Western Approaches
Mary Jane Minkin, MD, OB/Gyn, teaches at the Yale University School of Medicine, and is the co-author (with Carol V. Wright) of numerous books on women’s health, including A Woman’s Guide to Menopause and Perimenopause (Yale University Press, 2004). When it comes to treating the symptoms of perimenopause, Minkin likes to begin with the least invasive approach. She explains that the very individualized experience each woman has deserves to be addressed in an equally individual way. Sometimes, this includes hormone replacement therapy, commonly referred to as hormone therapy or HRT or HT.
“First, I look at what symptoms a woman is having, then what level of relief she seeks, and what treatment options she is comfortable with. I want to know what her personal mythology is. Some women breeze through this phase, while some at the other end of the spectrum are completely miserable. In terms of symptoms, most people fall somewhere in-between.”
When addressing hot flashes (one of the most common complaints she hears), her first course of action is to counsel patients to explore simple solutions. These include lowering the heat in their homes and work environments, layering their clothing, and wearing sleepwear made from materials that wick moisture away from the body. Next, she urges them to look for specific triggers: if a glass of wine precedes the hot flash, then eliminate wine from the diet.
The next level is non-medical; it includes adding soy to the diet through food sources (rather than supplements) and trying Remifemin (she hesitates to recommend herbal preparations because she sees ongoing problems within the industry with regard to standardizing herbal products to guarantee therapeutic amounts of active constituents). If symptoms are still wreaking havoc with a woman’s day-to-day life, Minkin moves on to medical interventions, including estrogen.
“There are a lot of philosophical and anthropological discussions surrounding the use of estrogen,” says Minkin, “but the fact is that it’s very effective. Many women fear an increased risk of breast cancer, but you won’t get breast cancer if you only take estrogen for a year. It can be a powerful transitional aid for people who are symptomatic.”
Minkin adds that studies have shown that women in societies and cultures that revere age report women as having less menopausal symptoms. She suggests we take something from that information, and focus on developing and maintaining a positive attitude about aging and our lifestyle choices. Regular exercise can improve mood, while weight-bearing exercise can help prevent arthritis and stretching can keep joints flexible.
“Some women report getting achy around this time, which may correlate more with age and lack of exercise than with menopausal states. I’m a fan of glucosamine, which is supported by data, and feel that chondroitin may also be helpful. Yoga, stretching, and practices such as Tai Chi can also be very helpful, but do whatever activity you enjoy. The important thing is to engage in regular exercise. While it’s always important, after menopause, exercise won’t prevent osteoporosis. Weight-bearing exercise to prevent osteoporosis is most effective while you still have estrogen.”
Balance
“By the time we’ve reached thinking age,” says Lisha Simester, author of The Natural Health Bible (Quadrille Publishing, 2006), “we’ve been inundated with junk food, environmental toxins, and habits that have already begun to have an effect on our health. It’s not really that difficult to do the simple things needed to keep ourselves healthy, like eating well and getting adequate rest and exercise.”
Women at the age of perimenopause, Simester points out, are often sandwiched between caring for their children and their aging parents. Rather than trying to find time, she says we must choose to make a commitment to create the time to nurture and care for ourselves.
“As a culture, we’re consuming too much animal protein, dairy, and wheat,” she says. “We eat cereal, toast or muffins for breakfast, sandwiches for lunch, and breads and pasta for dinner. Some French research has indicated that an over-consumption of modern wheat, which has different chromosomes in its molecular makeup than the healthier grains consumed historically by our agricultural ancestors, is a leading cause of autoimmune diseases in industrialized cultures.”
Perimenopause is an opportunity, says Simester, to switch to healthy habits, and make sure they are firmly in place. We can choose to be cavalier with our health, or we can make wise, healthy choices that include increasing our intake of organic fruits and vegetables, avoiding processed foods, incorporating weight-bearing exercise to help prevent bone loss, adding yoga or stretching to ensure flexible joints, and striving for balance and lowered stress through meditation and mindful activity such as yoga and Qi Gong.
“We were built to move. That’s when the rot sets in – when we stop moving. Do what you love to do. Take up Pilates, dance! Perimenopause is a very individual journey, a unique path we each walk on our own. We are such creatures of habit. Opting for healthy habits sets us up for a more graceful passage.”
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