Women in Fiji have it easy, at least when it comes to menopause.
We were in Fiji to study bra wearing and breast cancer, but took advantage of the opportunity of being with these non-western people to ask about the way local women experienced menopause. Margaret Mead, the famous cultural anthropologist, discovered that the discomforts young western women often associate with the "coming of age" were mostly absent for Samoan women. As medical anthropologists, we wondered if the coming "out of age" was any different for Fijian women than for those in the west who complain of various symptoms, such as hot flashes and profuse sweating.
So we asked some post-menopausal women how they experienced their menopause. The response was pretty similar from each.
"What's that?" they asked, perplexed.
We soon discovered that there is no equivalent word in Fijian for "menopause". In Fiji, when a women lives long enough to stop menstruating, she simply goes to the doctor to make sure she is not pregnant. Once she is assured this is not the case, she is happy and carefree. The lack of negative physiological and psychological effects, so troublesome for some western women, has resulted in the absence of a term to describe this time in a Fijian woman's life.
The hot flashes and profuse sweating of menopause is therefore not universal among all cultures. And in western cultures, it is not even universal among all women. While the medical literature has harped on lack of estrogen and excessive gonadotropic hormones as the most likely causes of this "pathology", the fact that most women who pass through menopause have little or no problem at all suggests that the mechanism for the reported problems must be something other than altered endocrinology post-menopause. In other words, since all women have reduced estrogen and elevated gonadotropins as they enter menopause, why do some women have troubling hot flashes and sweats, while others do not? Could there be another mechanism that has been overlooked?
Perhaps the solution lies in the way we are conceptualizing menopausal "symptoms". We already realize that many so-called "symptoms" of disease are actually the body's way to defend itself. Hence, a fever, often regarded as a symptom of illness, is actually part of the process of immune response. Coughing, vomiting, diarrhea, and nausea can also be regarded as defense mechanisms. Could hot flashes and sweats be a defense mechanism, as well?
It was this line of thinking that led us to start the Menopause Relief Project, which included a preliminary study of menopausal women with hot flashes and sweats that no treatment would cure. Here is the theory behind the study.
One of the most critical functions of the human body is to eliminate waste. We do this through several primary pathways: the lungs; the intestines; the skin; and the kidneys. One other mechanism is typically overlooked, and is only available to women. That is, elimination via menstruation and the sloughing off of the endometrium.
The purpose of the endometrium, of course, is to provide nutritional support for a fertilized ovum until the placenta develops and takes over. The endometrium lining of the uterus is rebuilt following the previous menstrual flow under the influence of estrogen and progesterone. The thickness of the endometrium increases as blood vessels and tissue proliferate, while the endometrium soaks in nutrients like a sponge. Some nutrients are secreted, while others are stored for later use.
Naturally, a highly vascular, secretory organ like the endometrium can also absorb and secrete (excrete) toxins, as well.
Meanwhile, another effect of estrogen makes toxins especially available for absorption by the endometrium. One physiological effect of estrogen is to cause salt and fluid retention, making the entire body slightly swell just prior to the commencement of the period. This essentially flushes the tissues, as the fluid cleanses the interstitial spaces. This helps remove toxins from the tissues, as the fluid travels back into the bloodstream via the lymphatic channels for toxin elimination. It is at this time that some women experience PMS, or pre-menstrual syndrome. Leg, breast and abdominal swelling are manifestations of estrogen mediated fluid retention. Depression, irritability, confusion, and fatigue, also PMS symptoms, may be related to the increase in circulating toxins released from the tissues.
As these toxins circulate in the bloodstream, some are eliminated by the kidneys, some are processed by the liver and excreted with the bile into the intestines, some are exhaled by the lungs, and some are sweated out. Many women report increased body odor and bad breath during this toxic time. Meanwhile, some toxins are absorbed by the receptive and "hungry" endometrium. If pregnancy is not achieved, the endometrium is sloughed off, eliminating the toxins with the unneeded uterine lining.
Menstruation, then, is a time of cleansing for women of childbearing age. What happens when this mechanism stops at menopause?
Clearly, if there is a reduction of one mode of elimination, the other modes must take the burden. This means that it would be important for menopausal women to move their bowels regularly, drink plenty of fluids and urinate when needed, breathe deeply, and perspire freely.
And here is where western women have trouble. Many western women, as well as men, hold in their urge to urinate or defecate. This usually has to do with the reality of modern, urban life, with few available public toilets, and with those that are available often unacceptable for use. (More on this point in a future article.) Deep breathing is difficult for women with a tight bra strapped to their chests.
As for sweating, our culture is extremely sweat-phobic. Besides the smell of sweaty armpits, there is the armpit stain on shirts and blouses to worry about. While this is not an issue for women in Fiji, who perspire freely, most western women use antiperspirants to deal with this. This may make their armpits more culturally acceptable, but it does so at the price of eliminatory efficiency.
So here we have women who are holding in their waste and impairing their ability to sweat. On top of this, they stop menstruating. The outcome is an accumulation of toxins in the body. Over time, these toxins cause irritability and moodiness. Eventually, the toxins build up to the danger point, compelling the body to take matters in its own hands, so to speak. To eliminate the toxins, the body makes itself sweat.
This, we believe, is the reason for the hot flashes. These are the body's way of jump starting a sweat. Hot flashes can happen any time, and sometimes stop for months to only start again. Could it be that the hot flashes, and the sweat response this produces, are the means to eliminating toxins that have accumulated as a result of menopause, along with a hampered toxin disposal system?
If this were the functional "purpose" of menopausal hot flashes and sweats, it follows that women could avoid the spontaneous sweats by deliberately sweating each day to eliminate the toxins. After all, the problem with hot flashes is that they happen at inconvenient times, out of the control of the woman. If she can choose the time when she wishes to eliminate toxins, it would make spontaneous sweating unnecessary, ending the hot flashes.
To test this theory, we found 10 volunteers who were menopausal, experiencing very distressing hot flashes and sweats. We asked the local YWCA to provide free passes for these women to use the sauna and steam room, and asked the volunteers to take 20 minute sweats daily, for 8 weeks. We relied on their subjective responses for the results.
By the end of the first week, 4 of the women had dropped out. They reported that they personally disliked sweating and found this form of prevention unappealing. All of these women continued to have hot flashes and spontaneous sweats.
Of the remaining 6, one could not sweat effectively, and merely overheated in the sauna. She also dropped out.
Of the remaining 5, all experienced relief by 2 weeks of daily sweats. They reported that they no longer had night sweats or hot flashes, apart from a minor blush.
We later discussed our study with an AIDS researcher who was exploring hyperthermia treatments. He said that a side effect of the hyperthermia, which caused sweating, was that it stopped AIDS patients from having night sweats.
We would like to see further research done on this, and encourage physicians to try this out with their patients. Most women can withstand the rigors of a sweat bath, but some conditions may contraindicate hyperthermia treatment, such as heart disease, hypertension, diabetes, etc. The women should also be told to replace fluids as needed, with electrolytes as well as water.
This relationship between the need to sweat and the development of hot flashes may help explain a mechanism by which estrogen replacement reduces hot flashes. Estrogen replacement regimens call for three weeks on and one week off the hormone. This causes the body to retain fluid when the estrogen is high, and then release the fluid from the tissues as the estrogen falls, effectively functioning as a tissue cleanse. However, the potential cost of using estrogens is high. It can include cancer of the breast, cervix, vagina, endometrium, and liver, as well as gallbladder disease, stroke and pulmonary embolism, and exacerbated migraines, asthma, epilepsy, heart disease, and kidney disease.
Perhaps it's better to listen to the body and simply sweat to relieve and prevent menopausal discomfort. It is also easier on the millions of pregnant horses that are immobilized and catheterized to collect their urine for the drug Premarin (Previously Mare Urine).
Clearly, women with menopausal problems need to examine their diet, along with the health and function of all their eliminatory organs. However, when we realize that menopause is not a disease, and that the body knows how to deal with disturbances to its equilibrium with mechanisms such as perspiring, understanding the cause of menopausal discomfort is really no sweat!
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