By Carol Leonard

Carol Leonard, a foremother of the Women's Spirituality movement, is a New Hampshire Certified Midwife and has been practicing midwifery for more than 20 years. She presents her workshops, "Women's Ordinary Magic," which explores women's blood mysteries of all ages and "Witches, Midwives, and Other Healers" to women's groups around the country.

So this was it. My cycles had definitely become erratic and much shorter and I had to finally admit to myself that "it" was beginning. The menopause I had always thought about as "in the future" was, well … now. So, with much excitement and some trepidation, I began to gather all the information I could find to help me make informed decisions regarding my health and well-being during this confusing, transitional journey. In addition to reading all I could get my hands on about mid-life transitioning (including some great stuff in the supermarket check-out aisles), I started to interview various types of health-care providers to see what they had to say. I resolved to keep an open mind, particularly when it came to drugs such as Hormone Replacement Therapy. Now, this was patently ridiculous. I am a quintessential Baby-Boomer. I am almost always passionately opinionated about everything. Also, I am a child of the 60's -- the pills we were supposed to take were never the more interesting way to go. Needless to say, my research took me from conventional, mainstream medicine to shamans. Oh well, so be it. The following is a couple of years worth of (blatantly biased) research on menopause in a nutshell:

At the turn of the century, the average life expectancy for women was 55; thus menopause coincided with women's final years. In the United States today, the average age at menopause is 52 and our life expectancy is 80! This means many of us will live a good 30 years after menopause. And yet, menopause is still viewed as a disease of the aging associated with disintegration and dying. Menopause is only the end of fertility, not the end of life or productivity. Now, with the approaching millennium, a Baby-Boomer turns 50 every seven minutes (an astounding statistic). There will be 50 million Women of Menopause by the year 2013. A planet full of Changing Women -- imagine the possibilities! It is up to us to de-pathologize this natural event and make our non-reproductive years the most powerful productive years of our lives.

It is ironic that fluctuating hormone levels have been blamed for supposed irrationality and instability, yet after menopause when our hormone levels are not longer cyclic, we are considered estrogen-deprived, and still abnormal. Has it never occurred to medical researchers to trust in our bodies' inherent wisdom, that perhaps women are supposed to have decreasing hormone levels at this phase of our lives? The medicalization of the menopause experience describes menopause as a "deficiency syndrome" or "ovarian failure" and teaches that something is lost or inadequate and needs to be replaced. The reality is that ovarian estrogen is already declining after about age 25, and estrogen made by the adrenal glands has already begun to increase. Estriol made by the body's fatty tissue is mainly what supplements the remaining ovarian secretions after menopause. Other body sites make the same hormones as well; these include the liver, breasts, hair follicles and the pineal gland. With adrenal secretions, all these body sites together supply all the estrogen needed by a woman who will not be bearing a child. In the truest sense, for most women there is no "estrogen deficiency" after menopause.

Unfortunately, in the "fast-food" mentality of our culture, we have come to expect immediate solutions to our troubles, preferably in pill form to make annoying symptoms disappear. For Changing Women, this means the "fountain of youth" in the form of Hormone Replacement Therapy.

The widespread use of exogenous (produced outside the body) estrogen began in the mid-60's (oh those drug-crazed years). By 1975, Premarin, a form of estrogen made from pregnant mare's urine (hence Pre-Mar-In), became one of the top five most prescribed drugs in the US. In December 1975, two studies were published which reported that women taking estrogen had a 5 to 14 times increased rate of endometrial cancer.(1)   The risk was linked to dosage and the amount of time the estrogen was taken. Three years exposure to unopposed estrogen caused abnormal endometrial changes in 34% of women with a uterus. 6%of the women had to have hysterectomies during the 3 year study.(2)   In 1977, the American College of Obstetrician and Gynecologists unsuccessfully sued the Federal Drug Administration (FDA) to block a requirement for patient information inserts for all estrogen products. Women now had access to information about the risks of estrogen. The drug companies reacted with increased media coverage, and by the mid-1980's, they were promoting "HRT" or "Hormone Replacement Therapy." This was prescribing progestogens with does of estrogen, the thinking being that the increase in risk associated with estrogen was diminished by adding progestogen.(3)  This means in laywoman's terms, that when estrogen is taken with progesterone, the increased risk of uterine cancer is canceled out, and the two hormones taken together is called HRT. (Conversely, women without uteruses do not need to take progesterone.)

Osteoporosis

In 1984, based on osteoporosis studies conducted with white women only, it was concluded that estrogen use reduced the number of hip and wrist fractures and delayed postmenopausal bone loss. The use of HRT has been approved by the FDA only for the prevention of osteoporosis; none of the other claims for HRT have been substantiated enough to warrant FDA approval. And certainly, no study to date has proven that all women who don't take HRT are at risk for osteoporosis. Yet HRT is routinely prescribed as a matter of course for postmenopausal women. In fact, in a 1992 study published in the Annals of Internal Medicine, the overall incidence of hip fractures in post-menopausal women was 9.2% as opposed to 11.2 in women who were not taking HRT.(4) This is a good statistic to consider if you are weighing the pros and cons of HRT. (See further information on osteoporosis.)

Heart Disease

Estrogen can increase good (HDL) cholesterol, an important risk factor for health disease in women. Several studies found that women who used estrogen were less likely to have heart attacks than women who didn't use estrogen. It is not clear whether estrogen itself is responsible for this protection, or if it is due to other lifestyle factors common in estrogen users, i.e. more health consciousness in general and also, the women who took estrogen in their early studies may have been healthier than those who didn't since doctors were wary of giving estrogen to women with existing risk factors for heart disease, like smoking. The package insert for estrogen (estradiol) itself states, "The protection shown may have been caused by characteristics of the estrogen-treated women, and not by the estrogen treatment itself. In general, treated women were slimmer, more physically active, and were less likely to have heart disease [to begin with] than the untreated women." (Berlex Laboratories, 1996) Although the evidence was much weaker than usually required for approval of a new drug intended for long term use in healthy people, in 1990 Wyeth-Ayerst asked the FDA to approve Premarin to prevent heart disease in post-menopausal women. The FDA refused to grant approval, but even so, many clinicians now recommend that menopausal women take estrogen to reduce the risk of heart disease.(5)  No research was published on the heart disease rates of women who took HRT, even though this combination was common by the late 1980's. It is now known that the most commonly used progestin, Provera, "significantly interfered with the positive effect of estrogen alone on HDL cholesterol levels" and "these forms of HRT were also found to increase triglyceride levels which are a risk factor for heart disease in women.(6)  In other words, progesterone has the opposite effect on cholesterol and the HRT combo negates any beneficial effect on the lipid profile -- that although progestogens protect the uterus, they also partially counteract the HDL cholesterol benefit of estrogen alone. Also, the statistics don't quite add up: in a recent study of the incidence of heart disease in post-menopausal women (published in the Annals of Internal Medicine), cardiovascular disease occurred in 64.4% of women who had been taking HRT compared to 71.3 of women not taking HRT.(7)  Obviously not a highly significant difference. Perhaps we should refocus cardiovascular problems as a possible disease of aging, not of hormonal deficiencies.

Breast Cancer

Estrogen is also consistently associated with 30% increase in the risk of breast cancer in women who are currently using it and have taken it for 5-10 years or longer. In 1990, researchers for the Nurses Health Study, a well-done study of the most rigorous design, released their findings that women who use estrogen have a 36% greater chance of developing breast cancer than do other women. Soon after these troubling results, researchers at the Federal Centers for Disease Control (CDC) published a summary analyzing sixteen separate breast cancer studies, again finding a 30% increase in breast cancer.(8) These statistics received little attention from the main-street press, as the drug companies obscured these results by funding a huge media blitz publicizing the heart disease findings. But this is a known fact: with our breast cancer rates so outrageously high (one woman in nine!), the average woman who dies of heart disease loses 8 years of life, whereas women who die of breast cancer lose, on average 19 years.(9)

At this time, we know even less about breast cancer and HRT. The addition of progesterone to estrogen does not eliminate the breast cancer risk. Preliminary findings from a breast cancer study with large numbers of women on HRT were reported to the FDA in 1991. Women who used HRT had significantly higher rates of breast cancer, about a 70% increase over women on estrogen alone or those who switched from ERT to HRT.(10)  Clearly, women who have already had breast or other cancers or have breast cancer in their immediate families should be discouraged from taking HRT.

And in the biased research department, to refute the anecdotal new claims that estrogen may prevent or slow the progression of Alzheimer's disease -- there is a glaring gap in the studies. Women on estrogen may be more likely to maintain healthy brain function throughout their life due to life circumstances, not hormonal help. A truly randomized, double-blind, prospective, case-controlled study with large numbers of women has yet to be conducted.(11)

The first and only large, long-term controlled study on the safety and effectiveness of HRT trial results will not be available until the year 2007.

So, despite the fact that some researchers point to the 50-year life expectancy common in the beginning of the 20^th century and theorize that women simply weren't meant to live past menopause (oh, please…), some of us seem to have the audacity to be living past our natural life-spans. We need more information about the normalcy of menopause and clear instructions to guide us with self-care.

Normal Menopause

Normal menopause is just that - normal. It is a definite physiological milestone in a woman's life heralding the beginning of a powerful new phase of growth. It is a good idea to be well prepared for this journey. The following are definitions of the language used to define the menopause experience, to help you negotiate decisions regarding your health during this time.

Pre-Menopause - is the time of greatest hormonal fluctuation during the later reproductive years (can feel like horrendous PMS), when periods become irregular and other changes may begin to occur. The actual age at which menopausal change begins varies considerably from woman to woman; the norm is 45, with a normal range of 35 to 55. During the pre-menopausal years, menstrual periods may become noticeably different (closer together, further apart, scantier, more profuse). Changes in the menstrual cycle are often the first sign that menopause is approaching. Changes may be sudden and significant, or so gradual that they go almost unnoticed. Periods may be very different from what they once were. Menstrual cycle changes can affect cycle length an the amount of menstrual flow. Night sweats and/or hot flashes may come, if at all, only sporadically and are usually blamed on too many blankets, a sweaty partner, or a spicy meal.

Menopause - is the end of menstruation, defined after the fact, that is once 12 months have passed without a period. Meno (menstruation) pause (stops) is technically, the last menstrual flow of a woman's life. The menopausal climax years include the year or two before and a year or more after the very last menstruation. The average age of a woman in the midst of her climax is 51. During the 2-5 year climax period, the bones refuse to take in calcium (perhaps so we don't become too rigid in our resistance to change?) and bone scans will show lessening bone density; flashes, flushes and night sweats may be frequent; palpitations, emotional sensitivity and sleeplessness are common. Depending on the individual woman and her circumstances, other physical and emotional changes may occur with the climax. Or she may breeze right through. All symptoms are transient and correctable. However, it is currently the fashion for physicians to take blood samples and then diagnose "low" hormone levels in women whose hormone levels are perfectly normal for their age.

Post-menopause - the several years after the end of menstruation during which time the body completes its adaptation to its new stabilized hormonal state. After menopause, the ovaries continue to produce low levels of estrogen and androgens, as do the adrenal glands. Androgens can be converted to estrogen by fatty tissue. So, post-menopausal women have some, albeit lower, levels of estrogen present throughout the rest of their lives. Post-menopausal women who have not had their ovaries removed are not more estrogen deficient than are pre-pubertal girls. The post-menopausal years symbolically begin on the 13^th new moon after the final menstruation, and continue -- obviously -- for the rest of the lifetime. Commitment to a healthy lifestyle in the postmenopausal years can halt and reverse the loss of bone density (the bones do accept calcium once again!) Being vigilantly health-conscious can prevent estrogen and progestone sensitive tissues in the vagina and bladder from weakening and drying out, and maintain a healthy, vigorous heart and circulatory system.

Surgical Menopause - is the menopause brought on by the surgical removal of a woman's ovaries or by radiation treatment or chemotherapy. If the woman has not already gone through a natural menopause when she has this surgery, radiation or chemotherapy, she will go through immediate menopause at that time and will skip the pre- and peri-menopausal stages.

Menopause is a very individual experience, but all women deserve accurate information about the normal changes of menopause, safe remedies for common discomforts, and medical intervention for the small minority whose discomforts are severe. The following information is a culmination of many years of working with women as their community midwife and practicing as an herbalist working with plant allies to create healthier living for women and their families. I offer simple common sense alternatives to conventional, allopathic medicines' drug-oriented approach. These natural treatments can be used as an alternative to HRT in all but the most sever cases. This drug-free approach preserves the time-honored knowledge of our grandmothers, as well as modern, alternative methods that work for alleviating and preventing symptoms of menopause.

Due to the constraints of time and space for this article, I will only focus attention on the two most common menopausal symptoms: hot flashes and vaginal changes. Other symptoms can include emotional instability, "fuzzy" thinking, insomnia, depression, stiffening joints, sore breasts, dry skin, and abdominal congestion (constipation, gas, bloating). I will cover self-care for menstrual cycle changes and lessening bone density in Part 2. All symptoms are transient and correctable. If you are experiencing any of these symptoms and would like more information on alternative therapies, call your local midwife, an herbalist skilled in botanical medicine, or nearest naturopathic physician for homeopathic remedies. They will refer you to the appropriate treatment.

Hot Flashes

Hot flashes (or "Power Surges" for women in the know) and night sweats occur in about 75% of American women; the frequency, intensity, duration of flashes is unique to each individual. They are the result of vasomotor instability. The vasomotor nerves are the body's thermostat controllers. It's their job to regulate body temperature by controlling the diameter of the blood vessels. A disturbance in hormone levels interferes with the signals transmitted to the vasomotor nerves, and prickly hot sensations, dizziness, and sometimes, heart palpitations result. As your system finally adjusts to the lower or different levels of hormones, the symptoms will stop. With the use of herbs and diet, it is possible to exert some control over the length and time of hot flashes and even, in some cases, eliminate them completely. The following suggestions have significantly reduced hot flashes for many women.

• Herbs - My favorite herb for hot flashes is Motherwort, Leonurus cardaca, which translates from Latin to "Lion-Hearted." (Actually Motherwort, is a a phytoestrogen -- plant-derived estrogen -- and is my choice for many "female complaints," including the crazies.) This showy Eurasian mint with spiky lavender flowering tops and early, large, indented, bright green leaves has naturalized herself in my back field and is perennially present from April to late fall. The bees love her. Motherwort's medicinal component is the alkaloid Leonurine, which is a mild vaso-dilator. The medicinal properties are in the flowering tops and leaves and are soluble in alcohol. Motherwort is common in New England; it is very easy to tincture to extract the medicinal alkaloids.
  
  Here's how: Once you have a positive identification of the plant (you could enlist the expertise of a local root-woman if you're unsure), gather the flowering tops and leaves, being sure to leave at least half of the mother plant and always thanking the plant as you do so. Chop the plant material coarsely, pack fairly tightly in glass jars, then cover with regular, inexpensive 100 proof vodka. Cap tightly. Label with plant name and date and put away in a dark closet for at least six weeks, then pour off the medicinal liquid (decanting) and compost the used plant material. The tincture will last for a long time. You can take half a teaspoon of this tincture up to four times a day when flashing heavily. Expect results in two to four weeks. (NB -- Do not use if you are experiencing menstrual "flooding.")
  
  Motherwort tincture and all of the following natural remedies should be available in your neighborhood health food store or organic co-op.

• Take Dr. Christopher's Change-Ease formula three times a day. This is a formulation of phytoesterol-rich herbs by a master herbalist, available in natural or health food stores.

• Diet - Switch to a grain-based diet and eliminate all sugars and sugar-rich foods including fruit and fruit juices.

• Soy - Adding 50 mg of a soy-based food daily to your diet (such as tofu, tempeh and soy milk) could significantly reduce the incidence of hot flashes. Soybeans contain compounds called isoflavones, a natural plant form of estrogen. Also, soybeans and yams contain a preformed steroidal nucleus so your body can easily manufacture steroids and hormones when you eat them. A typical Asian woman ingests about 30 to 50 mg of isoflavones in her diet daily. The Japanese and Chinese do not have a word for menopausal hot flash in their language.(14)

• Exercise - Daily exercise diminishes hot flashes by decreasing the amount of circulating leutinizing hormone (LH) and follicle stimulating hormone (FSH), by nourishing the hypothalamus and by raising endorphin levels, which drop when flashing. As little as thirty minutes three times a week can produce positive results.

• Keep Cool - Drink lots of water and herbal teas. Turn down the thermostat, literally. Eat smaller meals, more often. Walk away from aggravating situations. Soak your feet in essential oils of basil or thyme. Breathe deeply. Visualize the heat as Kundalini energy rising up your spine, as the very life-force, Chi, combusting within you. Harness the energy, ride it. Wear silk. Envision polar bears. Put ice on your cheeks. Fan yourself in public. Take your clothes off. Jump into the tub.

• Buy a Safari Hat with the battery-run fan in the front. Print "Red Hot Mama" on the top.

• You could yell, "I'm hotter than a red-assed bee!" That's what my grandmother did every time she had a hot flash (I am entirely serious).

• Vitamins - Take 400-600 IU of Vitamin E daily. Vitamin E supplements have a well-documented and long-standing reputation as a remedy for hot flashes. Be sure to check for freshness when purchasing Vitamin E. Taking rancid Vitamin E will have a negative effect. Use only 100 IU Vitamin E if you have bleeding problems, and only 50 IU if you have diabetes, high blood pressure, or rheumatic heart murmur.

• Take Ginseng (2 mgs daily) to normalize the body's response to hot and cold.

• Drink several cups of Sage tea daily. Use regular garden sage, Salvia officinalis -- you can grow it yourself in your backyard; it's perennial. Harvest only half of the plant in the fall and hang the sage to dry then use one tablespoon of dried sage per one cup of boiling water. Infuse it for 20 minutes. Sage is a "yang" or grounding herb and is renowned for its ability to reduce and eliminate night sweats. The effect is fast acting (NB: Do not use sage for night sweats from nursing -- sage will dry up breast milk.).

• Lastly, a personal opinion here: To prescribe synthetic hormones to eradicate hot flashes is like calling out nuclear weapons to settle a neighborhood dispute.

Homeopathic Remedies for Hot Flashes
by Susun Weed, 1992 (13)

Lachesis - For when the flashes emanate from the top of your head, are worse just before sleep and immediately upon wakening, and are accompanied by sweating, headaches, or easily irritated skin.

Sepia - When your flashes make you feel weak, nauseated, exhausted, and depressed.

Pulsatilla - If you flash less outdoors, but your flashes are often followed by intense chills and emotional uproar.

Valeriana - If your face flushes strongly during the flash, and you have intense sweating and sleeplessness.

Ferrum metallicum - When your flashes are sudden, your general health is good but ordinary activities bring exhaustion.

Sulfuricum acidicum - If your flashes include profuse sweating and trembling, and are worse in the evenings and with exercise.

Sanguinaria - when your cheeks are red and burning, and your feet and hands feel hot.

Belladonna - When the flash centers on your face, which burns and turns bright red, and you feel restless, agitated, and have palpitations.

Vaginal Changes

After menopause the walls of the vagina become thinner and produce fewer secretions. Vaginal lubrication with sexual excitement occurs more slowly. As the amount of estrogen decreases, the vagina becomes less acidic, making women more susceptible to vaginal infections, including yeast. If changes are significant, women may have a feeling of dryness or irritation. Severe dryness can cause vaginal pain. Women are most likely to feel vaginal discomfort during of just after sexual intercourse, especially without being wet enough. Thinner, more easily injured vaginal tissue combined with decreased acidity of the vagina can lead to infections. The usual symptoms are increased vaginal discharge, itching and burning.

The disrespectful, patriarchal name for menopausal thinning and associated symptoms is Atrophic vaginitis and Dyspareunia (painful intercourse), but this is not inevitable. These symptoms can be remedied with understanding and simple loving care. And, as with all of menopause, good solid healthy nutrition and exercise is key to preventing drying and thinning. Here are some important suggestions for self-care for a dry vagina:

• Take 400-600 IU of Vitamin E daily. Again, only 100 IU Vitamin E if you bleed heavily, and only 50 IU if you have diabetes, high blood pressure, or rheumatic heart murmur.

• Drink at least two quarts of water a day.

• Take Dr. Christopher's Change-Ease formula as directed.

• Start your day with two dropperfuls of Motherwort tincture.

• Self-help for dry vaginas: Get Slippery! There are several "light, personal, modern lubricants" on the market today, the current favorite being Astro-Glide, probably because the name is so great. It is mostly glycerin. You can experiment with your own natural concoction to see what works for you. Here are some suggestions:

• Coconut oil or cocoa butter -- smells great, tastes better, solid at room temperature, liquid at body temperature.

• Honey -- hydroscopic (water-drawing), will moisturize and heal a tender yoni. Apply directly where needed (and obviously, great tasting).

• Aloe Vera and Slippery Elm paste -- to sooth inflammations. Mix enough slippery powder into aloe vera gel (bottled or fresh) to form a paste. Apply along the labia and inside the vaginal entrance. This lubricates, heals and nourishes.

• Oil from a Vitamin E capsule -- use a capsule that has 400 or more IU's. Some women say this works as well as estrogen cream. Wheat Germ Oil is a good source of Vitamin E, cool and soothing.

• Almond oil or olive oil (cold-pressed) are nice. Apply to the fingertips and massage all around the vaginal opening and perineum.

• Look for Comfrey-based ointments with names like "Green Gold," etc. in natural food stores. Comfrey has an alkaloid called Allantion which regenerates skin tissue and will keep skin flexible and strong. I've had a long love affair with Comfrey as a midwife, using it to speed repairs of perineal tears. Comfrey could be combined with other herbs such as St. John's Wort (Hypericum, used for burns) and Calendula (Pot Marigold) for added healing. (Goldenseal will probably be too drying.)

• A commercial option is Replens, a new over-the-counter cream available in drug stores. The active ingredient, Polycarbophil, pulls water into vaginal cells and lowers the pH of the vagina, which helps prevent overgrowth of bacteria.

• Natural progesterone creams made from Mexican wild yam roots (Dioscorea species) appears, so far, to be as effective as estrogen cream in restoring youthful moistness and elasticity. Seems to be the herbal equivalent without the side effects. Estrogen creams are the common allopathic (conventional medical) solution, but these products have potentially serious risks and should be used with caution and awareness. I literally had a male physician friend say that estrogen cream was "more bang for the buck!"

• Kegels. Remember the annoying Kegel exercises (squeezing the PC -- pubococcygeal muscle) from our child-bearing years? In the car, at every red light? Well, they are back -- and they still make the supporting muscles of the vagina stronger and healthier.

• And speaking of exercise -- of course the health of your vagina depends on stimulation like any other part of your body. It needs to be exercised regularly to keep fit. Remaining sexually active in the second half of your life, either with a partner or by self-pleasuring, is the key to maintaining a healthy vagina.

And self-pleasuring, either by yourself or with your partner is an art to be joyfully practiced. Staying in love and orgasmic with yourself gives you a more positive outlook on life. So, go on girl! There are lots of interesting new toys on the market. Be creative. Experiment! You and your yoni will benefit -- and you may discover places of hidden pleasure you never knew existed.

Vaginitis

The walls of the vagina tend to thin as estrogen production falls off and this can lead to vaginitis. Vaginitis is a generally inclusive term that describes several conditions or causes of irritation and inflammation. The usual cause is irritating, alkaline (pH6+) secretions burning tender atrophic vaginal tissue, especially if it is abraded or cracked. The following suggestions should help reduce itching and burning and get you back into the pink.

• Motherwort tincture (take 2 dropperfuls daily) quickly restores pliability and thickness to vaginal walls.
• A Comfrey root compress will soothe itchy, dry vaginal tissues and promote healthy skin growth and regenerate cells. Infuse the comfrey root and soak a face cloth in the liquid. Apply the wet, warm compress to your yoni while reclining and sitting on a towel.
• Brew an infusion of nettle several times a week. To invigorate and nourish vaginal tissues, drink it and sit in it. While sitting in the tub, hold the nettle juice in your vagina for several minutes by elevating your hips slightly or by holding your nether lips closed with your hand. (Note: nettle is a wonderful woman's herb but harvest with care; wear gloves. If she doesn’t sting you, it is probably too late in the season and her medicinal qualities will be dormant.)
• Chinese herbs such as Dong Quai (Angelica sinensis) are helpful and indicated here, but my personal preference is to use herbs that are indigenous to my own area. I prefer to gather the healing plants from my own backyard. Just a personal thing.
• To avoid the problem of burning with intercourse as part of your love play, try sensual, sexual escapades that don't involve penetration. Vitamin B complex and reducing stress help relieve burning.
• Apply the oil from Evening Primrose Oil capsules directly to the affected area. This is a natural plant source of GLA (gamma linolenic acid).

Caution: Anti-itch creams containing cortisone contribute to osteoporosis. Avoid them.

Yeast

Yeast infections, sometimes called thrush or monilia, can be curdy, profuse, sweetly odoriferous white discharge with itching and inflammation. Yeast infections are not really yeast nor an infection, but a yeast-like fungus, known as Candida albicans. The condition is known as Candidiasis when it proliferates. Here are some tips to take the yeast beasts:

• Nix the "feminine deodorant sprays, no soap, nylon bathing suits, or pantyhose without a cotton crotch. Wear only cotton or nothing at all. Hot, moist environments incubate yeast.
• Lactobacilli such as acidophilus are natural residents of a healthy vagina. They prevent overgrowths of yeast. (They also turn milk into yogurt.) Insert two acidophilus capsules into your vagina daily. Adding Lactobacilli vaginally stops yeast from growing and creates copius amounts of lubrication.
• Plain unsweetened yogurt which is available in natural food stores can be inserted as is into the vagina to help maintain or restore natural bacterial balance. Be sure the yogurt you use contains live cultures of acidophilus or lactobacillis (it will say so on the label). Insert at least two tablespoons daily: you will need to wear a pad. Here are some tips on getting it in there. Yogurt can be inserted with an empty tampon inserter, vaginal cream inserter or a turkey baster (the baster works best). Symptoms should be relieved within 48 hours.
  
  If the yeast is persistent and you experience chronic or repeated overgrowths, then all of your lovers need to be treated as well. If your partner is male, have him soak his penis in yogurt or diluted apple cider for 5 minutes daily to kill the yeast living in or on the glans; this way he won't keep re-infecting you.
• If neither acidophilus or yogurt cure the yeast, you need to re-acidify your vagina. Boric Acid is the most efficient, and you can purchase it in the drug store. Dilute it one teaspoon to one cup of warm water and mini-douche daily with the barrel of a syringe, or use a diaphragm jelly inserter which can be bought at the pharmacy without having to buy the jelly. Don't use if the skin is raw or broken, and discontinue if an irritation develops. This is wet and messy but boric acid is anti-bacterial and will cleanse some non-specific vaginitis as well.
• Apple cider vinegar douches (two tablespoons vinegar to a pint of warm water) is very effective. Even though yeast flourishes in an acidic environment, there is something in vinegar that inhibits its growth. Vinegar can also inhibit the growth of bacteria and trichomonas by establishing the proper acidity (pH) for the proliferation of "good" bacteria. Don't douche for longer than 10 days.
  
  Regular douching should be discouraged. The vagina is a self-cleaning environment, so routine douching shouldn't be necessary and could make your vagina too alkaline. Women who douche more than three times a month are four to five times more likely to have rampant yeast.
• There are drugs sold over-the-counter now in pharmacies such as Nystatin or Mycostatin (fungicides) and Monistat or Gyne-Lotrimin, etc. Also in some pharmacies, homeopathic remedies such as Yeast-Guard are now available.

Non-specific Vaginitis

Non-specific vaginitis is bacterial and characterized by burning and itching, usually with a discharge, odor, sometimes a rash and painful intercourse. It's probably a good idea to visit your local midwife or nurse practitioner and have her check it out under a microscope to see what kind of bacteria you're dealing with. To eliminate a mild bacteria infection:

• Garlic -- Insert a peeled clove of garlic high up into your vagina, being sure to push it all the way up to the cervix (which feels like the tip of your nose), every night for a week. Garlic is well known for its antibiotic properties, but you may walk around smelling vaguely like a pizza.
• Betadine (povodone-iodine) suppositories and douches are available in drug stores and help cure nonspecific vaginitis. Wear a pad to control staining.
• Your health care practitioner may prescribe Metronidazole (Flagyl), taken orally, when an infection is severe or chronic. Flagyl is very heavy duty, however, and should be taken only as a last defense.
• Lastly, as with all of menopause, you are more likely to be troubled with vaginal complaints of your adrenals have been exhausted by overuse of coffee, cigarettes, alcohol and white sugar. Yeah yeah, I know the same old advice -- but it's true! Throw that coffee pot away, it's a bad drug. (Each cup of coffee robs your body of 5 mgs of calcium!) It's nasty stuff.

Estrogen Replacement Therapy and Hormone Replacement Therapy

ERT and HRT have not been shown to be effective :

• to prevent aging of the skin
• to prevent bladder or urinary problems
• to relieve depression
• to increase sexual desire
• to prevent Alzheimer's disease
• to prevent heart disease.

If you are interested in further information about healing and natural remedies for the menopausal years, I highly recommend these two books.

• Wise Woman Ways for the Menopausal Years by Susun Weed. 1992. Ash Tree Publishing, PO Box 64, Woodstock, NY 12498.
• Herbal Healing for Women by Rosemary Gladstar. 1993. The Herb Quarterly, PO Box 689, San Anselmo, CA 94960.

Womenspirit!

Just as important as maintaining a healthy "flora and fauna" physically, is the need for women to explore their spiritual selves during their mid-life transition. Menopause is the time to turn the profane into the sacred. In many cultures other than ours, elder women are respected for the culmination of their life experiences; they are revered for their wisdom. They are the honored Grandmothers who carry the keys of knowledge for their people. In our society, which worships youth, older women are considered dispensable, done with their usefulness, and discarded to infantile status.

There was a time when women's Blood Mysteries were honored and celebrated, and menopause was the culmination of these experiences, the last of the Great Rites. This Rite served to acknowledge this powerful change and to honor the woman's crossing over to "cronehood." (I realize there is a negative connotation to the label "Crone" but this wasn't always so. This was originally a term of respect and honor and was not derogatory in any way, another twist of our language brought to you by patriarchy.)

The Croning Rite which follows is a simplified version of the ceremony I wrote for my book, The Women's Wheel of Life: Thirteen Archetypes of Woman at her Fullest Power (Viking Arkana, 1996, co-authored with Elizabeth Davis, my friend and another midwife).(15)  It is imperative that we reclaim the power of our biology, that we understand clearly what is happening to us physiologically, psychologically and spiritually so we can support each other through this tremendous, frightening, wonderful journey.

The Croning Rite of Passage is observed when the final physiological milestone is passed, when a woman has completed menopause and her bleeding time has come to an end, usually on the 13^th new moon after her last bleeding. The post-menopausal stage heralds the transition to a new life experience. It is a time of celebration. (If a woman has undergone premature menopause due to surgical or chemical intervention, then approximate guidelines place Cronehood at 56 years old.) The body of the rite can take various forms, from partying with ribald humor to giving gifts of acknowledgement. I recall the rite we held for a Crone midwife, who was retiring from active practice. Each midwife in attendance shared some memory of working with this woman, and as they told their stories they wove red, white and black yarn, along with a special trinket to illustrate their tale into a "story belt." Some of the stories were hilarious, but the result was a poignant ceremonial object of inestimable value.

My favorite way for this rite to be done is a solitary experience. The new Crone goes off by herself to somewhere in the wilderness that only she knows to a place where there is a three-way crossroads. Here she leaves a gift of food to Hecate, Crone Goddess and Ancient Queen of Wisdom, and meditates on her life. She recalls all she has learned in life and the wisdom she still needs, and the things she must yet do to fulfill herself and complete her life's work. She concludes with a prayer of Thanksgiving:

I have traveled the road from my mother's breast to Cronehood. Thank you, Hecate, for the good seasons past and the good seasons yet to come."(16)

After the crone makes her offering, she must leave quickly and not look back, as an act of letting go of regrets while trusting what is yet to come. This aspect of seclusion is found in numerous rites, and is symbolic of rebirth and reintegration. It is best to do this particular ritual at the dark of the moon or the earliest crescent as this lunar phase represents a time of new beginnings.

Meanwhile back at the ranch, her friends have been feasting and making merry. They welcome her return with love and laughter, and all together they create a circle of lasting friendship and support for her in the crowning years of her life. She is invincible!

Footnotes and Resources

1. Smith, D.C. et. al. "Association of exogenous estrogen and endometrial carcinoma." New England Journal of Medicine, 1975; 293 (23): 1164-1167, and Ziel, H.K. and Finkle, W.D. "Increased risk of endometrial carcinoma among users of conjugated estrogens." New England Journal of Medicine, 1975; 293 (23): 1167-1170.
2. The writing group for the PEPI trial (Postmenopausal Estrogen/Progestins Interventions). "Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in post-menopausal women." Journal of the American Medical Association (1995); 273 (3): 199-208.
3. Grady, D. et. al. "Hormone therapy to prevent disease and prolong life in postmenopausal women." Annals of Internal Medicine 1992; 117 (12): 1016-1037.
4. Northrup, Christiane. HRT Advisory. Phillips Publishing, Inc., 1996, p. 10.
5. National Women's Health Network. Taking Hormones and Women's Health. 1995, p. 11.
6. PEPI trial, Ibid.
7. Northrup, Christiane. Creating Health Through Menopause (video lecture). Phillips Publishing, Inc.
8. National Women's Health Network.Ibid. p. 25
9. Miller, B.A. et. al. eds. Cancer Statistics Review 1973-1989. National Cancer Institute, NIH publication no. 92-2789, 1992.
10. Mack, T.M. "Risk-benefit analysis of ERT vs. HRT" (presentation). Food and Drug Admnistration Fertility and Maternal Health Drugs Advisory Committee Meeting, 21 June 1991.
11. Northrup, Christiane. Health Wisdom for Women. Phillips Publishing. Vol. 4 No. 1; January 1997, p. 2.
12. McCord, Holly. "Menopause Naturally." Prevention Magazine, August 1996, p. 66.
13. Weed, Susun. Wise Woman Way for the Menopausal Years, Ash Tree Publishing, 1992, pp. 58 & 133.
14. Lee, John. What Your Doctor May Not Tell You About Menopause. Mill Valley, CA.
15. Davis, Elizabeth and Carol Leonard. The Women's Wheel of Life: Thirteen Archetypes of Woman at Her Fullest Power. 1996. Viking Arkana, pp. 191-194.
16. Budapest, Zsuzsanna. Holy Book of Women's Mysteries. Berkeley: Wingbow Press, 1989. p. 86.

more books on menopause
Part Two of Carol Leonard's "Hotter than a Red-Assed Bee"

Tribute to Lorraine Rothman, author of Menopause Myths and Facts

Feminist Women's Health Center