Menopause

Also indexed as: Change of Life, Climacteric, Hot Flushes/Flushes

Menopause is not a disease—it’s a natural part of life. According to research or other evidence, the following self-care steps may be helpful:

Control symptoms with isoflavones
Supplements containing at least 80 to 100 mg a day of isoflavones from soya or red clover may help control symptoms

Cool down with black cohosh
Take 20 mg of a concentrated herbal extract twice a day for relief from hot flushes

Eat soya and linseed
Make foods high in phytoestrogens, such as linseed, tofu, soya milk, tempeh, and roasted soya nuts, a regular part of your diet

Find relief with exercise
Even light aerobic activities can help reduce menopausal symptoms

Quit smoking
Smokers are more likely to experience hot flushes and other menopausal symptoms

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full menopause article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About menopause

Menopause is the cessation of the monthly female menstrual cycle. Women who have not had a menstrual period for a year are considered postmenopausal.

Most commonly, menopause takes place when a woman is in her late forties or early fifties. Women who have gone through menopause are no longer fertile. Menopause is not a disease and cannot be prevented. Many hormonal changes occur during menopause. Postmenopausal women are at higher risk of heart disease and osteoporosis, presumably because of a decrease in the production of oestrogen or other hormones.

Product ratings for menopause

Science Ratings	Nutritional Supplements	Herbs
	Soya	Black cohosh
	Progesterone	Black cohosh combined with St. John's wort (for women with both menopausal and psychological symptoms) Red clover Sage and alfalfa (in combination)
	DHEA Flavonoids (hesperidin) Vitamin C Vitamin E	Alfalfa Asian ginseng Blue vervain (Verbena hastata) Burdock Dong quai Liquorice Motherwort Sage St. John’s wort Wild yam
See also: Homoeopathic Remedies for Menopause
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Several unpleasant symptoms may accompany menopause. Some, such as vaginal dryness, result from the lack of oestrogen. Others, such as hot flushes and decreased sex drive, are caused by more complex hormonal changes. Some women experience depression, anxiety, or insomnia during menopause.

Medical options

The most common prescription drug treatment for symptoms of menopause is hormone replacement therapy. This includes an oestrogen, either conjugated oestrogen (Premarin®), estradiol (Estrace®, Estraderm®), or ethinyl estradiol (Alesse®), and a progestin (Provera®, Prometrium®). Some prescriptions contain both oestrogens and progestins in a single tablet (Prempro®, Premphase®). Some products add methyltestosterone to esterified oestrogens (Estratest®) to help enhance sex drive.

Dietary changes that may be helpful

Soybeans contain compounds called phytoestrogens that are related in structure to oestrogen, though some reports show soya’s oestrogenic activity to be quite weak.¹ Soya is known to affect the menstrual cycle in premenopausal women.² Societies with high consumption of soya products have a low incidence of hot flushes during menopause.³

In one double-blind trial, supplementation with 60 grams of soya protein caused a 33% decrease in the number of hot flushes after four weeks and a 45% reduction after 12 weeks.⁴ However, in further analysis of the data in this trial, researchers credit constituents in soybeans other than phytoestrogens for the therapeutic effect.⁵ In one controlled clinical trial, high intake of phytoestrogens from soya and linseed reduced both hot flushes and vaginal dryness; however, much (though not all) of the benefit was also seen in the control group.⁶ In another double-blind study, 100 mg per day of isoflavones extracted from soya was effective in relieving hot flushes,⁷ and another double-blind trial found that 120 mg of soya isoflavones per day was as effective as oestrogen therapy for relieving menopausal symptoms.⁸

As a result of these studies, doctors often recommend that women experiencing menopausal symptoms eat tofu, soya milk, tempeh, roasted soya nuts, and other soya-based sources of phytoestrogens. Soya sauce contains very little phytoestrogen content, and many processed foods made from soybean concentrates have insignificant levels of phytoestrogens. Supplements containing isoflavones extracted from soya are commercially available, and linseed (as opposed to linseed oil) is also a good source of phytoestrogens.

Lifestyle changes that may be helpful

Sedentary women are more likely to have moderate or severe hot flushes compared with women who exercise.⁹ ¹⁰ In one trial, menopausal symptoms were reduced immediately after aerobic exercise.¹¹

Cigarette smoking may be related to hot flushes in menopausal women. Preliminary data have shown that women who experience hot flushes are more likely to be smokers.¹² Another preliminary study found that new users of hormone replacement therapy for the relief of menopausal symptoms were more likely to be current cigarette smokers than were those who had never smoked.¹³

Vitamins that may be helpful

Many years ago, researchers studied the effects of vitamin E supplementation in reducing symptoms of menopause. Most,¹⁴ ¹⁵ ¹⁶ ¹⁷ ¹⁸ but not all,¹⁹ studies found vitamin E to be helpful. Many doctors suggest that women going through menopause take 800 IU per day of vitamin E for a trial period of at least three months to see if symptoms are reduced. If helpful, this amount may be continued. Using lower amounts for less time has led to statistically significant changes, but only marginal clinical improvement.²⁰

In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the flavonoid hesperidin taken over the course of the day helped relieve hot flushes.²¹ Although placebo effects are strong in women with hot flushes, other treatments used in that trial failed to act as effectively as the flavonoid/vitamin C combination. Since then, researchers have not explored the effects of flavonoids or vitamin C in women with menopausal symptoms.

The mineral boron is known to affect oestrogen metabolism. In one double-blind trial using 2.5 mg of boron per day for two months, hot flushes and night sweats worsened in 21 of 43 women, but the same symptoms improved in ten others.²² Women who are experiencing hot flushes or night sweats that have been diagnosed as menopausal symptoms and who are also supplementing boron (sometimes found in significant amounts in osteoporosis formulas and multivitamin-mineral supplements) should consider discontinuing use of boron-containing supplements to see if the severity of their symptoms is reduced.

Aging in women is characterised by a progressive decline in blood DHEA (dehydroepiandrosterone) and DHEA-sulphate (DHEAS) levels. These levels can be restored with DHEA supplementation. This process also improves the response of some brain chemicals, called endorphins, to certain drugs.²³ These endorphins are involved in sensations of pleasure and pain; improving their response may explain why DHEA has an effect on mood symptoms associated with menopause. In one double-blind trial, however, menopausal women who took 50 mg of DHEA per day for three months had no improvement in symptoms compared with women taking placebo.²⁴ Further study is needed to validate a role for DHEA in the management of menopausal symptoms.

Natural progesterone supplementation has been anecdotally linked to reduction in symptoms of menopause.²⁵ ²⁶ ²⁷ In one trial, natural progesterone was found to have no independent effect on symptoms, and synthetic progestins were found to increase breast tenderness.²⁸ However, a double-blind trial found that topical administration of natural progesterone cream led to a reduction in hot flushes in 83% of women, compared with improvement in only 19% of those given placebo.²⁹ Preliminary research has found that oral, micronized progesterone therapy is associated with improved quality of life among postmenopausal women. However, oral micronized progesterone is available only by prescription in the United States.³⁰ Hot flushes, anxiety, depression, sleep problems, and sexual functioning were among the symptoms improved in a majority of women surveyed. Synthetic progestins, also available only by prescription, have reduced symptoms of menopause.³¹ ³² ³³

Progesterone is a hormone and, as such, concerns about its inappropriate use (i.e., as an over-the-counter supplement) have been raised. The amount of progesterone in commercially available creams varies widely, and the progesterone content is not listed on the label because the creams are legally regulated as cosmetics, not dietary supplements. Therefore, a physician should be consulted before using these hormone-containing creams as supplements. Although few side effects have been associated with topical progesterone creams, skin reactions may occur in some users. Effects of natural progesterone on breast cancer risk remain unclear; research has suggested both increased and reduced risk.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Double-blind trials support the usefulness of black cohosh for women with hot flushes associated with menopause.³⁴ In a three-month study of postmenopausal women, 40 mg per day of an extract of black cohosh was as effective as oestrogen therapy in the treatment of hot flushes.³⁵ A review of eight trials concluded black cohosh to be both safe and effective.³⁶ Many doctors recommend 20 mg of a highly concentrated extract taken twice per day; 2 to 4 ml of tincture three times per day may also be used.

In a double-blind study of postmenopausal women who were experiencing psychological symptoms, a combination of black cohosh and St. John's wort was significantly more effective than a placebo in improving both menopausal symptoms and depression. The product used in this study contained (per tablet) black cohosh standardised to 1 mg of triterpene glycosides and St. John's wort standardised to 0.25 mg of hypericin. The amount taken was two tablets twice a day for eight weeks, followed by one tablet twice a day for eight weeks.³⁷

A variety of herbs with weak oestrogen-like actions similar to the effects of soya have traditionally been used for women with menopausal symptoms.³⁸ These herbs include liquorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of liquorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.³⁹ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.⁴⁰ A double-blind trial using a standardised extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flushes, though it did improve function of the arteries.⁴¹ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.⁴² In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flushes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁴³

Sage may reduce excessive perspiration due to menopausal hot flushes during the day or at night.⁴⁴ It is believed this is because sage directly decreases production of sweat. In a preliminary study, supplementation with a product containing extracts of the leaves of sage and alfalfa resulted in complete elimination of hot flushes and night sweats in 20 of 30 women, with varying degrees of improvement in the other ten cases.⁴⁵

Blue vervain (Verbene hastata). is a traditional herb for menopause; however, there is no research to validate this use. Tincture has been recommended at an amount of 5–10 ml three times per day.

Preliminary evidence suggests that supplementation with St. John’s wort extract (300 mg three times daily for 12 weeks) may improve psychological symptoms, including sexual well-being, in menopausal women.⁴⁶

A double-blind trial found that Asian ginseng (200 mg per day of standardised extract) helped alleviate psychological symptoms of menopause, such as depression and anxiety, but did not decrease physical symptoms, such as hot flushes or sexual dysfunction, in postmenopausal women who had not been treated with hormones.⁴⁷

Warning: Kava should only be taken with medical supervision. Kava is not for sale in certain parts of the world.

In a double-blind trial, a standardised kava extract was found to be effective at reducing anxiety and other symptoms associated with menopause.⁴⁸ The study used 100 mg of kava extract standardised to contain 70% kava-lactones, three times per day. Most commercially available kava extracts contain up to 35% kava-lactones. In another study, administration of kava enhanced the anti-anxiety effect of hormone replacement therapy in postmenopausal women.⁴⁹

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Integrated approaches that may be helpful

Acupuncture may be helpful in the treatment of menopausal symptoms. Animal research suggests that acupuncture may help normalise some biochemical changes that are associated with menopausal disturbances of memory, mood, and other functions.⁵⁰ One preliminary trial in humans demonstrated a significant reduction (more than 50%) in hot flushes in menopausal women receiving either electroacupuncture (acupuncture with electrical stimulation) or superficial acupuncture (shallow needle insertion).⁵¹ Other preliminary trials support these results⁵² ⁵³ and suggest additional menopausal symptoms may also respond to acupuncture.⁵⁴ However, no placebo-controlled trials have been done to conclusively prove the effectiveness of acupuncture for menopausal symptoms.

References
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.