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How today's approach to menopause differs from what stood out two decades ago

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Compare today's approach to menopause to that of the mid-1990s era when the emphasis spotlighted conventional HRT.Back in 1995-1996 no one in Sacramento or San Diego, the two cities of our family's living quarters, thought of treating menopause by prescribing vitamin K-2 (MK-7) from natto and vitamin D3 along with adequate magnesium and a little calcium to stop bone loss and help prevent arteries from calcifying. No one mentioned the DHA and EPA in cod liver oil to reduce triglycerides. And no one told women over age 50 to take ubiquinone, the reduced form of COQ10 (that's absorbed better by older adults). Too many people broadcast menopause meltdown media stories compared to menopause exercises and menu choices.

No one suggested lowering cholesterol by reducing inflammation. And only athletes knew about d-ribose for muscle energy and special grape seed extracts to relax blood vessels. All doctors wanted to prescribe was estrogen from horse urine and synthetic progestin. If you strayed from Premarin and Progestin, you were scolded by your HMO doctor. Then you found an alternative practitioner who'd fill you up on soy products.

Neither product worked well in this corner. The next step: Internet databases, searches, newsletters, and fact sheets for nutrients, supplements, or herbs. Which worked? Which could be validated as safe? But in 1995, primarily journalists and computer industry workers knew the medical side of the Internet. In April, the Netscape browser helped.

Back then, you went into menopause, and, if you questioned your HMO, you were prescribed the drug of the decade. At that time, the Internet began to list incredible research databases for alternative healing tools, whole foods, nutrients, and supplements.

Supplements and menopause

See the supplements aisles, for example at Sacramento Natural Foods, Whole Foods Market, Elliot's Natural Foods, General Nutrition Center (GNC), or Sacramento, Roseville, and Auburn health food stores such as Sunrise Natural Foods, where there's a wide choice of various herbs, vitamins, minerals, and other nutritional products of interest to anyone going through menopause. Also check out the various herbal remedies on shelves at the various natural foods sections of supermarkets and organic food sections or stores in Sacramento.

This captivated audience represents a huge market for makers of hormones, vitamins, and other specialty products, much of which is advertised on the Web. So a wealth of information has appeared on the Internet to meet the needs of the 38- to 55-year-olds undergoing menopause, as well as younger women with PMS, infertility, and contraception concerns.

Searching online for menopause solutions now can be a journey of linking connections

Have treatments changed that much? Or are they still pretty much the same? In 1995, menopause treatments focused on conventional medical drugs. Today, you have more choices from identical biological hormone therapies to nutrition and supplement changes adjusted to the menopausal woman's issues surrounding carbohydrates.

You may not be able to digest carbs as well as when you were younger. Through the medical resources on the Internet, you can obtain information your doctor hasn't got time to give you, and talk to people who share your problems.

Back in 1995, when I went through menopause, I had to back away from conventional medicine as the Premarin and Progestin I had been told to take by my primary care HMO doctor (for a 10-month stretch) revealed tests that had been worse than before I took anything for menopause. So I stopped prescribed drugs specifically for menopause. And my normal test results returned to what they were before I had begun to take anything for menopause.

The decision to walk away from conventional medical treatments for menopause were reflected in my article, published in Internet World magazine, back in Februrary,1996 when the Internet's infancy became a new source for seeking medical alternative solutions to menopause questions.

I had found back in 1995, when I already was in my middle fifties, that doctors don't always have the time or breadth of knowledge to discuss alternative, customized solutions to a family's healthcare needs. You know the old cliche: the more things change, the more they stay the same. But today, there really are more alternatives online. And you need evidence that validates what's out there.

To find alternatives that work well and are safe (by validated evidence) is why I turned to the Internet when it had been so new that medical alternative information about menopause had just begun to surface. Not as many women then as today were going through menopause because we were seven or eight years before the baby boomer's began to reach fifty.

Fourteen years later, it's not menopause issues I'm searching for, but healthy, whole and raw food recipes--living foods--and information about supplements with a preventive inclination. The Internet resources are great for searching preventive and personalized medicine and nutritional alternatives remedies focused on prevention and balancing what's unbalanced in nutrition.

After searching the Net for Web sites, support groups, or little-known health newsletters, I found dozens of physicians trained in both medicine and naturopathy who offered to give me answers to my specific questions via e-mail. The Internet's use as a resource for information appeared to become a healing tool. After finding alternative solutions back in 1995, I took the resources to the media and joined the American Medical Writers Association where I had access to resources online that could show me more possibilities on getting through menopause and getting questions answered.

Each member of my family required a different healthcare service and support group to address their particular problems. In my case, I am allergic to synthetic progestin, which eases the side effects of menopause. At the health-maintenance organization (HMO) to which I am a member, I asked my doctor for natural, yam-derived progesterone.

He refused to prescribe it because he said it wasn't yet approved by the FDA, which left me with not too many conventional alternatives to prevent osteoporosis. Instead I was put on hormone-replacement therapy, which involved back then taking oral estrogen and synthetic progestin for ten months (before I stopped taking any conventional medicine for menopause). I believed that the oral horse-urine derived estrogen was raising my blood pressure sky high. When I mentioned this to my doctor's nurse, she snapped, "Prove it."

So I set off on my journey to prove it. First I checked the alt.support.menopause newsgroup, now listed as one of numerous Google discussion support groups, which was extremely helpful. I posted the following question: Is anyone else using a high soy and vegetarian diet, the herb black cohosh, and natural, yam-derived, progesterone cream for menopause--to help prevent bone loss--instead of the usual estrogen and progestin? If so, what are your comments and experiences?

The replies were practical, useful, and factual, providing medical references, titles of medical journal articles, and book bibliographies, as well as personal experiences and encouragement. For example, one person pointed me to an article entitled "Risks of Estrogens and Progestogens" in the December 1990 issue of Maturitas, an English-language European medical journal.

The author, Dr. Marc L'Hermite, found that five to seven percent of women on conjugated equine estrogens could get severe high blood pressure and that they would return to normal when the hormone-replacement therapy was withdrawn. A bibliographic reference to this article also appeared in Dr. Lonnie Barbach's book, The Pause. Not one physician at my HMO had mentioned these concerns.

To obtain more information about what alternative health solutions were available and how particular products would change my body or health, I searched the Web under the keywords "menopause," "alternative healthcare," "herbs," "homeopathy," and "naturopathy." I also looked under "natural progesterone."

Through this search I found the MenoTimes, a quarterly journal published in San Rafael, California in 1996 and still online today. I subscribed back then because it had the information I sought on Dr. John Lee's book, Natural Progesterone: The Multiple Roles of a Remarkable Hormone. But later I found out, the wild-yam-derived progesterone cream I ordered online and used daily over-stimulated my thyroid, and I had to resort to nutritional supplements and whole foods instead of trying to balance my menopausal issues with hormones. Also online today and also online in 1996 is the up-to-date Women's Health Hotline.

At a holistic health convention I attended in the mid-1990s, foods emphasized back then had been soy along with lots of vitamin B complex. So after eating too much soy such as tofu, tempeh, and drinking gallons of soy milk, my thyroid again had been overstimulated by too much vitamin B and soy, plus the progesterone cream, and I had to stop eating that way and stop the topical creams. The physicians I met at that conference emphasized using estrogen to what they thought back then would protect us all against heart disease and bone loss.

Little did they know that later studies would be published in medical journals showing that taking what I had been prescribed in 1995, Premarin and Progestin, would not protect against what they thought it would, at least not for a lot of women. After 10 months of taking daily Premarin and Progestin, my medical tests scores looked worse than what they were before I started making any changes to my regimen of natural whole foods and a basic multi-vitamin.

I had been told to take 1,500 mg. of calcium daily but only a small amount of magnesium. That had been wrong for my body's needs. What worked much better, I eventually found out, had been multiple ionic minerals, especially a tablespoon of magnesium citrate powder, and far less calcium.

I didn't have any remarkable menopausal symptoms, but all the lectures I'd gone to held at university medical centers kept pushing synthetic hormone replacement therapy at me as if it were the one size fits all solution for everyone going through the changes. I never understood why my HMO doctor insisted, "If you go off of estrogen and progestin, it will be like a diabetic going off of insulin."

Why did he tell me that? My menopause had not been due to a deficiency of synthetic progestin or estrogen from horse urine. And when I mentioned natural, bio-identical hormones, my doctor snapped, "It's not approved by the FDA, and this HMO doesn't use it." Was I trapped by the insurance for the specific HMO provided by my husband's employer? Or could I research alternative nutrition for menopause on my own?

Also through my search I found a laboratory that would test my saliva and tell me whether my hormones were balanced. Most of all, I wanted to know how taking natural progesterone would affect my fast thyroid and adrenaline-drenched body, with its low blood sugar and excess insulin production. My HMO physicians did not answer these questions, but told me that going off conjugated equine estrogen and synthetic progestin was like a diabetic going off insulin.

On the Net I found physicians who answered my letters, labs that sold natural progesterone cream that I could use to prevent bone loss after menopause, and other labs that could monitor my condition until I found a doctor in my community who would listen to alternative solutions to menopausal questions. It's amazing how many medical sites that contained excellent answers to questions about menopause or other health issues that had been active in February 1996 and that are still online and current today.

I found the Menopause Matters site very helpful. There are Menopause mailing lists. The "black cohosh" that I mentioned in my letter to the alt.support.menopause newsgroup is an estrogenic herb and vasodilator, and I wanted to find out how safe it was and whether it was as good for menopause as the homeopaths and naturopaths claimed, as well as how much to use and what effects it would have. I found the alt. folklore.herbs newsgroup helpful, as well as articles by Anthony Brook entitled "Why Herbs?" and "Historic Uses of Herbs" at the Drum Holistic Herbs page. Today, view the many links on the Discover Health & Wealth herbs site.

I wanted to find out everything I could about natural progesterone. So back in late 1995 and early 1996, I went to the Health and Science page at Polaris Network (not online now), which described itself as "A Guide to Understanding and Controlling PMS, Fertility, Menopause, and Osteoporosis."

It contained information about natural progesterone and how it balances the side effects of unopposed estrogen, how it's required for proper thyroid function and progestin counterparts in the drug industry. There's no site online today with this name that I could find. Polaris Network today is listed as an IT technology company. You might search today under Web MD.

It also offered a seemingly sound scientific and unbiased evaluation of how certain hormones affect the system, what the hormone's results are on various bodily functions, and side effects. And it had an excellent bibliography of books and medical journal articles on osteoporosis reversal using natural progesterone.

I wanted to query a physician about the high blood pressure resulting from the equine oral estrogen I was taking, and at the Atlanta Reproductive Health Centre page I had been able to send e-mail to a doctor who answered my question quickly, providing information that I could consider when making my final decisions or in looking further. His answer was more to the point than the counseling I had received from my own physician. The same site with more links and current information is still running online to provide you with accurate information in areas of womens health.

Another doctor of mine had wanted to give me high blood pressure medicine on top of the estrogen and synthetic progestin. I asked him to consider the alternative--taking me off the hormones to see whether a low-salt diet and exercise could change things--because before I went on hormones my blood pressure wasn't high.

The Internet became one of my best alternative healthcare information resources after the last of three reproductive endocrinologists I saw (not affiliated with my HMO) told me to wait two months to see how I felt off the hormones.

Another resource I found informative was the Women's Health Hot Line newsletter. Its topics include infertility, endometriosis, contraception, sexually transmitted diseases, stress, menopause, and PMS. Most of all, it doesn't close its pages to alternative therapies for women who can't tolerate standard hormone replacement therapy.

Hernia Hunt

The year 1996 had been the time when my husband needed hernia repair surgery, but his busy HMO surgeon spent only a very short time briefing him a month before his surgery. Because it would take hours to describe in detail what is done during hernia repair surgery, he searched on the topic using Web search engines, which yielded a list of information about all kinds of hernias. The most thorough site discovered was the Hernia Information Home Page in England.

It included articles that explained such things as the benefits of using mesh rather than stitches to close incisions. Information about hiatal hernias and diaphragmatic hernias could be found at the Collaborative Hypertext of Radiology. There was more information about hernias on the Net than my husband could possibly find time to read.

After seeing shark cartilage in many health food stores, my husband asked his surgeon about its ability to aid in faster wound-healing. The surgeon laughed, yet I found several references to articles discussing shark cartilage on the Internet. Some medical journal articles on the healing and other properties and uses of shark cartilage can be found on the Simone Protective Pharmaceuticals page. Also at the site I found health-style questionnaires, in-depth descriptions of a variety of nutrient products, and how each product affects the body. You'll also find information about where to order or buy shark cartilage from pharmacists.

Search Tips

From the many healthcare sites I visited, my three-ring binder is packed with more than 500 pages of answers to questions. Productive keyword searches can be made using terms such as "alternative health," "healthcare," "medical," "medicine," "nurses," "nutrition," "pharmacy," "physicians," and "smart drugs." I found the search word "healthcare" to be more specific for asking personal medical questions than trying to search under the word "health."

Some sites are best reached through links on dedicated healthcare Web pages. For example, Subhas Roy had in 1996 created a page online with links to 25 other Internet health sites at Health Info. Today, the key words, "health information," brings up numerous sites, including the Health Information site at the US National Institutes of Health.

There also is a large collection of links at the Internet Medical and Mental Health Resources page. It's maintained by Jeanine Wade, Ph.D., a licensed psychologist in Austin, Texas. One particularly comprehensive directory of health and medical sites on the Web is MedWeb, which lists Web sites and mailing lists in 70 categories, from AIDS to toxicology.

One of the best medical referral Web sites I found in 1996 that is not online currently with medical information, had been Richard C. Bowyer's page that had links to U.S. hospitals, medical resources, medical journals, medical schools, medical students, medicolegal resources, oncology, pathology, and different surgical disciplines, such as plastic surgery, general surgery, laparoscopic surgery, and telesurgery. Healthcare workers of all specializations also could find job opportunities on some of these sites. Today, pages put up by individuals like Bowyer's page have been replaced with sites such as Medline. Current Bowyer's pages online focus more on genealogy.

My son, a physician practicing neuroradiology, is interested in Medline, a collection of medical and scientific reports used by physicians, articles on the educational needs of physicians and the public, physicians' supplies, prescriptions, and advice by pharmacists about drugs. Clinical cancer information that is intended for physicians is useful to patients as well. There is a listing of surgeons according to the types of surgery they perform, the notes of the Physician Reliance Network, and a Gopher menu of physicians listed according to their specialty.

As for informative newsletters available on the Net, I highly recommend the University of California at Berkeley Wellness Letter at the Electronic Newsstand. It contains the latest news of preventive medicine and practical advice--including information on nutrition, weight control, self-care, prevention of cancer and heart disease, exercise, and dental care.

As a medical journalist, I found the Journal of the American Medical Association (JAMA) to be a reliable resource. If you are looking for a description of a particular drug, the Physician's GenRx Web site provides a database of drugs you can search. You must register first.In seeking answers to my health questions, I found the Internet to be a valuable source for a wide range of healthcare information. I'm sure your efforts will be rewarded, too.

A woman can beat middle-aged spread, her disease risks, and her hot flashes with the help of her healthcare provider

And even a short term program can spell success for women and fit into a busy provider's practice, shows a demonstration obesity-fighting and health risk reduction program detailed in an article just published online in Menopause, the journal of The North American Menopause Society (NAMS). The new can-do plan gets women trimmer, healthier, and cuts hot flashes with a new program that shows potential to fit into today's healthcare environment. See the study's abstract, "Clinical intervention to reduce central obesity and menopausal symptoms in women aged 35 to 55 years."

Making lifestyle changes can take a lot of work. Programs that have successfully helped women lose weight and reduce their other heart disease risks have been long and intensive—and they work as long as the program goes on. Most first-line women's healthcare providers, such as obstetrician-gynecologists or primary care providers, don't have the time and might not be reimbursed for so many consultations. You also may be interested in the abstract of a study, "Whole-body vibration exercise training reduces arterial stiffness in postmenopausal women with prehypertension and hypertension."

This pilot program, called WAIPointes (WAI stands for "who am I"), took only five visits that all were reimbursed by insurance

And it kept the participants engaged in achieving their health goals by showing them that they could reduce their menopause symptoms, in addition to their long-term disease risks, with healthy lifestyle changes. The 83 women who completed the 6-month program ranged from 35 to 55 years old, and most were in perimenopause or menopause. At an orientation, the women learned about menopause and the health risks that come with it and were told they have the opportunity to get their personal health risks assessed if they joined the program.

At the first visit, they answered questionnaires and got assessments of body weight and fat and menopause status and went home with a pedometer and a health diary, educational materials, and goal-setting worksheets to develop their personal health goals. From the second to the fifth visit, each woman had health assessments including waist measurement, blood pressure, menopause symptoms, mammograms and bone density tests if needed, and blood tests to look for inflammation, high cholesterol, and diabetes.

Once a woman had her goals set, she discussed with the healthcare providers how to reach those goals, what obstacles stood in the way, and how to overcome them

If distressing menopause symptoms were obstacles, the providers offered the women treatment options, such as lifestyle modifications or medications, to overcome them. "Empowerment through education is a cornerstone of our intervention," wrote the authors, according to the February 13, 2014 news release, "Can-do plan gets women trimmer, healthier, and cuts hot flashes."

Their surveys of the participants and the health assessments showed that approach was working. By the end of the program, the women understood their health risks better, and they had already made significant progress toward achieving their health goals.

They trimmed their waistlines by an average of an inch and a half and lowered their diastolic blood pressure by 2 points. What's more, their hot flashes and other menopause symptoms, such as energy, libido, mood, and vaginal dryness, had all improved significantly. And each woman had a "life action plan," with personalized recommendations, to continue working toward their health goals.

You also may wish to check out the abstract of another study, "Mood disorders in midlife women: understanding the critical window and its clinical implications." Founded in 1989, The North American Menopause Society (NAMS) is North America's leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging.

Its multidisciplinary membership of 2,000 leaders in the field—including clinical and basic science experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education—makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause and healthy aging. To learn more about NAMS, visit the Menopause.org site.

Did menopause arise because men prefer younger women?

Local Sacramento and Davis University of California, Davis researcher, Cedric Puleston, who was not involved in the new menopause evolution research but coauthored a 2007 paper in PLOS ONE that examined the role of fathers in the evolution of extended human lifespans, told the Los Angeles Times that the latest study on men being the cause of women's menopause over time, in evolutionary terms was "really compelling," if not the last word on the evolutionary history of menopause, according to the article, "Did menopause arise because men prefer younger women?"

After decades of laboring under other theories that never seemed to add up, a team led by biologist Rama Singh has concluded that what causes menopause in women is men. Menopause is actually an unintended outcome of natural selection generated by men's historical preference for younger mates, the researchers of a new study report.

Even the word 'menopause' evokes a connotation, men pause before seeking a mate their own age or older, perhaps because nature programs or 'wires' humans for choosing the most fertile and hormone-balanced mates, preferably picking the one who's ovulating, at least by looking at the facial and body signs of peak fertility and health.

Rama Singh, an evolutionary geneticist, backed by computer models developed by colleagues Jonathan Stone and Richard Morton, has determined that menopause is actually an unintended outcome of natural selection – the result of its effects having become relaxed in older women

Over time, human males have shown a preference for younger women in selecting mates, stacking the Darwinian deck against continued fertility in older women, the researchers have found. "In a sense it is like aging, but it is different because it is an all-or-nothing process that has been accelerated because of preferential mating," says Singh, in a June 13, 2013 news release, "Researchers conclude that what causes menopause is -- wait for it -- men." Singh is a professor in McMaster University Department of Biology whose research specialties include the evolution of human diversity. Stone is an associate professor in the Department of Biology and associate director of McMaster's Origins Institute, whose themes include the origins of humanity, while Morton is a professor emeritus in Biology.

While conventional thinking has held that menopause prevents older women from continuing to reproduce, in fact, the researchers' new theory says it is the lack of reproduction that has given rise to menopause.

The scientist's work appears in the online, open-access journal PLOS Computational Biology. See the study or its abstract, "PLOS Computational Biology: Mate Choice and the Origin of Menopause."

Menopause is believed to be unique to humans, but no one had yet been able to offer a satisfactory explanation for why it occurs, Singh says

The prevailing "grandmother theory" holds that women have evolved to become infertile after a certain age to allow them to assist with rearing grandchildren, thus improving the survival of kin. Singh says that does not add up from an evolutionary perspective.

"How do you evolve infertility? It is contrary to the whole notion of natural selection. Natural selection selects for fertility, for reproduction -- not for stopping it," he says in the news release, "Researchers conclude that what causes menopause is -- wait for it -- men."

The new theory holds that, over time, competition among men of all ages for younger mates has left older females with much less chance of reproducing

The forces of natural selection, Singh says, are concerned only with the survival of the species through individual fitness, so they protect fertility in women while they are most likely to reproduce. After that period, natural selection ceases to quell the genetic mutations that ultimately bring on menopause, leaving women not only infertile, but also vulnerable to a host of health problems.

"This theory says that natural selection doesn't have to do anything," Singh says in the news release. "If women were reproducing all along, and there were no preference against older women, women would be reproducing like men are for their whole lives."

The development of menopause, then, was not a change that improved the survival of the species, but one that merely recognized that fertility did not serve any ongoing purpose beyond a certain age

For the vast majority of other animals, fertility continues until death, Singh explains, but women continue to live past their fertility because men remain fertile throughout their lives, and longevity is not inherited by gender. Singh points out that if women had historically been the ones to select younger mates, the situation would have been reversed, with men losing fertility.

The consequence of menopause, however, is not only lost fertility for women, but an increased risk of illness and death that arises with hormonal changes that occur with menopause. Singh says a benefit of the new research could be to suggest that if menopause developed over time, that ultimately it could also be reversed.

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