Q: Since the menopause started every time I sneeze, cough, laugh or run I can’t stop leaking a little urine. Are there any natural ways to stop this happening?

A: About half of women experience ‘stress incontinence’ in the menopause because levels of the hormone oestrogen –which keeps the muscles at the base of the bladder tight and strong – decrease. Performing pelvic floor workouts or Kegel exercises to help strengthen your pelvic muscles can help combat the problem. To find out which muscles you need to use, stop urinating midstream by contacting your muscles; these are your pelvic floor muscles. Use these muscles to perform a Kegel; contract and hold for a count of five and then relax. Repeat 10 times at least five times a day and you should notice a big improvement. You can also practise stopping the flow of urine when you go to the toilet. There are some really good pelvic toners on the market now that help with stress incontinence and are very easy to use. There are two that I would particularly recommend, so for more information on these go to www.naturalhealthpractice.com or call 0845 8800915. 

 

Retraining your bladder may also help. Begin by allowing yourself one trip to the toilet every hour for a week and then the following week extend the time between trips by half an hour. Continue until you can hold your urine for three hours at a time. This exercise teaches your bladder to hold more urine and become less sensitive when full.

 

Don’t be tempted to drink less if you are prone to incontinence. Restricting your fluid intake won’t stop leaks. In fact it can make things worse by producing highly concentrated urine that irritates the bladder. Drink lots of water instead. You’ll know when you are hydrated if your urine appears clear to pale yellow. If it’s dark yellow you aren’t drinking enough. And finally, as your symptoms are linked to lowering levels of oestrogen be sure to eat plenty of phytoestrogens (plant oestrogens) found in soya, legumes and nuts and seeds.

Q: In the last few months I’ve noticed that my vagina feels dry and sex is increasingly painful. I’m approaching the menopause and wondered if there are any natural remedies that you can recommend?

A: During and after the menopause the walls of the vagina can become thinner and less elastic. You may find that you take longer to lubricate and that intercourse can be painful. Thinning and drying of pelvic tissue can occur but women who maintain a healthy weight and eat a healthy diet generally experience few problems with vaginal/bladder weakness in the menopausal years. There are also a number of natural therapies that may help:

 

Make sure you eat a healthy diet rich in hormone balancing phytoestrogens, found in soya, legumes, nuts and seeds, and drink plenty of water. Try cranberry juice (unsweetened of course, or a powdered cranberry, see the Resources Page) especially if you are prone to cystitis.

 

Exercise can help keep your vagina supple and lubricated. Regular sex and masturbation can too. The saying if you don’t use, you lose it doesn’t just apply to your brain and bones it apples to sex too. Regular sex can keep your vagina healthy and happy. Although vaginal dryness is common during the menopause some women do still lubricate rapidly when aroused and the most likely reason for this is that these women continue to have sex once or twice a week.  There are also some really excellent natural vaginal lubricants – one I recommend to my patients is called Yes – see the Resources Page.

 

Kegel exercises can help strengthen your pelvic muscles and combat incontinence and make sex more enjoyable. To find out which muscles you need to use the next time you go to the toilet stop urinating in midstream by contracting your muscles; these are your pelvic floor muscles. Use these muscles to perform the Kegel exercises, contract them and hold for a count of five and then relax. Repeat these ten times and do at least five times a day. If Kegel exercises alone aren’t sufficient studies show that training with pelvic toners that provide resistance produce significantly better pelvic floor muscle strength than did exercise without them.  (Go to the Resources Page for information on two types of pelvic toners.)

 

Avoid douches, talcum powder, perfumed toilet papers, bubble baths and foams as they can irritate the vagina. Avoid washing the inside of your labia with soap too as it will dry out the skin. Spend longer on foreplay as it will help you to lubricate.

 

Motherwort tincture used orally may increase vaginal lubrication and vaginal wall thickness within a month of use. Vitamin E in daily oral doses of 300-400ius for 4-6 weeks has been found to increase vaginal lubrication. Acidophilus inserted vaginally can help prevent yeast infections and create more lubrication. You can get acidophilus in pessaries (called Intrafresh – see the Resources Page) which is a convenient way to get acidophilus into the vagina.  Also you can take a probiotic (like BioKult) orally to help maintain healthy intestinal flora and vaginal balance.

Many of the women I treat in my clinic who are in their thirties or forties are concerned about changes in their menstrual cycle. The most common worry is that the timing of bleeding is different or their cycle is a week earlier or later. ‘I’m usually regular,’ they tell me. ‘This isn’t what I’m usually like.’ ‘What’s going on?’ Others want to know if their irregularity is a sign of impending menopause.

Although the hormonal changes that signal the beginning of menopause can cause cycle changes, such as skipping a period one month followed by a real drencher the next, it is important to understand that many other things can cause the timing of your periods to change and these include stress, travel, job change, moving house, over exercise and poor eating habits.

 

Although diet and lifestyle changes can trigger menstrual irregularities there is no getting away from the fact that the journey into the menopause is typically accompanied by menstrual changes and these are perfectly normal and natural changes are most likely to occur in your late 30s and forties. But how can you tell if your cycle changes are diet and lifestyle related or menopause related?

 

The answer is to follow the diet and lifestyle advice below which is all designed to help regularise your periods. If this still doesn’t help, listen to your body and keep a note of your bleeding and symptoms that occur during your cycle. This will help you distinguish the normal irregularities of the menopause from really unnatural symptoms, such as hair loss, acne, facial hair and fatigue that require attention or treatment. And if you are concerned in any way consult your doctor immediately because irregular or absent periods are also a symptom of very common hormonal imbalances in women, such as thyroid disorders and polycystic ovary syndrome (PCOS). 

 

Heavy bleeding (menorrhagia) is one irregularity that is typical among menopausal and peri-menopausal women. Flooding is a response to changing hormonal levels.  Excessive bleeding may, however, be linked to other medical conditions such as fibroids or ovarian cysts so once again it is wise to consult your doctor if a period lasts more than twice as long as it ever did or if there is a persistent low back/pelvic pain.

 

If underlying medical issues have been ruled out you need to understand that your cycle will change as you age. Many of us think that our bodies will stay the same forever but it is perfectly normal for periods to change in women over the age of thirty. So, although irregular periods in your 30s and 40s can’t always be controlled, following the diet and lifestyle recommendations below will encourage regularity and ensure you aren’t making things worse for yourself than they need to be.

 

Pay attention to the signs and plan ahead

Your body often gives you signals when a period is due. You may feel breast tenderness or bloating so learn to listen to your body. It also helps to plan ahead by having pads or tampons stored in your bag, car or office in case of emergencies.

 

Keep the light on

Some women have always had irregular cycles or cycles that are just longer than the usual 28 days. Experts aren’t sure why this is but one study from the University of California in San Diego observed that the length of women’s cycles was shortened when they were exposed to a light source when they were sleeping. Although there is no guarantee that night time light exposure will shorten cycles if you have longer cycles researchers believe it is worth a try. Simply set a timer so that a lamp goes on half an hour after you normally fall asleep.

 

Eat a hormone balancing diet

A healthy diet rich in whole grains, fruits, vegetables, legumes, nuts, seeds and oily fish will give your body good amounts of the nutrients it needs to balance your hormones and encourage regularity. Most important of all a healthy diet will ensure that your blood sugar levels are balanced. Blood sugar imbalances often trigger hormonal imbalances, which in turn trigger irregular periods.

 

Take a multi vitamin and mineral

As much of the food we eat today has had the vitamins and minerals processed away, a good quality daily multivitamin and mineral that includes B vitamins, zinc, vitamin C, beta carotene and vitamin E will be a good insurance policy to make sure your body isn’t deficient in the essential vitamins and minerals it needs for a healthy reproductive cycle (see the multi MenoPlus I use with my patients on the Resources Page). You may also want to take an additional vitamin B6 and zinc supplement as studies link deficiencies to irregular cycles (see the Resources Page)

 

Get your EFAs

Make sure you eat plenty of legumes, nuts, seeds and oily fish to ensure you are getting enough EFAs or essential fatty acids. EFAs are important for hormone balance and menstrual cycle regularity. Aim for 1000mg Omega 3 fish oil a day (with 700mg EPA and 500mg DHA). (See the Resources Page for a high strength Omega 3 fish oil in fish oil gelatine capsules not bovine.)

 

Maintain a healthy body weight

The advice in the previous feature on losing weight and gaining body confidence in 2009 will help you manage your weight as studies have shown that women who are underweight or overweight tend to have irregular cycles. When a woman loses too much weight her reproductive cycle often shuts down. Experts believe this is simply nature’s way of stopping a woman getting pregnant when her body doesn’t have the fat reserves to support a pregnancy and breastfeeding. And the same is true for women who gain too much weight. Excess body fat increases oestrogen production and this can trigger irregular periods. 

 

Watch your stress levels

Stress is a well-known inhibitor of periods. Many women find that they skip a period when they move house, travel or change job. If your life is stressful make sure you take time out every day to relax and unwind or simply daydream.

 

Exercise, but don’t over do it.

Regular, moderate exercise for at least 30 minutes a day can help balance your hormones and encourage regularity. The key word here though is moderate as exercising too long or too hard can make periods stop or become irregular.

 

Herbal remedies

Hormone-balancing herbs to choose when your periods are irregular are:  agnus castus, dong quai and Siberian ginseng (if stress could be a cause). For heavy bleeding choose: Dong and Ladies’ Mantle which can be used to improve the functioning of your womb, to help stop excessive blood flow, and to balance the hormones.  Other useful herbs are: cranesbill, which is an astringent with a good track in treating menorrhagia and yarrow also has astringent qualities and is believed to tone the blood vessels (for more information see my book ‘Nutritional Health Handbook for Women’ see the Resources Page).

  

Important nutrients

Foods rich in phytoestrogens, such as soya, nuts, seeds and vegetables, can help ease heavy bleeding because they can help to keep oestrogen under control and prevent excessive build up of the lining of the womb. Foods rich in vitamin A, B, C and zinc, such as wholegrains, fruits, vegetables, nuts and seeds, are also important for heavy bleeding but it is especially important to make sure you are getting enough iron. Ask your doctor to confirm whether or not you are anaemic. Essential fatty acids can also be an important way to control heavy bleeding so include an Omega 3 supplement if you do not eat much oily fish (see Omega 3 Plus on the Resources Page).

 

Avoid coffee

Coffee increases menstrual flow so best to avoid. It’s also best to avoid drinking black tea with meals because this reduces the amount of iron that is absorbed. Nettle tea can be helpful as it improves the absorption of minerals including iron. 

 

Agnus Castus

The single best herb for regulating the menstrual cycle is agnus castus. When taken regularly it regulates the timing of the menstrual cycle by acting on the pituitary gland which in turn releases the hormones that regular ovarian function. Lady’s mantle is another herb often recommended for heavy bleeding or flooding. (see Agnus Castus Plus on the Resources Page).

 

Cinnamon

Chinese herbalists often recommend cinnamon for keeping menstrual cycles regular and stemming heavy bleeding. If you are bleeding heavily sip a cup of cinnamon infusion, chew a cinnamon stick or take five to ten drops of tincture once or twice a day.

 

Acupuncture

Pressure on acupressure points for one minute of every fifteen is an effective sedative for flooding. One point is located above the centre of the upper lip (under the nose), and the other is at the top of the head.