The reason for the strong interest in finding an answer to the menopause question is that it affects the lives of so many people. We had originally discussed this with Garry Gordon, M.D., D.O., in two columns in 2007 (2, 3). So, let’s see what we have learned with nine more years of experience. For an update, I am calling upon the world-renowned women’s health physician, Christiane Northrup, M.D. You may have read some of her five books on menopause (4–8). I have. Perhaps, you have seen her discussing menopause on national television. I have.
Dr. Northrup is a leading authority in the field of women’s health and wellness, which includes
the unity of mind, body, emotions and spirit. Internationally known for her empowering approach to women’s health and wellness, Dr. Northrup teaches women how to thrive at every stage of life. A board-certified OB/GYN physician, Dr. Northrup graduated from Dartmouth Medical School and did her residency at Tufts New England Medical Center in Boston. She was also an assistant clinical professor of OB/GYN at Maine Medical Center for 20 years.
In 1994 (revised 2011), her bookWomen’s Bodies, Women’s Wisdom(Bantam) was a New York Times bestseller and is still a classic in its 3rd edition, becoming the veritable bible of women’s health. Her second book,The Wisdom of Menopause(Bantam, 2001, 2010), has been embraced by women everywhere, including Oprah Winfrey, who sought Dr. Northrup’s wise words when she turned 50 and faced “The Big M.” Her third book,Mother-Daughter Wisdom(Bantam, 2005), was voted Amazon’s #1 book of the year in both parenting and mind/body health and was also nominated for a Quill Award. Her fourth book, The Secret Pleasures of Menopause (Hay House, 2008), outlines the crucial link between health and pleasure.
Her bookGoddesses Never Age: The Secret Prescription for Radiance, Vitality, and Wellbeing(Hay House, February 2015) quickly became a New York Times bestseller, inspiring both women and men with an entirely different mindset about what it means to grow older.
Dr. Northrup has also hosted eight highly successful public-television specials, beginning in 1998. Her latest is based onGoddesses Never Age: The Secret Prescription for Radiance, Vitality, and Wellbeing, and first aired nationwide in February 2015. Dr. Northrup has been featured on The Oprah Winfrey Show, TODAY, NBC Nightly News, The View, The Rachael Ray Show, Good Morning America, 20/20 and The Dr. Oz Show. Women clearly trust Dr. Northrup’s approach. In 2013, Reader’s Digest named her one of “The 100 Most Trusted People in America.” In 2016, she was selected for Oprah Winfrey’s Super Soul 100, a group of individuals who are using their voices and talents to elevate humanity. More information about Dr. Northrup is found atwww.drnorthrup.com.
Passwater:Dr. Northrup, why did you decide to dedicate your life to women’s health?
Northrup:In medical school, when I witnessed my first birth, I was overcome with awe and emotion. Nothing had ever moved me this much. And though I first wanted to be a family doctor, I eventually decided to devote all of my time to women’s health. After all, women set the tone for the health of the entire family and make the vast majority of healthcare decisions for their families.
Women are more concerned about their health during pregnancy than at any other time. They know that their health habits directly and profoundly affect their children. And so, pregnancy and childbirth turn out to be ideal times to support women in creating healthy lives and behaviors.
As time passed, my obstetrical patients eventually began to go through menopause. And I learned that this stage of life was a metaphoric birth canal for the woman herself.
Passwater:You have successfully treated women of all ages and stages. What is it about perimenopause and menopause that are most important to you? What problems do women face during these times?
Northrup:The perimenopause, which lasts anywhere from six to 13 years, is a profound developmental stage in a woman’s life. By definition, menopause is the final menstrual period. So, when women say, “I’m menopausal,” what they really mean is that they are in the perimenopausal phase. This is the time when they are most apt to experience uncomfortable symptoms such as fuzzy thinking, sleep disturbances, loss of sex drive, vaginal dryness, headaches and hot flashes. Though these symptoms gradually abate with time, many women continue to experience discomfort for years after their final menstrual period.
Perimenopause is, developmentally speaking, “adolescence in reverse.” And, it is a time when women are called to upgrade their health regimens and behaviors. Failure to do so may set the tone for a downhill slide in health. But, if a woman uses this time to reevaluate her lifestyle and give birth to her deepest desires, then she can look forward to the best years of her life. The Chinese culture calls this time, “The second spring.” It can be a new beginning. But only if you approach it with the right mindset and lifestyle behaviors.
Passwater:Why is there menopause? It’s obvious there is reason for a young girl not to have children before puberty, but is there a species advantage to shutting down a woman’s ability to bear children after a certain point in life?
Northrup:This is such a wonderful question. You really have to ask yourself, Why would the Creator have made it so that women outlive their reproductive capacities for many decades? Well, there are some intriguing reasons having to do with the value of post-menopausal women and their life experiences.
In some native cultures, for example, women couldn’t be shamans until they were past menopause because they were said to now “contain their wise blood.” In the Iroquois Treaty of the Great Nations after which the United States Constitution was modeled, it was the council of grandmothers who had the final say—yes or no—about decisions that would affect the tribe (e.g., whether or not to go to war). (The Founding Fathers of the United States left that part out).
Historical research also documents the fact that having a living grandmother in a family gave the grandchildren a distinct survival advantage. There are various theories about why this is so. But quite frankly, all you have to do is hang around families for a while to see what a powerful healing effect a grandmother can have.
But you don’t have to have had children to tap into wisdom post-menopause. Though I know of no research that proves this, I believe that the neurotransmitters FSH and LH that rise after menopause (to the same levels as during ovulation) signify a brain style based on maximum receptivity to others—just like when a woman is ovulating and these brain chemicals are at their peak. The way I put it is that a woman is moving from an AC current of wisdom during her reproductive years to a DC (direct current) of wisdom once she is finished with menopause. During the perimenopause, she’s between those two worlds.
Passwater:Is perimenopause/menopause under-programmed genetic control? What changes are initiated by the body to accomplish perimenopause/menopause?
Northrup:We appear to go through menopause at the same age as our mothers did. And so, it is felt that the age of the final menstrual period is influenced by genetics to some extent. However, there are many other factors involved such as a woman’s nutritional status, how much stress she’s under, and whether or not she has reached menopause through surgery or radiation. All of these factors can create a very different experience for a woman.
For example, in the United States, one in three women will have a hysterectomy by the age of 60. A surgical menopause is far different from a natural menopause. A surgical or medical menopause (from radiation or chemo) can put a woman into instant menopause before her body has had any time for transition.
Then there are the women who go through premature menopause—as early as their mid-30s. This is felt to be autoimmune in nature. However, I have come to believe that the label “autoimmune” is a misnomer. And we use it when we don’t understand what is happening. The body does not attack itself. And telling women that it does is very damaging to a woman’s self-esteem and sense of self. It’s more likely that so-called “autoimmune” disorders result from a flare up of a virus such as Epstein-Barr. And that happens when a woman is under stress for any number of reasons.
During a natural menopause, a woman’s ovaries begin to decrease monthly egg production. And the result is lower progesterone levels from the lack of corpus luteum. In the face of emotional or nutritional stress, the body often produces too much of one of a woman’s four natural estrogens at this time, resulting in what is called estrogen dominance.
Passwater:The three major naturally occurring forms of estrogen in women are estrone, estradiol and estriol. A fourth estrogen, estetrol, is only produced during pregnancy. Estradiol is the most important estrogen in non-pregnant females who are between the menarche and menopause stages of life. In postmenopausal women, estrone becomes the primary form of estrogen in the body. The gradual shift from primarily estradiol to primarily estrone results in fluctuating estrogen levels and what is clinically called estrogen dominance.
Northrup:Estrogen dominance—in the face of too many stress hormones (i.e., cortisol and epinephrine) as well as insulin levels that are too high from eating a high-glycemic diet—results in the production of catecholestrogens, which act like additional stress hormones. It becomes a vicious cycle.
Passwater:What unpleasant effects do these changes cause?
Northrup:Generally, the first thing a woman notices—often even before she starts skipping periods—is difficulty with sleep. She may find herself feeling tired, but also wired, as it were. Then, there are night sweats, hot flashes, mood symptoms, a feeling like your skin is crawling, dry eyes, a changing eye glass prescription, dry vagina, painful sex, dry skin, urinary symptoms and the list goes on. More than 100 symptoms can be part of premenstrual syndrome. Perimenopause is like PMS on steroids for some women.
Passwater:You have been a leading menopause expert for several years now. You are highly regarded as a pioneer but you started out as a conventionally trained OB/GYN physician. When you entered practice, what was the standard treatment for menopausal symptoms?
Northrup:The standard treatment for menopausal symptoms when I began practice was Premarin (stands for Pregnant Mare’s Urine) and Provera. Premarin is a mixture of conjugated equine estrogens (CEE) made from the urine or blood of pregnant horses. No one has ever been able to truly duplicate it in a lab so there is no generic form of Premarin. It became very, very popular—and began to be prescribed to almost every woman. I read a book called Feminine Forever (1966) by a doctor named Robert Wilson when I was in medical school. The picture that it painted of what happens to a woman after menopause was so bleak that before long, Premarin became the gold standard for staying “feminine forever.” And, of course, it also became a huge economic success.
I don’t think women would take this drug if they realized how awful the Premarin horse farms are that supply the urine. Horses spend their entire lives standing on concrete, always pregnant and being hooked up to bags to collect all their urine. Their foals, if male, are taken away to be slaughtered. I once had a friend who worked on those farms as a veterinary assistant. One of her tasks was to draw as much blood out of the horse as possible on a regular basis. She said the horses almost couldn’t continue standing. It broke her heart. But that’s another story.
The equine estrogens in Premarin are not native to the female human body and are often stronger than a woman’s own estrogen. This is why studies have linked it with an increased risk of uterine and breast cancers. This became clear in the 1970s and early 1980s when doctors realized that Premarin alone was causing an increased risk of uterine cancer. The reason for this was that Premarin acted like a growth hormone for the uterine lining. When the lining was not regularly sloughed off, the risk of cancer increased. That is why a synthetic progestin was introduced in the 1980s as a way to counteract the effects of Premarin. Generally, Provera (medroxyprogesterone acetate) is prescribed for 10 days out of the cycle. Eventually, Premarin and Provera were combined into one pill known as Prempro. Provera, because it contains CEE, is not native to the female human body, and as a result, many women experience a lot of side effects from it that are very similar to PMS symptoms themselves.
Passwater: What changes have you witnessed or used in the treatment of menopause symptoms?
Northrup:In the late 1980s, research began to suggest that CEE and other estrogens such as 17-beta estradiol (e.g., Estrace, Vivelle dot, Climara) raised the levels of the so-called “good cholesterol” HDL in the blood. It was posited that this increase in HDL would likely prevent heart disease in millions of women. And since heart disease is the number one killer of women, it suddenly became standard practice to prescribe what was called hormone replacement therapy (HRT) to all women during perimenopause as the sine qua non of cardiovascular health! If a woman questioned this, she was sometimes dismissed from her doctor’s practice—that is how strong the belief in HRT was back then.
Passwater:I was amused when they called it Hormone Replacement Therapy, although the horse hormones were not the same as human hormones. Can “different” really be true “replacement?” What evidence did they have that it would work as intended?
Northrup:Well, they didn’t have any, so to prove the hypothesis, the famous Women’s Health Initiative (WHI) was started in 1991. The WHI was a 15-year multi-million-dollar endeavor and was one of the largest U.S. prevention studies of its kind (9). The randomized, controlled clinical trial component of the WHI, which involved CEE, enrolled 68,131 postmenopausal women 50–79 years of age. Back then, I wrote in the first edition of Women’s Bodies, Women’s Wisdom that the WHI likely wouldn’t find the answers they were looking for since they were using the wrong drug and giving everyone—regardless of size—the same dose. I felt that using so-called bioidentical hormones with molecular structures that exactly matched the female human body was a much saner option. And, of course, those hormones should be given at individualized doses.
Perimenopause can be a new beginning. But only if you approach it with the right mindset and lifestyle behaviors.Sure enough, in July 2002, the clinical trial portion of the WHI was abruptly stopped because this massive study found that the CEE they were using actually increased the risk of heart attack and stroke (10). This sent shockwaves through the medical community and caused thousands of women to go off all hormone treatment cold turkey.
Passwater:This is when I started getting numerous calls and letters asking what could be done naturally. There was almost a panic.
Northrup:Eventually, the medical community came to the conclusion that hormone replacement or hormone treatment should be individualized and used at the lowest dose for the shortest possible period of time. Since that time, there have been many more hormonal options available to women besides Premarin. These include the transdermal patches like Vivelle dot and Climara (which are 17- beta estradiol). There are also some oral natural progesterones such as Prometrium or the vaginal gel known as Crinone.
Passwater:Did you use HRT (CEE) until its problems became known?
Northrup:I was never a fan of Premarin though I prescribed it often for women who were already using it and felt good on it. However, I was always looking for better, safer alternatives. I did a significant amount of work with Aaron Tabor, M.D., who developed a product that contained 180 mg of soy protein in each daily serving. The research supporting its use was quite robust. I mentioned this in the first and second editions of The Wisdom of Menopause because many of my patients had good results with it. However, there were quite a few who had adverse reactions to this much soy and also had digestive problems. Later, I foundPueraria mirificawas better and had essentially no adverse effects.
Another example of looking for a safe natural alternative was that I learned about bioidentical progesterone from John Lee. He and his daughter made ProGest, a natural progesterone made from wild Mexican yams. I found that ProGest and other forms of bioidentical progesterone worked very well for many menopausal symptoms, especially premenstrual migraines that were often triggered by waning progesterone when a woman started to skip ovulations.
I also used the different bioidentical estrogens as they became available. One of my mentors was Joel Hargrove, M.D., founder of the Vanderbilt Menopause Center. He pioneered the use of transdermal bioidentical estrogens mixed with progesterone—and all were made at a formulary pharmacy (the Delk Pharmacy founded by Joe Delk, a true pioneer in formulating individual prescriptions) in Tennessee. I was able to individualize a patient’s dose of hormone using this approach. She could also dose herself depending upon symptoms. For example, if she developed hot flashes, then she knew she needed an extra drop or two of the hormone preparation. The 1990s saw the beginning of the bioidentical hormone revolution, which picked up significant speed through the influence of Suzanne Somers and her book, The Sexy Years. Despite having had breast cancer, she became the face of anti-aging medicine in general and bioidentical hormones in particular.
Passwater:You recommend P. mirifica in several places in your books and on television. What interested you about P. mirifica? How do you find P. mirifica in comparison to other treatments?
Northrup:I first heard about P. mirifica in 2009 from Dr. I. Sandford Schwartz, a nutritionally oriented naturopathic physician who co-founded the late Robert Atkins’ clinic in New York City. He is better known as “Dr. Sandy” by his friends. When I was on the board of the American Holistic Medical Association, I had visited Dr. Atkins in New York and knew of his pioneering work with nutritionals. When Dr. Sandy told me about P. mirifica and all of its benefits, I immediately began recommending a brand that I knew contained the necessary active component, miroestrol.
The results were very, very gratifying. Sometimes, women would experience relief of their symptoms in as little as four days. This was truly gratifying. Though I no longer have a one-on-one practice, I do have a significant social media following, a weekly call-in radio show and a website, www.drnorthrup.com. It is through these avenues that I was able to vet the efficacy of P. mirifica.
Passwater:Do you personally take P. mirifica?
Northrup:Absolutely. 100 mg twice per day along with some cofactors that help the body utilize it more effectively.
Passwater:Given what you now know, what is your treatment of choice for most women experiencing some “change of life” discomforts such as hot flashes etc.?
Northrup:Without a doubt, I recommend P. mirifica as the treatment of choice for menopausal symptoms. It is the most effective treatment I have ever seen for perimenopausal and post-menopausal symptoms—and also premenstrual symptoms, I might add. As a matter of fact, I was so impressed with the results that women were getting with this herb that I decided to start my own company (Amata Life) to expand the many uses of P. mirifica and get the word out more widely.
Passwater:Are there any women who you would not see as ideal to take P. mirifica? Are there contraindications?
Northrup:P. mirifica, as an herb with hundreds of years of safe use, is optimal for just about all women. I have, of course, been told of a couple women who appear to be allergic to something in the P. mirifica capsule. But this is exceedingly rare.
Passwater:Are you using P. mirifica in forms other than capsules for specific applications? Do you recommend it for health benefits other than relieving menopausal symptoms?
Northrup:Most women do well with P. mirifica in capsule form. However, a significant portion of the population prefers a liquid form. Therefore, I designed a liquid supplement that contains everything that’s in the capsule.
It is also well documented that P. mirifica has a very beneficial effect on vaginal mucosa—re-estrogenizing dry tissue. And so, I designed a vaginal moisturizer that is helping many, many women. In addition, because P. mirifica has a collagenase inhibitor in it, I also developed a line of skincare products that helps women achieve a more radiant complexion. I also personally use the skin cream daily.
Passwater:P. mirifica does not require a physician’s prescription. Is there any harm in a woman entering the change of life trying P. mirifica to relieve discomforts on her own? What do you recommend in your books?
Northrup:I would recommend an over-the-counter P. mirifica supplement with certified miroestrol (Puresterol) content to any woman experiencing menopausal symptoms. Miroestrol is the active component and a dose of 60–100 mg twice per day should be taken for relief from menopausal symptoms. That is roughly 4–5 mg/kg of body weight. Some women will need to increase that dose by one extra pill for about a month. But after that, they can go back to the twice-per-day regimen. I mentioned Solgar’s PM Phytogen Complex and H.R.T. Plus from Longevity in my books because I have had good experiences with them. The formulations that I designed are branded as Amata Life. There may be additional brands, but the important factor is that it’s certified on the label to contain the active component miroestrol (also known as Puresterol). There is nothing to lose and so much to gain.
Passwater:Why did you take the time and effort to write Women’s Bodies, Women’s Wisdom (Bantam 1994, 2011 revised)?
Northrup:When I first began my practice, I discovered how profoundly a woman’s lifestyle affected her reproductive health. I saw how beautifully lifestyle changes worked. But I also saw how profoundly a woman’s beliefs about her body affected her experience. On planet Earth today, one in three women will be raped or beaten in her lifetime. That’s one billion women. Men are abused, too—most often by other men. This kind of abuse tends to be intergenerational and run in families. Those who have been victimized tend to be re-victimized. “Our biography becomes our biology,” says medical intuitive Caroline Myss.
As I began to truly talk with women and hear their stories, I saw how chronic pelvic pain, painful sex, PMS, fibroids, painful periods and severe menopausal symptoms were the language that the body uses to speak of its pain and unfinished business. I helped so many women change their beliefs and their behaviors, and reclaim their birthright of vibrant health. I wasn’t seeing this kind of thing talked about back then. So, I decided I had to write about it. I found that the kinds of problems women were having in a small town in Maine were common worldwide. It wasn’t just my patients. It was a global problem. And the solution lay in reclaiming the wisdom of the female body.
Passwater:I believe that you completely updated that book in 2011. This revised edition was the first that I read in which you recommended P. mirifica. You mentioned it in several chapters. This book probably introduced P. mirifica to thousands of women for the first time. Did you receive any feedback from your readers on P. mirifica?
Northrup:Yes. The revised edition gave me the opportunity to introduce an entirely new audience to P. mirifica—with great results. I’ve heard from women all over the world about their positive experiences with this herb. It is very gratifying.
Passwater:Your second book was The Wisdom of Menopause (Bantam, 2001, 2010). What was your emphasis in this book?
Northrup:My emphasis in this book was the fact that perimenopause is a time when a woman is moving into a new developmental stage in which her life must be fueled by her soul—and not just the needs of her family, husband or job. It is the springtime of the second half of her life. She needs to truly see her worth and take time to develop herself. I also emphasized the fact that there is no need to suffer from debilitating symptoms. Good solid help is available. P. mirifica is one pillar of successful treatment.
Passwater: You provide more advice in Mother-Daughter Wisdom (Bantam, 2005).What is the “take home message” in that book?
Northrup:The take-home message ofMother-Daughter Wisdomis that our mothers are our most powerful role models for what it means to be a woman and how to take care of ourselves. But the role of mothers has been undermined for centuries. As a result, many women don’t have good solid nurturing relationships with their mothers. This book is actually a manual for mothering YOURSELF optimally. It was originally supposed to be called Mothers and Daughters: The Bond that Wounds, The Bond that Heals. My publisher talked me out of that title, unfortunately.
Passwater:Your fourth book, The Secret Pleasures of Menopause (Hay House, 2008,) will help any woman deal with menopause. Are there really pleasures in menopause?
Northrup:There truly ARE pleasures in menopause because it’s a wakeup call from your soul. Asking you to reinvent yourself. All of what you knew to be true at the age of 12 comes roaring back—except you now have skills, ego strength and some financial clout. And you can use all those skills in service to your true self. You know who you are, and it’s a very exciting time. For many, it’s the start of the best years of their life.
Passwater:Your book Goddesses Never Age: The Secret Prescription for Radiance, Vitality, and Wellbeing (Hay House, February 2015), is aimed at helping everyone deal with growing older. What’s your best advice?
Northrup:My best advice is to live agelessly. Stop talking about your age. Just step out of it altogether. Notice ageism and resist it. We co-author each other’s biology. As a culture, we spend way too much time blaming things on our chronologic age (Oh—I can’t…fill in the blank…because I’m too old ). None of that needs to be true. In the words of Dr. Mario Martinez who wrote The Mind Body Code, “Growing older is inevitable, aging is optional.” That’s based on his studies of over 500 healthy centenarians on six continents, all of whom practice “the causes of health.” Studies have shown that our beliefs are more powerful than our genes. So, we have to question the common cultural belief that decline is inevitable with advancing age. It isn’t. And there is a lot of science to prove it. For example, partner dancing decreases your risk of dementia by a whopping 76%. Moreover, only 4% of older Americans are living in nursing homes. And women in their 60s and 70s are having the best sex of their lives!
Passwater: Interesting books, indeed. Dr. Northrup, thank you for sharing your experience and wisdom with our readers.WF
Dr. Richard Passwater is the author of more than 45 books and 500 articles on nutrition. Dr. Passwater has been WholeFoods Magazine’s science editor and author of this column since 1984. More information is available on his Web site, www.drpasswater.com.
References1. R.A. Passwater, “Menopause and Vitamin E,” Prevention 28 (7), 35-43 (1976). 2. R.A. Passwater, “Pueraria mirifica: Just for Menopause or the Herb of the Decade?: Part 1. An Interview with Dr. Garry Gordon,” WholeFoods Magazine (Feb 2007). 3. R.A. Passwater, “Pueraria mirifica: Just for Menopause or the Herb of the Decade?: Part 2. An Interview with Dr. Garry Gordon,” WholeFoods Magazine (March 2007). 4. C. Northrup, Women’s Bodies, Women’s Wisdom (Bantam, NY, 1994; Revised 2011). 5. C. Northrup, The Wisdom of Menopause (Bantam NY, 2001; Revised 2010). 6. C. Northrup, Mother-Daughter Wisdom (Bantam, NY, 2005). 7. C. Northrup, The Secret Pleasures of Menopause (Hay House, Carlsbad, CA, 2008). 8. C. Northrup, Goddesses Never Age: The Secret Prescription for Radiance, Vitality, and Wellbeing (Hay House, Carlsbad, CA, 2008). 9. Women’s Health Initiative, www.nhlbi.nih.gov/whi/ctos.htm. 10. Writing Group for the Women’s Health Initiative Investigators, “Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women’s Health Initiative Randomized Controlled Trial,” JAMA 288 (3), 321–333 (2002).
Published in WholeFoods Magazine October 2016