Menopause – Healthy.net

Balance Your Diet, Control Your Weight

Kathleen Barnes — Fri, 13 Mar 2009 21:13:33 +0000

Our Standard American Diet (SAD for short!) is anything but nourishing. High in carbohydrates and unhealthy fats, sugars, preservatives and other toxic chemicals, this diet virtually guarantees obesity and ill health.

In the name of convenience, we’ve actually sacrificed our health and even our lives.

Sure, it’s easy to stop by your favorite fast food outlet and get a burger, fries and soft drink for you, and even, for your family. It avoids the hassle of fixing dinner and perhaps buys you a precious hour of time in your stressful life. But what is the long-term cost?

Overfed and Undernourished

We live in a time when food is more plentiful and cheaper than at any other time in history. Never before have so many Americans been so overweight. Yet, because we fill up on all the wrong foods, we are woefully undernourished.

We eat too many processed foods that not only have almost no nutritional value – but they set up a cycle of cravings that keeps us coming back for more and more… and more.

It’s a dangerous addiction! These so-called “foods” are loaded with chemicals, salt, simple (i.e. non-nutritious) starches and, worst of all, sugar. It’s amazing that our bodies can glean even the most minimal nutritional requirements from this kind of diet. Often, they don’t, and we become overweight and chronically ill. For example, depressed, tired, foggy-brained and overweight women are often told by their doctors that they need Prozac. What they really need is a steady supply of real food to get their brains and bodies back on track. This is what I (Dr. Cass) see in my office all day long.

Diets Don’t Work

All of us are constantly bombarded with pitches for diet plans. It’s almost impossible to avoid them if you pick up a magazine or turn on the news. Some of these plans may help you to shed extra pounds, but unless you’ve made some basic lifestyle changes, these hard-fought losses will come right back on.

If you ask your doctor about your weight problem, you’re likely to hear the standard misinformed answer: “You need to eat less and exercise more.” That’s because most doctors are still thinking in a linear manner; that is, calories in minus calories burned equals calories that turn into fat. However, there’s far more to weight gain than that, since we all burn calories differently based on our body’s metabolic efficiency. True, you may be eating too much, not exercising enough or not doing the right kind of exercise for your needs. But there is much more to the story than that.

Start with the 8 Weeks Wellness Journal and Health Questionnaire
For free download click here. Your answers, combined with selected laboratory tests, will help you find out the source of your imbalances, and how to treat them naturally.

Discover for yourself if your weight gain is due to such problems as hormone imbalances, low thyroid, adrenal overload, blood sugar swings, food allergies, or neurotransmitter (brain chemistry) imbalances.

Don’t simply count calories. Also, use the glycemic load calculator rather than simply the glycemic index of foods. For details and a chart of foods, click here.

Most importantly, if you have weight issues, here are the facts:

You are not to blame. You likely have a physiological imbalance.
You are responsible for taking the steps you need to take to correct the problem.

Join us Thursday, March 19 for the third in our series of 8 free teleseminars for more tools for balancing your biochemistry and controlling your weight. Register now

Feel Great: 8 Weeks to Vibrant Health Basics for Women

Kathleen Barnes — Sat, 14 Feb 2009 23:52:39 +0000

Are you one of the millions of women who have sought medical help in the past year, only to feel you have been ignored, stereotyped or even ridiculed?

Most of us are looking for a diagnosis when we seek medical attention for symptoms that range from weight gain to insomnia, depression, fatigue and memory problems.

Instead of a diagnosis that uncovers the underlying causes of these health challenges, we most often wind up with a pill and sometimes a patronizing pat on the head.

Overweight, fatigue, memory loss, depression, joint pain and stomach upsets aren’t diseases. They are symptoms. Unless you can get to the underlying causes of those symptoms, long-term relief will elude you.

Prescription drugs like may address your symptoms temporarily, but they aren’t going to solve the underlying problems or give you long-term relief from your symptoms. In fact, so many pharmaceutical drugs cause side effects that, after your doctor writes those prescriptions, you’re likely to end up with an even larger list of symptoms than you had at the outset.

The truth is that many doctors don’t have the time or even the training to delve into the reasons for your symptoms. Did you know that your doctor only received a handful of hours of nutrition education during four years of pre-med and four years of medical school? That’s shocking considering the large numbers of health challenges that are based on nutritional deficiencies.

That’s just the tip of the iceberg. So many doctors have become so reliant on pharmaceuticals that they don’t even consider other treatments that are frequently more effective and cause fewer side effects.

Here’s a typical case from Dr. Cass’ files:

“I remember Jean, a 55-year-old college professor whose story is pretty typical. She was being treated by her internist for high blood pressure, osteoporosis and heart palpitations. She as referred to me, a psychiatrist by training, because of her anxiety, depression and insomnia.

I could find no obvious psychological explanation for these symptoms, except maybe for the stress of her physical illness.

She was taking an array of medications, with their attendant side effects. Based on some simple lab tests and my own clinical experience, I determined that magnesium deficiency was a likely cause of her symptoms.

After a brief trial on this inexpensive and common mineral, together with a multi-vitamin formula and essential fatty acids, Jean was able to decrease her medications. Encouraged by this results, she trusted me enough to eliminate some foods to which she was allergic, which helped her even more.

In a short time, not only were her anxiety, depression and insomnia gone, but she was soon medication-free, depending instead on a list of supplements to restore her normal body chemistry.

Situations like Jean’s leave me with some questions:

Why had Jean’s internist been unaware of her mineral deficiency, or even of its possibility? Why hadn’t he at least given her a basic multi-vitamin formula?
Why give the prescription drugs first? This approach is like unplugging the noisy fire alarm instead of looking for the fire!”

Many readers will undoubtedly relate to Jean’s story. It is an unfortunately common occurrence.

If your doctor is “unplugging the fire alarm instead of looking for the fire,” the 8 Weeks to Vibrant Health program can help you make some powerful discoveries about yourself and your health.

The first teleseminar offers the basics:

Starting a Wellness Journal (with online resources)
Getting enough sleep
Drinking enough water
Choosing the right kind of exercise and creating an exercise program that works for you.

In the coming weeks, Dr. Cass and Kathleen Barnes will guide participants through the basic program, offer tools to scientifically discover the underlying health issues and offer specific approaches to restore vibrant health.

You can join in these no-cost teleseminars by registering at:

www.8WeekstoVibranthealth.com.

Non-Hormonal Therapies for Dealing with Peri Menopause and Menopause

Holly Lucille — Sat, 13 Sep 2008 15:36:40 +0000

While the fluctuation and decline of reproductive hormones is a normal and expected event in mid-life women, the associated symptoms are nonetheless disruptive. Until very recently, millions of women alleviated their hot flashes and night sweats with conjugated equine estrogens and medroxyprogesterone acetate (hormone replacement therapy or HRT).

However, mounting evidence from several recent clinical trials, has shown that women using HRT are at significant increased risk of developing breast cancer, coronary heart disease, pulmonary embolism, and stroke.

With little room for HRT in current practice and little else in the traditional medicine chest to consider, physicians are increasingly turning to natural non-hormonal therapies for women who need relief from menopausal symptoms. As a naturopathic physician, I have used botanical medicines and other natural alternatives for many years with great success to help women create and maintain hormonal health.

I’ve found the most effective approach combines stress management, diet, exercise and nutritional supplements to support and work with a woman’s body, not against it. While each patient’s treatment plan is unique, it has been my experience that most symptoms caused by menopause and/or hormone fluctuations and imbalances will respond to natural therapies.

Hot Flashes/Night Sweats

These core symptoms reflect the hypothalamic response to rapidly fluctuating and falling levels of estradiol. Hot flashes vary in severity, from a sudden sensation of warmth to acute drenching sweats and bright red flushing. Duration ranges for a few months, to a few years or not at all. By some estimates, 10-15 percent of women in menopause are awakened by night sweats throughout the night.

Black cohosh (Cimicifuga racemosa) is the most widely used and most thoroughly studied natural supplement for menopausal symptoms and has been clinically proven to reduce hot flashes and night sweats. While black cohosh’s exact mechanism of action is unknown, compounds in the herb appear to bind to estrogen receptors without changing hormone levels in the body. Recent studies demonstrate black cohosh has no effect upon luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin or sex hormone binding globulin (SHBG).

A placebo-controlled, double blind study compared standardized black cohosh extract to conjugated estrogen. Women experiencing menopausal symptoms were randomized to receive black cohosh, conjugated estrogen, or placebo for three months. The participant’s symptoms were assessed using the menopause rating scale (MRS) and individual diaries.

The results showed that the women taking standardized black cohosh extract had clinical and statistical improvement of symptoms equal to the women taking conjugated estrogen. No improvement of menopausal complaints was observed in the control group. (Wuttke, et al 2003).

Because black cohosh does not have estrogenic action and does not contain phytoestrogens it is safe for use in patients with a history of breast cancer. My usual recommendation is 40 mg of black cohosh daily, standardized to 2.5% triterpene glycosides, daily.

Isoflavones are compounds with both hormonal and non-hormonal properties and are considered to be phytoestrogens with selective estrogen receptor modulators (phytoSERMs). Unlike estrogen, which is not tissue selective, phytoSERMs exert estrogenic effects in desired tissues such as the heart, skeletal system, and brain, but ideally have no effects in other tissues, such as the breast.

The various biologic activities of isoflavones suggest that they offer many of the beneficial effects of estrogen. Controlled trials have indicated these compounds support healthy serum cholesterol levels and support healthy bone resorption.

Soy has received attention as a dietary alternative to HRT largely because it is a unique source of isoflavones. World wide soy consumption is highest in Japan, where urinary levels of phytoestrogen metabolites are extremely high and reported frequency of hot flushes is extremely low. The majority of clinical studies examining this inverse relationship have shown soy isoflavones to significantly reduce hot flashes.

There have been some concerns about the safety of soy isoflavones in women with a history of estrogen receptor positive breast cancer. These questions stem in part from limited research that showed soy increased the growth of isolated breast cells. However, the weight of evidence shows that soy supports healthy cell growth and, therefore, most practitioners feel confident recommending soy isoflavones to their patients with a personal or family history of breast cancer.

I usually begin with 100 mg soy extract and increase to 300 mg as needed. While a decrease in hot flashes begins almost immediately, maximum benefit may not be apparent for as long as 12 weeks.

DHEA (dehydroepiandrosterone) is a steroid hormone produced in the adrenal cortex. Serum levels of DHEA decline with age, peaking at age 25 to less than 20% of peak at the 70th birthday. DHEA levels are also reduced in inflammatory diseases (rheumatoid arthritis, systemic lupus), as well as cancer and acquired immunodeficiency syndrome (AIDS). Clinical research has shown that DHEA supplementation reduces menopausal symptoms as effectively as HRT (Genazzani 2003). Most research used 25mg of DHEA per day for at least 3 to 6 months.

Mood, Energy, and Wellbeing

While menopause has been identified as a time of depression and irrational behavior, the data does not support this perception. Research has consistently shown that depression is much more common in women who are in their third and fourth decades, not at mid-life. There are no associated increases in suicide, suicide attempts, or psychiatric hospitalizations among menopausal women.

Energy, however, or the lack thereof, can be problematic, sometimes profoundly so. Low adrenal reserve or adrenal insufficiency can be contributing factors. Many women enter menopause with chronic nutritional depletion and sub-optimal adrenal function. In milder degrees of adrenal insufficiency and low adrenal reserve, the adrenal gland still produces sufficient hormones to maintain health.

Adrenal Extracts/Adrenal Support Supplements formulated with adrenal supportive botanicals can restore vitality, increase feelings of energy, increase mental and physical performance, and improve the body’s response to stress. Adrenal polypeptide fractions provide small amounts of adrenal hormones and promote improved adrenal function.

Panax Ginseng – Women experiencing lack of energy due to fluctuations or depletions in their reproductive hormone levels will benefit from Panax ginseng. A double blind, placebo controlled study of postmenopausal women showed overall symptom relief and improvement in mood and wellbeing after ginseng supplementation (Wiklund 1999). I’ve found great success using Ginseng Phytosome, ginkgo formulated with a patented process that results in superior absorption: one part Panax Ginseng Extract, standardized to contain 37.5% ginsenosides, bound to two parts phosphatidylcholine.

Green Tea (Camellia sinensis) – Green tea is a rich source of flavonoids and polyphenols that have been studied for their support of immune system health. Green tea also contains small amounts of caffeine, which supports stamina and reduces fatigue. There is some evidence that green tea supports daily energy expenditure and may be beneficial in weight management. An effective dose for women is 250mg of Leaf Extract standardized to contain 35mg of caffeine.

Rhodiola (Rhodiola rosea) – While fairly new to American practitioners, rhodiola has been used to support healthy energy levels for centuries in Russia, Scandinavia, and Iceland.
Animal research demonstrates rhodiola reduces cortisol levels and boosts adenosine triphosphate (ATP) synthesis. For women struggling with energy drain related to menopause, rhodiola may support mental concentration and alertness and support healthy endurance levels.

Chaste Tree – (Vitex agnus-castus) Vitex is used for the management of menstrual disorders, premenstrual syndrome (PMS), and hot flashes in menopause. The key actives in chaste tree fruit support the pituitary gland’s regulation of ovarian hormone production, directing menstruation, fertility, and other processes.

Vitex preparations have been used by women with menstrual difficulties for at least 2,500 years. And recent research has validated this history. In a double blind, multi-center study, 175 female patients were randomized to receive either chaste tree extract or pyridoxine for relief of premenstrual syndrome (PMS). Using self-report and physician assessment to determine results, the women in the Vitex group had significantly reduced breast tenderness, edema, tension, headache, constipation and depression. (Lauritzen, 1997).

Sleep and Relaxation

Hormonal fluctuations in menopause and the late-luteal phase of the menstrual cycle are known to interfere with sleep quality. Researchers now believe that lack of sleep in menopausal women may account for much of the irritability and emotional ups and downs usually blamed on hormonal changes.

Valerian (Valeriana officinalis) has been clinically studied for the relief of insomnia and stress, and works well combined with hops when taken at bedtime. The active ingredient has yet to be clearly identified. While valerian’s disagreeable smelling volatile oil was initially thought to be responsible for its sleep supportive effects, research now indicates a combination of volatile oil and other constituents may be involved.

Valerian improves several sleep measurements, including sleep latency, final wake time after sleep, waking frequency, and sleep quality. While it has an excellent safety profile, the presence of vivid dreams has been reported with initiation of valerian use.

L-theanine, a naturally occurring amino acid found in tea leaves, has demonstrated wide-ranging physiological activity, from supporting healthy blood pressure to supporting the therapeutic activity of chemotherapeutic drugs. It does not cause daytime drowsiness, an important consideration for women with existing energy and endurance deficits.

References:
Wiklund IK, Mattsson LA, Lindgren R, Limoni C. Effects of a standardized ginseng extract on quality of life and standardized physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group. Int J Clin Pharmacol Res. 1999;19:89-99.

Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas. 2003;44:S67-77.

Shevtsov VA, Zholus BI, Shervarly VI, et al. A randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work. Phytomedicine. 2003;10:95-105.

Lauritzen CL. Treatment of Premenstrual Tension Syndrome with Vitex agnus-castus – Controlled, double blind study Versus Pyridoxine. Phytomedicine, 1997 4(3):183-189.

Genazzani AD, Stomati M, Bernardi F, Pieri M, Rovati L, Genazzani AR. Long-term low-dose dehydroepiandrosterone oral supplementation in early and late postmenopausal women modulates endocrine parameters and synthesis of neuroactive steroids. Fertil Steril. 2003;80:1495-501.

Interview with Susan Winter Ward:Yoga for the Young at Heart

SusanWinter Ward — Sat, 17 Feb 2007 19:11:55 +0000

It is very good to meet you, Susan. Yoga has definitely moved into the mainstream, along with healthy aging which is coming to the forefront of baby boomers’ thinking.

Can you tell me how you first came to yoga?

I discovered yoga while I was seeking relief from back pain…and I found that and much, much more! After two classes a week for a month, I knew that if I ever stopped doing yoga I’d be really sorry someday. I never expected to become a yoga teacher!

Would you define yourself as a pioneer in yoga in N. America? How so?

I think I’m a pioneer in wanting to bring the benefits of yoga to seniors. Most yoga in the early 90’s was geared to the hard-bodied athletic types. I knew that it was a powerful practice for everyone regardless of age or physical condition, and I started teaching to seniors. I wrote the first book that was in print at that time, Yoga for the Young at Heart, especially for senior yoga. Then I made the first Yoga for the Young at Heart video. That was the first video teaching senior yoga that I’m aware of. Recently, I launched my new website, http://www.YogaHeart.com. It’s been a great journey!

How did you arrive at the notion of accessible yoga as a driving force in your brand of yoga?

So much of the yoga we see presented is intimidating and demoralizing for people who are just beginning a yoga practice. I think that does a disservice to the gift of yoga, as well as to people who would benefit from it if they were comfortable beginning a practice. No one should be afraid to try yoga, so I wanted to make it available…and accessible to everyone. My style of teaching is not intimidating and will entice people to yoga who would otherwise be left out…even people in wheelchairs can stretch and breathe. I say, if you’re breathing, you can do yoga!

What are the defining characteristics of your approach to yoga?

On some level, yoga is accessible to every body; even only breathing is a form of yoga practice. My approach is based on the concept that the body should be gently treated and honored. Yoga is not competitive, and it shouldn’t hurt. We begin at the fitness level where we are and progress from there in a compassionate practice. We celebrate the wonder of our bodies, quiet our minds so we can hear our inner wisdom and gently become stronger, more flexible and more peaceful. Yoga works, all we need to do is do it.

Tell me more about your Basic Series for Boomers, the over 50 men and women in my age range.

Maturing Baby Boomers today are not passive about health. We’re proactive and creative. By making yoga part of our daily routines, we can develop and maintain the fitness and relaxed attitude that supports us in living life on our terms, then we can enjoy every minute to the fullest!
In my videos, the yoga student is actually joining my class and practicing along with a class of “real people”.

The Basic Series consists of three DVDs. Each program is progressively is bit more challenging than the previous one, giving the student the ability to progress in their practice, or mix the programs to fit their mood of the day. My programs bring the benefits of yoga to people who may not otherwise have a yoga practice. Or, it’s great for people returning to yoga and looking for a gentle and effective way to get back in shape.

If I’m over weight and out of shape, do you think I can do it?

My yoga programs can be adapted to any level of ability. One of the lessons of a yoga practice is self-acceptance. You can only begin where you are. Take it slowly and gently, honoring your limitations and lovingly doing what your body allows you to do. In time you’ll begin to see the positive effects of your practice and it won’t take as long as you think. Do what you can. Be patient. You have to start somewhere.

I’ve never exercised much. Why start yoga at my age?

Anyone can start yoga at any age. Baby Boomers want to stay strong, vital, healthy and youthful, and yoga has a 5000 year track record of success in doing just that. As we get older, we reach a point where we can’t get away with abusing or ignoring our bodies anymore. Either we’re doing something positive for ourselves, or we’re neglecting ourselves. We get to choose daily which way we’re going to go. To create and maintain the quality of life we desire, we need to take action! Why not start now? You won’t begin any younger!

Can yoga help prevent osteoporosis?

The Rhode Island Department of Health states, “Exercises that put demands on your bones are known as “weight-bearing” or “resistance” exercises. They help to strengthen bone. Exercise (in combination with a healthy diet and lifestyle) is important in the prevention of osteoporosis.” Yoga is a weight-bearing exercise. Our bones are not static; they are living tissue that renews itself throughout our lives. Poses that challenge our muscles put stress on our bones increase bone mass. If you do any type of weight-bearing exercise, you can begin to reverse osteoporosis regardless of age.

Other health benefits?

The list is enormous! In addition to building strength, flexibility and stamina, Dr. Dean Ornish uses yoga in his heart disease treatment programs because it lowers blood pressure and initiates the “relaxation response” of the parasympathetic nervous system. Yoga helps to prevent osteoporosis, reduces stress and stress related maladies like headaches and high blood pressure, energizes and relaxes the nervous system, hydrates the joints and spine, stretches the hamstrings and can alleviate back pain. Yoga can increase and strengthen respiration, and help to cleanse the digestive systemâ€¦the list goes on and on. In short, yoga can keep you healthier, stronger and more able to do the things you want to do with vitality and focus.

How can yoga help menopause?

My video, Embracing Menopause: A Path to Peace & Power gives Boomer women inspiration in addressing our opportunity to redefine ourselves through this important life transition. We don’t need to buy into the idea that we become useless or unattractive…to the contrary, menopause is our most powerful time of life. It’s an opportunity to live our wildest dreams and be our most attractive selves. Yoga brings us back to center, helping us to remember who we really are, feel our inner strength and reconnect with our inner wisdom.

Physically, mentally, emotionally, and spiritually, menopause is a rebalancing and redefining of ourselves on the deepest levels. Many of the symptoms of menopause can be aggravated by stress, and menopause can be a stressful time of life. Yoga relaxes us, brings us into balance and helps us to tune into our deepest self. Yoga helps to cool the body, relax the nervous system, oxygenate and detoxify our organs and muscles, and prevent osteoporosis. Yoga balances the endocrine system, which can help to stabilize hormone levels, and calm our emotions. As a total practice, yoga is a powerful support through the menopause process and Embracing Menopause: A Path to Peace & Power is an easy way to begin to reap those benefits.

How often do I need to do yoga for me to feel better?

Find your own rhythm. At least two times a week for an hour would be a minimum yoga practice. Make a commitment to yourself and stick with it for a month and see how it feels. Of course, the more yoga you do, the better you will feel and the benefits will be realized faster. Stay tuned in and encourage your body to keep going. Watch your process from both the inside and the outside. If you do yoga, it works. My website, www.YogaHeart.com, provides stories from many people who have enjoyed success with the programs.

How does your seated yoga program compare with a regular yoga class?

Although a consistent yoga program of standing, balancing, lying poses and inversions is a more complete practice; yoga need not be relegated to a full yoga class. Sitting Fit Anytime is a seated yoga program for those who sit too much…at work, at our computers, traveling, or any activity that makes us forget we have a body. Doing a seated pose or two hourly throughout the day can give you some of the benefits of a yoga practice and help relieve the inevitable stiffness that comes with sitting too long. Yoga poses adapted to small interludes may not have the same intensity as a full yoga class, but the benefits of yoga are readily available to those who nibble on yoga throughout the day.

Sitting Fit Anytime is available as a CD Rom & ScreenSaver for the computer bound, or as a DVD for people who are physically challenged. Seniors can benefit from Sitting Fit Anytime to assist in building the strength and flexibility that will enable them to do a standing yoga practice if they so desire.

Can people who are confined to a wheelchair do seated yoga?

People who are physically challenged due to age, illness, or who just can’t get down on the floor, don’t need to miss out on the many benefits of yoga. Those confined to wheelchairs or recovering from injury, with their physician’s approval, can benefit from their own adaptation of the breathing and gentle seated poses. Sitting Fit Anytime, seated yoga can build the strength and flexibility, needed to progress to more and more challenging poses. Breathing, stretching and strengthening can be introduced at a slow pace, gently bringing bodies to new levels of fitness, increasing circulation and bringing in healing energy and vitality.

If I feel agitated when I sit at my computer, what can I do about that?

Your body is asking you to move! Sitting needs to be balanced with moving, breathing and stretching, so try some simple yoga stretches: twists, arms overhead, forward bends and deep conscious breathing for a “mini yoga break.” With the Sitting Fit Anytime program, you’ll feel the difference and return your attention to your work refreshed, more relaxed and with a clearer mind.

Susan, thank you for sharing your insight and knowledge with us. We appreciate your depth of experience in this wonderful area of exercise we call yoga. In conclusion, what can you tell about the mental or spiritual aspects of yoga?

Yoga is widely recognized as a spiritual path as well as a physical fitness practice. In all of my programs, I incorporate the spiritual and physical. Through yoga we learn to focus, to bring ourselves to center and to calm our minds. By quieting the mind, we can hear more clearly our quiet inner voice. That voice is our highest wisdom that can guide us to our highest path in life. We become more centered, more insightful and more peaceful. Then we can take that inner strength and peace out into the chaos of the world and hold a calm, peaceful perspective. this is how world peace can be achieved…one heart at a time.

COMMENT:WOMANHOOD IN FAST FORWARD

What Doctors Don't Tell You — Sun, 02 Jul 2006 10:49:15 +0000

Normal menopause, even with its roller coaster of hot flushes and erratic periods, is a natural stage in a woman’s growth. But for the prematurely menopausal woman, there is a sense that, somehow your life has been jammed in fast forward.

No one is sure why some women experience the menopause at an earlier age. It can be genetic, or caused by metabolic disorders or viral infections. But surgery, radiotherapy or chemotherapy can also be the culprits.

The official line is that surgical removal of the ovaries and uterus can trigger menopause. What you’re less likely to be told is that any form of pelvic surgery risks disrupting the ovaries’ blood supply.

One such procedure is tubal sterilisation. Sterilisation is chosen by thousands of women each year as an ultimate method of birth control. Usually performed as a laparascopy, two small abdominal incisions are made, allowing a narrow instrument through to clip, cut, cauterise or constrict the fallopian tubes in order to block the passage of sperm to the egg.

Anyone considering sterilisation will be counselled by their GP, their Family Planning Clinic or their surgeon as to the implications of such a procedure. To paraphrase from the BPAS leaflet: Sterilisation should be regarded as permanent; there is a very slim chance of getting pregnant if the tube has not been completed sealed; there is a slightly higher risk of an ectopic (tubal) pregnancy; most women continue to have normal periods, although about one in 10 find their periods are a little heavier; sterilisation does not affect hormone production so there is no effect of early menopause.

The latter is a rather strong statement particularly since medical journals have been debating precisely this since the 70s. And despite regular new research, the jury is still out on whether tubal sterilisation can disrupt a woman’s ovarian functions enough to bring on perimenopause.

Early negative reports were inevitably dismissed as being poorly set up. However, in 1984, one study found that, while early studies of “post tubal ligation syndrome” had “serious methodological problems”, it still had to be admitted that “there was some data to support the concept that, in certain individuals, sterilisation may result in disruption of ovarian blood or nerve supply” (Fertil Steril, 1984; 135: 1368-81).

One hypothesis is that an oestrogen deficiency can occur if the ovarian artery is blocked during sterilisation (The Lancet, 1985; i: 847-849). The ovary’s production of these hormones depends on blood supply. The same author later showed that oestrogen excretion dropped further over a longer time frame following a tubal ligation.

In 1992, the Division of Reproductive Health in Atlanta published the result of a 10 year survey. It showed a marked difference between the menstrual cycles of women one and five years after they had undergone tubal sterilisation. The authors concluded that if tubal sterilisation affects menstrual function, such changes may take time to develop (Am J Epidemiol, 1992; 135: 1368-81).

Another study discovered a significant drop in progesterone levels with an significant increase in follicle stimulating (FSH) and luteinising (LH) hormone levels, in their study group of 43 women before and after tubal ligation (Adv Contracept, 1994; 10: 51-56). Two years later, a Finnish study came to a similar conclusion by studying progesterone levels in 55 women before and after tubal sterilisation (Obstet Gynecol, 1996; 88: 797-796).

The research continues and conflicts abound. Britain’s leading exponent of HRT, John Studd, is dismissive. His view is that most women who are sterilised are in their early 40s, so they are probably already entering perimenopause naturally. Charles Kings land, head of reproductive and endocrinological medicine at the Liverpool Women’s Hospital, however, regards ovarian failure as one of the most underdiagnosed conditions around. He agrees that pelvic surgery runs the risk of interrupting the blood supply. Even Dr Miriam Stoppard, in her book Menopause, claims that if tubal ligation does cause a loss of ovarian function, it is due to interference with ovarian blood supply.

Women who are contemplating sterilisation are entitled to know the real risks, however slim. Until researchers can ensure that tubal ligation methods will not affect the blood supply to the ovaries, then categorical statements like the one contained in the BPAS leaflet should be avoided.

Perhaps the most telling part of the leaflet is a disclaimer in a draft contract designed to be made between the patient and her doctor before sterilisation. It says: “I understand that no guarantees can be given that the operation will be successful or that it will be free from side effects..”

!AGeri Parlby

Geri Parlby, health editor of Positive News, underwent sudden perimenopause following sterilisation at 41.

QUESTION FROM READER:ANDROPAUSE: THE MALE MENOPAUSE

What Doctors Don't Tell You — Sun, 02 Jul 2006 10:49:15 +0000

I am very interested in osteoporosis and the andropause. I read that antiresorptive drugs, such as palmidronate, are actually counter-productive for bone density.-HB, Wilton……..

As modern medicine has turned menopause into a disease, so it has now manufactured the male equivalent. Dr Malcolm Carruthers, a Harley Street psychiatrist and author of Maximising Manhood: Beating the Male Menopause, is one of those most responsible for coining the term “male menopause”. Although the condition was described in a medical article in 1944 (JAMA, 1944; 126: 472), it wasn’t accepted or dignified with the euphemism “andropause” until recently.

Carruthers became interested in the condition after studying 1000 men attending his London clinic complaining of numerous symptoms similar to those mentioned in the early study. These included fatigue (82 per cent), depression (70 per cent), irritability (61 per cent), reduced libido (79 per cent), awareness of premature ageing (43 per cent), aching and stiff joints in the hands and feet (63 per cent), increased sweating, especially at night (53 per cent) and even classic hot flushes (22 per cent). Some 80 per cent reported erectile dysfunction, or reduced early morning erections-an early warning sign.

Much as many like to think of this as equivalent to female menopause, there are a number of important differences between the male and female condition. The collection of symptoms reported in Carruthers’s men didn’t come on at a set threshold of life, as they do, in the main, with women. In Carruthers’s study, the men were aged anywhere from 31 to 80.

So-called andropause also doesn’t appear to be an inherent condition of being male, but one that is brought on by a variety of external factors. Ordinarily in healthy men, bioavailable levels of testosterone decline by about one per cent every year between ages 40 and 70. But this decline is more pronounced in men who aren’t healthy (Ann Med, 1993; 25: 235-41).

In Carruthers’s study, most patients had suffered some psychological or physical stress which triggered their symptoms. Nearly two-thirds reported suffering from psychosocial stress, a third had problems with alcohol consumption and a quarter with smoking. Nearly a third had suffered injuries or underwent an operation, particularly vasectomy, and almost a third were taking some form of medication. A fifth were too fat, a tenth had had some form of infection, such as the orchitis caused by mumps, glandular fever or prostatitis, and one in 20 had undescended testes.

In other words, not all men go through the menopause, as all women do. Rather than a natural diminishing of hormones, the male menopause is an unnatural insult to the male body.

There is no question, however, that this insult affects levels of testosterone, the most important male hormone. Although total testosterone levels, which is all that is usually measured in men complaining of these symptoms, were only low in 13 per cent of Carruthers’s cases, levels

of the carrier protein, Sex Hormone Binding Globulin (SHBG), were too high. These caused levels of the Free Active Testosterone (FAT), obtained by dividing total blood testosterone level by SHBG, to decrease in 74 per cent of his cases.

Carruthers argues that this biologically active testosterone in the blood and tissues decreases markedly with age. In Carruthers’s survey, andropause symptoms appear when the FAT levels fall to around 50 per cent, or if the total testosterone level is subnormal.

The problem, of course, is that the definition of andropause is so elastic that any man over 35 suffering from stress could fall into this category. Fatigue, loss of energy, depression, excessive sweating, irritability and anxiety could be symptoms of stress, undiagnosed allergies or even AIDS. Loss of memory could be due to drinking, ageing or mobile phones. A low sex drive could be caused by low levels of a variety of nutrients, or difficulties in a relationship. Most of these problems could have a source in nutritional deficiencies, which also occur more often with ageing if not addressed. In a landmark study, Dr Stephen Davies demonstrated that most adults have marked deficiencies of chromium as they age (J Nutri Environ Med, 1997; 46: 1-4).

As with women, medicine treats andropause with a magic bullet – in this instance, testosterone replacement therapy (TRT). In the US, synthetic testosterone is given by tablet or injection.

Methyl testosterone, the oral synthetic variety, has been removed from the market in Europe because of potential liver toxicity and even a possible cancer risk. Both countries offer natural testosterone implant pellets, which, when inserted under the skin, deliver testosterone over four months. America’s Food and Drug Administration recently approved a transdermal patch of natural testosterone, and pharmaceutical companies, who sniff the financial implications of discovering a new type of menopause, are at work on creams and gels.

Luckily, men are more reluctant than women to take hormone replacement and for good reason. TRT is often confused with its synthetic version, anabolic steroids, which are often abused by athletes. It’s also associated with hypersexual criminal behaviour.

Common side effects include acne, increased body hair growth, increased male pattern baldness, and increased muscle mass. Doctors are advised to monitor a patient’s liver function, and to stop their patients from taking the hormone if there is any change. Since exogenous testosterone suppresses the production of luteinizing hormone and follicle stimulating hormone, TRT lowers sperm count and general testicular volume. The longer lasting injectable preparations, which are synthetic steroids, have numerous potentially dangerous side effects, including liver toxicity from excessive doses.

The greatest issue about TRT concerns whether it causes benign enlargement of the prostate or prostate cancer, since high levels of testosterone are present in both conditions. Carruthers says that in his study, TRT did not adversely affect heart, liver or prostate gland over five years of continual monitoring.

Many enthusiasts like to tout TRT as helping to “prevent” prostate disease. Carruthers says that in his study, 12 cases of early non invasive prostate cancer were found prior to testosterone treatment in his first 1000 patients. During treatment, he says, only two developed it, and they were picked up by repeated screening at an early, treatable stage. “This would suggest that by providing the benefit of this careful repeated screening, testosterone treatment is overall more likely to save lives from prostate cancer than to cause it,” says Carruthers.

By test, presumably he means the prostate specific antigen (PSA) test, which has been wrong in detecting cancer 52 per cent of the time (JAMA, 1995; 273: 289-94). Even a recent ejaculation can send PSA levels soaring (Urology, 1996; 47: 511-16).

This echoes the logic used by many doctors in their claims that HRT, by requiring constant monitoring to detect whether it has caused breast cancer, actually helps “prevent” it.

In the medical literature, Carruthers argues that testosterone treatment has been used in a multitude of studies right round the world often in much higher doses than those used to treat the andropause without any convincing evidence of it causing either benign enlargement or cancer.

It’s true that little evidence exists on the effects of long term TRT. However, a few medical reports have established a relationship between TRT and prostate cancer or prostatic disease (Arch Intern Med, 1989;149: 2365-6).

Furthermore, animal studies have shown that synthetic testosterone supplementation is twice as potent in stimulating prostate growth as ordinary testosterone (J Clin Endocrinol Metab, 1998; 83: 4212-9). Other animal tests show that synthetic testosterone causes significant growth of cells in the prostate (Anat Rec, 1998; 252: 637-45). While these animals studies may be irrelevant to human experience, they do raise significant questions.

In one other human study, which followed 23 middle aged men given TRT for eight months, the average prostate volume increased by 12 per cent (Prostate, 1993; 23: 99-106). However, TRT may only have this effect on older men; a study of healthy young men with a normal prostate who were given testosterone injections didn’t show any increased prostate size or activity (Urol, 1998; 159: 441-3).

This means that TRT may have a negative effect only on the population most likely to use it. Indeed, one other study showed that prostate size increases with age in men with low levels of hormone treated with testosterone (Clin Endocrinol [Oxf]. 1994; 40: 341-9).

As with female HRT, TRT is being promoted as the equivalent of a male fountain of youth, which will help to stave off heart and bone problems. Testosterone is an anabolic hormone, which helps to build protein tissue, muscles, bones and connective tissue hence why synthetic versions help pump up athletes. Therefore, the argument goes, taking testosterone must serve a function in preventing osteoporosis. Although a few studies show that bone mineral density increases during TRT (Pol Arch Med Wewn, 1998; 100: 212-21), no solid evidence has demonstrated that testosterone will actually prevent bone loss, any more than there is good evidence that HRT prevents osteoporosis in women (see WDDTY Guide to the Menopause).

Palidronate, originally developed for bone problems in cancer patients and Paget’s disease of bone, is now being (wrongly) used to treat bog standard osteoporosis. One common side effect is low levels of blood calcium and magnesium, which would exacerbate osteoporosis.

Instead of relying on a magic bullet, any man suffering from what he considers the “andropause” might do better to work with a good nutritionist, who will suggest a nutrient dense diet with appropriate supplements and regular exercise. As with women, as WDDTY panel member Annemarie Colbin writes in her new book Food and Our Bones (New York: Dutton-Plume, 1998), bone loss is not inevitable with ageing or loss of sexual hormones, but has more to do with Western diet. See WDDTY vol 9, no 10 for a detailed dietary programme for minimising bone loss. Briefly, eat fresh, unrefined and organic foods, good quality plant or animal protein, soy products, high iodine sea vegetables, whole grains and lots of water.

Harald Gaier is on holiday. His Alternatives column will return next month.

UPDATES:PROGESTERONE CREAM DOES NOT CURB OSTEOPOROSIS

What Doctors Don't Tell You — Sun, 02 Jul 2006 10:49:15 +0000

A natural progesterone cream supposed to reverse postmenopausal osteoporosis is ineffective because it is not properly absorbed into the system.

Researchers tested the rub on cream Progest on 20 postmenopausal women aged between 37 and 70. All the participants had had a hysterectomy at some stage.

The women applied one teaspoon of the cream morning and night, which is four times the manufacturer’s recommended dose. But on analysis, it was found that absorption of progesterone from Progest was far too low to offer protection or conserve bone.

The researchers, from the Menopause Clinic at King’s College Hospital in London, say Progest should not replace conventional HRT treatment (Lancet, 1998; 351: 1255-6).

CREAM CONTAINING PROGESTERONE POORLY ABSORBED

What Doctors Don't Tell You — Sun, 02 Jul 2006 10:49:15 +0000

New data from Australia add to the growing scepticism about the effects of rub-on progesterone creams as a miracle cure for everything from menopausal symptoms to osteoporosis.

Researchers from the Sydney Menopause Centre conducted a clinical trial using transdermal oestrogen and progesterone on 27 postmenopausal women, aged 50 to 65 years. All the women were given continuous oestrogen via a transdermal patch for a cycle of 12 weeks. The women were then randomly allocated 16 mg, 32 mg or 64 mg of micronised progesterone daily for 14 days during the second half of four 28-day cycles.

The idea of the study was to determine whether ‘natural’ progesterone could replace the progestogens used with oestrogen in hormone replacement therapy (HRT). Many women, leery of progestogens, have been substituting rub-on progesterone with their HRT.

Endometrial biopsy samples were obtained before treatment on day 14 of the first cycle of transdermal oestrogen, and on day 27 or 28 of the third cycle of micronised transdermal progesterone. The use of micronised progesterone, even at the highest concentrations, did not increase circulating blood progesterone concentrations enough to induce any change in the endometrium. This suggests that claims that rub-on progesterone protects against endometrial cancer and other abnormalities must be treated with caution.

It also adds weight to previous studies which concluded that rub-on progesterone is poorly absorbed (Lancet, 1999; 354: 1447-8).

QUESTION FROM READER:PROGESTERONE

What Doctors Don't Tell You — Sun, 02 Jul 2006 10:49:15 +0000

Q:I am 48. My doctor has prescribed natural rub-on progesterone for me to help me through the menopause. As I’m a singer, it’s also important for me to look young. What are the known dangers? I’ve heard that because it’s natural, there aren’t any. A

A:Lately, everyone is jumping on the “natural” progesterone supplement bandwagon, prescribing it for everything from PMS and recurrent miscarriage to breast pain, menopausal symptoms, vague hormonal imbalances and even, in your case, for just being female and over 40.

Progesterone is the female sex hormone secreted by the corpus luteum during the second half of the menstrual cycle, the adrenal cortex or the placenta during pregnancy. Its function is to prepare the uterus for pregnancy and then to maintain the pregnancy once it has occurred. Recently, several in medicine, particularly Dr John Lee of California, have put forward the theory that many women these days are suffering from “estrogen dominance” and that this accounts for breast cancer, recurrent miscarriage and other complaints. Hence, why women who are low in progesterone or menopausal should be given supplements of natural progesterone.

For anyone who hasn’t heard of it, progesterone is mainly administered as a rub-on cream, in a micronized form given orally dissolved in oil, as vaginal pessaries or as a shot. The reason it’s given every way but orally is that when taken by mouth, the liver quickly breaks it down, rendering it mostly ineffective. Rubbing on or injecting progesterone enables it to bypass the liver and supposedly reach the bloodstream directly.

Many people are seduced by the fact that this progesterone is “natural”, derived from soybeans or wild yam, and therefore presumed to be safe. This is a critical point because so-called synthetic progestogens (also known as progestins) have been examined in many studies and found to have many side effects, including the possible ability to cause cancer.

In fact, no supplemental progesterone or any other hormone is “natural” in the sense of being identical to what women produce in their own bodies. These new forms of progesterone are made from wild yam or soybeans, which contain substances which are converted into progesterone only after undergoing a series of synthetic chemical steps.

With the wild yam, progesterone is made from a substance called diosgenine.In an information sheet, one manufacturer says that it derives from a sterol compound called stigmasterol, extracted from soybean oil. “The sigmasterol is then synthesized to progesterone,” says a company handout.

As Dr Alan Gaby points out in the Townsend Letter for Doctors (August/September 1995), another “natural” hormone is derived from horse estrogen, which “differs substantially from the hormones secreted by the human ovary”.

Many forms of progesterone released on the market in the UK and the US have not been evaluated for their safety and effectiveness.

Ordinarily, when a drug company wants to market a new drug, it must register a new drug application with the FDA and undergo or provide evidence of both animal and human studies to demonstrate safety and effectiveness before the drug gains FDA approval. However, if you don’t intend to promote or distribute a product on the open market, there is nothing to prevent a drug company from producing a drug or substance, such as powdered progesterone, and selling it to licensed chemists, so long as the drug company adheres to the US Pharmacopoeia standards of purity. It is also perfectly legal for licensed pharmacists to “compound” this product say, mix it up in a gel or as suppositories if a doctor requests it or writes a prescription for it. As one FDA spokeperson put it, “Extemporaneous compounding by licensed pharmacists is normally done when certain medical needs of individual patients cannot be met by the use of approved commercial drug products.” So long as the use is, in the FDA’s words, “medically acceptable” which can tend to be a moveable feast any doctor can prescribe to a patient any drug he feels like, even those that haven’t been tested for FDA-approved safety and effectiveness.

The only progesterone product listed in the Physician’s Desk Reference or the official FDA drug handbook is Progestasert, an intrauterine device containing slow-release progesterone. At the moment, doctors around the country have progesterone made up as a compound for specific patients. The point is, since nobody has applied for FDA approval, there is very little in the way of published studies about the safety or effectiveness of progesterone, and little knowledge about who shouldn’t take it and why. Klim McPherson, leading epidemiologist on pill risks and professor of public health epidemiology at the London School of Hygiene and Tropical Medicine, said progesterone is “hopelessly, poorly understood.”

The rub-on progesterone cream hasn’t undergone review by the Food and Drug Administration because numerous companies sell the product as a cosmetic. It is possible to get the rub-on cream in the States by mail

order, but only by prescription in the UK.

Recently when we rang one manufacturer as ordinary customers and asked if their cream was good for menopausal symptoms, a woman called Alisha told me that her company couldn’t make any claims for their cream, or discuss the amount of progesterone in it, since “our deal with the FDA is that it’s a cosmetic.” She told me that they were selling the cream “as a moisturizer for dry skin”, but if I wanted to know what else it was good for, I should get hold of Dr John Lee’s book, and she helpfully supplied me with the publisher and address. Dr Lee’s book, Natural Progesterone: The Multiple Roles of a Remarkable Hormone, claims that supplemental progesterone will help to alleviate many female problems, from infertility and PMS, fibroids, endometriosis, pelvic cysts to osteoporosis. She also said she could send me directions for usage, and indicated that they varied depending upon whether you were “menopausing” or not. Her company recommends using it daily for three weeks and then refraining for a week.

We then moved onto the FDA. According to Alan Halper, compliance officer in the Office of Cosmetics and Colors, cosmetic products are not specifically required to register with the FDA. “If you wanted to come out with a cosmetic tomorrow, you could formulate, label and sell it without telling the FDA,” he said. The industry is largely self-policing; they rely on a product causing gross injury to generate complaints.

At the moment, any amount of hormone can be put into cosmetics so long as there are no medicinal claims being made for the preparation. However, the FDA would like to see things tightened up. On September 9, 1993, the agency submitted a notice of proposed rule-making which would consider all over-the-counter drugs and cosmetics listing “hormones” in the ingredient statement to be an implied drug claim, and that such labeling would cause the product to come under ordinary drug regulations requiring safety testing. In one of two exceptions, the FDA proposed to limit the use of progesterones in cosmetics products to 5 mg/per ounce of progesterone when used in an amount not exceeding two ounces per month, or 10 mg of progesterone per month.

According to one doctor, the two ounce-per-month supply of rub-on progesterone provides 20 mg of progesterone per day. Although proposed more than two years ago, the final FDA ruling on this issue has not been made, as the regulatory gears grind slowly.

The issue of how much progesterone is contained in the cream is pertinent when you consider the minute doses required by the body to keep things ticking over. During the menstrual cycle of the ordinary woman, progesterone blood levels range from 0.5 to 20 nanograms per ml, according to Harrison’s Principles of Internal Medicine. This amount is the equivalent of one part per billion in weight. With the rub-on cream, women could be enhancing the progesterone concentration in the blood by four or five times. To prevent miscarriage when levels needed are higher, women can receive from 25-200 mg per day.

The theory has been that this progesterone would “drip feed” into the system as it would normally. But several studies show that progesterone can tend to accumulate in the skin, causing unknown chemical effects in and under it. In one study of rub-on progesterone applied to breast tissue, both progesterone and estrogen levels increased by four times, and yet any blood levels of progesterone were short-lived (P Mauvis-Jarvis, et al, Percutaneous Absorption of Steroids, Academic Press, 1980). According to this same article, the average amount absorbed is about 10 per cent of the applied dose, so that if you are using 50 mg of progesterone, you’d absorb about 5 mg.

Furthermore, not everyone absorbs progesterone in the same way. In the same book, J De Boever and his colleagues at the University of Ghent in Belgium, conclude: “After topical administration of a single dose of progesterone, there is a wide variation in the results observed in breast tissues”.

If this massive increase is happening locally, whether by shot, pessary or cream, we have no idea what on earth it’s doing.

Many in medicine attempt to claim that progesterone can protect against such diseases as breast cancer. However, according to Klim McPherson, there is also a good argument for the opposite being true high progesterone levels being a risk factor for breast cancer (BMJ, March 4, 1995). This makes sense because the primary function of progesterone in the breasts is to promote development of breast cells.

Progesterone is listed as a carcinogen in numerous chemical handbooks. In animal studies, progesterone increased the incidence of cancer of the ovary, uterus and breast in mice (IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, December 1979). Several researchers have also hypothesized that breast cancer is caused by increased levels of progesterone (Fertility and Sterility, March 1992).

As for its indications, most studies published demonstrate that progesterone doesn’t seem to make much difference alleviating PMS (JAMA, July 5, 1995) or in preventing miscarriage (Hum Repro, March 1992; J Repro Med, March 1992). One study showed that pregnancies may even be viable at very low levels of progesterone and concluded that there was no minimal threshold where anyone could say progesterone was definitely needed (Gyne & Ob Inves, 1992; 34 (3): 133-8). In fact, supplemental progesterone may have deleterious effects. Another set of researchers concluded that the progesterone may not be such a good idea, since it mainly caused “delayed gland maturation”, and in those receiving IVF, showed pathological changes in the womb lining (Ann Chir et Gynae, 1994; 208: 33-9), or significantly higher blood estrogen levels (Gyn & Ob Inves, 1992; 34 (4): 206-10).

In the UK, two companies produce progesterone. Hoeschst produce Cyclogest (which are vaginal or rectal pessaries), which is intended to treat PMS and post-natal depression, and Paines & Byrne produce Gestone, which is given by injection, and indicated for the treatment of abnormal uterine bleeding or to prevent miscarriage for women with abnormally low progesterone or undergoing IVF. Both have received UK Committee on Safety of Medicine approval.

Ironically, of Cyclogest, the PMS drug, its manufacturers says that it is “not expected to have adverse effects” during pregnancy that is, cause birth defects although “no evidence is available to this effect.” Gestone, the miscarriage drug, on the other hand, says that as it contains “progesterone itself, the same as the naturallys secreted hormone,” it is “not associated with masculinization of a female fetus as are synthetic progestins.”

On the issue of birth defects and use during pregnancy, the FDA takes a tougher line. “Systemically administered sex steroids, including progestational agents, have been associated with an increased risk of congenital anomalies” it says about Progestasert (Physicians’ GenRx, 1993). The reevaluated results of the US Collaborative Perinatal Study of the Drug Epidemiology Unit found that the risk of cardiovascular malformation more than doubled in infants exposed to female sex hormones during the first four months of pregnancy (Teratol, March 1994).

For Gestone, the manufacturer warns that you should stop the drug if you develop loss of vision, bulging of the eyeball, double vision, swelling of the optic disc, vascular lesions in the retina or migraine. Other side effects include changes in the cervix or breast, depression, jaundice, insomnia, nausea, hair loss or growth, darkened skin, weight gain, edema and changes in menstrual flow or cycle.

Weight Loss and Low Fat Diets

What Doctors Don't Tell You — Sun, 02 Jul 2006 10:49:15 +0000

One of the major risk factors for osteoporosis is being too thin. Once the ovaries stop producing estrogen, a woman’s body keeps on making small amounts of it from subcutaneous fat, especially abdominal fat. Therefore, a little extra weight is actually a good thing for menopausal women. Putting on this weight will help protect the bones, not just because of the continued natural estrogen production, but also because the strain of carrying the extra weight is a form of exercise and makes the bones work harder against gravity, thus helping to preserve bone density.

An extremely restricted diet after menopause that keeps the body as thin as that of a teenager could cause problems since weight loss is a known risk factor. According to the National Institute on Aging, women who lose 10 per cent or more of their body weight after the age of 50 have twice the risk of breaking a hip than women who don’t lose weight (New York Times, June 4, 1996).