Can Menopausal Symptoms Be Controlled - Thesis Example

?Menopausal Symptoms can be controlled, the Natural Way, with Vitamin D and E Menopause is a milestone in the natural life process of women marking the end of the reproductive capability. Several hormonal changes occur during the menopausal period affecting women physically and emotionally. A number of symptoms are characteristically associated with menopause including hot flashes, night sweats, vulvovaginal atrophy, sleep distubances and insomnia, sexual disturbance, weight gain, changes in hair growth pattern (loss of hair on head, increase in facial hair), changes in skin, and psychological disturbances such as irritability, mood swings, depression and anxiety. The symptoms can start to show up many years earlier (MedlinePlus). A Gallup poll of menopausal women conducted in 2002 revealed the four major reasons for medical attention as hot flashes (70%), night sweats (68%), mood disturbances (50%), and sleep disturbances (48%) (Utian, 2005). An estimated 75% to 85% of menopausal women experience vasomotor symptoms such as hot flashes and night sweats (Ohayon, 2006; Umland, 2008). The pathophysiology of hot flashes is uncertain but it is widely accepted that a dysfunction of the central thermoregulatory centers e.g., hypothalamus caused by certain factors might lead to hot flashes (Shansfelt et al., 2002). Diminishing level of circulating estrogen as a result of waning ovarian function during menopause is believed to cause a narrowing of the thermoregulatory threshold between sweating and shivering in the hypothalamus, leading to hot flashes (North American Menopause Society, NAMS, 2004; Mayo Clinic, 2009). Also, according to Mayo Clinic (2009), rather than low estrogen levels alone, it could be the withdrawal of estrogen occurring during menopause that causes hot flashes. This is in agreement with the observation that hot flashes are predominant at the initial stages of menopause and do not usually continue throughout the postmenopausal period despite circulating estrogens being low (Sturdee, 2008). Norepinephrine and serotonin have also been implicated in the complex neuroendocrine pathway controlling the thermoregulatory zone (Shanafelt et al., 2002). Hot flashes involve the sudden onset of uncomfortable sensation of intense warmth beginning in the chest and moving to the neck and face, or spreading throughout the body. Anxiety, palpitations, profuse sweating, and red blotching of the skin are accompanying symptoms. Among the women experiencing hot flashes, the severity was reported as mild by 50% of the women, moderate by about 33% of the subjects, and 15% had severe hot flashes (Ohayon et al., 2006). Hot flashes can have an adverse effect on a woman’s work capacity, social well being, sleep pattern besides her general perception of health (Shansfelt et al., 2002). More than 81% of women experiencing severe hot flashes regularly had symptoms of chronic insomnia as well (Ohayon et al., 2006) since hot flashes often occur at night and cause sleep disruption. It has recently been observed by Szmuilowicz and Manson (2011) that menopausal hot flashes could be a good sign for the heart. Their study reviewed medical information gathered from 60,000 women who were enrolled in the Women's Health Initiative Observational Study and followed for ten years, to determine the relationship between menopause symptoms and cardiovascular events. According to these authors, women who experience severe hot flashes and night sweats may have a lower risk for cardiovascular disease, stroke and death. Their study also revealed that women who experienced symptoms at initial stages of menopause had fewer cardiovascular events than those who experienced hot flashes late in menopause or not at all. The results reported by Szmuilowicz and Manson (2011) assume much importance since menopausal symptoms, being the result of instability of the blood vessels in the skin, have been thought to cause other types of vascular problems as well in women suffering from hot flashes. Vaginal atrophy or the thinning of the vaginal lining occurs as another frequent symptom of menopause. This again is due to declining estrogen levels that cause the layers of the vaginal surface to become dry and sensitive, the thinning and loss of elasticity of the vaginal wall, and increase in vaginal vulnerability to infections. Physiological changes in the vagina including lack of vaginal lubrication, and a change in the hormone (androgen) levels may lead to sexual problems. Menopause is an extremely important risk factor for bone loss in women. Normally about 50% of the trabecular bone and 30% of the cortical bone is lost by women during the course of their lifetime; about 50% of this loss occurring in the first ten years after menopause (Riggs and Melton, 1992). Vitamin E therapy for symptoms of menopause Hormonal therapies involving estrogens and progestogens are the most effective treatment for control of hot flashes. However, the safety of pharmacologic estrogen therapy raising serious concerns (Rossouw et al., 2002), treatment using natural substances (e.g., phytoestrogens namely soy bean isoflavones and flax seed lignans, black cohosh, vitamin E) is increasingly favored. Vitamin E was first recognized as a possible treatment for hot flashes in the 1940s but the first randomized, cross-over, clinical trial was conducted in 1998 with 120 women subjects receiving daily 800 IU vitamin E for 4 weeks followed by 4 weeks of placebo therapy or vice versa. Although on crossover analysis, vitamin E was associated with a moderate reduction of hot flashes, the patients did not prefer vitamin E over the placebo (Barton et al., 1998). The earlier apprehensions about the carcinogenicity of vitamin E have been refuted. But, up to the present time, no proper study has conclusively recommended vitamin E as an effective treatment for hot flashes (Pachman et al., 2010). Larger randomized controlled trials with vitamin E are needed to support the initial findings. For treatment of mild vasomotor symptoms that are not controlled by lifestyle changes, NAMS (2004) recommends treatment with natural substances including vitamin E (800 IU given as divided daily dose). Studies have shown that the risk of heart disease intensifies drastically around the time of natural menopause in women. Estrogen has a protective effect on the heart, and the significant drop in estrogen levels occurring at menopause can, therefore, contribute to the higher risks of cardiovascular disease (Northwestern Memorial Hospital, 2010). ?-Tocopherol which is the main and most active form of vitamin E in humans is the major antioxidant in lipid phases. ?-Tocopherol is another antioxidant component of vitamin E that helps lower the risk of heart disease (Flax Council of Canada). Epidemiological data indicate an inverse association between cardiovascular risk and vitamin E intake but randomized trials have failed to confirm this because of the relatively short period of observation involved (Lonn et al., 2005). An apparent cardiovascular benefit of Vitamin E therapy has been reported in a sub-group of middle-age individuals (Milman et al., 2008). The Nurses’ Health Study conducted on approximately 90,000 women showed a 30% to 40% decrease in heart disease in women consuming vitamin E supplements (Stampfer et al., 1993). Flaxseed is a rich source of the phytoestrogen, lignan which is structurally similar to estradiol. Besides, flaxseeds contain up to 0.04% of ?-tocopherol (Flax Council of Canada). Research is being increasingly conducted on the efficacy of flaxseed treatment for hot flashes following a pilot trial involving 30 women who were administered 40 g of crushed flaxseed daily and reported 50% reduction in hot flash frequency after 6 weeks of therapy (Pruthi et al., 2007). Another double-blind, randomized controlled trial reported significant reduction in the severity of hot flashes following ingestion of flaxseed muffins by 87 women subjects (Lethaby et al., 2007). It is yet to be studied whether the beneficial effects of flaxseed on vasomotor menopausal symptoms such as hot flashes are entirely due to the phytoestrogens or whether they are also due, in part, to 0.04% w/w of ?-tocopherol present in flaxseeds. Vitamin D therapy for menopausal syndrome At menopause and for several years thereafter, women undergo higher bone loss at a rate of 3% to 5% per year (Levinson and Altkorn, 1998). Weight-bearing exercise is likely to decelerate bone loss in postmenopausal women. Vitamin D is a steroid hormone that influences the regulation of calcium homeostasis and mineralization of bone (Mulder et al., 2006). The Women's Health Initiative (WHI) in the United States which examined, in a multicenter study, 36,282 postmenopausal women taking calcium (1,000 mg) with Vitamin D (400 IU) found 29% reduction in hip fractures when the supplements were administered together (Mulder et al., 2006). Bone mineral density loss is accelerated considerably in the late perimenopause and continues at the same rate in the initial postmenopausal years (Finkelstein et al., 2008). Postmenopausal osteoporosis has immense public health importance. Large individual variations in rates of bone loss among women are reported. Screening of menopausal women to detect and monitor bone mineral density losses is important in order to prevent osteoporosis. Serum 25-hydroxyvitamin D [25(OH)D] is the major circulating form of vitamin D and the most stable form of vitamin D. Hence 25(OH)D is used to measure vitamin D status. Circulating 25(OH)D levels less than 20 ng/mL denote vitamin D deficiency while insufficiency of the vitamin is defined by levels under 32 ng/mL (Murphy and Wagner, 2008). Osteoporosis, is generally associated with serum 25(OH)D levels lower than 25 ng/mL. Apart from maintaining bone health, vitamin D influences many other biochemical mechanisms in the human body. Vitamin D receptors are present in bone, skeletal muscle, immune cells, and several body tissues, including the brain, prostate, breast, and colon (Murphy and Wagner, 2008). Hence vitamin D intake helps with mood disorders, autoimmune problems, and prevention of certain cancers. An increase in colon and breast cancer has been observed in postmenopausal women with low vitamin D levels. It has been shown that women with serum 25(OH)D levels >52 ng/ml had a 50% lower risk of breast cancer compared to those with levels Read More