Dr. Nancy Lonsdorf, M.D., was formerly the Medical Director of the Maharishi Vedic Medical Center at The Raj in Fairfield, Iowa. The author of a number of books including A Woman’s Best Medicine: Health, Happiness and Long Life through Maharishi Ayur-Veda (Tarcher/Putnam) and A Woman's Best Medicine for Menopause, she has lectured extensively on Maharishi Ayurveda and appeared on The Donahue Show, Geraldo, and CNN.
Total Health News recently asked her to talk about better health during menopause.
Q: We are pleased to welcome today Dr. Nancy Lonsdorf, formerly the Medical Director of the Raj in Fairfield, Iowa, and author of the book A Woman's Best Medicine for Menopause. Welcome, Dr. Lonsdorf. What prompted you to write a book about menopause? Can you tell our readers why you felt a need to undertake this project?
Dr. Lonsdorf: Mainly, I realized that there is a tremendous need for a more natural approach to easing the transition of menopause. The hormone replacement therapy that most doctors are promoting is very risky. It has been promoted by physicians, leaders in women's health and the media in general, as a magical solution for the problems of aging such as osteoporosis and heart disease. However, the evidence for hormone replacement therapy really preventing those conditions or effectively treating them is not very solid.
I felt the risks of taking hormones were great and the benefits not well proven. Yet, women were being told that HRT was the answer. This is misleading, and women may end up suffering from some as-yet-unknown consequences from taking HRT. I felt it was important to bring out the research on HRT and its risks so that women could make more informed decisions.
Secondly, not only does HRT have risks, but it has become clear in the last few years that it is not as beneficial for preventing heart attacks and treating or preventing osteoporosis, as has been promoted. In the last couple of years, studies have indicated that HRT can actually increase heart attacks and strokes. As far as osteoporosis goes, the long-term benefits of hormone replacement therapy have not been proven. The risks from taking HRT for twenty to thirty years (which is probably necessary to prevent bone fractures from osteoporosis) entail quite a high risk of breast cancer. Now, the experts in the field are no longer recommending hormone replacement as a main prevention for osteoporosis. So, simply put, there are a lot of risks to hormone replacement therapy. In particular, breast cancer risks increased by as much as 80% in women taking HRT over the long-term. That is almost twice the risk without delivering the promoted benefits.
Another reason is that women themselves are seeking a more natural approach to menopause, and the book fills this need. Yet natural approaches women were seeking are quite fragmented and carry unfounded claims for safety and effectiveness. Even the natural approaches to menopause were being promoted as proven safe and effective. In reality, many of them have not been proven safe. Many women are taking so-called natural hormones, thinking there are no risks of cancer or other health problems. Actually, these products carry similar risks as the other hormones that have been used and researched. There is a tremendous misunderstanding and confusion in the field of treatment. I saw that there is a need for a truly natural approach, free of side effects, that can assist women through menopause, as well as support their health in the long term.
Q: That is very important. Menopause is a universal phenomenon where every woman undergoes this important transition. Why is it, then, that it is a problem in some parts of the world and not so much in other parts of the world?
Dr. Lonsdorf: I think that the most important factor is diet and lifestyle. Women in Japan, for example, rarely have problems with hot flashes; in fact, they don't even have a word in their language for hot flash.
This is usually attributed to the fact that the Japanese diet is richer in phytoestrogen-containing foods, i.e., plant based estrogens. For example, soy is a primary food in their diet, and is not so common in the American diet. However, lots of whole grains and many vegetables and legumes have phytoestrogens in them. Our Western diet is not only lacking in soy, but it's often lacking in fresh vegetables and whole grains. We have many more processed foods in this country.
Also, it appears that stress and lack of a good routine create more menopausal problems. At least that's what I've observed as a clinician. The ayurvedic physicians that I've worked with in this country, who have observed women in India and Japan and in other parts of the world, say that when women are living a more Western lifestyle, with more stress and staying up late at night and not getting enough sleep, they have more problems. According to ayurveda, their doshas are more likely to be out of balance. So, that's another factor. They are comparing women who are living a superwoman lifestyle versus one that is more balanced. A simpler lifestyle, such as eating meals on time and going to bed by 10:00 p.m., keeps your body in tune with the natural rhythms of life.
There are also psychological components of menopause that play a role for some women. In many cultures, such as Japan and India, going through menopause and leaving the reproductive years behind is seen as a marker of the woman entering another productive phase of her life. She is seen as a leader in society — as someone you can turn to for deeper knowledge and greater wisdom of life. The transition is seen as a time where you're actually graduating to a higher level of society, rather than from the perspective of losing youthfulness, on which Western cultures put great emphasis.
Q: How widespread do you think this problem is in the West? What percentage of women would you say experience one or more signs related to menopause?
Dr. Lonsdorf: Simply put, about 25% of women really have virtually no symptoms and about 25% of women have quite troublesome symptoms. The other 50% in the middle have milder-to-moderate degrees of symptoms. Usually those symptoms are hot flashes or some vaginal dryness and perhaps some sleep disturbances due to hot flashes.
Q: Do you think that only women who experience some of these symptoms actually seek treatments like HRT, or do you think that it is instilled into every woman that when they reach that time of life they need to use HRT in order to stay healthy?
Dr. Lonsdorf: I think that both things are true. The latter has been the case more in the last ten or twenty years as more women in midlife go to the doctor. Their physician may bring up the subject of hormone replacement therapy and recommend HRT to prevent heart disease and osteoporosis, and encourage their patient to take HRT for prevention.
This has been common practice throughout the United States for a couple of decades, and HRT is still being recommended to women. However, in the last year or two, as evidence is coming out regarding the limitations of HRT — that it doesn't prevent heart attacks but actually increases the risk of heart attacks — more doctors are realizing that HRT is not the great preventative. General practice is moving towards giving HRT only to those women who are having really severe menopausal symptoms, such as severe menopausal hot flashes that are causing sleep disturbance — symptoms that are really interfering with a woman's life. Then, the official recommendation is that women should be kept on hormone replacements for only about a year and after that their treatment reassessed. Ideally, the woman could be weaned off the HRT, and hopefully her body will then adjust more easily to the lack of estrogen. The risk of breast cancer and other symptoms tends to go up after a year.
Q: You already discussed some of the physical symptoms that occur with menopause, but what about the peri-menopausal stage? Also, what is the range of symptoms that can occur during menopause? We know that these symptoms are not just physical but can be mental, like loss of short-term memory or emotional upsets such as mood swings or depression. Are these symptoms all necessarily related to the fact that a woman is coming of age for menopause, or is it something else that contributes to those symptoms?
Dr. Lonsdorf: These are really important questions. I'm aware of one study which addressed the basic question about whether these type of problems are due to the hormone fluctuations during menopause, or whether they should be attributed to that particular stage in life, 40s and into the 50s. This study was conducted in England some years ago. Middle-aged men and women were both polled on several dozen symptoms that occur commonly in midlife. The interesting point was that only two symptoms were found to differ significantly between the men and the women — hot flashes and vaginal dryness. It's pretty clear that only those two symptoms can absolutely be tracked to estrogen deficiency.
The point in that study was that many of these symptoms turned out to be simply signs of aging. Other experiences did appear to be related to menopause, however. While both men and women experienced a crisis around mid-life that involved loss of confidence and difficulty in making decisions, peri-menopausal women seemed to have more trouble with these than did men or post-menopausal women. So it's exactly what you said: lack of confidence and difficulty making decisions.
Let's take a moment to examine the symptoms of hot flashes and vaginal dryness. Obviously, we could say these are physical symptoms. Studies now indicate that only if a woman is having hot flashes and night sweats (vasomotor symptoms), does HRT actually improve her mental or emotional state. The evidence is growing that women do not innately have more mental and emotional changes at menopause due to fluctuations in hormones, unless they're really sleep deprived or having so many hot flashes that it's upsetting their sense of well-being. For women who were experiencing hot flashes and depressive symptoms, taking hormone replacement therapy led to improvement in their mental and emotional symptoms. This is also true for memory and some cognitive functions.
However, if a woman isn't experiencing hot flashes, even if she has mental and emotional symptoms, giving HRT did not seem to make a significant difference. There are other factors that you alluded to that occur at mid-life. One, these could be the effects of aging. The second factor may be the personal transitions and changes in women's lives. Children may be leaving home or a woman may be going through a divorce, or perhaps elects to go back to work for the first time in many years, or her job changes. She may also have responsibility for taking care of an ailing parent, which increases stress. Sometimes children have gone away to school and return because of personal difficulties. There are many situations at mid-life that can put extra demands on women, which can be the causes of many of these problems. Depression, mood swings, irritability, anxiety and short-term memory problems are common. I think part of the problem is that there's a tremendous overload on the nervous system.
Q: Does menopause affect a woman's sense of self-worth and that in turn contributes to mental and emotional problems? I think in the West, especially, there's a certain concept of the image of a woman, and as you start getting older, self-worth becomes something that is questioned and may lead to depression.
Dr. Lonsdorf: This is an interesting question. It turns out that studies find women between the ages of 50 and 65 are happier than at any other time in their lives. However, this is not true for women in their 40s. When asked, fifty-one percent of older women stated that they were happiest between the ages of 50 and 65. Only 16% of women in their 40s said that that was the time they were most happy and fulfilled. So there's a big difference between the 40s and 50 to 65.
Q: Please define menopause for us from the Western point of view and from the ayurvedic perspective.
Dr. Lonsdorf: First of all, I'm happy to say that I believe Western medicine is beginning to evolve in the approach to menopause. But, for simplicity's sake and historically, the Western model has been one where menopause represents "ovarian failure." It's been seen as a disease, a disorder — an abnormal lack of hormones that creates health problems. Whereas the ayurvedic point of view is that menopause marks a natural transition in one's life. You've got failure versus transition for a mindset. The basic ayurvedic concept is that if your body is essentially in balance, the transition will be easy and if it's not in balance, the transition will be more difficult.
Ayurveda actually views menopause as part of a larger transition that's common to both males and females. This is a transition from a time where life is dominated by Pitta, the metabolic principle, to one dominated by Vata, which is the movement principle. This transition occurs due to aging. You just need to know that your body needs special care, and you have to treat it in a certain way to prevent those kinds of health problems from cropping up.
Q: You just mentioned that conventional medicine looks at menopause as a disease or disorder, so what are the treatments that are normally prescribed? You've talked about hormone replacement therapy, but what is the range of treatments conventionally used to address this so-called disease?
Dr. Lonsdorf: It's the term hormone replacement therapy with "replacement" boldly emphasized. That tells the story. Western medicine has viewed menopause as a failure of the ovaries to produce the hormone. It is the same model as when a person's thyroid no longer produces enough thyroid hormone. It is viewed as a disorder, so we correct the disorder by giving the thyroid hormone and then we think everything will be perfect. This has been the viewpoint guiding Western treatment for the last two or three decades. For lack of estrogen, we'll give estrogen. It is becoming clear that the body isn't meant to have that much estrogen during mid-life, and that it's giving quite serious side effects and diseases down the line in many women.
Q: What are some of the side effects? You said there's increased risk of heart disease and strokes.
Dr. Lonsdorf: There is a somewhat increased risk of heart disease and stroke, or heart attacks and strokes in the first three years of use. An increase in risk for breast cancer is also seen. There has also been a dramatic increase in risk of blood clotting in the legs and lungs. There is an increased risk of gall bladder disease, or the risk of having your gall bladder removed. Some recent studies show that women who take hormones get more problems with dryness of the eyes, lower energy, more fatigue and urinary incontinence problems.
Q: This is a wide range of side effects. Why have doctors been promoting hormone replacement therapy then?
Dr. Lonsdorf: It's simply that until the past three years or so, all the evidence on hormone replacement therapy was derived from studies in which women had chosen to take hormone replacements and the results looked really positive. However, they were not randomized trials.
The problem with those types of studies, where you just look at all the women who chose to take hormones versus all the women who chose not to, is that you have a population of women who may be more health conscious to begin with. These women were just adding one more thing as a means of prevention, and perhaps were already exercising more and eating healthier — and those were the real reasons why they experienced less health problems — less osteoporosis or fewer heart attacks, for example. In the past three years, the first actual data on controlled trials, where they just took a certain number of women and then assigned them randomly to either taking hormone therapy or taking a placebo, revealed some pretty surprising results. This is where all this new information is coming from — that hormone replacement isn't as good as originally thought, and actually is pretty dangerous.
Q: You previously mentioned that women have to take HRT for an extended period of time for it to work on things like osteoporosis?
Dr. Lonsdorf: Yes. It seems that for osteoporosis, that just taking HRT from age 50 to 60 and then stopping it when a woman gets to be 75 (when she's at the most risk for having a serious fracture), has virtually no effect. Basically, you have to take it throughout the 20 or 30 years after menopause — by then you've more than doubled your risk of breast cancer. Those are some pretty serious drawbacks. More than ever, women want an approach that doesn't have long-term side effects.
Q: You mentioned that there were many other approaches being promoted as "natural." There are many herbs, for example, that are reported to address the symptoms individually or maybe all together. What do you say about these approaches?
Dr. Lonsdorf: What I think is most misleading to women is that books are being written on natural alternatives and doctors are prescribing what is called "natural" hormone replacement therapy. This simply means that those hormones are the exact replica of the body's own hormones. They're better called bio-identical hormones. The word "natural" is used because it denotes that this product is risk-free, which has not yet been proven. It is likely these natural hormones will turn out to have similar long-term cancer risks as the other hormones.
Q: What about individual herbs that are being promoted such as evening primrose oil or black cohosh?
Dr. Lonsdorf: The only individual herb that has been shown quite definitively to help reduce hot flashes is black cohosh. I think this is as close to the most natural approach you could have other than Maharishi Ayurveda. Black cohosh has been studied for only six months, however. There is always a potential danger when one is taking a singular herb for a long time in a large dose that it may bring about some unwanted side effect. Black cohosh is recommended for only six months, but there are a lot of other things going on for women at mid-life which this herb doesn't address. This is where Maharishi Ayurveda gets to the root of the problem and can address the woman's entire health situation.
Q: This is a good lead-in to talking about the Maharishi Ayurveda approach to menopause — why it's effective and how it addresses the whole woman and not just symptoms. How does Maharishi Ayurveda empower women to take control over their own health?
Dr. Lonsdorf: There is a saying that knowledge has organizing power. If a woman can really understand why she's having certain symptoms, such as increased risk factors for high cholesterol, or putting on weight, or high blood pressure, she can make changes in her life that can help to eliminate those problems. This is a more holistic approach as opposed to taking one herb to try to get rid of hot flashes, but then ignoring the fact that your weight, cholesterol and blood pressure are going up as well and that you are being plagued with fatigue and irritability. From the ayurvedic perspective, this woman's system is out of balance.
Ayurveda allows women to understand what specific physiological imbalances they have and how to correct those imbalances. This approach helps eliminate menopausal symptoms, but also addresses what is going wrong in their physiology which may in turn lead to some chronic health problem. Women are empowered with knowledge to understand how their lifestyle and diet may need to change to eliminate a particular problem.
Q: What would you say are all the components that go into this program?
Dr. Lonsdorf: Basically, health is a result of everything in a person's life. Ayurveda literally means knowledge of life or lifespan, and ayurveda gives us the knowledge and understanding of how to adjust every aspect of our life to promote excellent health and our longevity and our spiritual development, all at the same time. We have to look at what's going on in our lifestyle during this time for clues to the causes of our symptoms.
Western culture has tended to view menopause as a mistake. It's a failure. The body has failed, so now things are going wrong. However, nature's inner intelligence is infinitely wise, and menopause and the winding down of the reproductive hormones is actually part of the natural transition of life.
A woman needs to examine how she's been living her life that has created a disturbance in the inner intelligence that is not allowing the body to adjust to the change in hormones. This is a warning signal given relatively early enough in life when the body can still be brought back into balance. Diet and a balanced routine are key factors. Those two things tend to create balance in the doshas.
If a woman's doshas are out of balance, she may have a multitude of symptoms during menopause. Secondly, if she has more severe symptoms or symptoms that don't go away even after making lifestyle adjustments, it is usually a sign that there are some deeper blockages in the in the body called ama. All those fast-food meals and late-night pizzas and eating on the run are dietary mistakes that have led to the buildup of some improperly digested food or toxins called ama. These toxins accumulate at a cellular level and block the metabolism. They also disturb the functioning of the hormones even on a cellular level. They're blocking the effects of the hormones. So this type of woman needs to improve her diet, go to bed earlier and may need to integrate exercise into her routine. If her symptoms continue, it is most likely due to ama in the physiology, which requires a deeper cleansing of her system over a period of months. Or receiving the Maharishi Rejuvenation Treatment (MRT), or panchakarma, can be effective. If you have a lot of ama, or toxins, in your body, then even herbs may not reach all the cells or be as effective, because there's so much waste in the system. This is where panchakarma excels.
Q: So how often should one do this rejuvenation treatment?
Dr. Lonsdorf: At menopause it's very good to do Maharishi Rejuvenation Treatment twice a year for a year or two at least. Even once a year for a week can turn around years of imbalance and accumulation of ama.
Q: I understand that the ayurvedic approach to diet is quite individualized, but are there any general dietary recommendations for women during menopause?
Dr. Lonsdorf: The main thing to remember is that Vata and Pitta doshas go out of balance during menopause. Balancing Vata and Pitta by favoring certain foods and spices and avoiding other foods that may be too hot or spicy, for example, is very important. There are a multitude of lifestyle tips in Maharishi Ayurveda, such as eating your main meal at noon and going to bed by 10:00 p.m. and awaking by 6:00 a.m. that create balance and greater health.
One of the most important foods to eat is whole grains. Whole grains include quinoa, amaranth, barley, millet and rye. All of these whole grains have an ingredient called lignin, which is a type of phytoestrogen. Another helpful tip is to use balancing spices in your cooking or use a pre-prepared spice mixture (Churna) on your food. Spices such as turmeric, fennel, cumin and coriander also have phytoestrogen and hormone-balancing effects.
Q: How about the need for calcium? Does the ayurvedic approach consider dairy, or including calcium-rich foods in the diet?
Dr. Lonsdorf: Yes, that's important. The ayurvedic diet does include quite a bit of dairy if a person is vegetarian. There are certain rules or guidelines on how to use dairy products in order to not give the unwanted side effects such as excessive mucus. Dairy products are a good source of calcium, as are green leafy vegetables and certain nuts. Grains such as quinoa and amaranth are also quite high in calcium, magnesium and phosphorous. These are all very good for the bones.
The foundation of an ayurvedic diet is lots of whole grains, daily fresh vegetables and lots of fresh fruits. You would also include some legumes. Those principles are the same in ayurveda as in Western nutritional science.
You could also include plenty of nuts. One of the greatest discoveries of the last five years in nutrition is that regular nut consumption is associated with a reduction in heart disease or heart attacks by about 30%. This is pretty significant. Nuts are also a good source of the omega-3 fatty acids. You don't have to eat fish if you are a vegetarian, if you eat nuts and plenty of green leafy vegetables.
Q: There are some conflicting reports that have appeared recently about soy. You talked about soy as a source of these phytoestrogens.
Dr. Lonsdorf: I know that in some studies, giving animals soy phytoestrogens has yielded mixed results. The results are mixed regarding increasing or blocking breast cancer in animals. We really don't know what the effect is in humans. However, most of the cultures that are eating a lot of soy have much lower risks of rates of breast cancer than Americans.
Some consumption of soy protein does seem to help increase bone density and also reduces cholesterol. I think you could say that soy overall is promising for benefiting heart disease and bone density. One study indicates, however, a higher rate of dementia in people consuming tofu more than once a week. It has yet to be replicated.
We do know from ayurveda that if you take too much of one food, herb, etc., it could create an imbalance. I think probably the safest approach is to include soy in your diet as you would legumes and grains — but do not overdo. Don't try to have 2-3 servings of soy a day. Also, it is best to cook soy with balancing spices, as soy and legumes are high in enzyme inhibitors. This means there are factors in them that might actually impair your metabolism or your digestion. Actually, a diet high in phytoestrogens from a variety of sources may turn out to be even better than a diet that's getting all its phytoestrogens from soy alone. To me it is healthier, because there are a variety of minerals and antioxidants in each different grain, vegetable and legume. I wouldn't be overly frightened of soy, but I also don't think that people should make a point of having lots of soy every day.
Q: What about lifestyle tips to ease the transition?
Dr. Lonsdorf: One important lifestyle tip would be to eat your meals on time. The other is to transition towards whole, fresh foods. Thirdly, make it a habit to go to bed early — a lot of sleep disturbances crop up because people go to bed well after 10:00 p.m. According to ayurveda, if you go to bed later than 10:00 p.m., your sleep is not as deep or refreshing, and you tend to wake up more during the night.
We have learned that both Vata and Pitta doshas are aggravated by staying up after 10:00 p.m. Establishing an earlier bedtime can improve sleep and reduce evening and night hot flashes and night sweats. Also, Transcendental Meditation® (TM®) is a very powerful way to reduce stress in your life and improve your ability to handle stress. We can't really reduce the stressors that we are exposed to, but we can improve how our body, mind and emotions respond to those stressors. TM is an effortless way of improving your resistance to stress. In fact, just learning TM has been a key factor in many of my patients handling their menopause much more easily.
Q: Can you tell us a little bit about your book? Why would someone want to run to the store and purchase a copy?
Dr. Lonsdorf: The book will clarify the facts about hormone replacement therapy and provide all the latest research as to the limitations and risks of HRT. It will also help clarify the field of so-called natural alternatives and help the reader to understand which of them are really natural and safe. The best part of the book is the individualized and complete approach to their menopausal symptoms and their health as a whole that they will find in the book. In other words, the book will help women (through some self-care quizzes) assess exactly what their imbalances are. It will also give them a personalized self-care approach to correct those imbalances, which will include a very specific diet, herbal recommendations that they customize for themselves, and of course guidelines for products they can get through Maharishi Ayurveda. It will also include advice on many different treatments and natural approaches for specific health problems. For example, if someone has low bone density or heart disease or risk factors for heart disease, natural options will be explained.
Q: Thank you, Dr. Lonsdorf, for giving us such extensive information on women's health and specifically menopause.
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