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In this episode, Regina shares clinical insights for supporting and revitalising women during the menopausal transition through herbal medicine, diet and lifestyle modifications and dispels the stigma of menopause. 

Transcript

Wendy McLean (00:01): Welcome to Common Ground, a weekly podcast, discussing new research and interesting projects in the field of complementary medicine. Hello, my name is Wendy McLean educator at Vital.ly.

Women's experience of the menopausal transition can be vastly different. For some, it is a welcome change. For others it can be a struggle accompanied by a sense of loss and overwhelming and debilitating physical and mental symptoms. These symptoms can significantly impact quality of life and the stigma of menopause can compound the distress and struggle.

Joining me today is Regina Lasaitis, who will discuss the challenges associated with this transition. With a focus on herbal dietary and lifestyle modifications, Regina will discuss options for supporting and revitalising women during this period and she will dispel the stigma of menopause.

Specialising in the treatment and management of health issues using herbal and naturopathic medicine, Regina is a Master's qualified medical herbalist and naturopath with over 20 years’ experience. Prior to her training in complimentary medicine, Regina was a biomedical scientist and she combines her medical and scientific knowledge with her skills in natural therapies.

Regina is also a lecturer and student clinic supervisor at Torrens university, and she offers a support service for newly graduated practitioners.  Regina has a special interest in the treatment of women's health issues with a particular interest in the menopausal experience and hormonal imbalances.  Welcome Regina.

Regina Lasaitis: Thank you, Wendy

Wendy McLean: Regina, could you explain what exactly the menopausal transition is and why there is such a stigma associated with it?

Regina Lasaitis (01:46): Well as I explain to my patients, it's the period where the ovaries are going into retirement, which is a natural process, and there can be various symptoms that women will encounter during this transition. And to answer your question about the stigma associated with it, I think that's because generally in Western society there's a negative view on aging and menopause seems to be viewed as this time of aging, whereas it should be seen as just a journey of change and initiation into being a fully mature woman. And I'm on a quest to try and change that viewpoint from being a negative one to a positive one, because although women do experience various symptoms during this time, there are things and, being a herbalist, I would say that herbal medicine has a strong role to play in helping to smooth this transition, which is a natural phase of life.

And I think that it should be viewed as more of a positive time rather than something negative and something to be feared or dreaded. And also, I think the language around it should change and be more positive. Because I can speak from experience that you do come to a new balance, a new equilibrium. The hormonal shifts can be seen as something positive and not something to fear. And so I want to promote a sort of positive viewpoint of this phase of life.

So what women will come to me for help with is, is they'll notice that there'll be a change in their cycles. There could be an irregularity in their periods. Their cycles could become shorter or perhaps longer. There might be a change in the period. Often women will experience heavier periods. And of course, that's something that we question around thoroughly and determine whether they need further investigations because you can't just think, Oh, it's just, you know, menopausal transition. It could be something going on that's beyond the scope of my practice. So I'm always mindful of that.

And also women that have never experienced PMS before all of a sudden they get very severe PMS. And all of these challenges are a sign that the hormones are not in the same balance they were during the more reproductive years. So some of the symptoms that women will complain about apart from the irregularity in the cycles is that they might experience the hot flushes. And this can vary in intensity. It can be mild, just a mild sort of feeling of heat, or it can be described as a volcano erupting inside of them. And women's perception of this change, it can be very varied as well. And so for some women, it's not so bothersome for them. So that's something to assess, during a consultation, how bothersome is this? How frequent are the flushes, et cetera? So then we can sort of work out how we will treat that particular symptom.

Wendy McLean (05:23): Regina, why do some women experience more bothersome hot flashes than others?

Regina Lasaitis (05:31): Well, I think the exact cause of hot flashes is not exactly known, but it is due to, well, they think it is due to resetting of hormones. Sorry, the resetting of the hormones will narrow the thermoregulation system and that seems associated with decreased oestrogen that is occurring at this time. But I feel from my own sort of observations, that there's a real link between the state of the nervous system, state of adrenal function, the hypothalamus-pituitary-adrenal axis is involved obviously with the HPO, which is the ovarian axis. And if there's a disruption and there's an increase of stress at this time, which very often there is, that can impact and make the whole transition worse. So one strategy of treatment is always to be nurturing the nervous system, nurturing the adrenals.

I'm looking at that, because as I said, the ovaries are going into retirement. So our adrenal glands are supposed to step up and support the ovaries. Often they're too busy, as I say to my patients, pumping out stress hormones to be able to give any support to the ovaries. This is a time a woman’s life where there might be various stresses to do with, it could be family, could be their own family, or it could be parents, in-laws, et cetera, or it could be work issues. One of my patients described it as being the sandwich generation, where you've got problems with your children, and you might have problems with your parents as well, with caring for them and supporting your own family. So that can be a difficult time. And so from my observation, women that have got less stress seem to coast through it a little bit easier.

There can be also a bit of a relationship with family history as well with how did your mother or grandmother go through that time? Although, often women will say, well, we didn't talk about that. So, sometimes it's hard to gauge - are you going through the same sort of process as your mum was? Or grandma? You don't always know that. But sometimes I have observed that there is a familiar pattern as well with that. So, but as I said, the exact cause of all this is not actually elucidated. So, from my own experience I'm seeing that connection with stress, with the nervous system, adrenals.

Wendy McLean: And do you see other symptoms in women as well?

Regina Lasaitis (08:29): Apart from the period changes, the hot flushes, there's also often sleep disturbances. These can become an issue, insomnia, waking during the night more frequently, which is something these women have never experienced before. And, so again, this can be very varied and often they're waking because of the heat. So some women will describe night sweats. They can be so severe that they have to get up and change their nightwear, change bed sheets, et cetera, in really extreme circumstances. So perhaps that's what's waking them, but other times it could be that they wake with anxiety type symptoms because anxiety can increase at this time. Perhaps apart from the sleep issues, or because of the sleep issues, there may be variation in their energy levels as well. They might feel really tired. Also some women can start to feel really down. They can have signs of feeling depressed, which is something they've not experienced before. So mood swings are often something that will bring women to come and seek help; sleep; also other symptoms such as vaginal dryness, low libido, painful intercourse, which can often be the cause of the low libido. Also there is a connection between oestrogen and the urinary tract, so they can be an increase in frequency of UTIs. But all of these things are symptoms that can be supported with herbal and naturopathic medicine.

Wendy McLean (10:20): It's very complex and there's a lot of things to look at. So what are some of the herbal interventions that can be supportive and that you use in your clinic?

Regina Lasaitis (10:32): As I said before, I go with where the woman is at the particular stage. So if there is some, if she's going through the perimenopause, which is that time leading up to the final menstrual period, then it could be that they're needing some herbs to regulate their cycles. So Vitex agnus-castus, chase tree, would be my number one for helping to regulate. So often women will complain that they're having periods every couple of weeks, a few of those in a row, and that's not really pleasant. But I've found that long-term use of Vitex can actually help and smooth that transition. Okay, so Vitex would be my number one for going into menopausal transition when there's those hormonal irregularities. Of course, it's brilliant for decreasing PMS just generally in all ages. So particularly at this time I find giving a 500 milligram tablet first thing in the morning can be a really easy way to help to balance this transition.

Also if there's a heavy bleed that's becoming an issue, then one of my favorites is Alchemilla vulgaris, which is lady's mantle, which is really good for young girls going into their period, sort of their reproductive years when they just get their periods, they might be heavy. So that just sort of helps to balance the hormones at that stage of reproductive life. And then it also works really well at the end of the reproductive life to help with those heavy bleeds. So that would be one of the main ones that I would use.

For hot flashes, I'd have to say for the mild cases, Sage tea. Cooled Sage tea is something that has helped with a lot of women. And if it's more, if that doesn't help, then I will put it into a formulation. So as well as Sage I would use black cohosh, Actaea racemosa, which is the one that's had quite a lot of research behind it as being as effective in some trials for menopausal symptoms as HRT, but obviously without the side effects. 

And also I would combine that with Asparagus racemosus often, which is shatavari or shatavari, is the other pronunciation, I'm not quite sure which is the one. So that's a really great herbal. So for this stage, it's a really great tonic. It's a great tonic to the female reproductive system throughout all ages, but particularly at this time. Also another herb that I'm just starting to use a lot more is alfalfa because it's a very cooling herb and has some oestrogenic like effects.

Another one of my favorites, especially if there's night sweats and sleep problems, is ziziphus. It's a great one. And then, of course, whatever nervines, anxiolytics, antidepressants that would suit the particular patient in front of me. But some of my favorites are lavender, saffron of course, is one of my newest favourites. It's really good for those balancing of the mood swings.

Wendy McLean (14:07): Yeah. Definitely a few studies looking at it in PMS.

Regina Lasaitis (14:11): Definitely. Of course then, as I mentioned, the adrenals have an involvement, so adrenal tonics, such as rehmannia, licorice, often, I'll incorporate those into a formulation. And then liver support is important too, particularly in that perimenopausal stage where we're wanting to make sure that the liver is working at its optimal and clearing hormones as it should. So, you know, the usual liver herbs, St Mary's, Schisandra, but one of my favorites is Rosemary. And Rosemary is really great for helping with liver clearance, but it's also very uplifting. But it's other use, which I've just realised is another symptom that often women complain of, which is the mind fog. So, you know, memory issues. Often women are thinking, Oh, there's something wrong with my memory. Often that's to do with stress, but Rosemary can be really helpful with that, for the reasons that I mentioned as well.

But, then bacopa is another one of my favorite herbs, especially if there's anxiety and, obviously St John's wort would be one of the ones that I might use. And there have been some studies on St. John's wort, for a whole range of menopausal symptoms, particularly the ones to do with depression and anxiety. And then another herb that I have to mention that is one of my absolute favourites for this, and for all stages of life. I always find an excuse to put in some Centella Asiatica, Gotu kola, into a formula. I love putting that in formulas and women will be asking for it once I tell them that it's really good as a connective tissue promoter. And then it's also one of my, sort of, top multi-skilled herbs as I call it, because it's an adaptogen, which helps with stress, obviously a nervine helps with the nervous system. So I find Gotu cola works really well. And, also it's great for focus and concentration too, especially in combination with bacopa and rosemary. So that's often a sort of a trio that I would use – rosemary, bacopa, Gotu kola. But as you know, it depends on the patient, what's required for them.

Wendy McLean (16:39): Yes. And would you use the Rosemary in a herbal mix, or as a tea as well?

Regina Lasaitis (16:43): Could do. Yeah, but I often will put it in a formulation. But yeah, in a tea it could be great.

Wendy McLean (16:54): There's lots of powerful multi-action herbs there. Do you make any diet and lifestyle recommendations to your patients as well?

Regina Lasaitis (17:06): Well, my big lifestyle one would be to find exercise that you enjoy. So for me, I have my regular gym sessions with the trainer once a week. I think it's really good to really get a good sweat going, but, you know, the gym is not for everyone. So it's all about finding what's right for the patient. In my own practice I know what what's available in the area. There's a gym, but there's pilates, there's yoga. There's even aquarobics, there’s walking groups. Some women have found group training to be really good. And then I have a patient, she's well past menopause, but she's in her seventies and she loves her twice a week tap dancing classes. So it's all about what works for them. So it's good to give options and to work out what they're going to stick with and what's not going to be a chore because there have been studies to show, as I said, sweating and exercising can really help with this phase of life.

Wendy McLean (18:13): Yes. And I've read a few clinical trials looking at yoga, in particular, as well. But I do like that idea of group activities, you know, multiple aspects of improving fitness, but mental health as well. Social connection.

Regina Lasaitis (18:30): And then with regards to diet, it's like different things work for different people. And often I say, if there was one magic herb for weight loss, I'd be taking it. And I'd be probably a lot wealthier than I am, but there's not unfortunately, and different types of diets work for different women. Some find the intermittent fasting good, but then it doesn't work for others. Some are mindful of reducing carbohydrates. Again, there's no one diet and I tell people to be mindful of signing up for things that offer something, and it might be a quick fix. But it's more to do with just general good, healthy eating, and to be mindful of, you know, as I said, shopping around the outside of the supermarket food, et cetera, those general naturopathic dietary interventions. You know because this is a time if they're not eating well, then that is going to impact.

Wendy McLean (19:37): Exactly. And I do love that, that's Michael Pollan's principal. And if your grandmother wouldn't recognize it, don’t eat it.

Regina Lasaitis (19:44): That's right. That's right. Yeah.

Wendy McLean (19:47): So just a nice whole food approach and mindful eating. So how can we as CAM practitioners help to manage patient's fears around menopause?

Regina Lasaitis (20:02): Well, I think as I said earlier, it's when we really need to have a positive attitude about this time of life. As I said, I'm on a quest, to try and also to reclaim the crone, as such. The term, the crone, if you look it up in the dictionary, unfortunately says ugly old woman. But if you look further, it was considered to be an old woman with magical powers and the male equivalent is considered to be a wizard. So I think we need to make the crone a more positive term. It was considered an archetypal figure, as a wise woman, and this should be a time of life where we're seeing that it's a rite of passage into an era of wisdom, freedom, personal power.

And I think it can be a time of empowerment. I think that there is a positive in not being subjected to monthly changes of hormones. And that's basically what's happening in this time. We're going from those reproductive years. And unfortunately, for some, for the reasons that we talked about, it can be a harder transition, but you can get to the other side and I can speak from experience. You can get there and it can be a time of empowerment. It can be a time of considered, well, it should be, a wise person, a wise woman. Unfortunately some of us, and me included, have a bigger opinion gland at this time. That's one of the effects. But I think that that can be a positive thing, that we have more confidence in ourselves, we feel empowered, that we can, give our opinions more freely.

So, yeah, but being mindful not to be too offensive, but I think that's one of the positives, that you do have confidence. And I think not being subjected to those monthly cycles can be a feeling of freedom really. And yeah, as I said, we should look at this as a natural aging process and we should encourage our patients to look at it this way. And also we can offer them support. And, often what I see, is I'll see women in that perimenopausal phase where they're having the irregular cycles. We sort that out for them. And then I may not see them for a year or two, then they might come back and they might have a few other symptoms, we'll deal with that. And they'll have a smoother transition, with using the support of herbs, mostly that's what I would be using.

Wendy McLean (22:51): Well, that's wonderful. Thank you so much for your time today and for sharing your insights on the menopausal transition and really for highlighting that it is this powerful and positive process. So thank you very much.

Regina Lasaitis (23:12): Thank you.