1. WOMEN’S HEALTH AT ALL AGES EMBRACING MATURITY: MENOPAUSE AND BEYOND Dr. Christi Hartman

2. WHO IS THIS TALKING?  Naturopathic Doctor Four years post-graduate studies at Canadian College of Naturopathic Medicine Bachelor of Science from UBC Okanagan  Additional training Acupuncture Prescribing authority

4. TODAY’S DISCUSSION  What is menopause  Common concerns during this time of life  Natural support for the menopausal transition  Questions & discussion

5. WHAT IS MENOPAUSE?  Cessation of the menstrual cycle  Officially menopausal when no menstrual cycle for 12 consecutive months  Average age is 50-52 years (ranges 40-58 years)  Due to decreased activity of the ovaries and the cessation of ovulation

6. PERIMENOPAUSE  The time leading up to menopause including the 12 months after the last menstrual cycle  Lasts an average of 4 years  Typically characterized by shortening of the menstrual cycle, then by skipped cycles

7. A NATURAL TRANSITION  Menopause: is a normal, natural stage of life is often a time of increased opportunities and options may comprise as much as half of a woman’s lifetime, the time when she has the greatest knowledge and opportunity for creativity, spirituality, and personal growth

8.  In Traditional Chinese Medicine, menopause is seen as a time when women shift from a predominantly “yin” (passive, cool, moist, still, substance, dark, still) to predominantly “yang” (dominant, hot, dry, active, upward seeking, restless, productive) nature.  Often a time when women become more assertive, set boundaries, and pursue personal, academic and career goals

9. CELEBRATE!  Menses & PMS free  Sex without pregnancy concerns  Fibroids shrink

10. COMMON CONCERNS  75 – 90% of women have symptoms during the menopausal transition  For most women, the symptomatic period lasts from 4-7 years and symptoms resolve without treatment  10 – 25% of women have concerns that persist beyond this time

11. COMMON CONCERNS  Reduced fertility  Irregular bleeding  Hot flashes/night sweats  Disturbed sleep  Bladder difficulties

12. COMMON CONCERNS  Vaginal discomfort (dryness, irritation, painful intercourse, infection)  Headaches  Mood swings, depression, anxiety  Memory changes  Altered sex drive & function  Heart health, bone health

13. PREVENTION  Bone density drops significantly in the 7 years after menopause  Particularly important time to maintain physical activity, ensure adequate dietary calcium, vitamin K, and sunlight (or Vitamin D supplementation)  Also entering a time of increased cardiovascular risk.  Smoking cessation, blood pressure and cholesterol, and body weight must be addressed

14. UNDERLYING FACTORS  Women who are depleted when they enter menopause tend to experience more symptoms  This can be the body’s last call for change – if you have been neglecting your health up to this point, menopausal symptoms can be seen as a prompt to make changes  A time of life when “I’ll be healthy later” is no longer an option – it’s time to be healthy now!

15. UNDERLYING FACTORS  What does “depleted” mean anyway?  Let’s talk about hormones for a minute

16. HORMONES  Many people think menopausal symptoms are due to estrogen deficiency  In fact, it more often due to lower levels of progesterone and an imbalance in the amount of estrogen relative to progesterone  Both of these hormones are produced by the ovaries and adrenal glands during the reproductive years  During and after menopause, production of these hormones is largely from the adrenal glands

17. ADRENAL HORMONES

18. CORTISOL  Cortisol is the adrenal hormone released in response to stress  If you are constantly producing cortisol, it is at the expense of the other hormones, and they become deficient  This contributes to many of the symptoms experienced during the menopausal transition  Identifying and reducing stressors is the first (and most important!) step in restoring hormone balance

19. EMOTIONAL STRESSORS  Worry  Guilt  Anger  Anxiety  Fear  Depression  Lack of fun activities and experiences

20. ENVIRONMENTAL STRESS  Pollution  Chemicals (pesticides, food additives, fragrances, preservatives)  Allergies  Little sunlight  Temperature extremes  Light-cycle disruption (eg., shift work)

21. PHYSICAL STRESSORS  Excessive exercise  Poor diet, nutrient deficiencies  Refined carbohydrates & sugars  Overwork (mental and physical)  Surgery, trauma, injury, chronic illness or pain  Irregular/inadequate sleep

22. STRATEGIES  A holistic approach to wellness is the most effective and beneficial way to transition through menopause  We will also discuss some specific strategies for some of the more common concerns

23. EMOTIONAL HEALTH  Change how you perceive the world  Many of us can’t make stressors go away, but we CAN change what we focus on and how those stressors affect us  Heart focus exercise Increases DHEA by 100% Decreases anxiety and burnout Increases ability to care and sense of vigor Helps heal patterns of emotional stressors

24. EMOTIONAL HEALTH  Ensure you have hobbies that your enjoy  Develop and maintain close personal relationships  Learn something new – lifelong learning builds confidence, opens new opportunities, and improves cognitive function

25. RELAXATION  Hot bath with lavender essential oil and epsom salts  Bedtime ritual – favorite book, herbal tea, music  Deep breathing exercises – reduce hot flashes, irritability, anxiety  Meditation  Laughter!

26. NUTRITION  Highs and lows in blood sugar can aggravate and/or trigger many of the symptoms associated with menopause  Following a low-glycemic diet helps regulate blood sugar and can provide significant relief from hot flashes, irritability, depression, low energy, insomnia, and much more  A varied, whole-foods diet with adequate protein and healthy fat is essential to good health as we age

27. EXERCISE  Exercise: Reduces depression, anxiety, and irritability Improves blood sugar control and body weight Reduces hot flashes Maintains bone density and strength, and reduces fracture risk Strengthens your heart and blood vessels Improves energy, vitality, sense of well-being, and immune function Reduces stress hormones

28. EXERCISE  Walking  Swimming  Cycling  Paddling  Hiking  Dancing  Yoga  Pilates  Qi Gong  Weight training  Snow shoeing  Cross country skiing

29. SPECIFIC CONCERNS The Mature Years

30. HOT FLASHES  Loose breathable clothing, layers  Avoid caffeine, sugar, alcohol, hot and spicy foods, white flour  Sage tea, red clover tea, flaxseed, soy  Deep breathing & meditation  Vitamin C with flavonoids, B-Vitamins, Vitamin E  Herbal support: Black cohosh, Dong quai, Kudzu, Motherwort

31. VAGINAL IRRITATION  Use it or lose it  Vitamin E suppositories  Lubricants  Wild yam cream  Kudzu, Black Cohosh  Hormone replacement creams

32. INSOMNIA  Consistent bedtime and waking time  Avoid caffeine and alcohol  Relaxing bedtime routine  Calcium, Magnesium, Theanine, 5-HTP, Melatonin  Calming herbs: Passionflower, Hops, Chamomile, Valerian, Lemonbalm, Motherwort

33. MOOD  Address unresolved emotional stressors  Eat regularly  Focus on low glycemic foods and ensure you have enough healthy fats in your diet (low carb low fat diets will make mood worse)  Herbal support: Black cohosh, Kava kava, St. Johns Wort, Motherwort, Relora, Ashwagandha

34. ADRENAL SUPPORT  Blood sugar stability  Vitamin C  B Vitamins  Magnesium  Adaptogens: Eleutherococcus (Siberian Ginseng), Rhodiola, Schisandra, Licorice, Ashwagandha

35. SUMMARY  Menopause can be a time of great change in emotional, physical, social, and spiritual identity  An opportunity to improve health on all levels  Many menopausal concerns can be addressed naturally

36. QUESTIONS? Thank you for your time!