Menopause and Treatment

Soy

Soy is the first natural ingredient that strikes most women when talking about menopause symptoms, says Moores. The reason soy can help reduce symptoms, such as hot flashes, is because of the high level of phytoestrogens, or plant-based estrogens. But soy supplements have become controversial. Some experts believe it can increase your breast cancer risk. "Soy is complicated," says Dr. Marcie Richardson, Director of the Harvard Vanguard Menopause Consultation Service and a member of the North American Menopause Society. Perimenopause might be the time to use soy, because the phtyoestrogens can have a modulating effect. But this hasn't really been proven, she says.
Exercise

"Exercise is absolutely critical," says Susan Moores MSRD, registered dietitian and spokesperson for the American Dietetic Association. Exercise can be a powerful sleep aid, combating the sleep disturbances many women complain about. It has been shown to improve the whole gamut of menopause symptoms from hot flashes to mood swings. She says not to just focus on aerobic exercise, but also try strength training and relaxation techniques, such as yoga.
Flaxseed

"Flaxseed falls in the same camp as soy for the phytoestrogens," says Moores. One study by the Mayo Clinic found the incidence of hot flashes was reduced as much as 50 percent by consuming flaxseed. It is also thought to be very promising because, along with phytoestrogens, it also contains omega-3 fatty acids, which can aid in mood stabilization. According to A.D.A.M., an online health content provider, when compared to hormone replacement therapy, 40 grams of flaxseed was reported to be equally as effective in reducing hot flashes, vaginal dryness and mood disturbances.
Black Cohosh

Two German studies have shown black cohosh to be effective in reducing hot flashes, according to A.D.A.M. One study in particular showed 80 percent of women saw a decrease in hot flashes while using black cohosh. However, no long-term studies have been done and there have been reports of side-effects including upset stomach and low blood pressure, caution the experts at Harvard Medical School.

Natural Progesterone

This over-the-counter cure uses progesterone or progesterone-like compounds as the active ingredient. "Natural progesterone is a hormone and it works," says Dr. Richardson. "Skin creams that contain extracts of Mexican wild yams have been widely promoted for natural menopause relief for years," says Harvard Medical School. However, because of variation among products and the individual nature of skin's responsiveness, this method is not recommended by the North American Menopause Society, says Harvard. There's no safety data on this hormone, Dr. Richardson cautions. Learn more about the risks and benefits here.

Red Clover

Red clover is often used to reduce vaginal dryness and decrease hot flashes. The effectiveness of red clover is thought to be due to a plant-chemical, isoflavones, which has an estrogen-like effect in the body. However, according to Harvard Medical School, research results have been disappointing. Two studies published in the journal 'Menopause' found that women fared no better with red clover than a placebo for both hot flashes and vaginal dryness. Learn more about red clover here.

Omega-3 Fatty Acids

Fish isn't just delicious; it contains a valuable ingredient that may help stabilize your mood swings too -- omega-3 fatty acids. There have been some good studies to attest that omega-3 can help improve mood, says Dr. Richardson. There's also growing research that omega-3 fatty acids help fight heart disease. The best way to add this key ingredient to your diet is by eating fatty fish like salmon, tuna and trout.

Acupuncture

You wouldn't necessarily think that sticking needles in your body would be a helpful way to cure menopause symptoms, but when combined with other treatments, it can be helpful. Some controlled studies have shown some effectiveness in some woman for hot flashes, says Dr. Richardson. According to A.D.A.M., "both the World Health Organization and the National Institutes of Health recognize that acupuncture can be a helpful part of a treatment plan" for many illnesses, including menopausal symptoms.

Vitamin E

There has been a study, which showed a slight effect in decreasing hot flashes for women using vitamin E, says Dr. Richardson. Along with reducing hot flashes vitamin E may carry with it extra benefits, such as fending off macular degeneration, lowering blood pressure, and slowing the aging of cells and tissues according to A.D.A.M.

Cutting down on alcohol.

Who hasn't felt the negative effects of drinking too much alcohol, such as trouble sleeping or feeling flushed? This goes double for women during menopause. The thing about alcohol is: women metabolize it worse than men and we metabolize it worse as we age, says Dr. Richardson. According to Harvard Medical School, alcohol can act as a trigger for hot flashes. And if that wasn't enough to ward you off the bottle, studies show that consuming alcohol regularly ups your risk for other conditions like breast cancer and stroke.

Treatment options for menopause symptoms

Hot flashes. Meditative breathing exercises (paced respiration) have been shown to reduce hot flashes.9 Medicines that can improve hot flashes include short-term, low-dose hormone therapy, antidepressants, the high blood pressure medicine clonidine, and the antiseizure medicine gabapentin (Neurontin).

Heavy periods. The hormone progestin can help relieve heavy menstrual bleeding caused by very low or very high progesterone levels (after you have an exam to rule out other possible causes). Other options include nonsteroidal anti-inflammatory drugs (NSAIDs), the levonorgestrel (LNg) IUD, or birth control pills. For severe blood loss, some women choose permanent surgical treatment. These options include removing the uterus (hysterectomy) or using heat energy to damage and scar the wall of the uterus (endometrial ablation). For more information, see the topic Dysfunctional Uterine Bleeding.

Vaginal dryness and irritation. A vaginal lubricant can help with dryness. Low-dose vaginal estrogen can help if your symptoms are thin skin, dryness, and/or irritation. Less estrogen is absorbed into your system with vaginal use, so the risks associated with ERT are less likely.

Multiple or severe symptoms. Hormone therapy can relieve multiple or difficult menopause symptoms. For symptom relief before menopause, low-dose estrogen-progestin birth control pills or low-dose HRT (estrogen-progestin) can reduce heavy menstrual bleeding and other symptoms. After menopause, low-dose HRT is an option. Also, for severe symptoms that don't improve with estrogen-progestin, there is an estrogen-testosterone therapy. But testosterone is not FDA-approved for women, because it is not yet well studied. Talk to your doctor about short-term HRT along with checkups every 6 months.

Bioidentical hormone replacement therapy (BHRT) is an alternative to HRT. But it has not been well studied. The hormones are made in a laboratory from wild yams or soy. BHRT is thought to be more similar to human-produced hormones than synthetic HRT is. (Well-designed studies have not yet proved this theory.) But bioidentical HRT may carry the same heart, stroke, blood clot, breast cancer, ovarian cancer, and dementia risks that are linked to traditional HRT. Any form of hormone therapy, including BHRT, is best taken for as short a period as possible after menopause.

Should I use hormone replacement therapy (HRT)?
Testosterone is sometimes used to increase sexual desire in postmenopausal women who have low testosterone. But the U.S. Food and Drug Administration (FDA) has not approved testosterone treatment for this purpose. There is no testosterone product that comes in doses that are right for women. Studies of testosterone in women have not lasted longer than 6 months.13 FDA experts want to know more about long-term risks before they approve testosterone for use by females.

If you have a problem with low sexual desire, consider that most sexual problems in women relate to such things as relationship troubles, depression, or medicine side effects. For more information, see the topic Sexual Problems in Women.

Other treatment options
Women may also try alternative medicine to relieve menopause symptoms. These alternatives may include black cohosh (Remifemin) or dietary soy.
Many doctors now suggest trying nonhormonal treatment for bothersome menopause symptoms before considering hormone therapy (birth control pills, estrogen alone [ERT], or estrogen-progestin [HRT]). There are several nonhormonal prescription treatments that can relieve or reduce hot flashes and other menopause symptoms. You can also try using black cohosh or dietary soy.

Medication Choices
Prescription medication without hormones

Antidepressant medicines can lower the number and severity of hot flashes. Some women have side effects.10 The safety of very long-term use has yet to be studied.

Clonidine, a high blood pressure medicine, can reduce the number and severity of hot flashes. Some women have side effects related to low blood pressure.

Gabapentin (Neurontin), an antiseizure medicine, can reduce the number and severity of hot flashes. Possible side effects include sleepiness, dizziness, and swelling.

Prescription medication with hormones

Birth control pills (estrogen and progestin) regulate menstrual bleeding and can relieve symptoms until menopause. Birth control pills are not used after menopause. You should not use birth control pills if you smoke or have diabetes, untreated high blood pressure, cardiovascular disease, or a history of breast cancer. Low-dose formulations are recommended for women older than 35. Some women have side effects.

Progestin pills or the levonorgestrel IUD, which releases a form of progesterone into the uterus, reduce heavy, irregular menstrual periods during perimenopause. Some women have side effects.

Low-dose vaginal estrogen (cream, tablet, or ring) reduces vaginal and urethral dryness and weakening without introducing high levels of estrogen into the body.

Hormone replacement therapy (estrogen and progestin), in pill, patch, vaginal ring, gel, or cream form, can be used to treat menopause symptoms. Because studies have found that HRT increases some health risks for some women, doctors have changed the way HRT is used. For menopause symptom relief, experts now recommend that HRT only be used at the lowest effective dose for the shortest possible period of time.

Bioidentical hormone replacement therapy is made from plants and is thought to be more similar to human-produced hormones than synthetic HRT. But bioidentical HRT is not well researched and may carry the same health risks that traditional HRT does.9 Any form of hormone therapy is best taken for as short a period as possible.

Because of concern about hormone replacement therapy (HRT) health risks, many women have turned to alternative medicine for menopause symptom relief. As part of a stepwise treatment approach, you can consider using one or more of the following options for preventing or treating symptoms before trying prescription medicines or hormones.

The meditative breathing exercise called paced respiration may reduce hot flashes and emotional symptoms. This approach has no known side effects, risks, or costs and can be safely combined with additional treatment, if needed.

Black cohosh (Remifemin, 20 mg) may prevent or relieve menopause symptoms. But the research on black cohosh has had mixed results. Some studies have shown that black cohosh can relieve hot flashes. But other studies have shown that black cohosh does not relieve hot flashes. Also, the long-term safety is not yet known. (Risks similar to estrogen risks are a possibility.) Have regular checkups if you are using black cohosh, and make sure your doctor knows what you are taking.

Soy phytoestrogens (isoflavones) are in more complete form when you eat them as food, rather than in a pill or powder. A high-soy diet has been linked to stronger bones, especially in the first 10 years after menopause, when estrogen levels drop and rapid bone loss happens. Regularly eating and drinking soy may also help even out menopause symptoms. But studies have shown mixed results. They have not always shown that soy is effective for treating hot flashes.

Yoga (which often includes meditative breathing) and/or biofeedback give you tools you can use to reduce stress. High stress is likely to make your symptoms worse.

Alternative treatments to avoid
Based on the latest research, some therapies are not recommended for menopause symptoms, either because they are not effective or because they can cause dangerous effects. These include:
Kava, evening primrose, dong quai, valerian, dehydroepiandrosterone (DHEA), and angelica. Wild yam or natural progesterone creams.

Using alternative treatments
These types of medicinals are not required to have the same testing or purity standards as prescription and other nonprescription medicines. The amount of a drug in herbal preparations varies widely. It is also possible for nonregulated products to be contaminated with metals or other dangerous substances. Before trying any treatment, look for scientific studies that support its beneficial claims as well as information on risks. When buying herbs or supplements:

Find a reputable brand or supplier.
Look for the U.S. Pharmacopeia (USP)-verified mark on product labels. This is one way of finding a product that has been tested for safety and quality. For more information, see www.usp.org/USPVerified/dietarySupplements.
If you are using an alternative medicine or herbal remedy, make sure your doctor knows. Tell him or her the type and amount you are taking, how long you have been taking it, and why.

Organizations for help ..

North American Menopause Society (NAMS)
P.O. Box 94527
Cleveland, OH 44101-4527
Phone:
(440) 442-7550
Fax:
(440) 442-2660
E-mail:
info@menopause.org
Web Address:
www.menopause.org

The North American Menopause Society (NAMS) is a nonprofit organization that promotes the understanding of menopause and thereby improves the health of women as they approach menopause and beyond. NAMS members include experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education. The NAMS Web site has information on perimenopause, early menopause, menopause symptoms and long-term health effects of estrogen loss, and a variety of therapies.

American Botanical Council (ABC)
P.O. Box 144345
Austin, TX 78714
Phone:
1-800-373-7105
Fax:
(512) 926-2345
E-mail:
abc@herbalgram.org
Web Address:
www.herbalgram.org

The American Botanical Council's goals are to educate the public about beneficial herbs and plants and to promote the safe and effective use of medicinal plants.