Menopause: Hotter Than a Red-Assed Bee

"Hotter Than a Red-Assed Bee"
(Part Two)
The Baby Boomer's Survival Guide to Menopause

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.

My friend Iris, the belly dancer, says that menopause is just like puberty, only this time we have a clue.

Spotting Quiz. Circle One: Menopause begins when:

Your credit card is declined;
You swear off men;
Your car has broken down;
Your Rolodex becomes a blunt instrument;
You have recently maimed, dismembered, or bludgeoned your secretary, a soccer coach, hairdresser, taxi driver, or someone in a religious order.

from The Noisy Passage by Marie Evans & Ann Shakeshaft (1)

Okay, so I have to confess that I only recently had my first hot flash. Of course, I had no idea that's what was going on (I know, I know, one can never be too prepared for these things). It happened like this: I was in Penn Station in New York City waiting for my train home to New Hampshire. It was so impossibly hot in there. I thought, why on earth would anybody in their right minds waste so much money annually by deliberately keeping an entire train station heated to at least 95 degrees, February or not? This was ridiculous, I muttered aloud to myself, a shameless squandering of natural resources, blah, blah. The heat got so unbearable that I finally went to one of those little carts selling kitsch and bought a cotton, short-sleeved Indian print dress for twenty dollars. (It was actually kind of cute.) I went into a stall in the Ladies' Room and frantically ripped my clothes off, flung my sweater, my pantyhose, my pants in the air, avoiding the toilet. I slipped on that blessed slip of a dress and balled up my heavy woolen clothing under my arm and stumbled out of the stall. I caught a sideways glimpse of myself in the mirror and thought, "Whoa! Who is this stark raving mad woman?" My hair was sticking straight up from static cling, my face was beet red and my eyes were wild. I thought, "Holy #@$%, I look like the rest of the women who call these stalls home." Aha. And my mother said she never experienced a hot flash. Ha. Talk about denial!

And so, with my body's thermostat gone completely haywire, I once again set out to debunk the myths and secrets of this thing called menopause.

Making the HRT Decision: Some Historical Considerations

In hormone replacement therapy, natural or synthetic hormones are used to relieve uncomfortable symptoms associated with menopause, to prevent osteoporosis, or both. At first, when only estrogen was used, the treatment was called Estrogen Replacement Therapy (ERT). Hormone Replacement Therapy (HRT) refers to the treatment of combining estrogen and progesterone. HRT gained popularity when the safety of estrogen on its own was questioned. Progesterone was incorporated in recent years in an attempt to decrease the risk of endometrial cancer (cancer of the lining of the uterus) associated with estrogen used alone. Sometimes androgens--male hormones--are added to the therapy as well.

Originally, doctors recommended HRT as a temporary measure to help women over a difficult period. Recently, however, medical researchers are encouraging its use for the prevention of osteoporosis. Some physicians are proposing the use of HRT for all women for the rest of their lives. Either way, hormones are powerful drugs with potentially serious side-effects. Since HRT is an aggressive approach to the changes that sometimes accompany menopause, we need to be very sure that the treatment outweighs the risks.(2)

Some historical and political ramifications of estrogen use were presented in Part One of "Hotter Than A Red-Assed Bee: The Menopause Experience" but here are some further insights into its development.

Since its introduction in the late forties, estrogen has had more ups and downs than the hemline. It made its debut as DES (diethylstilbestrol), a drug that was used to prevent miscarriage and "make a healthy pregnancy healthier."(3) Within months of its development, thanks to pressure by the pharmaceutical companies and before any long-term safety testing was done, DES was on the market. Its disastrous consequences were known only thirty years later when the children of the women who took it (known as "DES daughters and sons") began developing serious health problems. It was taken off the market after the discovery that DES caused vaginal cancer and cervical and other congenital abnormalities in children born to women receiving the drug during pregnancy. We are still experiencing today the far-reaching catastrophe on the health and fertility of children whose mothers took DES to "prevent miscarriage." A short while later, synthesized estrogen came back in the form of the Birth Control Pill. After the Pill was linked to breast cancer, blood clots, heart attacks, and liver and gall-bladder diseases, they went back to the drawing board.

In the sixties, synthetic estrogen resurfaced as the wonder drug that would slow the aging process and make women "feminine forever." To give you an idea of the sexist advertising pitch in the early seventies, here is a quote from a (male) physician carried away in his enthusiasm for the wonders of estrogen, "one of the early steps in medicine's attempt to produce a wife who doesn't wear out. Furthermore, it will give women a tremendous psychological boost knowing they finally have something other than the artificial support of make-up to help them keep up with their husbands."(4) (I am absolutely serious. This is a real quote. Now, today in the enlightened nineties all we have are ads depicting the "state of untreated menopause" showing a woman looking forlornly out over a parched and cracked desert, implying she's all dried up and barren without hormonal treatment, creating a "From Tampax To Depends" imagery. And we've come a long way?)

In the early seventies, ERT became popular for treating depression, anxiety and hot flashes in mid-life women and for "preventing" aging. By 1975, estrogen was one of the five most prescribed drugs in the United States, earning approximately $70 million a year in profits for the drug companies. But nothing is forever. It happened again. They found it was linked to gall bladder disease and uterine cancer. As early as 1947, a warning was sounded in the medical journals about a possible link between ERT and cancer of the lining of the uterus. Yet it was not until 1975 that the first serious studies were published, showing a significant increase in endometrial cancer in women taking estrogen along. Hence the subsequent addition of a progesterone. The progestin Provera has never been approved for the treatment of menopause by the FDA.(5)

In the past few years, women have been hearing claims for the overall health benefits of estrogen that are remarkably similar to claims made in the 1960's and disproved in the early 1970's. Now, in the 1990's, awareness of osteoporosis as a major health problem and promotion of long-term use of HRT to prevent it are both increasing. Drug companies are trying to improve the image of hormone therapy and are promoting hormones as an essential part of a program of health maintenance for mid-life and older women to increase sales. Still no long-term testing has been completed; the results of the first comprehensive study (the Women's Health Initiative) will not be available until the year 2007. Estrogen has been hailed as a wonder drug. Based on this record, it's a wonder that it's still on the market at all.

With all this in mind, it's no wonder women are beginning to say, "Hey, wait just a minute here . . ." The Massachusetts Women's Health Study showed that forty percent of those on hormones continued to experience symptoms, and soon quit taking their medication, or took it intermittently; five percent experienced no relief at all, and twenty percent never filled their prescriptions. Previous studies found that half of all women on estrogen quit taking the hormone within one year after starting it.(6) It seems many women do not remain impressed by the wonder drug for long.

But the decision about hormone use for menopausal complaints is a very individual thing. Women need to know that menopausal symptoms are not the result of low estrogen levels but rather of major fluctuations of all the sex hormones. Many women choose to try alternative remedies first, and only move on to hormones if alternative approaches do not work, or are not available to them. These women use hormones to control their transition from pre- to post-menopause by taking gradually reduced amounts for as short a period of time as possible, probably for only three or four years. This decision is not completely risk-free, but most of the risks of ERT and HRT are linked to long-term use.(7) Although using hormones for a few years to cope with menopausal complaints will not prevent osteoporosis or heart disease, neither will it expose women to the unknown risks of long-term hormone use. However, there is new information that indicates there may be accelerated bone loss after termination of hormones even after short term use.

I have found a great Web Site for "menopausally savvy women" called DEAREST on Power Surge (http://members.aol.com/dearest/index.htm), an "on-line virtual community of Pausin' Women." Very cool. Dearest says, "There are no panaceas for menopausal complaints. There are those who would have us believe that any woman can restore the quality of life to which she was accustomed prior to menopause, simply by taking HRT. Would that it were so. I've heard countless stories from women on HRT who not only continue to have many, if not all, of the same problems they had prior to HRT, but also develop a whole host of new ones. We must face the reality that there are risks in taking hormones. There are risks in not taking hormones. There are risks in living. The goal is to provide information and to encourage discourse in order to enable every woman to educate herself to make a choice as to the best method of treatment for herself." (Dearest, AKA Alice Stamm)

More Considerations for the Decision-Making Process

When women evaluate the potential risks and benefits of estrogen, or estrogen plus a progestogen, they often find themselves confronting a daunting plethora of conflicting scientific data. Here to perhaps further illuminate, are some little known, obscure and deeply troubling additional facts about hormone use:

As we have said before, Premarin, one of the top five most prescribed drugs in the United States today, is made from pregnant mare's urine (ergo, Pre-Mar-In). There are over twenty horse estrogens in Premarin, none of which are native to the human female body. There are currently five hundred farms in North Dakota and Canada where 75,000 to 85,000 pregnant mares are kept tethered in stalls for seven to eight months of their pregnancy, with specially designed pouches strapped to their bodies to catch their urine. Water is restricted, as that would dilute the hormones. Exercise is denied, and when the mares give birth, they are immediately re-impregnated.(8) About nine million women in the United States are now using this drug. Let's call it what it really is: Premarpiss.

Q: Do you know how you can tell if you've overdosed on Premarin?
A: You start craving oats, hay and wide open spaces and start looking for a stud.

In addition, three brands of HRT have hidden tranquilizers in them. One of them, Menrium, available both in the United States and Canada, contains chlordiazepoxide (Librium) and estrified estrogens.(9) Women are not told precisely what is being prescribed for them. Uppity women beware! Carefully check your patient information package insert before ingesting prescribed hormones. And we thought The Stepford Wives was just fiction.

The one thing I've learned in all these years of living, is never to say "Never!" However, in light of all the aforementioned information, I think I've arrived at a course of action that seems reasonable to me . . . for the moment. Distilling it all down in a nutshell is as follows:

HRT is probably warranted for women who experience extreme menopausal discomfort, women who are at a high risk of fracture (see following osteoporosis risk information), or who have already fractured due to severe osteoporosis, and (ERT only) for some women who have had hysterectomies with both ovaries removed at a young age (before age 44). Although it can't be overemphasized that no pill can replace all of the myriad hormones lost by surgical removal of the ovaries nor mimic accurately the normal process which includes a delicate interaction among various hormones. And it is important to note that women taking estrogen for a surgically induced menopause should have their dosage decreased to mimic natural menopause as they grow older.

Estrogen and progestogens should not be routinely offered to menopausal and postmenopausal women who are asymptomatic to promote overall "good health." It is inappropriate for clinicians to encourage hormone use in women who have experienced or are experiencing a natural menopause, without first individually assessing the woman's risk for osteoporosis, heart disease, breast and endometrial cancer and offering other safer options. Widespread use in women without symptoms or special menopausal risk factors is unjustified, routine use on healthy women is unconscionable. It is not okay to take hormones just to prevent heart disease. The FDA has not approved any form of HRT for the prevention of heart disease because the studies conducted to date have been observational only and do not measure up to the standards typically used to prove a drug is effective.

Most women will find themselves somewhere in-between these clear-cut situations. Women will have to decide for themselves how to apply what is currently known. More specific, accurate information for self-help and effective, common-sense remedies are proliferating as the need increases.

Alternative approaches to treating menopausal complaints are achievable and should be explored first.

Side Effects of HRT

Women sometimes experience the following side effects from estrogen and progestogens:

Nausea and vomiting
Weight gain
Breast enlargement and tenderness
Uterine bleeding or "breakthrough" bleeding, sometimes irregular, which usually diminishes with time
Enlargement of benign tumors (fibroids) of the uterus
Fluid retention (This may make some conditions worsen, such as asthma, epilepsy, migraines, heart disease or kidney disease)
A spotty darkening of the skin, particularly on the face (referred to as melasma)
Depression/mood changes
Changes in blood lipid levels which may make heart disease more likely than with estrogen taken alone

(All this for only $30 per month!)

Weaning Yourself Off Hormones

In light of all this information, you may be beginning to want to wean yourself off of hormones in order to try a more holistic approach to alleviating aggravating symptoms. The decision to stop taking HRT is made for different reasons for each woman and at different points in her treatment. Health problems and/or serious side effects may force you to stop, or you may have planned to use it for only a short time in the first place. Or you may be fed up with taking pills every day or with having a monthly "period" again. Whatever the reason, when you discontinue your pills, your hot flashes will return temporarily if you quit cold-turkey. It's best to wean yourself from the hormones very slowly and gently.

Here's a suggestion: Each day shave off a tiny bit of your standard HRT dose with a sharp knife or razor. Do so slowly over a long period of time while increasing the things that stimulate your body's inherent wisdom and desire to create balance. If you reach a point where you feel you are decreasing HRT too quickly, then stay at that dosage until your body stabilizes again. Then continue with the program of decreasing. This process of balancing and reawakening the body's natural ability to create its own hormones may take several months but has proven effective for most women.(10) And don't forget the non-drug strategies for coping with symptoms while you are doing this, including many of the suggestions found here in these pages, as well as a solid commitment to healthy lifestyle changes. It is also recommended that you use liver-nourishing herbs, like dandelion, to detoxify while taking HRT. Interface with phytosterol-rich herbs (phytosterol = plant-derived estrogen) as you taper off, optimally within thirteen months. If you do become an anarchist and deep-six your prescription entirely, as my mother did, you may receive several videos in the mail from drug companies as to why you absolutely need to resume taking your pills. Frightening.

If for medical reasons you must remain on HRT, those of you who are on the conventional regimen of Premarin and Provera might want to switch from horse estrogen to natural hormones (hormones that biochemically match those found in the human female body.) Twenty five percent of women in the United States over age fifty are on Premarin, so check your current prescription. The following preparations are made from one hundred percent all-natural estrogen native to Homo Sapiens: Estrace pills, Estraderm patch, Vivelle and the Climera patch. If you are on Ogen or Othoest, these are "quasi-natural"--but they are preferable to equine estrogens.(11) Also, if you find you feel pretty good when you're taking the estrogen but then really crummy when you start the Provera (a synthetic progesterone), you might want to switch to a natural, generic progesterone such as Pro-Gest cream (derived from Mexican wild yams).

For further information about natural hormone use, I highly recommend Dr. Christiane Northrup's work, particularly her book Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing (Bantam Books, 1994). Dr. Northrup is a pioneer in the field of natural hormone use and is an internationally renowned (and genuinely humorous) speaker on the subject of women's health. My only hesitancy about her work is that she is very quick to recommend hormones, albeit "natural." It is my understanding that these hormones are called "natural" due to the chemical structure, not due to the source, and the problem with any biochemical manipulation is that we don't really know what ill effects may be associated with taking a foreign steroidal structure. Besides, all this feeds into the "quick fix" mentality so prevalent in our culture today, instead of doing the real work of trying to figure out how to age consciously and gracefully.

Menstrual Cycle Changes

Spotting Quiz. Circle One: Menstruation Is:

A thick, hearty Italian soup;
The mark at the end of a sentence;
Banned by Orthodox Jews;
A hex placed on you by the sanitary napkin conglomerate whenyou were thirteen.

From The Noisy Passage by Marie Evans & Ann Shakeshaft

Changes in the menstrual cycle are usually the first sign that menopause is approaching. In the years before menopause you may find your periods coming more or less frequently and you may at times skip periods entirely. Sometimes your regular menstrual pattern returns for a few cycles, and then changes will happen again. Eventually your periods will stop completely. Most women experience some degree of cycle changes during the years surrounding menopause. Although there are some women whose periods stop abruptly, most of us go through a few months or even years of unpredictability before bleeding stops. Each woman's experience of menopause is uniquely her own. Menstrual irregularities in both cycle length and flow are normal because of the hormonal fluctuations of premenopause when hormone production is not very well balanced. Although this is a normal physiological process in all mid-life women, most medical textbooks label this as a "DUB" or "dysfunctional uterine bleeding," inferring a pathological disease state.

Erratic, scanty periods are caused by a decrease in estrogen. The aging follicles on the ovary produce less estrogen and this affects the endometrium (lining of the uterus) which does not thicken as usual during the early part of the cycle. With less lining to be shed, the periods are lighter. There is no need to treat this situation, unless the eccentricity of your cycles bothers you. Then you could try sleeping with the light of the full moon shining directly in your face, to see if that will encourage your body back to a lunar rhythm.

It is probably a good idea to begin keeping track of your periods. Start charting your periods by recording the day it began (Day 1), the amount of flow, the length of the cycle and any bleeding in between. This will give you an instant overview of your "pausin'" progression and is very useful when consulting with your healthcare provider.

You could take time away for yourself when you do bleed, meditate and do a full-body relaxation on the first day of your period, to honor these last few precious cycles. Personally, I love my blood and I am going to be very sad when my bleeding time comes to an end. I have a good friend who kept a little vial of her last menstrual blood in the freezer!

The adrenals, which take on the role of producing estrogen after the ovaries cease to, often need a boost during this transitional time. The following blend strengthens and tones the endocrine system and helps revitalize the adrenal glands:

Crone's Brew Tonic for Menopause

(I've experimented with variations of this formula on my friends for many years now. They say they're glad they were guinea pigs.)

3 parts Dandelion Root
1 part Black Cohosh Root
2 parts Hops (flowers)
1 part Motherwort
2 parts Yellow Dock Root
1 part Blue Cohosh
3 parts Sage Leaf
3 parts Red Raspberry Leaf
2 parts Stinging Nettle

Gather herbs together. All of these herbs are native to New Hampshire, but if you can't find them all, that's okay. Snugly fill any size jar with chopped pieces of fresh plant material. Fill the jar to the top with 100 proof vodka. Label and let stand in a dark place for six weeks. Use 1/2 teaspoon of this tincture diluted in water or tea, three times a day through your climacteric years. Regular use will gradually ensure steady, long-lasting results.

Menstrual cycles getting closer together is caused by a decrease in progesterone. After ovulation, the corpus luteum on the ovary may produce less progesterone. When levels of this hormone drop earlier in the cycle, an earlier menstruation is triggered and the cycle will be shorter.

If this becomes disconcerting for you, one thing to do is to reduce the animal fats in your diet, eliminate all red meats entirely and decrease poultry as much as possible. Animal fats are converted by the body into estrogens known as estrones, thus confusing the delicate feedback mechanisms regulating your own hormones. Plus, animals not organically raised are fed supplemental hormones (including Diethylstilbestrol--DES), which are passed on to you in animal fat, further confusing your poor body. Besides, meat is dead.

Yarrow flowers and leaves (Achillea millefolium) are progesterone promoting herbs used as a tea when menses come too frequently. Acupuncture is also very effective in regulating erratic menses; it unblocks stagnant Chi energy. Find a good Naturopathic physician in your community.

Lastly, birth control pills are sometimes used to regulate menstrual intervals; however, this treatment is now considered inappropriate for women past the age of forty, due to the increasingly dangerous side effects from synthetic hormones. Provera (a synthetic progesterone) may also be suggested here, but should be emphatically refused as the known and unknown risks greatly outweigh any possible benefit.

In the pre-menopausal years, two kinds of heavy bleeding can occur. The first is "flooding", or Menorrhagia (heavy menstrual flow). The other perimenopausal bleeding is called "breakthrough bleeding."

Menorrhagia is sometimes due to an "anovulatory" cycle (no release of the egg at mid-cycle), where periodic ovulation does not take place. This can affect both cycle length and amount of flow. Without ovulation, the endometrium becomes overgrown, extremely dense and fragile, when it does come, is usually heavier and longer and often accompanied by cramps. Excessively heavy menstrual cycles are associated with too much estrogen and insulin, not enough progesterone and an imbalance of the prostaglandin hormone known as F2 alpha, which is involved in regulating the female reproductive cycle. Unlike some of the milder changes, heavy bleeding and flooding can create stress and disruption in your life, and can be very frightening.

One of the most important ways to take care of yourself if you have heavy periods is to prevent anemia by increasing the amount of iron in your diet. Loss of blood always means loss of iron, and thin blood is more likely to hemorrhage. Repeated heavy bleeding month after month often leads to chronic anemia. Anemia is a decrease in hemoglobin, the iron-containing molecules in the blood which carry oxygen. The symptoms of anemia include fatigue, paleness and weakness. Dizziness, clamminess and mental confusion are warning signals. Be sure to have your midwife prick your finger to check your blood hemoglobin levels if you experience any of the symptoms. Iron supplements should be used. A very absorbable iron to reverse anemia is ANR Iron (to order, call 1-800-836-0644); it is 27 mg of time-released ferrous iron which is easily absorbed from the intestines.

Avoid aspirin, Midol, large doses of ascorbic acid (Vitamin C supplements) and Pennyroyal, as they thin blood and may increase bleeding.

Lady's Mantle (Alchemilla vulgaris), the alchemical herb, controlled menstrual hemorrhage in three hundred women in a recent survey.(13) When taken for one to two weeks prior to menstruation, Lady's Mantle prevented flooding. Use 10-20 drops of the fresh plant tincture three times a day for up to two weeks out of the month. Lady's Mantle plants make a beautiful low hedge with lacy greenish-yellow flowers, a welcome addition to any perennial garden as it is easy to grow. It is a little difficult to find in health food stores, so it should be cultivated in every woman's garden for its beauty and usefulness as a tonic herb.

Acupressure points can serve as an emergency preventative for flooding. Press very firmly on the point located in the groove above the center of the lip, right under the nose. Hold for at least one full minute. I first saw this down in Moscow, Russia for women hemorrhaging after childbirth.

Shepherd's Purse (Capsella bursa pastoris) is a styptic herb (stops bleeding), and is a renowned remedy for women with boggy uteruses, as it is also high in oxytocin, a uterine contractor. Use the whole plant, fresh or tinctured, as it does not store well. Shepherd's Purse is a specific remedy for excessive menstrual flow because of its high concentrations of tannin, tyramine and amino-alcohols: choline, acetylcholine and amino-phenol. Either by itself or combined with Yarrow, it will arrest menorrhagia, dysmenorrhea and uterine hemorrhages. Drink the tea freely throughout the day; put a dropperful of tincture under the tongue if flooding is severe. Expect to see results within a few hours, and strong results in a few days.

If you are wearing an IUD (an intra-uterine device for birth control), now is probably the time to have it removed.

Take a nonsteroidal anti-inflammatory drug (NSAID) such as Ibuprofen, daily. Start one to two days before your period and continue through your heaviest days. Use the lowest dose that gives you results, and stay within recommended dosages. NSAIDs such as Advil, Orudis and Aleve decrease menstrual blood loss by interrupting release of excess prostaglandins F2 alpha.

There are currently new drugs on the market to control excessive bleeding (Danazol, GnRh analogues), but apparently these have their own host of problems.

If flooding continues to be severe, the allopathic medical approach would be to suggest using Progestin (a synthetic progesterone) and then surgical curettage. Hysterectomy (removal of the uterus) may be proposed at this time as a permanent solution to menstrual flooding. One in four women in this country reach menopause via surgery or chemotherapy. More than one fourth of all hysterectomies are done to control flooding.

By the age of sixty, more than one-third of all American women have lost their uteruses, many unnecessarily due to benign fibroid tumors. Treatment of fibroids is the most frequently cited reason for hysterectomy. Fibroids are estrogen dependent and disappear after menopause anyway except in women who are taking hormone supplementation. American women are three times more likely to have hysterectomies than are women in Great Britain. Ninety percent of all hysterectomies are performed for conditions which are not life-threatening and could potentially be treated by alternative methods.(14) The frequency with which hysterectomy is recommended reflects the belief that the uterus is a useless organ once childbearing is over, which brings us this hysterical pearl: "After the last planned pregnancy, the uterus becomes a useless, bleeding, symptom-producing, potentially cancer-bearing organ and therefore should be removed." --Dr. R. C. Wright, Gynecologist, 1988.

Could the same be said for the prostate gland? While in rare situations hysterectomy is the only solution, it still is a radical one, and the decision to have a hysterectomy should be made very carefully, with several opinions and based on solid information.

The other perimenopausal bleeding besides flooding is called "breakthrough bleeding." This irregular bleeding between periods around menopause is often related to hormonal factors or extended progesterone effect which causes irregular shedding of the endometrial lining. Sometimes the corpus luteum doesn't shrink in the usual way after ovulation. The persistence of progesterone causes the endometrium to build up past the point in the cycle where it would normally be shed. However, without enough progesterone to completely prevent endometrial breakdown, women experience erratic bleeding over an extended time, continuing into the next cycle. Anovulatory cycles may also cause breakthrough bleeding if only parts of the endometrium break down at different times. Anyway, vaginal bleeding other than menstrual flow is called spotting.

There are two homeopathic remedies for women with menopausal spotting: CHINA is for women who also flood, feel weak, and are often depressed. PULSATILLA is for women who are highly emotional.(15)

Red Raspberry leaf tea is a uterine toner and is the herb of choice for the "pausin'" woman who is spotting for no known reason. Drink at least two cups of strong infusion daily. Regular menses may even be re-established.

Wild Yam root tincture (or Pro-Gest cream) can prevent and halt mid-cycle bleeding by contributing to progesterone production. Take two dropperfuls of the tincture daily until spotting stops.

N.B.--If the above suggestions have no effect, seek the help of your healthcare provider, particularly if it has been more than two years since your last period and you begin to spot or stain. While spotting and staining are normal manifestations of menopause, there's an off-chance it could be a distress signal indicating possible cancer of the reproductive organs. So get it checked out, especially if your spotting continues for more than ten days.

Now, before you fly into a panic about this, you need to remember that most normal premenopausal bleeding has a very "hormonal feel" to it. You'll identify the changes in your body that are associated with monthly bleeding, along with other premenstrual signs such as weight gain, chocolate craving, bitchiness and headaches, etc. You know the scenario: "Oh, so that's why I bit his head off last night." Well, the ebb and flow of menstrual energy is cyclic and we are cyclic beings. Bleeding from other causes may not have a normal cyclic feel to it and usually doesn't seem to have any pattern or rhythm at all. You know your body better than anyone; listen to the old girl.

Osteopsychosis

We are currently being terrorized by the medical establishment's warnings of crushed spines and brittle bones that will break and never mend, which has created a pathology of midlife for women. The drug companies manufactured campaign to remarket estrogen (yet again!) with a clean image has been stunningly successful this time. In the 1990's, the reorienting of osteoporosis as a women's disease is now firmly entrenched. It is now mandatory to include osteoporosis as a major "symptom" in any credible discussion of menopause. By convincing the public and the medical profession that osteoporosis is a "crippling" and "killing" disorder and estrogen is the only cure, HRT has been elevated to sainthood status. The projection is that HRT offers salvation where otherwise there would be tragedy, rescuing women from a horrific fate as deformed, "Dowager Humped" crones. The truth is, it is never too late to create healthy new bone.

Osteoporosis was covered quite expertly by Luita Spangler in the Fall, 1996 issue of WomenWise, so I will avoid being redundant in information, but I would like to add the following tidbits to help you in your self-care:

It is true that for about five years right after the last menses, the bones apparently refuse calcium and bone mass decreases during the climacteric years. Why? We'll probably never know for sure, but we do know that estrogen has a protective effect on bones as it blocks another hormone, parathyroid, from stimulation bone resorption. With less estrogen, bone loss is accelerated until the body readjusts. But bones do start absorbing calcium once again with this five to seven year hiatus is past.

Consumption of calcium-rich plants, combined with moderate exercise, can reverse osteoporosis. Flexible bone mass is built with balanced mineral intake (leafy greens, herbal infusions, supplements, etc.) and exercise. And bones that resist breaking are flexible. When you build bones with calcium rich greens and exercise, bone cell creation is stimulated and supported. Frequent walks and/or yoga (you don't even have to break a sweat!) and a diet high in calcium allies (at least 1500 mg daily) consistently reduces postmenopausal fractures by more than fifty percent.(17) Unfortunately, if you are taking HRT and you stop, there is a rebound effect, and the rate of bone loss can greatly increase. Controversy still exists as to whether HRT must be taken for life to prevent fractures. Taking HRT for five to ten years around menopause does not provide fracture protection, and women who stop taking it and who are several years past menopause could theoretically induce a second acceleration of bone loss.

It is never too soon to start building dense, flexible bones. The following are suggestions for lifestyle changes to minimize the possibility of developing osteoporosis in later years:

Build bone mass before menopause. Bone is very much "alive." New bone is constantly being formed and old bone is broken down (resorbed). This bone remodeling goes on all our lives. The body has totally replaced old bone with new bone growth every ten years. Women who are physically active, eat calcium-rich foods and have no abnormal interruption of their menses in younger years lose less bone mass and are less likely to fracture in old age.

Eat a diet rich in dark-green leafy vegetables to insure sufficient dietary calcium. Our bodies do not manufacture calcium and calcium makes up more than half of the total mineral content of our bodies, so we must depend on a well-balanced diet to meet this need. Cooked greens provide abundant, highly usable calcium. One cup of cooked broccoli, kale (yum!), plantain, turnip and mustard greens contains about 200 mg calcium. One cup of cooked collards, wild onions, lamb's quarter, or amaranth greens contains about 400 mg. Many of these plants grow wild in our lawn every spring, so we graze and joke about eating our backyard, our nouveau edible lawn cuisine. Menopausal women should try to ingest 1500 mg or more of calcium foods daily.

Natural vinegars, such as apple cider vinegar, are especially effective mediums for extracting the mineral riches of greens. Vinegar has the great ability to dissolve calcium (and some alkaloidal components as well) and hold it in solution, ready for assimilation. Plus, vinegar increases hydrochloric acid production for greater digestion of calcium. So freely douse your cooked greens with apple cider vinegar and increase their nutritional properties. I have this "out-there" theory as to why African-American women have a much lower incidence of osteoporosis than Caucasian women (only six percent for women of color). Many African-American women of the last generation typically grew up eating "soul food" of greens and pot-herbs steeped in vinegar or molasses and generally held jobs that were physically strenuous. Now these elder women are reaping the benefits with denser bones and fewer fractures.

Find an exercise routine that works for you and that you enjoy, then stick to it. Exercise is the surest way to slow down the advances of osteoporosis as it increases bone density. Exercise helps protect bone mass by increasing the body's own production of estrogen, which is important to bone maintenance. Plus, it makes us more agile and less prone to falling. Resistance-type exercises such as weight lifting and free weights are the best kind of exercise for building bone density. However, any type of weight-bearing exercise is beneficial, including such nonstressful exercise as yoga and walking. I try to do free weights with my fanatical sister three times a week for a hour and Phoenix Rising yoga stretching on the off days in the early morning. Women who exercise regularly live an average of six years longer than sedentary women.

Calcium-rich herbs that grow in our backyards include nettle, sage, chickweed, red clover, comfrey leaf, raspberry leaf and horsetail. Dry these to enjoy as a tea or soak in cider vinegar for six weeks to take by the tablespoon. One cup of infusion or one tablespoon herbal vinegar equals 250-300 mg calcium. I make the following cider vinegar based brew in the early summer when the plants are flowering. I find I crave it in the dead of winter. I can drink it straight with no chaser; sometimes I even use it in salad dressings.

Crone's Bones Brew

Comfrey (Symphytum) leaves/flower stalk
Horsetail (Equisetum arvense) leaves and stalk
Borage (Borago officinalis) leaves and flowers
Nettle (Urtica) leaves
Dandelion (Taraxacum) whole plant
Raspberry (Rubus) leaves
Motherwort (Leonurus cardiaca) leaves/flower stalk
Red Clover (Trifolium pratense) blossoms
Garden Sage (Salvia officinalis) leaves and flowers
Clean eggshells

You can easily find and identify all of these plants right in your neighborhood, but you don't need them all to make a kickin' calcium brew; just gather what is available to you. Always leave some of the plants undisturbed for next year. Using fresh plant material only, snugly fill up quart jars with coarsely chopped herbs, then cover with cider vinegar. Lid, label and put in a cool dark place for six weeks. Drink at least one tablespoon daily for strong Crones' bones; it supplies approximately 200 mg of calcium.

High calcium protein sources include tahini, tofu, oats, seaweed, sardines, salmon, yogurt, oatmeal, nettles and dandelion leave.

The verdict is still out on calcium supplements. We do not know for certain whether adding large amounts of supplemental calcium to our diets during and after menopause will actually lead to that calcium being deposited in our bones. The research results are inconclusive. How much calcium we really need each day remains controversial. It is currently recommended that premenopausal women take 800 mg and post-menopausal women 1200-1500 mg daily. Calcium fortified orange juice is the only way to get calcium citrate maleate, which is the easiest to digest and absorb. Crumbly tablets of calcium citrate are next best. Calcium cabonate provides the greatest amount of elemental calcium (40%). All calcium should be taken with Vitamin D (ten minutes in the direct sunshine provides this) so it can be assimilated, and 500 mg of magnesium is recommended as also necessary for strong bones.

Eat a low protein, low fat diet. Foods high in protein but low in calcium (such as red meat) result in calcium being excreted in the urine. Get fewer of your daily calories from protein, replace meat with beans or fish. Nonfat dairy products actually have more calcium than whole-milk products.

In addition to increasing your calcium intake, you can also avoid habits which decrease calcium absorption or increase its excretion from the body. This includes moderating alcohol and sugar and stopping smoking completely. Smoking literally poisons the ovaries and decreases production of all ovarian hormones chronically. Besides, speaking as a reformed smoker, I find it absolutely disgusting and obnoxious.

Eliminate excess salt and phosphorus (this includes soft drinks) from your diet--these produce urine loaded with calcium that accelerates bone loss and demineralization.

And last but not least, quit coffee! I know I went off on this before in Part One, but I bet in the future we'll identify coffee as the big culprit in the increase in the rate of osteoporotic fractures in elderly white women. "Those women who drink 2-3 cups of coffee daily, whether regular or decaffeinated, increase their risk of osteoporosis-related fractures by 69 percent; those who drink 3 or more cups per day increase their risk by 82 percent." (American Journal of Epidemiology, October 1990) I have learned since I wrote in Part One that one cup of coffee leaches 5 mg of calcium from bones, actually every cup of coffee leaches 11 mg of calcium from your bones.(18) There are 200 mg of caffeine in a 5 oz. cup of brewed coffee. The average American drinks 28 gallons of coffee a year. Excess intake of caffeine is associated with increased urinary excretion of calcium and demineralization. Not to mention breast tenderness. Deep six the java and I'll bet your breast tenderness is gone in one cycle! My theory is that the increase in osteoporosis that we are currently seeing in our grandmothers and now beginning in our mothers is due in great part to the fashionable vogue of an obsession with thinness, resulting in chronic dieting to embody the "one can never be too rich or too thin" mentality. So they subsisted on coffee and cigarettes, with an occasional salad paired with a martini and evidently peed all their calcium away. I think in the future, osteoporosis-related fractures will be easy to prevent: just quit drinking coffee and smoking cigarettes, and increase exercise and calcium. Amen.

Osteoporosis Risk Factors

As many as 25% of North American women will develop osteoporosis in their life-times, and these are predisposing factors. Some are irreversible but many can be changed by cleaning up your act:

Do you smoke?
Do you take steroids?
Are you sedentary?
Do you consume more than two alcoholic drinks or four or more cups of coffee or cola per day?
Did your mother or grandmother have a hip or other osteoporotic fracture?
Are you depressed?
Are you quite thin, with fair hair and skin, and have less than 18% body fat?
Is your diet low in minerals such as calcium, magnesium and other nutrients such as vitamins C and D?
Did you go through premature or surgical menopause before age forty?
Do you have a history of anorexia, irregular periods or amenorrhea (no periods)?
Has a recent DEXA scan (X-rays that measure bone density) shown you to be at risk?(16)

If you answered yes to two or more of these questions, you may be at increased risk for osteoporosis, but take heart--there is much you can do to improve your bones. So start now!

Iron

Increase iron for fewer hot flashes, less menstrual flooding, fewer headaches, better sleep with fewer night sweats, easier nerves, more energy and less dizziness.
Iron is depleted by: Coffee, black tea, enemas, alcohol, aspirin, cabonated drinks, lack of protein, too much dairy.
Food sources of iron are; Leafy greens, molasses, dried fruit, liver, yellow/red/orange vegetables, bittersweet chocolate, whole wheat, oatmeal, brown rice, mushrooms, potatoes, honey, seaweeds, canned salmon, sardines.
Herbal sources of iron are: Chickweed, kelp, burdock, catnip, horsetail, milk thistle seed, uva ursi, dandelion leaves/root, yellow dock root, black cohosh, echinacea, plantain leaves, nettles, licorice, valerian, fenugreek, sarsaparilla, peppermint. (12)
Try to consume 2 mg or more of iron from herbs and food daily.
Flooding will probably be noticeably less by the next menses.

Changing Woman Rite

Many women have expressed, in workshops I've presented, concern about their sexuality and decrease in libido. My answer to them is not to panic--it will return! Women's sex drives increase after menopause is over because our level of testosterone, a male hormone that we all have, becomes dominant as estrogen levels decrease. We are still the desirable, feminine, funny, sexual, beautiful and lusty women we were prior to menopause, but now only when we want to be, not when someone else wants us to be. Tough love.

It is very interesting to note that in every culture in which women's status improves after menopause, menopausal symptoms are nonexistent.(19) By the year 2000, there will be 57 million women in menopause--57 million women hot flashing--talk about global warming! It is time for us to alter the current perceptions, to shift the "consensus reality" regarding the "Change" and reclaim the power that comes with the 'pause. As my long-ago friend Starhawk says, "it is time to see ourselves as divine, our bodies as sacred, the changing phases of our lives as holy, our aggression as healthy, our anger as purifying, and our power to nurture and create, but also to limit and destroy as necessary, as the very force that sustains all life."(20) So in the following Rite, I want you to be free of inhibitions, to be explosive and intense like volcanoes, floods, winds and fire, to be raging and chaotic, to be ecstatic and to alter your reality.

A very simple but beautiful way to create the space for the Rite is to spread a blanket on the ground outside in a favorite place and to place flowers or something of beauty and power in the center to honor the Great Mother Of All. In the North you could place rocks, stones and gems to symbolize Earth, in the East you could place feathers and burn incense to symbolize Air, in the South you could burn candles to symbolize Fire, and in the West you could have a chalice of water or wine and seashells to represent Water. It is best to do this Rite by the light of the waning moon (the Crone Moon, when the crescent's horns are pointing West).

This Rite is done by women who are asking for guidance and clear instructions on their journey through menopause. You could begin by stretching your body very slowly to great the Four Directions, saying "I, [your name], am alive!" out loud four times. Then burn garden sage and cedar in a shell to purify the space, raise the smoke to the dark of the night and the Crone Moon and speak directly your intention of what it is you ask. Then sit with your spine straight and breathe very deeply and slowly, expanding your belly with every inhalation and contracting your belly with every exhalation. Breathe fully ten breaths without letting your mind wander, thinking only of the breath and the sound of your breathing. If your mind wanders, start breathing to ten all over again. When you have finished, sit very still with your eyes closed. Listen to all the sounds, both near and far. Watch the shifting shadows in your eyelids. Smell all the smells available to you outside. Taste the taste in your mouth at that moment. Feel all the sensations in your body. How does it feel? Feel the whisper of breeze on your skin. Slowly lie down if you like, cradling your belly with both hands and ask for wisdom and healing to come from your womb. Sink down into the comfort of Mother Earth. Give thanks for all the gifts you have to be joyous for. Now as you appear on the threshold of the next phase of your life, ask your Wise Woman to come to you to give Her advice. Picture Her clearly. She is not just a figment of your imagination. She has something of great importance to tell you which may astound you. Be in this gentle place for as long as you wish.

As you return your awareness to your body, be prepared to shift the energy to wild-woman as you claim the power coursing through you. Now stand solidly, defiantly, in your thickening, naked body and throw your head back. Let out a growl that grows to a long, clear satisfied howl of joy to the Lady of the Moon. Let Her know you are still cycling with Her, even though your bleeding time may have come to an end. Let the sound you make build until it reaches She Who Remembers. Reach up and pull down the light of the moon into your belly. Let Her heal you. Now squat down. Feel the moonlight warm your yoni. Pull the moonlight into your vagina, then up into your belly. Do a slow, sensual grinding of your pelvis. Fell the heat--it's okay. Loosen up those creaky old bones. Open. Open up. When you are done, place your hands firmly on the earth and slow your breathing. Give thanks to the Wise Ones for guiding you. To end your Rite you could chant (this is one of my favorite songs):

Ancient Mother, I hear you calling,
Ancient Mother, I hear your sound.
Ancient Mother, I hear your laughter,
Ancient Mother, I taste your tears.

(This was taught to me by Colorado midwives in 1976--I sang this a lot to women in labor).

Now that you've been through the "Change", don't stop! Break all the rules, keep grinding. Wear purple, become a belly dancer, get a tattoo, take up sea kayaking, learn to spit, take a woman lover, buy a motor home and move to the edge of a river, practice picking up inanimate objects with your yoni, eat pickles and chocolate for dinner--the possibilities are endless!

Good luck to you on your journey. May we all learn what we need before we need it and with great inspiration! Blessed Be!

Footnotes and Resources

Evans, Marie & Ann Shakeshaft. The Noisy Passage. Hysteria Publications, 1996. p. 83.
Montreal Health Press. A Book About Menopause. 1988, p. 7.
Sand, Gayle. Is It Hot In Here Or Is It Just Me? HarperCollins, 1993, p. 51.
McCain, Marian Van Eyk. Transformation Through Menopause. Bergin & Garvey, 1991, p. 24.
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 273 (1995):3, 199-208.
"Power Surge" Web Site. http://members.aol.com/dearest/index.html (Features online chats, AOL's Women's Interest Channel, Community Conference Online, regularly scheduled chat guests. Also weekly talks with naturopaths, authors and doctors.
National Women's Health Network. Taking Hormones and Women's Health. 1995, p. 7.
Northrup, Christiane. HRT Advisory. Phillips, 1996, p. 8.
Montreal Health Press, p. 36.
Gladstar, Rosemary. Herbal Healing for Women. Fireside Books, 1993, p. 15.
Northrup, Christian. Women's Bodies, Women's Wisdom. Bantam, 1995, p. 474.
Weed, Susun. Menopausal Years, The Wise Woman Way. Ash Tree Publishing, 1992, p. 6.
Weed, p. 7.
National Women's Health Network, p. 16.
Weed, p. 15.
Northrup, p. 452.
Northrup, p. 455.
Northrup, p. 611.
Northrup, Christiane. Health Wisdom for Women. Vol 3. Phillips, 1996, p. 6.
Starhawk. The Spiral Dance. HarperSanFrancisco, 1979.

more books on menopause
Part One 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