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The Book		Advanced, Integrative Management of Menopause
Menopause Type^® Questionnaire		by Joseph J. Collins, N.D
		The most advanced approach to managing menopause is an approach in which the healthcare needs common to all women are consistently addressed while at the same time meeting the unique needs of each individual woman. Rejecting the one-size-fits-all approach, both traditional and alternative practitioners realize that there will never be a specific drug, hormone, herbal, diet, exercise or any other remedy than can be widely administered to achieve optimal wellness for women.
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See Website Table of Contents		As traditional and alternative models of healthcare continue to merge, integrative healthcare now offers women an advanced integrative model to managing menopause. By its very nature, this model requires integrating multiple concepts and protocols, which collectively yield a comprehensive and personalized system to achieve improved quality of life and decreased risk of disease for each unique woman. The following seven concepts lay down the outline of this model and present a directive to address every part of every woman requesting support for managing menopause.
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1. Replenishing Lifestyle & Diet: Appropriate diet, exercise, rest, sleep, recreation, social interactions, hydration, and detoxification contribute to vitality and replenishing of vital tissues best when these components are truly part of a lifestyle. When detoxification and intestinal health are parts of a healthy lifestyle, it proves to be more effective for long term vitality and maintenance of function than waiting until “something has to be done”. Properly managing menopause always requires optimal lifestyle first. Even bioidentical HRT cannot make up for unhealthy diet and lifestyle.
2. Essential Fatty Acids: The ability of essential fatty acids (EFAs) to influence menopause related health issues is so strong that EFAs must be addressed as a category in and of themselves. The ability of EFAs to maintain ideal cell membrane fluidity, allowing optimal transport of molecules such as insulin across the membrane, is critical for adult health. Proper EFA balance may also down regulate inflammation, and enhance tissue health and bone density. Many of the optimal functions that have traditionally been surrendered as humans “grow old” are in fact due to becoming EFA deficient.
3. Complete Multiple Vitamin & Mineral: The debate is over. The fact is that optimal health requires the daily intake of a high-grade vitamin & mineral formulation, with additional Vitamin E. With a high percent of adults in North America having less than the minimum daily requirement of 10 or more essential nutrients, this becomes a greater concern as a woman goes through the biochemical changes inherent in menopause. Vitamins and minerals, the cofactors required for every biochemical process taking place in the human body, are all essential for quality health in the woman of menopause age.
4. Appropriate Herbal Formulations: When herbal therapies are appropriate to the unique needs of each women a more cost effective and clinically successful outcome is achieved. The recommendation for synergistic estrogenic, androgenic or progesterogenic herbal formulations must be based on a clear understanding of how menopause type® affects the life of each woman. Formulations must not only be synergistic for the specific hormone function that is targeted, but they must work synergistically with other formulations that may be indicated for a specific menopause type®. Understanding the menopause type® allows us to realize that each woman has an individualized need for phyto-estrogens, phyto-progestogens, phytoandrogens and/or phyto-anti-androgens, so the formulations must work together synergistically. Likewise herbal formulations must be synergistically formulated. Please review the Menopause Type® Approved formulations, to find out which formulations are synergistically formulated, and are effective for managing any of the menopause types®.
5. Uniform Health Preservation: Uniformly meeting the healthcare needs common to all women is part of comprehensive healthcare. Bone health and cardiovascular health have been long time concerns for the woman of menopause age. Increased awareness of insulin resistance, unhealthful body composition and excessive oxidative stress appear to be expanding the scope of what is considered good health preservation. While it is rewarding to women when symptoms abate and quality of life improves, healthcare professionals must diligently raise awareness of the silent, insidious diseases.
6. Special Needs: While the afore mentioned measures can collectively improve the quality of life and decrease the risk of disease, each woman’s biochemical individuality, health history and genetic function may present her own special needs. Insulin resistance, body composition and inflammation disorders that do not respond to diet and EFAs require targeted interventions. Residual symptoms that diminish quality of life, despite proper herbal therapies should be addressed at this time. Targeting special needs is most effective after foundational therapies have been implemented.
7. Evaluate and Consider BHRT: Evaluation and possible prescribing of bioidentical hormone replacement therapies (BHRT) is the last consideration in advanced management of menopause. Lifestyle changes, alone or combined with a nonprescription remedy (such as dietary isoflavones, vitamin E, or black cohosh) should first be considered. For BHRT to be clinically effective there must be proper levels of EFAs as well as the cofactors required to respond to hormonal messengers. Equally important is the ability of the body to maintain the increased demands for metabolic clearance brought about any form of HRT.
Applying the Seven Concepts of This Directive: Two Clinical Models
Classic Linear Model			Web-Like Interconnectedness
Though the seven concepts are presented in a sequential format, they can be applied in clusters of the first four, then the next two, and finally the last. These three steps are best performed in visits that are 3 – 4 weeks apart. They must be at least 3 weeks apart, which will ensure adequate time for physiological response to therapy. The length of time between these visits should be no longer than 6 weeks, which will ensure that a positive outcome is observed, and any need for modification of therapy is addressed.			Though a linear sequence of events can be used to demonstrate the process of therapeutic intervention, in reality, the seven concepts have a web-like interconnectedness. Any intervention in any of the concepts will affect all other concepts. An optimal Lifestyle & Diet will affect other concepts by contributing essential fatty acids, vitamin & minerals, phytohormones, calcium and health preservation behaviors. It will also address special needs and significantly determine the efficacy of BHRT.
To illustrate this in a linear algorithm, it would present as three distinct visits with a healthcare professional as noted below:			Therefore, while it is ideal to initially focus on Replenishing Lifestyle & Diet, it is understood that all seven concepts are being addressed at the same time.
1^st Visit	1). Replenishing Lifestyle & Diet 2). Essential Fatty Acids 3). Complete Multiple Vitamin & Mineral 4). Appropriate Herbal Formulations
2^nd Visit	(Ideally 3 to 4 weeks after first visit.) 5). Uniform Health Preservation 6). Special Needs
3^rd Visit	(Ideally 3 to 4 weeks after second visit.) 7). Evaluate & Consider BHRT
Conclusion:
The profound interdependence of these concepts cannot be overemphasized. As stated in the presentation of the first concept: “Even bioidentical HRT cannot make up for unhealthy diet and lifestyle.”
The same is true for Appropriate Herbal Formulations. For any herb to work properly there must be ample amounts of the cofactors present, which are provided by a Complete Multiple Vitamin & Mineral supplement. Likewise, Essential Fatty Acids are required for maintenance of cell membrane fluidity, which will allow optimal cellular response. As expected an unhealthy diet and lifestyle will significantly diminish the effective of herbal formulations, including phytohormones.
Once a woman has addressed each of the seven concepts, subsequent visits with a healthcare professional will continue to address each of the seven components over and over again in a continuous loop, which each visit identifying impedances to optimal positive outcomes. A subsequent visit may focus on a specific concept, such as adjusting the dose of the Appropriate Herbal Formulations, which may be weaned to a maintenance dose. Conversely, a different subsequent visit may focus on a specific interrelation, such as a specific component of the diet to address special needs.
When implemented in a complete and continuous fashion, these seven concepts will fully address every part of every woman requesting support for managing menopause.
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