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Photograph by Stephen Laufer

Naturopathic doc Audra Foster contemplates the pause that refreshes.

Hot Flashes and New Beginnings

Naturopathic doctors offer another option for women seeking alternatives to synthetic hormone therapy

By Sarah Phelan

Tall and willowy with sun-kissed waist-length hair, Audra Foster looks like she should be a model. In fact, she's a naturopathic doctor. That means she graduated from a four-year accredited medical school, is licensed to practice and carry out medical duties, including mammograms, pap smears and lab work, and specializes in the use of bioidentical hormones. All of which makes her an intriguing option for menopausal women seeking natural alternatives to synthetic hormone therapy.

"I see myself as a detective," says Foster, who studied at Bastyr University in Washington State and completed a yearlong residency before setting up her practice in Monterey 7 1/2 years ago. "Every woman's passage is very different. Women ask me, 'When is this going to be over?' and I say, 'No idea.' My role is to support women through menopause, not stop or change it. They ask, 'What's going to happen to my libido? Am I still going be attractive?' and I tell them, 'You have the choice to re-empower yourself.'"

Foster has a special empathy for menopausal women, having experienced symptoms of the midlife change--including hot flashes, night sweats and vaginal dryness--while she was in her 20s, something she attributes to a combination of factors, including coming off birth control pills, losing her periods for a while and getting overly thin.

"I was diagnosed with cancer and sterility and all kinds of crazy things, when all I needed to do was gain weight and change my mind-set," says Foster. "My mother and I were going through menopause at the same time!"

When Foster relocated to Monterey, naturopathic doctors weren't licensed in California. That changed in the fall of 2003, when Gov. Gray Davis signed SB 907 into law, shortly before being crushed by Arnold Schwarzenegger's recall machine. Davis' signature made California the 14th state to license naturopathic doctors, thereby doubling the numbers of Americans who have access to NDs like Foster, who lives in Santa Cruz and relocated her practice here a year ago. "The commute was starting to wear, and Monterey is smaller," she explains, "My practice there was starting to plateau and consisted mostly of middle-aged and retired women, whereas I'm open to women and men of all ages."

Breaking the Silence

Until recently, mentioning menopause was taboo. As Gail Sheehy wrote in The Silent Passage, back in 1992, "women still shrink from mentioning, even to their good friends, the fear they might be menopausal."

But as the baby boomers come of menopausal age, the topic is coming out of the closet.

"Women are more outspoken and liberal-minded," says Foster. "They're forcing the issue on doctors. They want to talk about bleeding, breasts and moodiness." Much like childbirth, menopause used to be considered a pathology, instead of a natural, healthy event, and Foster believes women's historic fear of menopause stems largely from a male-dominated culture, which has put women into two boxes: the washed-up sage, or the hot young thing.

"It's acceptable in our society for men to have a midlife crisis,' says Foster. "It's something they not only think could, but should, happen. And then there's the old cliché that 'men age gracefully, women just get old.' But the truth is, women don't have to have dry vaginas and cracked skin or lose their libido. They can regain and take control of their bodies. They can still be sexual beautiful creative creatures, in spite of not having a fertile body any more."

Male Change

Not that women are the only ones who going through a midlife change. While not as frequent, dramatic or intense in men, this change, which is sometimes called andropause, involves a fluctuation of hormonal levels, especially of testosterone, which can become lower.

"That's why many middle-aged men go for fast cars and hot women, to reassert themselves," says Foster, noting that men experience problems of impotence and premature ejaculation increasingly at this stage.

'For many men under 40, the majority of problems are psychological--stress can damage anyone's libido," she observes. "Then, between 40 and 60, there's a greater chance that their hormones, such as testosterone, will drop. They don't have the same libido, and it's harder for them to get and maintain an erection." Prostate cancer can cause impotence, as can being overweight or having diabetes. But while society has typically cast middle-aged women as the hysterical ones, Foster believes middle-aged men are generally "way more whacked" than their female counterparts.

"Women talk about their emotions and problems, whereas men go, 'Everything's fine. I have no problem with sex.'"

Earlier and Earlier

Foster believes menopause is a very challenging and very rewarding state-- and one that's happening earlier than ever. As the trend to choose career before children has risen, she notes, menopause, which on average happens in your 50s, can now start as early as 35, and perimenopause, the period of hormonal change before menopause--is also happening earlier.

"There's a lot of theories for why this is happening, but no definitive studies or proof. It may be because of increased exposure to estrogen in the outside world. There's a theory that it could be coming from animals that have been treated with hormones, whether it's beef or poultry, when they are ingested. And herbicides and pesticides can mimic estrogen, too. Or it could be because of stress, or because of weight. Skinniness may be hip, but women are becoming too thin."

As for when perimenopause begins and menopause ends, that's as varied and individual as the women themselves.

In general, women start to produce less progesterone, which is what encourages a conception to implant, in their 30s. These falling hormonal levels explain why miscarriage is most common among women in their 30s and 40s.

Foster notes that many women enter perimenopause (which begins 1-5 years prior to the onset of menopause) while their daughters are going through puberty, meaning that mood swings, cramps, bleeds and irritability start breaking out on both sides. That may sound hellish, but Foster advises women to use it as an opportunity to bond with their daughters.

"That way you have more chance of two chaos moments creating sanity," she says. As for menopause, it isn't said to have occurred until a woman's periods have stopped for a full year, and can go on for up to 10 years with postmenopausal symptoms lasting another 1 to 10 years, depending on a range of factors, including diet, exercise, weight and lifestyle.

Natural or Synthetic?

A few years ago, when synthetic hormone therapy was found to have serious side effects, including the potential to increase health risks, a lot of menopausal women stopped taking Premarin, an estrogen supplement made from pregnant mare's urine. (The means by which Premarin is harvested from the mares also raises questions of animal cruelty, making it an undesirable choice for vegans and those for whom humane treatment of animals is important.)

While the debate over synthetic versus natural still rages, Foster points out that menopausal women who swallow nonbioidentical estrogens and progesterones have a higher risk of cardiovascular disease than those who ingest them sublingually (by placing them under their tongue), or transdermally (by applying them to their skin), thereby bypassing the liver and so reducing those risks.


While it's tempting to wander over to the local health store and self-medicate, Foster warns that most over-the-counter supplements are estrogen-based plants derivatives, and so are generally not recommended during perimenopause.

"Black cohosh, soy and liquorice root are plant estrogens, which are great for menopause, but not perimenopause, because that's a progesterone problem."

She also cautions that advice dispensed at health food stores is "not always accurate," and then there's the danger of taking things to extremes. "Our society dictates excess, so, if someone says, 'Soy is good,' pretty soon, people are drinking a pint a day, plus they're eating tofu and edamame, all of which causes chaos, just like if you take vitamins and herbs in excess.

Second Adulthood

It's no secret that the standard American diet includes lots of meat, fats and carbohydrates. What's less well-known is that these ingredients can exacerbate hot flashes, mood swings and night sweats.

"Menopause can also go on longer if you're overweight, because then estrogen is released in crazy little spurts, but marathon runners with no body fat and no reserves can experience very intense symptoms, too," warns Foster.

That said, she's quick to point out that while body fat is OK, menopausal women need to get enough exercise to maintain metabolic balance, help eliminate toxins and keep their bowel movements regular.

"And sex has a lot to do with keeping a woman healthy. So, if you're in a healthy sexual relationship, you're likely to be happier, have less intense symptoms and a better sense of humor."

Above all, Foster recommends taking responsibility for your health.

"Improved diet exercise and lifestyle are the best medicine. I don't want to give people pills--and I don't have to," says Foster, who recommends eating live foods, like fresh veggies, not skipping meals, keeping caffeine and alcohol to a minimum, drinking plenty of water and avoiding junk food.

She suggests working out five or six times a week, including walking, biking and running, going to the gym and lifting weights.

As for moving through menopause in a positive way, Foster tells women to seek support from their partners, mothers, daughters and female friends--and to follow their creative urges.

"Don't be afraid of fulfilling your dreams, find time for joy and play and go for what makes you happy," she says.

Or as Gail Sheehy put it in The Silent Passage, far from being "a marker that means: This Way to the End'" menopause is better seen as the "gateway to a second adulthood."

For more information about bioidentical hormones, visit Dr. Audra Foster's office at 550 Water Street, Suite F1, or call her at 426.0141.

Navigating Menopause

By Hayward Hawkes Marcus

Thirty-odd years ago, a pubic hair in my underpants alerted me that something funny was going on down there. America was still a very squeaky-clean place in the late 1960s, and underpants and strange things in them were not openly discussed. Too embarrassed to ask anyone about this hirsute Harbinger of Things to Come, I fretted alone, until later that year, when the whole lot of us fifth grade girls at Monroe Elementary School were rounded up to nervously watch a faded, scratchy film, circa 1950, wherein a male narrator explained by way of simplistic animation that soon some horrible gland in our heads would awaken, dooming us to grow bumpy and hairy and smelly in all the most dreadful places, and, by the way, bleed in our underpants 13 times a year! Eewww! Welcome to menstruation, '60s-style.

Thirty-odd years later, funny things are happening down there again, and elsewhere in our bodies, only nobody's rounding us up to watch a film about it, which perhaps is too bad, since few of my female friends who are approaching menopause seem educated and prepared for this next phase of womanhood.

Sure, we expect those pesky bleeding spells to lessen and disappear (finally!). But we'll also have moments where we sweat up our best cashmere, and days where our loved ones will want to hide from us. And in this sexist and youth-crazed culture, discovering you're on the menopausal path doesn't exactly feel positive.

Among the most common symptoms are menstrual irregularities, hot flashes, night sweats, weight gain, bloating, fatigue, headaches, diminishing libido, vaginal dryness, mood swings, anxiety and sleeplessness.

Many of the above listed symptoms also make up premenstrual syndrome, or PMS, making it difficult to discern what is going on, especially when perimenopause first begins.

You might think, "I'll just have my hormone levels tested," but even that may be unreliable. A woman's hormone levels during perimenopause can look like a profile of the Himalayas, and may fluctuate wildly within the same day. So, what's a girl to do? Perhaps the best starting advice is, track your own symptoms, collect your own data, read about menopause, be your own detective, then make some educated choices. But much of what you find will be conflicting and confusing, so be warned.

Let's say you've written a list of unusual symptoms; your periods are coming earlier or later than usual; you feel anxious a lot for no apparent reason; you've suddenly developed migraines and a cute pot belly that won't respond to cottage cheese for lunch; you are 45 years old and are certain this is perimenopause.

Now what? Your options are as varied as your symptoms. You can do nothing and ride it out; change your diet and lifestyle; try exercise and maybe yoga for menopause (yes, there is such a thing!); visit an acupuncturist (see "The View From China" sidebar); consult a holistic healer; make an appointment with your gynecologist (see "The View From the West" sidebar), general internist, primary care physician, or naturopathic doctor (see "Hot Flashes and New Beginnings"); go to a hormone balancing clinic or specialist; or do all of the above.

The variety of options will likely continue to increase, since menopausal women are the fastest-growing segment of the U.S. population. Anyone you visit is bound to have an opinion about what to do, but that decision should be made between you and your care specialist--and you, should have the final say.

Above all, make yourself as healthy as you can as you enter this passage. If you're staying up till 3am watching old episodes of Sex and the City, eating cheese puffs for breakfast-- and your only exercise is walking across the street for more cheese puffs--consider some lifestyle changes, or chances are you'll have a crappy old age that could include diabetes, broken bones, osteoporosis, heart disease, achy joints and cancer. Don't wait for others to shove exercycles under your butt and make you eat beets; whip yourself into shape.

This sudden, mysterious flux of hormonal activity within us requires yet another whole set of coping skills. It can leave us feeling as confused and embarrassed as fifth-graders, but it can also point the way toward a new and rewarding stage of life.

The View From China

Hormone replacement therapy need not apply

Menopause in Chinese medicine is not usually seen as requiring hormone replacement therapy, according to J.J. Walton Hadlock, an associate professor at Five Branches Institute of Chinese Medicine. That said, Walton Hadlock, who has practiced Chinese acupuncture and medicine in Santa Cruz since 1994, adds that it's a myth that women in other cultures don't have menopausal symptoms. At the Chinese medicine college she attended, Walton Hadlock was taught to treat for hot flashes, night sweats and anxiety, which were seen as "lack of Yin."

Asian medical treatments for such symptoms, says Walton Hadlock, include herbs and acupuncture and aren't designed to turn back the clock, but to ease discomforts during the months or years it takes a woman's body to adjust.

Walton Hadlock questions the long-term safety of hormone therapy replacement and feels it can interfere with nature's course, namely, a decrease in reproductive hormones as one ages. Taking replacement hormones, with their accompanying risks, simply because one wants to stay young looking or be "be sexy for her husband" may be out of sync with nature's ticking clock, she says.

Noting that menopausal women have a tendency for light sleeping and a more rapid adrenal response to nearly any unexpected or negative stimulus--Walton Hadlock wonders if these tendencies might have been beneficial in a less industrialized community: post-menstrual women could watch over sleepless infants while younger women could rest.

The View From the West

Propogate more joy; hormones can be helpful

Dr. Anne Marie Jackson, ob/gyn, says when you look at menopause cross-culturally, it's pretty much only a "problem" in the Western developed world, in terms of people writing books about it, and discussing it, and Oprah talking about it.

Asked what she would change about how American society deals with menopausal women, Jackson, whose undergraduate degree is in anthropology, refers to the scene in Something's Gotta Give in which Jack Nicholson and Diane Keaton are going to have sex and he gets worried about birth control and she just starts laughing and says, 'I'm menopausal, I'm taking hormones!'

"It's a very joyful thing, and she's not ashamed that she's not young. If we could propagate more of that," Jackson says.

"Menopause is like puberty in reverse. Puberty is a time of great turmoil ... but there's all these things ahead of you to look forward to ... As you're becoming menopausal, it almost feels like there's nothing to look forward to, nothing ahead of you, but I would argue that a good, happier life is ahead. People want to go through menopause naturally, but what's natural is to birth all your children and then die. Life expectancy 100 years ago was maybe 50, so the state women are finding themselves in now is unnatural. Our society has changed such that we really haven't adapted to it, and that's where hormones can improve the quality of life for some people."

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From the July 27-August 3, 2005 issue of Metro Santa Cruz.

Copyright © 2005 Metro Publishing Inc. Maintained by Boulevards New Media.

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