How homeopathy can help with menopausal symptoms by Dr Jenifer Worden

The menopause is that stage  of a woman’s life when her repro­ductive system starts to wind down,  causing a wide range of symptoms, some of which can be very distressing  and debilitating. The vast majority of women will start to experience  the so-called “change of life” in their late 40s but symptoms may  persist after a woman has passed her 60th birthday.

The main symptoms experienced are hot flushes, night sweats, bladder  prob­lems such as cystitis and infections, depressed mood, reduced sex  drive, for­getfulness and reduced concentration. For most women,  symptoms will last two to three years, starting with an irreg­ularity of  periods and ending with the periods completely stopping. After 12  months, a woman who has not experi­enced any periods is commonly said to  have gone through the menopause and to be “post-menopausal”. Any  vaginal bleeding after this time should always be reported to a doctor  or practice nurse as it could be an early sign of endome­trial cancer  (cancer of the womb).

As a GP I am often asked by worried women to carry out blood tests to  see whether or not they are going through the menopause but such tests  do have drawbacks. They only give a “snapshot” of the hormone levels a  woman is expe­riencing at a certain point in time and are notorious for  being returned from the testing laboratory as being within the normal  range when the patient is quite clearly experiencing some or all of the  symptoms of the menopause. Patients often feel let down by the results,  which is why GPs tend to advise against these tests in general. The  excep­tion to the rule is where a woman has a congenital lack of a womb  or has had a hysterectomy with preservation of her ovaries. Changes to  the menstrual cycle are not apparent in these women and early subtle  changes of the menopause can be confused with a mild depression, perhaps  leading to incorrect treatment of the underlying problem. In the end,  the best way to judge whether a woman is going through the menopause is  to lis­ten to her and to look at her as a whole which is the holistic  approach.

Often all a woman will need at this point in her life is reassurance  that her symptoms are normal and that she is not suffering from a mental  illness. The ups and downs of teenage girls at puberty are echoed in  women at the menopause but without the ability to scream and shout and  to flounce out of the house, slamming the door. Instead, most women will  either be looking after a family or working, which can lead them to  feel­ing trapped emotionally and physically by their symptoms. Why some  women sail through the menopause with the minimum of symptoms and others  regard it as the worst time of their lives is not understood by the  scientific com­munity and exactly what causes hot flushes is also  somewhat of a mystery. Although we know that it is the reduc­tion of  levels of oestrogen (the principle female hormone) that seems to be  res­ponsible for hot flushes and night sweats, the exact means by which  this happens is not clear. What is clear is that for women with  debilitating symptoms and a markedly reduced quality of life, HRT can  literally be a life-saver, increasing the hormone levels back up to  normal and often having a dramatic effect, reducing symptoms to a more  manageable state within a week or so of starting treatment.

The problem with HRT 

So if HRT is so wonderful, why has it fallen from grace recently?  The main reason is research showing that HRT could increase the risks of  having a heart attack or stroke. The Women’s Health Initiative (WHI)  study (2002) was carried out in the United States on a population of  women ten years older than would commonly be prescribed HRT in the UK  and who also had existing risk factors for heart disease. Although the  older and less fit women in the research could have biased the results  against HRT as they were inherently more likely to suffer from heart  disease, the medical pro­fession was concerned enough by the results to  significantly reduce their prescribing of HRT.

This course of action was backed up by the Million Women Study,  funded by Cancer Research UK, which looked at an increased risk of  cancers linked to taking HRT, principally cancer of the womb. It is  estimated that at least 340,000 women stopped taking HRT after the WHI  research was published and that of the 300,000 women esti­mated each  year to enter the menopause, many will now look at alternatives to  conventional treatment. The National Institute for Clinical Excellence  (NICE) currently recommends HRT for the relief of debilitating vasomotor  and urogen­ital symptoms (hot flushes, night sweats, cystitis,  recurrent urinary infections, vaginal dryness) in women over 50 and for  two to three years only, with an annual review of symptoms. Women under  fifty (the most common age for the menopause), particularly those  hav­ing hysterectomy with removal of the ovaries or undergoing an early  (prema­ture) menopause can still be prescribed HRT as they are only  receiving hor­mones that they would normally have.

All this has meant that a reasonable proportion of women over 50 in  the UK have either stopped their HRT suddenly or have been persuaded by  their GPs to do so, and in so doing, have landed right back into the  menopausal symptoms that they were trying to escape from. Some women  would have been started on HRT for treatment or prevention of  osteoporosis (brittle bones) and may not have had any symptoms when they  started treatment but certainly have now. HRT is no longer a  recommended treat­ment in the UK for prevention of this disease and  other non-hormonal treat­ments are widely available on prescrip­tion, in  addition to the lifestyle advice of not smoking, maintaining a sensible  body weight, regular weight-bearing exercise like walking and a dietary  intake rich in calcium and vitamin D. The time that a woman takes to go  through the menopause varies but is usually said to be between two to  three years. I find that most menopausal symptoms peak about three to  six months after stopping HRT, and will often be manageable about 12 to  18 months after HRT was last taken.

Homeopathic treatment 

So if you are one of the unfortunate women who have to wear  sleeveless t-shirts on the coldest of days and who sleep on a beach  towel to save contin­ually changing the bed sheets, what can you do to  make life more comfortable for you and those around you? In my  experience, there is no single comple­mentary therapy or medication that  works for all women and this is borne out by conversations with other  doctors and therapists. There are, however, sev­eral homeopathic  medicines which can be effective at relieving menopausal symptoms. It is  especially important, however, to try to see a medical homeopath as a  prescription will work better if holistic and tailored to the  individual. Also, there are other problems that can affect a woman in  her fifties, such as an underactive thyroid gland, which can mimic  menopausal symptoms; thyroid problems can respond well to treatment so  it is important to have this particular problem excluded professionally  by blood tests and medical examination.

Feeling down 

One of the commonest homeopathic medications that I prescribe is  Sepia. This important gynaecological medicine is based on cuttlefish ink  and can be really helpful where the feelings of worthlessness and lack  of self confidence can damage a woman emotionally. These symptoms are  all too common for some women in the menopause and may not be helped by a  slightly dominant partner who may not understand or have patience with  their symptoms. There is often marked depression and tearfulness which  the partner can be irri­tated by and the whole relationship becomes  strained. The woman often feels isolated and cuts herself off socially,  withdrawing psychologically. Her fam­ily can find her distant and taking  less interest in her appearance which are typ­ical symptoms of clinical  depression. She feels worn out and sex is no longer of interest to her.  She may no longer find her partner attractive, a situation she may find  difficult to come to terms with, and the partner also. Tears are common  in the GP surgery when telling of her problems and a feeling of  desperation with the situation is apparent, sometimes leading to  irritability. Frequent attacks of sweating which lead her to feel clammy  on waking at night predomi­nate and often an unpleasant vaginal  dis­charge, brought on by the hormonal changes she is undergoing.

For severe symptoms, I recommend either a daily dose of Sepia 30c but  occa­sionally I find a weekly dose of 200c nec­essary for symptom  relief. As well as using homeopathy in this situation, I also feel it is  very important to encour­age my patients to undertake an activ­ity that  makes them feel good about themselves, even if it is as simple as  having a manicure or taking the dog for a walk. One must always treat  the patient as a whole and helping her to feel better in a very general  way will, in my experience, help the homeopathic med­ication act more  efficiently.

Night sweats 

One of the most difficult symptoms to relieve is the profuse  sweating at night and it is in this situation that I use Lachesis. This  is a remedy often asso­ciated with sexual jealousy and a pas­sionate  nature but even the mildest woman can be helped by this medicine,  particularly if her remaining menopausal symptoms have settled.  Typically, a patient who can be helped by Lachesis wakes to her symptoms  or suffers from them in her sleep. There may also be an element of  irritability. A dosage regime similar to that of Sepia can be used.

Black cohosh has been recommended by herbalists for the relief of  menopausal hot flushes but worries about possible toxic effects on the  liver have led to some health concerns about this remedy, par­ticularly  when combined with conven­tional medication. However, taken in the  homeopathic form of Cimicifuga, this can be a useful remedy and without  side-effects. Women who need this may tend to feel the cold rather than  being hot all the time and have a tendency to depressive symptoms.

Bladder problems 

There are numerous medications for bladder problems, including  Causticum, Staphisagria, Berberis and Sarsparilla but a  recently-discovered homeopathic medication called Adamas, based on  dia­mond dust, can be used for frequency of urinating, associated with  vaginal dry­ness. Reduced elasticity of the vaginal wall and a change in  the acidity of the vagina are both symptoms due to low oestrogen  levels. This is the reason for recurrent urine infections and  difficul­ties with sexual intercourse at the menopause. Conventionally,  these symp­toms can be treated with oestrogen creams or pessaries used  vaginally with­out many of the risks of HRT per se, but not every woman  wishes to do this. The Adamas can be used alone, or in com­bination with  Sepia.

Weight gain 

Many of the best-known homeopathic medications can be used during  the menopause such as Pulsatilla and Nat mur but Graphites is often  overlooked. I have found it helpful where a woman perhaps has gained a  few unwanted pounds over the period of the meno­pause, having previously  been perhaps slightly overweight. She is generally mild in temperament  but puts a brave face on things, a little like the Nat mur person. She  has the weepiness of Pulsatilla but tends to be chilly where Pulsatilla  is hot. Typically, Graphites like sweet foods, but occasionally dislike  such foodstuffs which can seem to be at variance with their body shape.  They may, or may not, have skin problems, such as a weeping eczema or  psoriasis. A woman who does well with Graphites may well be very  sensitive to music, weeping at her favourite piece.

A stage of life 

One thing that I would like to empha­sise is the menopause is just a  normal stage in every woman’s life, as difficult or as easy as it might  be for an individ­ual. Regular exercise can help maintain brain  function in older women, accord­ing to recent research and can also help  with the physical symptoms of the menopause as can homeopathy. The role  of soya (isoflavones) in the diet is not fully recognised but in  countries such as Japan, where soya is a staple food, less than 25 per  cent of women get hot flushes. It may be necessary to consume at least  25mg of isoflavones a day com­pared to the 1mg most UK women obtain  through their diet. Some women do experience allergy type symptoms, such  as swollen joints, with high levels of dietary soya so some caution is  needed if making a drastic difference to one’s intake. A daily dietary  allowance of 800iu of vitamin D and 1500mg of cal­cium is recommended to  prevent osteo­porosis. This can be obtained either through eating oily  fish two to three times a week and drinking at least half a pint of milk  a day or through nutri­tional supplements. Alcohol and caf­feinated  drinks can worsen flushing and irritate bladder function so a reduced  intake is advised.

Although some women do undergo a fairly permanent change in their  under­lying body temperature (thermostatic dysfunction), most women will  experi­ence only temporary changes with the menopause. There is help  available for this time of upheaval and the fact that it often coincides  with children “flying the nest” or other life events does not always  make it easier to manage. If you feel that your symptoms are adversely  affecting your life and wellbeing, please do not hesitate to contact  your GP or homeopathic doctor.

Websites such as www.menopausematters.co.uk or www.the-bms.org have more information about this inevitable, but not always welcome, change in our lives.

Jenifer Worden MBChB MRCGP MFHom is a part-time GP with a private homeopathic practice in Dorset.