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By definition, menopause is the transition period between the reproductive years of a woman's life and the cessation of ovarian function. Unless brought about by surgery or other causes, natural changes in a woman's body generally occur around the age of 50. At this time a decrease in the production of hormones in the ovaries occurs. Changes occur in the levels of four main hormones of the normal menstrual cycle including estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These changes in hormonal production, termed the climacteric, are found in a process that begins when a woman is in her 40's and may end during her 70's.
After a woman has menstruated for 30 years, estrogen levels begin to decline. At this time, there is essentially no progesterone produced by the ovaries. However, the adrenal glands continue to produce both estrogen and progesterone in small quantities. There needs to be a balance in the amount of estrogen and progesterone – the reason for hormonal replacement therapy (HRT).
Menopause not only causes unwanted symptoms such as hot flashes and insomnia, it also increases a woman's risk for serious problems such as osteoporosis and cardiovascular disease. Therapy for menopausal women should address not only the climacteric symptoms, but should also address cardiovascular support and prevention of osteoporosis.
For the women that initially make a decision to use estrogen replacement therapy, 20 percent never fill the prescription; 20 percent discontinue within the first nine months; 10 percent take the therapy intermittently; 50 percent drop the therapy after one year; and 70 percent are not on the therapy after five years. For many women, estrogen therapy is not an option that they will consider, they have had an adverse event, or the use of estrogens for them is contraindicated. It therefore becomes important to consider natural approaches as adjunctive and supportive therapies.
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