I INTRODUCTION
Menopause, permanent ending of menstruation in women. Menopause marks the end of a woman’s natural ability to bear children. Menopause is usually preceded by 10 to 15 years during which the ovaries gradually stop producing eggs and sex hormones, a period called the climacteric. Perimenopause encompasses this period of changing ovarian activity and also the first few years without menstrual cycling, typically characterized by hormonal and physical changes and sometimes emotional and psychological changes as well.

In the United States most women experience menopause in their late 40s or early 50s—about half by age 51. Menopause before age 35 is called premature menopause and may occur because of certain diseases, autoimmune reactions (in which the body’s immune defenses attack the body’s own cells, tissues, or organs), surgery, medical treatment such as radiation or drug therapies, or for unknown reasons. If both ovaries are surgically removed (due to ovarian cancer, for example), the woman will cease menstruation, a condition referred to as surgical menopause. Women who have a hysterectomy (surgical removal of the uterus) will no longer have menstrual periods, but if the ovaries are not removed the hormonal changes of menopause will not take place until the ovaries stop functioning.

II PHYSIOLOGY
Women are born with a finite number of ovarian follicles that develop into eggs. The process of ovulation, in which an egg is released from the ovary, is regulated by several sex hormones. As a woman matures and passes through her reproductive years, an egg is released each month and her supply of eggs gradually decreases. As menopause approaches, ovarian follicles gradually become less sensitive to the hormones that control ovulation, follicle stimulating hormone (FSH) and luteinizing hormone (LH), increasingly disrupting egg development and ovulation. The ovaries produce less estrogen, which directs the growth of the uterine lining during the first part of the menstrual cycle. Even when ovulation continues to occur, the decreased sensitivity to LH causes problems in the development and function of the corpus luteum (the ovarian follicle after ovulation). This leads to deficiencies in the production of progesterone, the hormone that controls the second half of the menstrual cycle. The hypothalamus, the part of the brain that controls hormone production and regulation, recognizes these hormone deficiencies and signals the pituitary gland, located in the base of the brain, to increase production of FSH and LH. Tests showing elevated levels of FSH in the blood are used to confirm that a women is perimenopausal.

Ovulation eventually becomes less frequent and stops altogether. Soon there is not enough estrogen produced to stimulate the lining of the uterus and menstruation also stops. FSH and LH levels remain high for two to three years after menopause and then decline.
A new hormone balance is established after menopause. The ovaries continue to produce small amounts of androgens and estrogen but most of the estrogen in postmenopausal women comes from conversion of other hormones made by the adrenal glands, which mostly takes place in fat cells. The liver and kidneys also aid in estrogen conversion.

III SIGNS AND SYMPTOMS
The experience of menopause differs among women, depending on differences in diet and nutrition, general health and health care, and even how women are taught to think about menopause. Not all women experience symptoms. All physical symptoms should be discussed with a health-care provider to rule out potential causes other than approaching menopause.
For a number of years before menopause women may notice longer menstrual periods, heavier menstrual flow, spotting, or irregularity. Hormone pills or low-dose birth control pills may be prescribed to control bleeding problems. Hot flashes or hot flushes range from a passing feeling of warmth in the face and upper body to extreme sweating and visible redness of the skin followed by chills. Heart palpitations and feelings of suffocation can also occur.
As estrogen levels decline, the vaginal walls become less elastic and thinner. Vaginal secretions are reduced and are less acidic, increasing the chances for vaginal infections. Insufficient vaginal lubrication during sexual activity can make intercourse uncomfortable or painful. Some women report a decreased interest in sex and a decline in sexual activity with menopause that are not due to vaginal problems.

Psychological symptoms may include depression, mood swings, weepiness, and other emotional flare-ups, as well as memory lapses. Although declining levels of estrogen may play a role in these symptoms, a number of other factors and stresses need to be considered as well. Excess alcohol, caffeine, or sugar may stress the adrenal glands and decrease the amount of adrenal androgens available for conversion to estrogen, thereby lowering estrogen and making menopausal symptoms worse. Smoking decreases estrogen production by the ovaries, leading to earlier menopause and osteoporosis. Stressful life events that may contribute to the emotional symptoms at the time of menopause include children leaving home and caring for aging parents.

IV ADAPTATION TO MENOPAUSE
In order to relieve symptoms of menopause, as well as to reduce specific health risks in menopausal and postmenopausal women, physicians often prescribe the synthetic hormones estrogen, progestin (a synthetic form of progesterone), and sometimes androgens. This therapeutic approach is called hormone replacement therapy (HRT). Administered as oral tablets, skin patches, or vaginal creams or suppositories, HRT alleviates symptoms of menopause and may increase verbal memory. It also may counteract some serious health problems associated with menopausal women. For instance, osteoporosis, in which bones become brittle and vulnerable to fractures, is caused by calcium loss. Calcium loss accelerates in women for three to seven years after menopause. The use of HRT combats bone calcium loss and significantly lessens the risk of osteoporosis.

Women who have had a hysterectomy can use estrogen replacement alone, but women with a uterus need the addition of progestin to prevent hyperplasia (overgrowth) of the endometrium (uterine lining) and decrease the risk of endometrial cancer. Androgens may help women with decreased sexual interest.
Hormone replacement therapy may be taken continuously or cyclically (usually three weeks on and one week off). Symptoms may return each month during the hormone-free week. The therapy may be associated with an increased risk of breast cancer and cardiovascular disease, although its benefits may outweigh these risks. Each woman and her health-care provider should assess her need for symptom control and the potential risks and benefits before starting HRT. Women who have a history of endometrial cancer, breast cancer, stroke, blood-clotting disorders, liver dysfunction, and undiagnosed abnormal vaginal bleeding should generally not take HRT. More research is needed on the long-term effects of the various HRT regimes.
Other ways of reducing negative effects of menopause include eating a healthy diet, eliminating caffeine and alcohol, reducing sugar and salt intake, stopping smoking, and taking vitamin supplements. Exercise helps increase conversion of androgens to estrogens and can help alleviate menopausal symptoms.
How women view menopause may also affect symptoms. Traditionally in our culture, menopause has been viewed negatively, as a period of fluctuating hormones that incapacitates women. In fact, many women experience only minor discomfort during menopause, and some find renewed energy and enthusiasm after menopause.

HOMOEOPATHIC TREATMENT
A constitutional remedy, and the guidance of an experienced homeopath, can be reassuring and helpful for both physical and emotional aspects of menopause.

Belladonna: This remedy can be useful if flushes of heat during menopause are very sudden and intense. Pulsation or throbbing may be felt in the head, or any part of the body. A heavy flow of blood that feels very hot appears with some periods. Although the woman may be fairly stable emotionally, short bursts of anger can occur during headaches or in stressful situations. Migraines, blood pressure fluctuations, and a craving for lemons or lemonade are often seen when this remedy is needed.

Calcarea carbonica: This remedy may be helpful to a woman with heavy flooding, night sweats and flushing (despite a general chilliness), as well as weight gain during menopause. People who need this remedy are usually responsible and hard-working, yet somewhat slow or plodding and can be easily fatigued. Anxiety may be strong, and overwork or stress may lead to temporary breakdown. Stiff joints or cramps in the legs and feet, and cravings for eggs and sweets are other indications for Calcarea.

Glonoinum: Women with intense hot flashes and flushing during menopause, along with feelings of pulsation or pounding in the head, may find relief with this remedy. Menstrual flow may start then stop too early, and be followed by a palpitations, surging sensations, or headaches, accompanied by irritability and muddled thinking. Problems can be aggravated if the woman gets too warm or stays in the sun too long, and are often worse from lying down.

Graphites: A woman who is chilly, pale, and sluggish—with trouble concentrating, and a tendency toward weight gain during or after menopause—is likely to respond to this remedy. Hot flushing and sweats at night are often seen. A person who needs this remedy may also have a tendency toward skin problems with oozing cracked eruptions, and be very slow to become alert when waking in the morning.

Ignatia: Ignatia is often helpful for emotional ups and downs occurring during menopause. The woman will be very sensitive, but may try to hide her feelings—seeming guarded and defensive, moody, or hysterical. Headaches, muscle spasms, and menstrual cramps can occur, along with irregular periods. A heavy feeling in the chest, a tendency to sigh and yawn, and sudden outbursts of tears or laughter are strong indications for Ignatia.

Lachesis: Intense hot flashes with red or purplish flushing, palpitations, and feelings of pressure, congestion, and constriction may indicate a need for this remedy. Tight clothing around the neck and waist may be impossible to tolerate. A woman needing Lachesis is often very talkative, with strong emotions (often including jealousy and suspicion)—a “pressure-cooker” needing an outlet both physically and emotionally.

Lilium tigrinum: A woman likely to respond to this remedy feels hurried, anxious, and very emotional — with a tendency to fly into rages and make other people “walk on eggs.” She often has a sensation of tightness in her chest, and a feeling as if her pelvic organs are pressing out, which can make her feel a need to sit a lot or cross her legs.

Natrum muriaticum: A woman who needs this remedy may seem reserved, but has strong emotions that she keeps inside. She often feels deep grief and may dwell on the loss of happy times from the past or brood about hurts and disappointments. During menopause, she can have irregular periods accompanied by backaches or migraines. A person who needs this remedy usually craves salt, and feels worse from being in the sun.

Pulsatilla: A person who needs this remedy is usually soft and emotional, with changeable moods and a tendency toward tears. Women are very attached to their families and find it hard to bear the thought of the children growing up and leaving home. They usually feel deeply insecure about getting older. A fondness for desserts and butter can often lead to weight problems. Changeable moods, irregular periods, queasy feelings, alternating heat and chills, and lack of thirst are common. Aggravation from stuffy rooms and improvement in open air may confirm the choice of Pulsatilla.

Sepia: This remedy can be helpful if a woman’s periods are sometimes late and scanty, but heavy and flooding at other times. Her pelvic organs can feel weak and sagging, and she may have a craving for vinegar or sour foods. Women who need this remedy usually feel dragged-out and weary, with an irritable detachment regarding family members, and a loss of interest in daily tasks. Exercise, especially dancing, may brighten up the woman’s mood and improve her energy.

Staphysagria: A person who needs this remedy usually seems mild-mannered, shy, and accommodating, but has many suppressed emotions. Women around the time of menopause may become depressed, or have outbursts of unaccustomed rage (even throwing or breaking things). Many people needing Staphysagria have deferred to a spouse for many years, or have experienced abuse in childhood.

Sulphur: This remedy is often helpful for hot flashes and flushing during menopause, when the woman wakes in the early morning hours and throws the covers off. She may be very anxious, weep a lot, and worry excessively about her health. A person needing Sulphur often is mentally active (or even eccentric), inclined toward messy habits, and usually feels worse from warmth.

Reference:
Microsoft Encarta Encyclopedia 2002.