Menopause Menopause is the cessation of the monthly female menstrual cycle. Women who have not had a period for a year are considered postmenopausal. Most commonly, menopause takes place when a women 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. Primarily as a result of decreases in estrogen, postmenopausal women are at higher risk of heart disease and osteoporosis. A number of unpleasant symptoms may also accompany menopause. Some, such as vaginal dryness, result from the lack of estrogen. Others, such as hot flashes and decreased libido are caused by more complex hormonal changes. Dietary and other natural therapies that may be helpful: Soybeans contain compounds called phytoestrogens that are related in structure to estrogen, though in some reports, the estrogenic activity of soy is quite weak.1 Soy is known to affect the menstrual cycle in premenopausal women.2 Researchers have linked societies with high consumption of soy products to a low incidence of hot flashes during menopause.3 In one double blind trial, 60 grams of soy protein caused a 33% decrease in the number of hot flashes after four weeks and a 45% reduction

after twelve weeks.4 Other double blind research has reported significant reduction in the number of hot flashes.5 In one randomized trial, high intake of phytoestrogens from soy and flaxseed reduced both hot flashes and vaginal dryness, but much (though not all) of the benefit was also seen in the control group.6 As a result of these studies, doctors of natural medicine often recommend that women experiencing menopausal symptoms eat tofu, soy milk, tempeh, roasted soy nuts, and other soy based sources of phytoestrogens. Soy sauce contains very little phytoestrogen content, and many processed foods made from soybean concentrates have low levels of phytoestrogens. Supplements containing isoflavones extracted from soy are commercially available, and flaxseed (as opposed to flaxseed oil) is also a good source of phytoestrogens. Although natural progesterone has been anecdotally linked to reduction in symptoms of menopause,7 8 9 clinical research has not yet supported the use of natural progesterone for this purpose. In one trial, natural progesterone was found to have no independent effect on symptoms, and synthetic progestins were found to increase breast tenderness.10 In trials reporting that synthetic progestins reduced symptoms of menopause, natural progesterone has not been tested.11 12 13 Lifestyle changes that may be helpful: Sedentary women are more likely to have moderate or severe hot flashes compared with women who exercise.14 15 In one trial,

menopausal symptoms were reduced immediately after aerobic exercise.16 Nutritional supplements that may be helpful: Many years ago, researchers studied the effects of vitamin E in reducing symptoms of menopause. Most,17 18 19 20 21 but not all,22 studies found vitamin E to be helpful. Many nutritionally oriented 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.23 In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the bioflavonoid hesperidin, taken over the course of the day helped relieve hot flashes.24 Although placebo effects are strong in women with hot flashes, other treatments used in that trial failed to act as effectively as the bioflavonoid/vitamin C combination. Since then, researchers have not explored the effects of bioflavonoids or vitamin C in women with menopausal symptoms. 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 studies support the usefulness of black cohosh for women with hot flashes associated with menopause.25 A review of eight trials

concluded black cohosh to be both safe and effective.26 Many doctors of natural medicine recommend 20 mg of a highly concentrated extract taken twice per day; 2–4 ml of tincture three times per day may also be used. Sage may be of some benefit for women who are sweating excessively due to menopausal hot flashes during the day or at night.27 It is believed this is because sage directly decreases production of sweat. This is based on traditional herbal prescribing and has not been evaluated in clinical studies. A variety of herbs with weak estrogen-like actions similar to the effects of soy such as licorice, alfalfa, and red clover have traditionally been used for women with menopausal symptoms.28 Modern research has not attempted to confirm the potential benefit of these phytoestrogens. Contrary to popular belief, wild yam is not a natural source of progesterone nor has it been shown to reduce symptoms of menopause. Although a pharmaceutical conversion process can produce progesterone from wildyam, the body cannot duplicate this conversion. Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions. References: 1. Baird DD, Umbach DM, Landsedell L, et al. Dietary intervention study to assess estrogenicity of dietary soy among postmenopausal women. J Clin Endocrinol Metab 1995;80:1685–90.

2. Cassidy A, Bingham S, Setchell KDR. Biological effects of a diet of soy protein rich in isoflavones on the menstrual cycle of premenopausal women. Am J Clin Nutr 1994;60:333–40. 3. Knight DC, Eden JA. A review of the clinical effects of phytoestrogens. Obstet Gynecol 1996;87:897–904 [review]. 4. Albertazzi P, Pansini F, Bonaccorsi G, et al. The effect of dietary soy supplementation on hot flushes. Obstet Gynecol 1998;91:6–11. 5. Murkies AL, Lombard C, Strauss BJ, et al. Dietary flour supplementation decreases post-menopausal hot flushes: effect of soy and wheat. Maturitas 1995;21:189–95. 6. Brezinski A, Adlercreutz H, Shaoul R, et al. Short-term effects of phytoestrogen-rich diet on postmenopausal women. Menopause 1997;4:89–94. 7. Lee JR. Natural Progesterone. The multiple roles of a remarkable hormone. Sebastipol, CA: BLL Publishing, 1993, pp 31–37. 8. Gaby AR. Commentary. Nutr Healing 1996;June:1,10–11. 9. Wright JV. Hormones for menopause.Nutr Healing 1996;June:1–2,9. 10. Greendale GA, Reboussin BA, Hogan P, et al. Symptom relief and side effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin Interventions Trial. Obstet Gynecol 1998;92:982–88. 11. Bullock JL, Massey FM, Gambrell RD Jr. Use of medroxyprogesterone acetate to prevent menopausal symptoms. Obstet Gynecol 1975;46:165–68. 12. Morrison JC, Martin DC, Blair RA, et al. The use of medroxyprogesterone acetate for relief of climateric symptoms. Am J Obstet Gynecol 1980 138:99–104. 13. Schiff I, Tulchinsky D, Cramer D, Ryan KJ. Oral medroxyprogesterone in the treatment of postmenopausal symptoms. JAMA 1980;244:1443–45. 14. Ivarsson T, Spetz AC, Hammar M. Physical exercise and vasomotor symptoms in postmenopausal women. Mauritas 1998;29:139–46. 15. Hammar M, Berg G, Lindgren R. Does physical exercise influence the frequency of postmenopausal hot flushes? Acta Obstet Gynecol Scand 1990;69:409–12. 16. Slaven L, Lee C. Mood and symptom reporting among middle-aged women: the relationship between menopausal status, hormone replacement therapy, and exercise participation. Health Psychol 1997;16:203–8. 17. Perloff WH. Treatment of the menopause. Am J Obstet Gynecol 1949;58:684–94. 18. Gozan HA. The use of vitamin E in treatment of the menopause. NY State J Med 1952;52:1289. 19. Christy CJ. Vitamin E in menopause: Preliminary report of experimental and clinical study. Am J Obstet Gynecol 1945:50:84. 20. Finkler RS. The effect of vitamin E in the menopause. J Clin Endocrinol Metab 1949;9:89–94. 21. Rubenstein BB. Vitamin E diminishes the vasomotor symptoms of menopause. Fed Proc 1948;7:106 [abstr].

22. Blatt MHG et al. Vitamin E and climacteric syndrome: failure of effective control as measured by menopausal index. Arch Intern Med 1953;91:792–99. 23. Barton DL, Loprinzi CL, Quella SK, et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol 1998;16:495–500. 24. CJ Smith. Non-hormonal control of vaso-motor flushing in menopausal patients. Chicago Med 1964;67:193–95. 25. Duker EM. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med 1991;57:420–24. 26. Lieberman S. A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Womens Health 1998;7:525–29. 27. Duke JA. CRC Handbook of Medicinal Herbs. Boca Raton, FL: CRC Press, 1985, 420–21[review]. 28. Crawford AM. The Herbal Menopause Book. Freedom, CA: Crossing Press, 1996.

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