholesterol. Many studies have suggested that this occurs because we substitute soy for meats and animal fat in our diet. Eat or drink two servings of soy a day. Soy foods will take 4 to 6 weeks to show an effect. Here are some easy ways to add soy to your diet: Choose tofu dishes instead of meat at your local Chinese restaurant. Make instant miso soup for a quick pick-me-up snack. Make fruit smoothies with soy protein powder. Drink chocolate or plain soy milk. Buy baked tofu in the supermarket and experiment at home. Add it to salads or stir-fry dishes, even try it on crackers. Buy canned soy beans and add them to soups, chili and casseroles. Next: Foods with boron and phytoestrogens to ease menopause symptoms.

Food Step 2: Eat More Fruits and Vegetables Fruits and vegetables offer many health benefits -- fiber, vitamins, minerals and naturally low -fat. But there are also many menopausal reasons to eat these foods. Plants have chemicals that help protect our bodies' health and well-being. Phytoestrogens are particular plant chemicals that are very similar in structure to estrogen, and may act as weak estrogen in our bodies. Simply put, phytoestrogens may trick your body into thinking it has more estrogen than it really does -- potentially diminishing some of the discomforts caused by lower estrogen levels during menopause. The mineral boron is another beneficial element of fruits and vegetables. Boron seems to increase the body's ability to hold onto estrogen. It also helps keep our bones strong by decreasing the amount of calcium we excrete each day. Here are top sources of boron that also contain phytoestrogens Fruit

Plums and prunes Apples Pears Grapefruit Red raspberries

Strawberries Tomatoes Grapes Oranges

Vegetables

Asparagus Bell peppers Cabbage Carrots Lettuce Soybeans Turnips

Beets Broccoli stems Cauliflower Cucumbers Onions Sweet potatoes Wheat

Food Step 3: Eat Beans More Often Beans are a nutritionally efficient food because they offer so many health benefits in one little package. They may slow the absorption of glucose in the bloodstream, thus curbing your appetite longer. They're full of fiber. They contain phytoestrogens. They're good sources of many vitamins and minerals, including calcium, folic acid and vitamin B-6. And they are a lowfat source of protein. Despite those benefits, most Americans eat beans only in the occasional chili or at a Mexican restaurant. Here are some ways to add beans to your diet and love them: Sprinkle beans in your green salads and pasta salads. Add beans to soups, stews or chili that you make. Buy canned bean soups and vegetarian chili for a quick dish at home. Order bean soups or cassoulets in restaurants. Make a quick 3-bean salad by tossing a light dressing with three different types of canned beans. Make a delicious bean dip for parties. Food Step 4: Eat More of the Right Fats It is important to avoid eating a diet that is high in fat, especially saturated fat. High-fat foods are usually high in calories and low in nutrients, exactly the opposite of what a woman in or past menopause needs. But it's even more important to get the right fats in your diet -- fats that may protect against heart disease and cancer. Research indicates the right fats are omega-3 fatty acids found in fish, olive oil and canola oil. The wrong fats are saturated fats and trans fatty acids found in foods like packaged cookies, chips, and crackers. Here are ways to build good fats into your meals, without sacrificing flavor: Switch to olive oil and canola oil. Eat more fish. Eat less animal fat by choosing leaner meats and lower-fat dairy products. Limit foods that contain hydrogenated and partially hydrogenated oils. Buy packaged products less often because most still used hydrogenated omega-6 oils. Avoid stick margarine. Look for tub margarine that lists liquid canola oil or olive oil as the first ingredient.

Food Step 5: Choose Your Beverages Wisely Most people believe we should drink eight glasses of water a day, but few of us do. Water helps keeps our kidneys flushed. On the other hand caffeine is a diuretic, which means it forces our kidneys to get rid of more water than they should. This can encourage dehydration. Caffeine, alcohol, and carbonated beverages such as soft drinks also don't do your bones any favors. Some lower the amount of calcium your body takes in from food, and others increase the amount of calcium your body loses through the kidneys. Try drinking a glass of juice each day instead. Most citrus fruits, in general, contain more than a hundred phytochemicals. What happens to these when an orange or grapefruit is "juiced?" Many of them remain, especially if you buy juice with pulp. Here are a few fun juices to stock in your fridge: Orange juice. Calcium-fortified orange or orange-tangerine juice gives you a nice dose of calcium along with vitamin C and folic acid. Carrot juice. It takes getting used to, but carrot juice can be refreshing, not to mention very nutritious. Carrots give us at least three important phytochemicals: phenolic acids, terpenes and carotenoids (including beta carotene). Purple grape juice. There are some powerful antioxidants to be found in these purple gems. In fact, the same beneficial antioxidants that are in red wine are also found in nonalcoholic grape juice. Food Step 6: Be a Grazer Not a Gorger Many women eat their largest meal of the day at the end of the day -- dinner. And many women eat light during the day when our body needs fuel the most -- breakfast and lunch. When you do this, your body is more likely to store much of those calories as body fat because your body is metabolizing all those dinner calories at a time you are burning the fewest calories when you're asleep. There are many reasons to become a grazer: Studies have shown that people who eat small, frequent meals throughout the day tend to consume fewer calories and fat grams at the end of the day. Here's another potential weight-loss payoff: You burn more calories metabolizing food when you spread it throughout the day. Grazing also prevents tiredness brought on by drops in blood glucose, and it's easier on your stomach.

Eating big dinners is a tough habit to break, especially if your family is accustomed to such meals. Here are some changes you can incorporate a little at a time. Soon you'll enjoy a light and comfortable dinner. Serve lower fat dinners and desserts as often as possible. Serve small or moderate portions at dinner and dessert. Select meals that lend themselves to lightness, such as all-in-one dishes, hearty soups, and dinner salads. Discourage late-night snacking and big desserts. Many people eat at night because they're bored. Instead of eating, take a relaxing bath, read a good book, listen to music, or catch up with friends on the phone. Food Step 7: Eat Calcium-Rich Food Every Day Calcium is essential to a woman's health as she ages. Most women should get at least 1,000 to 1,500 mg of calcium from food. But what if you don't like milk? Here are some alternative suggestions that may appeal to you: Make your oatmeal or hot cereal with water instead of milk. Order a decaf latte with low-fat or non-fat milk. Drink a cup of chocolate soy milk each day. Take a vitamin mineral supplement that contains 100% of the daily value for vitamin D and 25% of the daily value for calcium. Eat broccoli, a leafy green vegetable, or beans. Try some great-tasting low-fat yogurt, cottage cheese, or cheese. Just one cup of yogurt would add 345 mgs of calcium to your daily total. Enjoy creamed soups using low-fat milk instead of cream. Buy orange juice fortified with calcium.

Food Step 8: Avoid High-Fat, High-Sugar Foods At this time in your life, preventing weight gain is important. Now, more than ever, women need to minimize extra calories, especially from high-fat, high-sugar foods that don't offer a bounty of nutrients. We addressed fats in Food Step 4. There are equally valuable reasons to know your sugar. Too much sugar in your diet can cause your blood sugar to spike, which stimulates the pancreas to release more of the hormone insulin. Excess insulin accelerates the conversion of calories into fats in the blood. And it stimulates the enzyme that increases the uptake of fat from the bloodstream into fat in the body's cells.

The easiest way to avoid high-sugar foods is to understand what they are: Americans consume 21% of our refined sugar from soft drinks. 18% comes from sweets, including syrups, jellies, jam, ices, Popsicles and table sugar. 13% comes from bakery desserts, including cakes, cookies, pies, pastries, and sweet crackers. 10% comes from ice cream, puddings, yogurts and other milk products. 6% comes from breads and grains. 5% come from breakfast cereals. Food Step 9: Add Flaxseed to Your Diet Flaxseed is just now being studied in humans, mostly for its cholesterol-lowering benefits and tumor-reducing properties with some types of cancers. We'll know much more about its true health benefits in the coming years. Yet flaxseed has actually been around and used as food and medicine for hundreds of years. We know that flaxseed is an extraordinary source of the phytoestrogen lignans, containing 75 to 800 times as much as other plant sources. Lignans are thought to lower cancer risk by blocking some effects of the estrogen your body naturally produces. It's also packed with the plant form of omega-3 fatty acids, called alpha-linolenic acid. The omega-3s in flaxseed may help prevent blood clots that might lead to heart attacks, according to Stephen Cunnane, PhD, a University of Toronto nutrition researcher. But some people are highly allergic to flaxseed, so follow these tips to add it gradually to your diet: Start with 1/4 teaspoon of ground flaxseed a day, and increase the amount gradually if you don't have a reaction. Work up to 1 teaspoon a few times a week as a moderate approach. Women at high risk of breast cancer are taking up to 2 tablespoons a day in clinical trials, but you may want to wait until more is known about the optimum daily dose before consuming that amount. Remember, flaxseed oil won't work, because oil does not contain phytoestrogens, the plant form of estrogen. Also, you must grind the flaxseeds; if you don't, the whole seeds will just pass through your digestive system. Food Step 10: Exercise, Exercise, Exercise Exercise isn't a food, but it is tied into your diet. There are so many benefits of exercise during menopause that it deserves to be included in these 10 important steps. Exercising during menopause will help decrease blood cholesterol levels, decrease bone loss, improve your ability to deal with stress, improve circulation, improve heart function and improve your body's ability to use oxygen and nutrients.

And, of course, exercise is an ideal way to manage weight. Many women gain considerable weight in their 40s. This could result from the age-related drop in our metabolic rate. Or it could be caused by a reduction in physical activity as we age. Either way, exercise is your best defense. Make exercise a priority and a habit. Here are three regimens to follow, depending on your level of fitness and your doctor's advice. To Start: Frequency: 2 to 3 times a week. Intensity: 40% maximum heart rate. Duration: 15 to 30 minutes. To Become Physically Fit: Frequency: 4 times a week. Intensity: 70-90% maximum heart rate. Duration: 15 to 30 minutes. To Lose Weight: Frequency: 5 times a week. Intensity: 45-60% maximum heart rate. Duration: 45 to 60 minutes. RECIPE (COOKING LESSON) CURRIED TOFU AND PEAS INGREDIENTS: 1 lb. firm tofu 1/2 medium onion, sliced thinly 3 minced garlic cloves 3 whole cloves 1 Tbs. minced ginger 5 whole green cardamom pods 1 cup peas 1 cup coconut milk 1/2 tsp cinnamon stick 1 1/2 tsp. curry powder

PROCEDURES: 1. Heat 2 tsp. vegetable oil in pan. 2. Add onion and saut until onion is translucent. 3. Add garlic, ginger, and curry powder, cook for 2 minutes, then add coconut milk, spices, and salt. Lower heat and simmer. 4. Cut drained, pressed tofu into 1/2 inch cubes. 5. Add gently to sauce and continue simmering until tofu is heated through. 6. Add peas and cook until peas are heated through.