Reviews & Testimonials-2020-2021

Angela Ingendaay MD & Helios Academy

Angela Ingendaay MD, has been a holistic physician for over 20 years and has an active practice. There is an innumerable amount of testimonies from the past, (Integrative Medicine, 5-Element Acupuncture and The Helios Method) and now you have the the possibility to write your own review for Helios Academy and Angela Ingendaay.

Please go to the bottom of this page, login using Disqus, Facebook, Twitter or Google, and write your own testimonial.

Your writings will be much appreciated!

~ The Helios Academy Team





Hyrodroxychloroquine: Hype or hope? A possible treatment for COVID-19

As COVID-19 rages through the world with devastating consequences, scientists and doctors are attempting to come up with therapeutic solutions. Some of these are based on clinical experience already gathered in other countries. At this point, Hydroxychloroquine is one of the agents of great interest.  

What Is It?

The modern drug is a derivative of a constituent of the bark of the Cinchona plant, which was taken as an herbal remedy by indigenous Peruvians four centuries ago to treat fever. It is a medication that has traditionally been used against malaria but also has well-proven immunomodulatory properties. For years, this medication has been on hand for the treatment of the autoimmune arthritic type of conditions such as rheumatoid arthritis and systemic lupus erythematosus (that have nothing to do with malaria or any other infectious condition as such). 

For the past fifteen years, the premise involving Hydroxychloroquine is that it could be effective against coronavirus infections and found to have definite effectiveness. Hydroxychloroquine is remarkably well-tolerated, especially for short term use, as it would be as applied in the fight against COVID-19. It has been used successfully in both China and Australia. It is now on the drawing board for potential treatment protocols even in the U.S. Note we are referring to Hydroxychloroquine and not Chloroquine itself, a drug with considerably more side effects.

 How Does It Work?

Hydroxychloraquine appears to have several mechanisms of action. It seems to be an immunomodulator suppressing the malignant hyperactivation of the immune system resulting from certain viral infections. It also interferes with the virus’s ability to replicate, in two different ways. First, it works through channels in the cell membrane that the virus uses to enter the cell and seems to block access to those channels. The drug also prevents SARS-CoV from plugging into a receptor called angiotensin-converting enzyme 2, or ACE2. When the virus inserts its spike protein into the ACE2 receptor, it sets off a chemical process that alters the structure of the receptor and allows the virus to infect. An adequate dose of Hydroxychloroquine appears to undermine this process, and in turn, viral replication in general. 

However, Hydroxychloroquine is not an approved and tested therapeutic in humans. The U.S. Food and Drug Administration (FDA) this week stated that this drug is not on the approved list as treatments for COVID-19. The drug is approved to treat malaria, lupus, and rheumatoid arthritis, but assessment and testing in the framework of COVID-19 are still necessary.

Of course, like any medication, this drug has side effects and should be prescribed by a knowledgeable physician. The side effects are to a large extent benign with the more serious concern about damage to the retina in the eye not of concern in a short term course. Many patients with rheumatoid arthritis are readily started on a regimen of 400 mg twice a day and remain on that dosage for years. The COVID 9 protocol is a 7-day course.

Testing and Effectiveness in the United States

At present, the FDA is organizing a large clinical trial to assess the drug’s effects formally. FDA Commissioner Dr. Stephen M. Hahn (who spoke at a recent White House briefing), has noted that this trial to assess the drug’s effects was made at the request of U.S. President Donald Trump, but that caution must be utilized; that no promises can be made; and trials must be completed just like all FDA approved drugs. 

 Still, reports of successful informal trials are surfacing rapidly. For example, a medical doctor in New York state has announced that he has treated 350 people with COVID-19 with a one-week course of Hydroxychloroquine, azithromycin, and zinc, with a remarkable success rate and minimal side effects. Dr. Vladimir (Zev) Zelenko of Monroe New York has indicated in a public letter that his treatment plan has resulted in zero deaths, hospitalizations, and intubations. Adverse side effects reported in his trial are almost non-existent, other than approximately 10% of patients showing temporary nausea and diarrhea. Based on his treatment success, Zelenko is recommending initiation of treatment in an outpatient setting. He notes that in his experience, such treatment prevents acute respiratory distress syndrome (ARDS), avoids the need for hospitalization, and ultimately saves lives.

 It is interesting to note that researchers at the University of Minnesota have embarked on a study including 1,500 people to probe the drug’s effectiveness further in preventing the development of COVID-19 after people are exposed to SARS-CoV-2. The trial is open to an enrollment of healthcare workers or household contacts nationwide from across the United States, and researchers are hoping to have results within a matter of weeks.

 Global Testing and Effectiveness   

Preliminary reports from China, South Korea, and France suggest that the treatment is at least somewhat effective in treating human patients. For example, Chinese researchers report randomized trials in humans to indicate promising data. In France, results from a small study of 24 patients suggest that Hydroxychloroquine could quicken recovery. Doctors said 25% of patients who received the drug tested positive for the virus after six days, compared with 90% of those who did not receive it. 

 Another study in France published this week in the International Journal of Antimicrobial Agents described the treatment of 42 patients hospitalized with COVID-19, 26 of who received Hydroxychloroquine, and 16 of whom received routine care. Of the 20 patients who took the antimalarial and completed the study, six also received the antibiotic azithromycin. All six of these patients were free of SARS-CoV-2 by the fifth-day post-treatment, while seven of 14 patients who took Hydroxychloroquine alone were negative for the virus, and two of 16 control patients were no longer infected.

 Finally, Hydroxychloroquine is among the four treatments tested in an international “mega” clinical trial, announced on Wednesday by the World Health Organization (WHO), and the U.K. has added Hydroxychloroquine to its list of medicines under export controls. This study is referred to as SOLIDARITY. Overall, more extensive clinical trials will be necessary to determine how effective the drug is.    

 What About Accessibility? Good News and Bad News

Now for the bad news. According to the American Society of Health-System Pharmacists, Hydroxychloroquine has been in short supply since earlier this month. 

Fortunately, however, Israeli generic drug giant Teva has announced that it will provide ten million doses of Hydroxychloroquine to U.S. hospitals free of charge. Additionally, the pharmaceutical company Bayer donated three million tablets to the federal government, and Novartis, Mylan, and Teva are moving to follow suit.

What Happens Next?

Doctors in the U.S. have wide latitude to prescribe drugs “off-label,” meaning for conditions beyond their initial FDA approval. Doctors still have the liberty to mandate it in view for this purpose, given the fact that it has a good chance of at least improving the condition.

And this just in: The FDA is on the cusp of designating the drug for Expanded Access, or “compassionate use,” to address the novel coronavirus (COVID-19) pandemic, according to FDA Commissioner Stephen Hahn, MD, and President Donald Trump (Coronavirus Task Force. White House Press Conference. Presented: March 19, 2020. Accessed March 19, 2020.) Expanded Access allows patients with severe or life-threatening cases of the virus to have access to them as investigational medicinal products, in the framework of “compassionate use.”

 Dr. Ingendaay Weighs In

Hydroxychloroquine holds excellent potential in at least decreasing the intensity of the progression of this disease. While we don’t have all the information we need yet to consider this a 100% effective treatment, we are not taking much of a risk in allowing patients access to this course of treatment. The risk is minimal, the potential benefit now unmeasurable.

It certainly looks like the risk versus benefit ratio is rapidly tipping toward benefit. The risk of not giving this medication a chance vastly outweighs the risk of causing any side effects, especially since this drug is generally well-tolerated, especially for a short course. As a physician, I would highly recommend giving any patient with COVID 19 the chance to benefit from it. 


MenoPassage and the Wisdom of Chinese Medicine


MenoPassage: the holistic Journey through the menopausal years

Ancient Chinese medicine reveals the menopausal years to hold the potential of a profound transformational passage. This is for one simple reason: it sheds light on the deeper currents of life and how they start moving differently within one in the course of these years. This in turn allows the lotus to arise out of the mud. Actually, the mud turns into the deeply nourishing terrain it can be and allows new flowers of creativity and vitality to arise.

Indeed, it is a time of life to nourish the “Yin Essence”, the yin being the deep, nourishing energy within. “Essence” also relates to our core energy and the gifts we have carried through life from birth. Nourishing this aspect allows a woman to better regulate her hormones and sexual energies. Yin fluids build gently for release at just the right time.

It is difficult to boil things down to a nutshell because it encompasses such a deep understanding of how we function, how as human beings, we are suspended between Heaven and Earth and need to align with the laws of both these worlds. But I am passionate about sharing this understanding so here is my humble attempt.

Most people think of Chinese medicine as the use of herbs and acupuncture, perhaps to bring about better flow and balance of vital energy. This is certainly true, but it goes much beyond that. It is really more about understanding and stimulating the internal regulatory intelligence, making sure that the right part is in charge of each of our physiological processes and that all parts work in harmony.

Chinese medicine is not so much interested in the physical body as such, but rather in the regulatory functions that make it tick and allow it to function in harmony with Nature and in integrity with one’s deeper purpose. We are suspended between Heaven and Earth and have Body, Mind and Spirit to attend to and bring into harmony with the greater cosmic forces. This is the main thing, and everything else revolves around that.

They describe a whole microscosm, which they refer to as an Empire. It is ruled by an Emperor and a whole set of Officials which all have their own intelligence, their own identity and their own tasks. Each of  these officials is referred to as one of the inner organ systems, such as the LIVER, the HEART and the KIDNEYS. These terms by no means are confined to the physical organs but rather refer to a particular aspect of our self regulatory intelligence, with all its internal feedback loops on the level of the BODY, the MIND and the SPIRIT. They are all meant to work in harmony with a very precise set of tasks and mutual checks and balances. When we speak about these regulatory systems, we will always keep them capitalized to minimize confusion.

By the time most of us have reached midlife, the harmony and cohesive strength of this Empire has been challenged many times and eroded at least to some extent. In addition, the hormonal changes that happen around that time tend to disturb the natural balance of things just a bit more. The magic of it all is that by rekindling the intelligence of the system, one can reestablish the vitality of the whole with remarkably simplicity.

This is one of the great secrets of MenoPassage: it is a wake-up call to heed the order in our inner kingdom. Once we have woken up to this reality, it is completely in the realm of possibilities to return greater harmony to the Empire with a few well-guided steps and a bit more intensive self-care. We can not only regain the vitality we had in our younger years, but reattune ourselves to our inner compass. In this way, we can continue building on the richness and wisdom of our past experience to keep moving towards greater creativity and continue unfolding our destiny There is something innately magical about arriving at the midlife station, reassessing everything and consolidating one’s foundation so one has strong basis to move forward from.

The main Officials involved in MenoPassage are the KIDNEYS and the LIVER, followed by the SPLEEN, of course all overseen by the HEART, who represents the Emperor. And then of course there are a wide variety of individual variabilities. The KIDNEYS and LIVER are the primary Officials that will give us the classical menopausal symptoms, such as the hot flushes, night sweats, insomnia, mood swings, anxiety etc… so we will be to a large extent focusing our discussion on these for the time being. They are in charge of most of the hormonal realities as well as the interaction of hormones with neurotransmitters, thus indeed major players in the MenoPassage years.

On the level of the physiology of the Body, the KIDNEYS actually refer primarily to the adrenal glands and the aspects of the brain that regulate it, the HPA (hypothalamus-pituitary-adrenal) axis. Estrogen is a hormone deeply linked to the KIDNEYS, and its gradual diminishment during the menopausal years can cause some imbalance in that system, particularly if it is already strained for other reasons. They are also in charge of the health of the Bones, thus menopausal issues of osteopenia and osteoporosis, as well as our hair, thus a tendency to hair loss around that time.

Beyond that, the KIDNEYS is where our Essence, the “Jing” resides, that deeper gift of our heritage that we receive at birth, from both our parents and our “Heavenly heritage”. It is what shapes our Destiny, “Ming” and allows us to be in tune with our deeper destiny, the gift that we have been born with.  The Essences are also considered the basis of growth, development, and reproduction.


The KIDNEYS also give us the ability to will things into being, take action that creates a desired result. It is clearly one of the key players in the course of MenoPassage and we will spend more time to understand it. As we focus on supporting it, we will address not only many of the physical symptoms and issues of the menopausal years but also enrich the MenoPassage journey by supporting the deeper Essences.

Now let us now look at the LIVER. Again, the LIVER Official is only marginally related to the 3 lb organ under our rib cage. One of its primary functions is to “regulate the smooth flow of Qi”, Qi being our vital energy.  It is very much related to how we are able to relate to stress in all its many varieties. When things get too intense, the energy can tend to stagnate. This, in turn, can give rise to symptoms that usually have greater intensity, migraines, burning sensation in the eyes, peptic ulcer disease and gastroesophageal reflux, intense hot flushes, especially in the afternoon.

On the Mind level, the LIVER is responsible for the smooth flow of emotions. It is also “the general of the armed forces” within the internal Empire. It will strategize to allow us to accomplish our aims, make proper use of our resources and advance and retreat at the appropriate time.

On the Spirit level, the LIVER gives us a deep sense of DIRECTION in life. In the menopausal years, this is often very much something that a woman wishes and needs to recalibrate. If the LIVER official is functioning healthily, this will unfold on its own. If there is an issue, there may be a sense of lack of direction and motivation, dark outlook, maybe even the dark night of the soul. And of course, an imbalance in the health of that official will usually manifest on all levels, the body, the mind and the Spirit, so physical symptoms such as intense migraines and a history of intense PMS and pelvic pain may well accompany this mental state.

We are now getting a bigger picture of why the health of these OFFICIALS is so important to tend to, as they regulate our entire lives on all levels. The menopausal years act as a wake up call to attend to their balance and well being. As the endogenous hormones wane, so does some of the support for the KIDNEYS and the LIVER, and any imbalance will show itself more acutely. This in turn is an invitation to take a holistic journey through the menopausal years – MENOPASSAGE.

We should also briefly touch upon the SPLEEN, which is one of the Officials responsible for our deep inner nourishment. The STOMACH Official allows us to ingest… any type of nourishment, be it food, information, experiences or whatever else., and breaks these down into their constituents, the SPLEEN then takes these building blocks and makes them useful to us as an individual. In health, they allow us to receive deep nourishment and satisfaction from what we ingest, the constituents become transformed into the essence of who we are and enrich that. When these officials do not function properly, one will often have a sense of heaviness and fatigue, some digestive issues, perhaps excessive vaginal bleeding, issues with the clarity of the mind such as brain fog and forgetfulness. These are the Officials most readily responsive to proper self care, attentiveness to diet and backing up from excessive work or other activity etc…

Lastly, the HEART can also be involved, though more rarely. As mentioned before, the HEART Official is the great Emperor and holds the reins of the Empire in his hands. He also allows “the SPIRITs to circulate”, which allows us to live with a deeper sense of purpose and aliveness, a sense that Spirit is guiding our path and enlivening us. Dysfunction results in anxiety, palpitations, loss of control etc…

We will go into greater detail about the wonderful structure of this Empire of ours and how it relates to our inner well being and growth in a future blog. Suffice it for now to understand that it is about a regulatory intelligence that can be supported in a variety of ways to allow us to have a vastly fruitful MenoPassage.

MenoPassage and plant derived hormones

MenoPassage: Helping ourselves with plant-derived hormones

MenoPassage – A holistic journey through the menopausal years




It is well known that plants including herbs can have a very powerful effect on our endocrine system including all the sex hormone receptors.The best know kind are Phytoestrogens, but they include plants having a progesterone or testosterone effect. Let us have a more in depth look so that we might more readily be able to harness the power they have to offer. Fore women in MenoPassage, the message is simple: before or instead of opting for pharmaceutical hormone replacement, see if you can tap into the wide array of resources available in the natural pharmacopoeia.

There are a large variety of herbal formulas available over the counter, both as oral capsules or transdermal creams. Generally, I prefer the transdermal route, as it bypasses the stomach and the first pass through the liver and gives one better bioavailability. You can also do single herbs, depending on what you feel you need. The following discussion might elucidate how you might go about making a choice that fits your specific needs. These choices can be complex, it is good to have a framework within which the choices might be more straightforward. This will of course not be an exhaustive discussion, but might just start giving you some guidelines.

These plants used to be used primarily for the control of vasomotor symptoms, i.e. hot flushes, but their use has widely expanded in the last few years. Thus beneficial effects can be seen in a variety of tissues including bones, heart, brain, breasts, vagina. In addition, plants promoting progesterone activity can have beneficial effects on the immune system. Plants supporting testosterone activity will be strengthening and stimulating, while also supporting healthy brain, muscle, immune and cardiac functions.

These plants also have the power of modulating the emotions, decreasing anxiety, increasing mental focus and alleviating mood disorders. MA few major players in this category are: Hops (humulus lupulus), which will settle restlessness, anxiety and sleeplessness (yes! A glass of beer, which generally has hops as a major constituent, will do just that, but an herbal remedy might be a better friend on a daily basis), and Sage, which will help improve memory and have a calming action by activating the GABA system, the same neurotransmitter also targeted by the benzodiazepines such as Xanax and Valium.

Whether you need estrogen, progesterone and /or testosterone remains to a large extent experiential. Yes, you can get your blood levels checked, but that may or may not reflect what you really need and how you are going to respond to it. There are definite patterns that can be elucidated (subject for a future blog), but in my clinical experience, it is best to get started on some well balanced support and then adapt as one goes along, depending on symptomatology.

Theses plants act in a variety of ways and it is easiest to understand them by differentiating their mechanism of action.

  • Some bind to hormone receptors, “Phyto-hormones”
  • Some increase the ability of the body to make hormones, “Phyto-hormonogenics”
  • Some mimic important hormone functions , ”Functional mimetics”

The first kind, phyt-ohormones, generally have weak hormone activity. They will do something, but not necessarily a whole lot. This also implies that they are not going to be stimulating enough to cause much concern regarding the possibility of causing cancer, as pharmaceutical hormones can. Depending on the plant, they can stimulate estrogen (such as red clover, kudzu, sage and soy), progesterone (wild yam) and testosterone receptors (“horny goat”).

The second category, the “phyto-hormogenics”, may act either on the endocrine glands themselves or stimulate the brain to upregulate its production. Forskolin directly stimulates progesterone production Withania somnifera stimulates testosterone production.

The third type, the “functional mimetics” is perhaps the most intriguing as they do not even necessarily bind to the endocrine receptors in the cells to mimic the effect of the hormone. It’s like they don’t need to use the same key to enter the door and activate the intracellular mechanisms. The most well-known plant in this category is Bacopa Manniera, which echoes estrogen’s ability to help you adapt to stress and maintain cognitive function. Black cohosh also belongs to this category and is frequently found in menopausal herbal formulas.

Unfortunately, the whole world of “xeno-estrogens”, which are comprised primarily of environmental pollutants, also belongs here. These pollutants, such as a variety of different plastics, can have a powerful dysregulating effect on the endocrine system, causing such issues as premature puberty, infertility and cancer of tissues carrying gonadal hormone receptors, primarily breast, uterus and ovaries. This is a subject for future discussion.



Broadly speaking, phytoestrogens include isoflavones, coumestans, and lignans. Not only are they present in a variety of herbs, but foods as well, and just making some dietary adjustments may provide one with sufficient support. These compounds have been identified in fruits, vegetables, and whole grains. Soybeans, clover and alfalfa sprouts, and oilseeds (such as flaxseed) are the most significant dietary sources. Studies in suggest that dietary phytoestrogens play an important role in prevention of menopausal symptoms, osteoporosis, cancer, and heart disease, probably from  their\estrogenic and antiestrogenic effects, induction of cancer cell differentiation, inhibition of tyrosine kinase and DNA topoisomerase activities, suppression of angiogenesis, and antioxidant effects. Although there currently are no dietary recommendations for individual phytoestrogens, there may be great benefit in increased consumption of plant foods.

Let’s look at a few herbs first:

Black cohosh: not only does it have estrogenic effects that may alleviate hot flushes, it also has calming effects, “relaxes constraint and calms the mind”. It effectively addresses tension patterns, especially with a sensation of heat and flushing. Through its beneficial effect on the heart, it may alleviate anxiety and palpitations, especially when stress-induced.

Red clover: it is particularly helpful for supporting the fluids, thus addresses the dryness symptoms of perimenopause, vaginal dryness, dry skin, brittle hair. It is also good for eliminating toxicity creating inflammation/”heat” in the skin, chest or intestines.

And phytoestrogens in foods:

Soy: It has a very high content of isoflavones, particularly genistein. It is notable that Asian cultures generally consume large amounts of soy and studies have revealed much higher blood levels of genistein. At the same time, menopausal symptoms are generally much less predominant in these cultures, usually only in the 10-20% range, whereas in the Western cultures, it is more in the 80% range.

Its beneficial dietary use has recently been questioned and analyzed, but results suggest that soy is either beneficial or neutral in its effect on health. It is a nutrient-dense source of protein that can safely be consumed several times a week. I personally prefer the fermented and sprouted forms, i.e. miso, tempeh and fermented tofu, as the processes of fermentation and sprouting predigest the proteins and sugars that may otherwise possibly be problematic.

Fruit and berries – Some berries are rich in phytoestrogens, most notably strawberries, raspberries and cranberries. Peaches and a variety of dried fruits such as figs, apricots and dates are also particularly rich in phytoetsrogens.

Cruciferous vegetables such as brussel sprouts, cauliflower and broccoli also contain high levels of phytoestrogens and specifically have an enzyme called indole-3-carbinol, which gets metabolized into diinolylmethane, DIM. This DIN is well-known for supporting healthy hormone levels by favorably influencing the ratios of estrogen metabolites. Indeed, estrogen may be metabolized into toxic waste products, and DIM steers the body away from this (more on this in a future blog).


Thus there are multiple ways in which we can augment our estrogen intake and enhance its metabolism that gives us support in the menopausal years without having to have recourse to pharmaceutical grade hormone replacement. The effect will be milder and in harmony with our bodies.

For a discussion of plants having progesterone and testosterone effects, please stay tuned, the next blog will be dedicated to this subject.

by Angela Ingendaay, MD

Angela Ingendaay








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Wisdom of MenoPassage

Wisdom of MenoPassage: your own deep feminine knowing…to make a shift

MenoPassage: a holistic Journey through the menopausal years.

Wisdom of MenoPassage

Menopause can be very tough, a time when women seem to lose their bearing to some extent and need to work their way through increased anxiety, instability, perhaps depression and reestablish their sense of direction and identity. Even though nowadays there are many solutions readily at hand, a little guidance through the maze of options may well be warranted, especially if it can address more than just the basic health issues of the menopausal years.

I would like to introduce you to the MenoGuide. She is personified by an OWL! She represents your own inner wisdom that has already led you through so many stages of developing as a woman and is ready to accompany you through yet another journey. Indeed, MenoPassage is about a journey and encompasses body, mind and Spirit, and we need to honor the wisdom of Spirit in lending us guidance in managing our body and our mind. The OWL’s wisdom is given voice by many great experts in the field, but the reason she is able to guide you is that she is actually within you, a deep inner knowing that guides you in transforming the many challenges of the menopausal years into new opportunities for growth and creativity.

The MenoGuide – the OWL – is highly experienced in leading you through the thick, the dark and the magic of MenoPassage and allowing you to see the new potential unfolding for you. Her sight is sharp in the dark of the night and in her wisdom, she loves exploring all the recesses where the obstacles to your well-being may be hidden. Her world encompasses magic, mystery and ancient knowledge, and this is exactly what she wants to share with you. The OWL is known to be in perfect synchrony with the moon’s cycles of renewal. Deeply connected to femininity and fertility, she loves to guide women into a cycle of renewal after reproductive fertility has come to an end.

We will explore a variety of experts that seem to reflect her wisdom, such as gynecologist Christiane Northrup, author of “The wisdom of menopause”,  “The secret pleasures of menopause” and “Goddesses never age”, and neurologist Daniel Amen, author of “Unleash the power of the female barin”. We will also look at the ancient Chinese as they encourage self tending during this challenging time of life and shed a different light on the physiology of menopause. They ancient Chinese are experts at ushering in the “second springtime” of a woman’s life. And we will use compassionate inquiry to unravel the personal pitfalls that women may be encountering. All this is part of the exploratory wisdom of the OWL.

Today, we will begin with the Owl’s wisdom as reflected in the writings of Christiane Northrup MD, a visionary pioneer and a leading authority in the field of women’s health and wellness, addressing the unity of mind, body, emotions, and spirit.

Because in essence, the menopausal years rock the boat, they are such a powerful wake up call to be in touch with our vital force, bring deep nourishment to ourselves and learn to bring our kingdom into new balance. As the hormones recede, you may now become aware of underlying levels of fatigue, anxiety, lack of motivation or direction, it may feel like a breakdown, but in essence it is a breakthrough. It is a bit of a cleansing fire.

Indeed, according to Christiane Northrup MD

In the course of menopause and thereafter, we can be” more in touch with what really matters to us, and our bodies act as incredibly accurate barometers that indicate how closely we live our lives in-line with our true heart’s desires… The menopausal transition is a wake-up call that’s urging you to make changes that will keep you in touch with your vital life force (sometimes called chi or prana). “

It is time to bring in more self-tending, be cognizant of the need for rest, touch, acknowledgement, intimacy and find a connection to inner guidance. As long as there is disconnect and denial, pain will ensue, which takes a lot of energy to uphold. It is time to do deep physical and emotional housecleaning to rid your self of all the old baggage that might be holding you back from unfolding into… such as the relationships and undertakings in our lives that deplete us because we fail to take charge and make sure we draw some benefit. With the shift may come a much greater ability to create the life we love.

Christiane Northrup MD

“The truth about this time of life is that when you have the courage to change your beliefs and behaviors so that you speak your truth and dare to cultivate pleasure instead of stress, you have the power to create a life of unbridled joy, unlimited abundance, and vibrant health.”

 The OWL is sending out an invitation to wholeheartedly cultivate a deep current of pleasure in our lives. This may not imply veering towards a hedonistic life… far from it, perhaps it is more of an invitation to move into deeper self-acceptance and self-embracing, tending to the deeper pleasures of the moment, the rich ness of friendship, beauty and sensuality that we are so much more able to open to as we mature. In many ways, this simply implies giving ourselves permission and delving deeper into what truly matters for us.

Christiane Northrup MD:

You have a chance of having “a much stronger creative drive now since your life energy isn’t being used in order to have periods and create babies. Instead, it gets rerouted into powerful urges to create other things—anything from a personal journal of poetry and sketches to a thriving new business… This is a time in life when your creative juices are ready and willing to flow like never before, even if you haven’t previously thought of yourself as very creative.”

As we start tending more towards our own need for deep nourishment, our creative juices may start flowing like never before. It is a bit like a flower opening in the sunshine of the new love and nourishment we bring to it. Many perceptions come together in a new way, we are able to synthesize a new understanding that will lead us to new ventures. And a new guidance will emerge as we become more open to a deeper current within our lives.

Christiane Northrup MD:

“Whatever doesn’t feed our soul and doesn’t make us feel vibrantly alive needs to fall by the wayside now. Our lives have no room for such things anymore. Everything we think, say, and do from this point on will either keep us actively engaged in living passionately and joyfully, or it will hasten degeneration and increase our chances of poor health and disease. It’s our choice to make.”

Be cause of the profound internal shifts and changes, it becomes so much more necessary to take a strong stance and make the changes that now suit us in a whole new way.

Again, from Christiane Northrup:

“Women who make a point of maintaining a strong, passionate life force become magnetically attractive to uplifting people and circumstances. So while you’re having a great time with all of the wonderful things you’re bringing into your life, you’ll also be sending out signals that say to the universe, I’m loving life and loving that I love life, so bring on more of the good stuff! The universe always responds, because whatever you give your attention to grows. And when you give your attention to bringing life-affirming, fun things into your life, you open up a channel for more of the same to come in. It’s as simple as that. In fact, this feeling of being in love with life itself is absolutely vital if you want to have a passionate, fulfilling relationship with a partner.”

This work in turn leads to the springtime of a whole new chapter of life, and we have so much more maturity to bring to it. The more we understand it is OUR CHOICE and that we get to embrace OUR OWN FREEDOM, the better this will go.




Northrup, Christiane:  “The Wisdom of Menopause.” New York: Bantam Books, 2012


HOT FLUSHES  and the nervous system

* Featured image by Julia Yellow for The Washington Post

MenoPassage: a holistic Journey through the menopausal years

Hot flushes are perhaps the one symptom that is most classically associated with menopause. Many women wonder why they have this pesky symptom that sometimes disturbs life quite profoundly. Pesky and sometimes deeply disturbing they are, and yet there are things we may gain from having to endure them, they may well become part of the MenoPassage Journey that leads one to greater inner strength and tranquility.

There are many aspects to this enigmatic phenomenon of HOT FLUSHES. A lot of it has to do with the brain and our nervous system. Indeed, the brain has receptors for estrogen that regulate its activity. In the menopausal years, estrogen levels tend to fluctuate a lot, and the brain has to make corresponding adjustments.

Our sense of how warm it is in our environment and whether we need to do something about it (primarily by SWEATING) is regulated by a specific center in our brain that acts as our thermostat, the “thermoregulatory nucleus”, it maintains the core body temperature within a specific range, “the thermoregulatory zone”. Sweating occurs when it goes above the upper threshold, whereas chills occur when it dips below the lower threshold. Women with hot flushes seem to have a more narrow range that they can tolerate, thus more readily developing the sweats and chills for no apparent reason.

But what leads to the narrowing of the range? This question remains unanswered, it most likely has to do with the large fluctuations of hormones in the brain during menopause. The sudden withdrawal and/or great variability in estrogen levels definitely seem to be a factor, these changes seem to entrain greater variability in certain neurotransmitters including norepinephrine and serotonin.  This in turn will also lead to mood swings, depression and sleep abnormalities.

Can we take charge of these changes in our nervous system?

It does appear to be so. Researchers have found  that it is indeed possible to calm down the fluctuations in hormone levels and thereby diminish hot flushes in a study involving almost 500 women. They were able to show that a key to diminishing hot flushes is RELAXATION, specifically slow-breathing techniques, which in essence are particularly effective in reducing an adrenalized/stressed state. This seems to help widen the thermoregulatory zone, or the range of tolerated temperature. So – enjoy and RELAX, breathe deeply and slowly and watch the hot flushes diminish.

I would particularly recommend the yogic practice of alternate nostril breathing (instructions to this are widely available on YouTube). Though of course, it is easy to just be attentive to one’s breathing and simply deepen the breath, but from my experience it is a good idea to get specific instruction as they are many nuances to pay attention to that will make the experience more effective. One such set of instructions is available for a free download from  the home page of my web site on the right hand side.

Another interesting observation that came out of the same study: endorphins plummet when you have a hot flash, so if we can keep our endorphin levels even and well boosted by exercising regularly as well as other methods outlined below, we have a greater chance of moderating this symptom.

This is actually quite significant, because it shows how much the state of our nervous system, the level of tension vs. deep quiet reserves is a significant factor in hot flushes as well as other menopausal issues. Nourishing our nervous system becomes a crucial element in our approach to hot flushes.

We can accomplish this in so many ways:

  • Exercise, somewhat vigorously, 3x/week for 20 minutes at a time, preferably accompanied by music you really like to get the most enjoyment and maximize the endorphins…. This will also help diminish hormonal fluctuations and thus stabilize your whole experience of menopause.
  • Making space for deep rest, sound sleep (which tends to suffer during menopause as well, subject for another day…)
  • A meditation practice
  • Herbal remedies: here we have a variety of different approaches:
  • Tonifying the nervous system with herbs such as oat straw, the queen of the nerve tonics, hops, gemmotherapy (another blog)
  • Detox and nourish the liver, which is essential to minimize the hyperreactivity of a stressed nervous system. Dandelion, Ho Shou Wu (a Chinese herb), yellow dock, milk thistle, chicory, burdock are all examples of herbs that may work well. You can easily find liver detoxification formulas that include some of the herbs.
  • Phytoestrogenic plants, includingmotherwort, fenugreek, fermented soy products
  • Supplements, vit E, Selenium, vit B, bioflavonoids esp Hesperidin 1000 mg
  • You can also try a homeopathic, lichesis, preferably 30X, has an 80% chance of working

In essence, the more you nourish your nervous system, detoxify your liver and connect to a deep, quiet place inside, the more you will be able to moderate this symptom. This also takes us into the realm of Chinese medicine, which I intend to get more deeply into in future blogs. Chinese medicine provides an in depth understanding of how to nourish and balance one’s nervous system to bring harmony and vitality to all functions and address a variety of symptoms that arise from stress and depletion of energy. 

Taking time to nourish yourself more deeply will enhance your whole MenoPassage Journey, will give you a foundation for stepping into the full vitality and creativity of the next phase of your life. We will continue discussing this in greater depth as we go along, so please stay posted.


by Angela Ingendaay, MD

Angela Ingendaay






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Hormone Health by Helios Academy

Hormone Health: things you can do yourself to enhance it

Menopassage: a holistic Journey through the menopausal years

 In the course of menopause, our estrogen and progesterone levels vastly diminish, no question about it. And yet, in the framework of enhancing your life in the course of MenoPassage, there are many things you can do for yourself that makes this trend have less of a negative impact. Thus the change in hormone levels can be seen as a great call to pay attention to the foundation of our health to ensure some level of stability and maximize our vitality.

 Let’s look at how hormones work for a moment, there are a few principles that we need to understand:

  • In general, hormones – sex hormones not exempt – activate receptors inside the cells to stimulate them to act in a very specific way. Now the receptors are set to a particular level of sensitivity, the stronger the signaling, the less sensitive they become. Thus as the hormone levels diminish and the signal becomes weaker, the sensitivity goes up and the response continues to be more than one might expect. This definitely acts in our favor.
  • For the hormones to act on our receptors, they need to be taken into the interior of the cells, and this process can be enhanced with essential fatty acids, EFA’s, as they help to maintain ideal cell membrane fluidity, allowing optimal transport of hormones across the cell membrane and into the cell.
  • The estrogen we do retain – or supplement for that matter – gets metabolized, meaning broken down and made ready for excretion. This process occurs in the liver and the gut, and can take several pathways, some of which are more toxic than others. One of the pathways can actually end up with carcinogenic metabolites, meaning that it will increase your risk of cancer. There are ways of guiding this in the right direction, especially with appropriate diet. There are also ways of measuring which pathway predominates, I recommend this for anyone on hormone replacement or at higher risk of cancer to begin with. Ask your doctor for the test.
  • It is worthy to note that we not only have our own estrogens on board but also are exposed to a variety of estrogens in what we consume, be it phytoestrogens form a variety of vegetables which actually help us stay healthy and vibrant, or xenoestrogens, the wide array of estrogen mimicking compounds present in plastic, packaged food and drink trays and containers, ( more so when they’ve been heated in the sun or an oven ) as well as hormones fed to animals and transmitted through meat and milk consumption. All of these need to be metabolized and eliminated and it behooves us to maximize healthy elimination.
  • Hormones are also eliminated through the intestinal tract. There are a few items that will enhance this elimination. For example, a healthy gut flora is essential for this process to occur. Thus PROBIOTICS are particularly helpful for this issue. In addition, plentiful fiber is essential as we will see below.

Thus the four pillars of hormone health are:

1.Healthy lifestyle and dietary choices that support optimal hormone function
2.Complete high-grade multiple vitamin-mineral formulation
3. Omega-3 essential fatty acids rich in DHA and EPA
4. Probiotics with multiple species and high count

Hormone Healthy Lifestyle & Diet

Appropriate diet, exercise, rest, sleep, recreation, social interactions, hydration, and detoxification all contribute to vitality and health. Sleep deprivation, excessive stress, or inadequate exercise can each result in decreased levels of testosterone and thyroid hormones, and in an increased risk of obesity. A balanced diet with fruits, vegetables, salads, fish, and lean meats or poultry will support optimal hormone health.

The foods that actually promote hormone health and  promote proper metabolism and detoxification of estrogen include:

  • High quality protein, fish, poultry, meat, eggs… will provide the necessary amino-acids that the liver requires for a healthy detoxification process
  • Essential fatty acids, as we discussed above, as can be found in salmon and mackerel. EFA’s come primarily in 2 highly beneficial forms, DHA and EPA, and I generally recommend a combined content of more than 2 g/d.
  • Eat seeds such as sesame, fenugreek and flax, they produce a fiber called lignan that helps eliminate estrogens form the intestinal tract. In fact dietary fiber of all kinds enhances healthy estrogen metabolism
  • Eat cruciferous vegetable, broccoli, brussel sprouts etc… they contain an enzyme referred to as DIM, which helps to safely eliminate estrogens. It ahs actually been shown that people with higher levels of DIM have lower cancer rates,
  • Keep your levels of VitD optimal, it definitely is able to promote healthy metabolism of estrogens
  • Eat fermented food such as sauerkraut, kimchee and pickles and/or add a good probiotic to your diet.
  • Avoid sugar! Sugar has been shown to INHIBIT the regulation of testosterone and estrogen, causing imbalances in hormone balance

These are all simple things that are part of a healthy diet to begin with. It behooves us to pay attention to all these details to have a healthy passage through menopause… and in the end, a highly productive MenoPassage, a holistic journey through the menopausal years that opens a door to new levels of vitality and creativity.

Please add your comments at the bottom of this page. Don’t hesitate to contact us for any questions you may have.

by Angela Ingendaay, MD

Angela Ingendaay






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Part 2-Riding Your Planetary Cycles

Riding Your Planetary Cycles through MenoPassage– an astrological guide to emotional turbulence, growth, and renewal in midlife and onward.

MenoPassage: a holistic journey through Menopause


As we have discussed in part 1 of this article, our lives and all the challenges and treasures they hold for us may well be influenced by planetary cycles, and these become particularly interesting in midlife, when the MenoPassage Journey is in full swing. Understanding these cycles can bring greater understanding, acceptance and depth to one’s experience, so we will continue to explore these in greater detail.

Riding our planetary cycles through midlife and beyond

William Sebrans, evolutionary astrologer and coach

We had seen that for the midlife / Menopassage Journey, the following planetary shifts may be of particular significance:

 Uranus opposition — somewhere between the ages 40-44, often over the course of a year or more — involving radical breaks from the past, liberation, sudden loss. A liberation and entering into the MenoPassage Journey, setting up the process of becoming remolded.

Chiron return, around age 50. — involving an activation of a sacred wound, up for healing, and also a break from the bonds that have held us back. THIS may very well be the greatest contributor  and challenge to the MenoPassage Journey.

Second Saturn return — the year around age 58, a life accounting of sorts — either a harvest and/or a sober recognition of what has passed and what is possible. A Third Act beginning. This coincides with a certain kind of graduation from the MenoPassage Journey, and reflects to some extent on how deep the Journey has been.

Now we will explore more closely how to Employ These Astrological Descriptors and Revelations

“Astrology is not so much concretely predictive as archetypically predictive.”

                                                                                                     – Richard Tarnas

While there are methods to divine amazing things with astrology, including finding lost keys (really!)  precise astrological predictions are notoriously unreliable to the detail. That said, — they are often in the ballpark.

Archetypes are ranges of potentials, not exact characterizations. There are , for example, different kinds of kings and different kinds of servants, but the roles are distinct.  

A Saturn to Moon transit, for example,  will likely not be festive and will almost always accompany some contraction, or limits, or commitment, or responsibilities, or loss …but mapping out how it will unfold can be a crapshoot.  

A Jupiter-to Moon conjunction for a month or a season will, for better or worse,  be expansive… as in someone gets a new opportunity for meaningful work, yet she may actually gain a lot of weight! That’s expansive, right?

The point being — the archetypal unfolding of life will tend to follow certain patterns we can align with and even plan around,  but there is enormous wiggle room around the details of unfolding.

Specifically, then:

If you are 40-43…a good astrologer will look at all the transits,  but will be examining how a Uranus opposition may be unfolding in your life.

A Uranus opposition is when the planet Uranus in its 84 yr cycle (an average human life) has moved to the point opposite it where it was in the natal chart. The corresponding effect of that  is contingent on how Uranus in your natal birth chart relates to the other planets in the chart.

These planets are like forces, or people, or like gods on Olympus who are in relationship to each other in ways that range from exalting and facilitating to challenging and disruptive or denying.

Uranus, as a rule, represents breaks from established patterns, imposed from the outside or as arising from within.  Phrases like – I‘m done. I’m outta here. Gotta do something new –start welling up on the inside. On the outside – WTF just happened? Or I can’t believe he, she, they did that!  Wow – what a ride this year has been!

Sometimes, it is not so extreme but still notable. And sometimes, it is extreme – like lightning and thunder has struck.

“Now that barn has burned to the ground, I have a much clearer view of the Moon.”

                                                                                                                      – Zen proverb

It can be like that. Uranus wants to free up your vision and can nuke things and relationships that stand in the way of your liberation.  It’s a cycle…and the Cosmos is not picking on you.

Chiron Return

Chiron is an asteroid/planetoid discovered in 1977 and lies between Saturn and Uranus.

There is an entire mythology around Chiron from the Greeks – the Centaur and wounder healer – which applies to its significance in current astrological charts.

People did great astrology before Chiron’s discovery, but his presence on the scene lends reliable nuance to understanding ourselves,  and Chiron’s  effect is now commonly accounted for in most astrological circles in the West.

Chiron represents our sacred “wound” – and also, where we subvert the ordinary way of doing things. In mythology, he was the first recorded “alternative healer”. It sheds light not only on the wound but about the resurrection and transformation of it by significant pattern shifts.

The Chiron return around age 50  is often timed right around the time of menopause, and for many a very intense time of their MenoPassage Journey. It marks not only biological and psychological changes but often a call to deep soul-work.

If someone has a Chiron placement in the 6th House of work and service, their life may be set up to experience wounding in that area… for example,– they may have had challenge finding their place in the world of work…or,  if in the 3rd house of communication , – maybe a feeling of unworthiness in expressing themselves or feel rebellion against speaking in traditionally predictable ways in conventional  language.

The Chiron return can invite in therapies and processes to transform that wound. Burnt-out she-warriors in the corporate marketplace lose their jobs, get therapy to find what has been driving them, and train in therapy themselves for a second career. Men who have been too timid to show up fully in relationships find themselves testing the metal in empowering Men’s Work circles.

Second Saturn Return  (age 58)


The Second Saturn Return at age 58 is the pivot point. For many, it may crown the end of the MenoPassage Journey, and they may reap great benefits or have to face hard realities and go through yet another crowning transformation.

Before exploring this fertile and oftentimes challenging year, it demands mention that Saturn – the influence of contraction, limits, lessons,  discipline and the Lord of Time – is ALWAYS operating in our lives, bringing his removing/separating influences… or his mastering, solidifying impact.

Every 2.5 years approximately,  on average, Saturn changes zodiac signs and moves through one of the 12 houses in our charts — bringing his reign to those distinct areas such as finances/resources, communications/siblings, home, work, relationships and so on.

In addition, he is often “aspecting” other planetary forces – that is making an astrological contact , either enabling, challenging, or restricting them, so that the entire astrological and personal picture resists facile sound-bite descriptors.

That said,  there are major arcs of observable major shift, like the 2nd Saturn return.

By age 58, for most people, the children, if they have had them,  are grown and moved out. If they haven’t moved on – that represents right there Saturn’s call to extra responsibility.

Around this time, — the drive to climb the ladder in a prior field of endeavor starts to dissipates.

We lose employment, or get ill from insufficient body-care, or from the “thousand natural shocks that flesh is heir to.” (Shakespeare)

We may finally finish the ever-demanding- never-ending dissertation begun in the Chiron return, 8 years before. We harvest a few decades of gainful employment … or the harsh rewards of not applying ourselves over the years and the regrets that surface in regard to that.

Saturn is not for sissies.

That said, a right relationship to Saturn invites authentic accounting of our strengths, our foibles, and our remaining possibilities. Here, we are not rewarded for displays of either blustering bravado or for self-pity, hoping to chalk up karmic points  by being in self-denial.

Saturn wants our true sovereignty.

His sometimes stern teaching aims to  end  our individual stories of separation and lack, and he does that by challenging us with the events and feelings that counterpoint that sovereignty – feeling dis-empowered, dependent, or coming up short… Until we get it right, understanding, at last, that we are generally the cause of our own tribulations.

A Saturn return will have us count our losses or regrets … but, rightly used, we dwell on our present gifts and future gains – a mature Saturnine perspective.

“I dwell in possibility,”  – said Emily Dickinson.

It is where we arrive when we have integrated Saturn’s teaching, shedding one skin and growing another.

But let’s say by  58, we feel have won a lottery ticket in life with solid life-work, great children, good health,   and meaningful relationships. Then we are invited to be humbly grateful for whatever abundance has come our way through pluck, luck,  and discipline, but pride does not go down well in Saturn’s domain. He can remove anything at anytime, as an operative principle.

Good astrologers, coaches,  guides, or creativity circles among friends with shared purposes, can bridge the gap between the what was, what is,  and what can be during and following such a transit. Many of my clients reach out during this period without knowing what led them to make the call.

Contemplation and meditation vs. obsessive ruminating is one of the right practices during a Saturn return, and ultimately can lead to the harvest of our hard-won wisdom. Gracefully letting go of what has past and embracing what can be –  can make this 3rd Act  of life joyous, fruitful, and liberating.


There is no real conclusion to all of this. We are in an ever-spiraling and deepening inquiry.

Each one of these life passages marked by the planetary cycles can represent challenges, even crises to health, identity, purpose, and belonging.

There are golden opportunities in each of them when they are embraced for their demanding, liberating, mischievous, and sometimes stern teaching.

We are not being punished but rather groomed, not unlike the beloved story of the chickpea from Rumi, translated by Coleman Barks who brings us to a ripe pause in this exploration.

A chickpea leaps almost over the rim of the pot
where it’s being boiled.

‘Why are you doing this to me?’

The cook knocks him down with the ladle.

‘Don’t you try to jump out.
You think I’m torturing you.
I’m giving you flavor,
so you can mix with spices and rice
and be the lovely vitality of a human being.

Remember when you drank rain in the garden.
That was for this.’

Grace first. Sexual pleasure,
then a boiling new life begins,
and the Friend has something good to eat!

We hope that this has shed some light on your Journey and will help you face the challenges and step into the great opportunities in the Journey through MenoPassage. Please contact me for any questions you may have. Sign Up to get updates.

by Angela Ingendaay, MD

Angela Ingendaay








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Riding Your Planetary Cycles through MenoPassage

– an astrological guide to emotional turbulence, growth, and renewal in midlife and onward

MenoPassage: a holistic journey through Menopause


In the MenoPassage years, most women undergo profound psychological shifts, often causing some instability and possibly leading to quite a new sense of identity. We are going to explore whether these shifts, challenges and transformations may actually coincide with the influence of the planets upon our lives, in the framework of the well charted system of astrology.

Indeed, for some, the MenoPassage years may be accompanied by significant emotional turmoil, anxiety, depression, and sometimes, the fear of aging and the unknown. For others, it is simply a time to shed one skin, perhaps a part of them very oriented to caring and nurturing, and move into another part of their lives,  – often a creative, more focused and determined part.

Regardless of the shape it takes, what is clear is that a new chapter is opening. And we tend to attribute so much of these shifts to the level of our hormones and, perhaps, make attempts to keep things in their status quo by taking on hormone replacement,- yet women seem to undergo these shifts,  regardless of this physiological aspect. The following article will shed light on this issue.

Riding our planetary cycles through midlife and beyond

~ William Sebrans, evolutionary astrologer and coach

We live our lives in cycles;  no-one knows this better than every woman that endures the energetic ebb and flow of the menstrual cycle. And so our lives also encompass much larger cycles and recurrences, and through them, we have a chance to change, grow, mature, expand… and if one takes a very large step back, one starts seeing very specific patterns, and these patterns in turn do in fact reflect astrological patterns, as we shall explore.

Throughout history, many have referred to these larger cycles… Shakespeare referred to it as the seven ages of man,; psychologist Eric Erickson speaks of five stages; the ancient Chinese speak of 7 stages. By understanding these greater laws, we have a chance to embrace our changes and even move deeply into  and through them to come out stronger on the other side.

According to astrology , these cycles are guided and influenced by the planets, as we will examine more closely. It paints a very detailed map of how our psychology gradually unfolds and what opportunities and challenges arise at various points of our lives.

Some of these planetary influences, of course, are highly individual, but there are also broader patterns and cycles that can be delineated and help us understand our road map regardless of our personal chart. This does not require for you to take on the whole ideology of astrology;  simply may shed some light on patterns that unfold.

Understanding these cycles may well reassure one that, despite the legion messages that spill out from the glossy lifestyle magazine covers, that ambush us with an overwhelming menu of options for living the good life –  in fact, all the great lessons that often happen in midlife, when one’s  whole being seems to be thrown into greater flux, deeper experiences such as loss, shock, disorientation, regret, and other tart experiences are all quite normal and built in to the greater scheme of things.

And it is reassuring to understand that these enormous challenges guided by the planets may lead to a renewal of ourselves, and may even be our sacred invitation.

So What Do Planets Have to Do With It?

In every culture on the planet and from every epoch, there have been astrological traditions that have observed the relationship between planetary movements and the lives of people,  nations, and even the Earth itself.

Without claiming it as a belief system that some planet  –say, -Mars made me throw the dishes at the wall… or that Venus made me fall for a jerk…it has been verified repeatedly through the millennia that when the planets (and distant stars)  are in certain positions in the sky and in relationship to each other, certain lines of character develop in a newborn child and certain predictable ranges of events unfold throughout the life. So, while we might not proclaim the planets and stars are the CAUSES of our lives, we can confidently assert  there are compelling and useful CORRELATIONS to them, validating the ancient maxim from Trismegitus – As above, so below. As without, so within.

As a person progresses through the “ages of man” (see– Shakespeare’s  As You Like It) — there are fairly predictable seasons of expansion and contraction (Jupiter vs. Saturn), abundance and loss, love and loneliness, growth and decay.

By the time we are in mid-40s, we should be getting the impression that  we are not entirely in charge of this play in which we play a part. Change happens. Falls follow rises, and rises follow falls. We are in favor, then not, – in a flow, then not.

“Fate leads she who follows and drags she who resists.”  — Plutarch

Fate is tricky, though. I am biased to think that Fate is not digital terrain of either-or... but rather an analog field of maybe, but also.  Fate has a range of potentials, as does its more upbeat sibling — Destiny. That said, there are times, when something’s gotta give, and that’s what we will explore in this piece.


Everyone has a unique trajectory in life…even twins. That trajectory is based on what planetary influences were present at birth, the planetary movements (transits) that follow over the years, family and societal conditioning, karma perhaps, soul age and soul perception, and even Grace.

The diverse elements in that stew of influences suggests that planetary movements affect people quite differently, despite what the astrology tabloids might influence the gullible to believe.

There is no fixed recipe for how people will experience outer and inner change.

But there are parameters.

Speaking quite broadly, here are some classic times of shift, change, growth, and/or loss.

Saturn Return: Saturn works in a cycle of 29 years, and within one cycle it leads us through all one’s “astrological houses”, i.e. all the different aspects of one’s relationship to oneself and intimate sphere as well as the greater world one interacts with. Thus at the end of the first Return, age 29, one has had a good taste of all that is within one, one’s challenges, and potential. It is a certain coming of age, often challenging with more responsibility. One may well have achieved a basic level of maturity and stability. The next Saturn cycle, ending around age 58, will bring potential deepening and refinement. Most of the MenoPassage years land up within the second cycle of Saturn and are reflecting the challenges of this maturation process. The wine of one’s being acquires depth and character.

At the Second Saturn return the year around age 58, we have a life accounting of sorts — a harvest and/or a sober recognition of what has passed and what is possible. Third Act begins. This coincides with a certain kind of graduation from the MenoPassage Journey, and reflects to some extent how deep the Journey has been.

Jupiter return – every 12 years. New cycles of growth. A Jupiter’s return adds a hue of meaning and being supported by the universe in a mysterious way. When you align with what you’re meant to be doing, magic happens. This may well recur several times in the course of MenoPassage.

Uranus oppositionsomewhere between the ages 40-44, often over the course of a year or more — involving radical breaks from the past, liberation, sudden loss. For many, this marks the time of entering the MenoPassage Journey, setting up the process of becoming remolded. For some, the sense of liberation is a gradual unfolding, for some it comes quite abruptly.

Chiron return, around age 50. — involving an activation of a sacred wound, up for healing, and also a break from the bonds that have held us back. THIS may very well be the greatest contributor  and challenge to the MenoPassage Journey.

These are very broad strokes…In reality, it can be more complex and confounding with multiple significant transits occurring at once that either accentuate or attenuate the themes at play, or both,  — for better or for worse.

Understanding these cycles can help one to take on all the challenges of MenoPassage with courage and an open heart, knowing that it represents a great calling upon one to emerge stronger and freer, more deeply connected to who one truly is. We will explore this in greater detail in section 2 of this article, please stay posted.

by Angela Ingendaay, MD

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Do I need Estrogen?

MenoPassage – a holistic Journey through the menopausal years

 In the menopausal years, our hormones vastly diminish, no doubt about it. WhetherDo I need Estrogen? to opt for hormone replacement or not is perhaps one of the most hotly debated subjects concerning menopause, it is a multifaceted subject and there are many schools of thought, each supported by volumes of scientific literature and statistics. In the end, a woman must of course chose what feels right for her body, and we encourage her to develop the sensitivity to know what that might be. By being in tune with our body’s needs and tending to its holistic care, we make the choice easier for ourselves and place it in the framework of a larger perspective, that of the MenoPassage Journey, a gateway to new chapter full of creativity and vitality.

The very short answer to the question “Do I NEED estrogen?” is : MAYBE

One principle that has always worked in my practice is: respect the body’s own self regulatory physiology and intelligence. Listen to you your body and its cues and see what is really going on with you… then find a practitioner that is willing to work with support you in the most appropriate manner. The fact is that even if you do supplement with hormones, they will always be “extrinsic”, i.e. applied from the outside and not incorporated into the regulatory loop that has dictated our hormone levels until now. Their levels are now imposed upon the body, it no longer has a say as to what they should be according to its own intelligence. In health, the level of all hormones are regulated by the brain with the aid of feedback loops so that we can make adjustments from day to day, according to need and circumstances. When you ingest or apply a topical hormone, that is outside of the feedback loop.

The following discussion by Jim Paoletti, (BS Pharmacy, FAARFM, FIACP, Clinical Consultant with over 30 years’ experience creating and using bio-identical hormone and faculty member for the Fellowship of Functional Medicine) very much resonates with my own clinical experience. His approach facilitates a healthy and fruitful MenoPassage Journey.

First of all, let us address the need for estrogen in the PERIMENOPASUSAL years, while a woman is still menstruating…

“The truth is: A woman’s estrogen levels do not decline until the last 6 to 12 months of perimenopause. Furthermore, estradiol levels typically rise slightly when a woman first enters perimenopause, so the hot flashes experienced at this stage of life are not actually caused by a lack of estrogen.”

Many health practitioners were taught to measure FSH levels to confirm that estrogen levels were low. However, it has been shown that estrogen is not the major controller of FSH. Instead, FSH is controlled primarily by inhibin, a hormone produced in the corpus luteum i.e.the ovaries.

Once ovulation ceases, the corpus luteum will no longer produce inhibin, so FSH rises due to lack of inhibit and not lack of estrogen. Progesterone is also produced by the corpus luteum, so elevated FSH is reflective of decreased production of progesterone. A physiologic amount of progesterone is required to make estrogen work correctly.

In early peri-menopause, a woman’s hot flashes are most often caused by a lack of progesterone rather than lack of estrogen.

Although progesterone is key for obtaining optimal effects of estrogen, other hormones may cause or influence the symptoms that we often perceive as a lack of estrogen.

  • High cortisol levels can also cause weight gain, irritability, irregular cycles and hot flashes, even in the present of normal estrogen levels. Consistent low cortisol can also cause or aggravate hot flashes.
  • Low thyroid function can cause similar symptoms that appear as estrogen deficiency.
  • Insulin resistance can do the same.

In recent years, one of the biggest changes to approaching physiologic hormone balance is the way estrogen need is approached. Because so many other hormone levels affect estrogen and estrogen receptors, correcting other hormone issues have led to further and further reduction in the amount of estrogen commonly administered. In other words, if the other hormone or endocrine issues are addressed first, then the amount of estrogen required to treat her assumed “estrogen deficiency” symptoms becomes much less.

No symptom or set of symptoms guarantees estrogen needs.

Many symptoms can be explained by another possible hormone imbalance. Even vaginal dryness or atrophy, which almost always indicates a lack of estrogen, can exist when estrogen levels are normal. Vaginal tissues are also supported by testosterone and thyroid, and a significant deficiency in one or both of these hormones can be the source of the problem. Lack of progesterone can also result in ineffective estrogen. Properly assessing estrogen need and assessing response to estrogen therapy requires balancing the other endocrine hormones simultaneously or prior to estrogen administration.

At certain stages, even precise estrogen level measurement may not reliably indicate need. Estradiol levels begin to fluctuate during peri-menopause, with much wider vacillations towards the end of perimenopause. Therefore, it is wise to not rely on estradiol level measurements during this period. The best approach would be to correct deficiencies or issues with progesterone, cortisol, thyroid, insulin resistance and nutrition or lifestyle, then correlate remaining symptoms with levels, and address estrogen therapy as required.

Does she really need that much estrogen?

Even when women do need estrogen replacement therapy, they are often given too much. Excessive estrogen may help control the hot flashes for a month or two, but eventually the symptoms return.

Too much estrogen causes the same symptoms as too little estrogen, just with a slight time delay before the symptoms return.

At first, excessive estrogen increases the number of estrogen receptors, but after a period of time the body downregulates the number of receptors, so the estrogen cannot work properly regardless of how much is there.

The keys to optimal physiologic estrogen replacement therapy are:

  • Make sure she needs estrogen by correlating symptoms with measurement of levels.
  • Never assume a woman needs estrogen.
  • Always restore progesterone to a physiologic level before assessing how much—if any—estrogen is needed.
  • Test cortisol with a 4 x per day saliva test to help determine adrenal influence on “estrogen deficiency” symptoms. Address as necessary.
  • If symptoms of hypometabolism (hypothyroid) are present, test the TT4, fT4 direct, fT3 direct, TPO and TSH to properly assess. Address appropriately.
  • Check insulin resistance if symptoms indicate and address appropriately
  • ALWAYS start very low on estrogen dosing and make changes slowly.
  • Take steps to ensure safe estrogen metabolism by optimizing liver conjugation, bowel elimination, methylation and glutathione conjugation and by reducing lipid peroxidase activity.”

*From Jim Paoletti, A Practitioner’s Guide to Physiologic Bioidentical Hormone Balance, 2015.

Thus it is really about addressing the foundation of your health before moving forward to hormone replacement and not just treating the symptoms without understanding the underlying condition.

These endocrine imbalances mentioned above also very much reflect the wisdom of Chinese medicine and their view on the multiple self regulatory systems involved in menopause. Once properly identified, they can all be supported in their own specific manner to support overall wellbeing and a holistic approach to menopause.

Understanding these principles is an essential step in a healthy MenoPassage, a journey that can lead you to the next stage of your life in a balanced and well supported state that opens the doors to new vitality and creativity.

by Angela Ingendaay, MD

Angela Ingendaay, MD







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