Menopause

There are ways to treat the symptoms of menopause without hormone replacement therapy. These include:

Herbal Medicines. Research has shown that several herbal medicines may be useful in treating many menopausal symptoms. Before taking natural or herbal products, discuss with your doctor, who will be able to notify you of any health risks and potential interactions with medications. Because natural products used for menopausal symptoms can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy. Some findings from this research are highlighted below.

• Black cohosh (Actaea racemosa, Cimicifuga racemosa). This herb has received more scientific attention for its possible effects on menopausal symptoms than have other botanicals. Studies of its effectiveness in reducing hot flashes and other symptoms have had mixed results.
  • A study funded by NCCAM and the National Institute on Aging (NIA) found that black cohosh, whether used alone or with other botanicals, did not relieve hot flashes and night sweats in postmenopausal women or those approaching menopause. In the same study, black cohosh also had no effect on gynecological problems such as vaginal dryness and abnormal bleeding.
  • Other research suggests that black cohosh does not act like estrogen, as once was thought.
  • A 2012 systematic review of 16 randomized clinical trials that included more than 2,000 women was unable to draw any conclusions about the effectiveness of black cohosh on menopausal symptoms. This was primarily due to the wide differences in how the studies were performed.
  • United States Pharmacopeia experts suggest that women should discontinue use of black cohosh and consult a health care practitioner if they have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice. There have been several case reports of hepatitis (inflammation of the liver), as well as liver failure, in women who were taking black cohosh. It is not known if black cohosh was responsible for these problems. Although these cases are very rare and the evidence is not definitive, scientists are concerned about the possible effects of black cohosh on the liver.
• Dong quai (Angelica sinensis). Only one randomized clinical study of dong quai has been done. The researchers did not find it to be useful in reducing hot flashes. Dong quai is known to interact with, and increase the activity in the body of, the blood-thinning medicine warfarin. This can lead to bleeding complications in women who take dong quai.
• Ginseng (Panax ginseng or Panax quinquefolius). The 2005 NIH panel concluded that ginseng may help with some menopausal symptoms, such as mood symptoms and sleep disturbances, and with one’s overall sense of well-being. However, ginseng has not been found helpful for hot flashes.
• Kava (Piper methysticum). According to the 2005 NIH panel, there is no evidence that kava decreases hot flashes, although it may decrease anxiety. Furthermore, it is important to note that kava has been associated with liver disease. The U.S. Food and Drug Administration (FDA) has issued a warning to patients and providers about kava because of its potential to damage the liver.
• Red clover (Trifolium pratense). The 2005 NIH panel found no consistent or conclusive evidence that red clover leaf extract reduces hot flashes. A large clinical trial and several reviews of the research literature concluded that red clover had no significant beneficial effects on menopausal symptoms. A review of the research literature also found no apparent evidence of adverse events from short-term use (up to 16 weeks). However, the same review noted the lack of data on the safety of long-term use. There are some concerns that red clover, which contains phytoestrogens, might have harmful effects on hormone-sensitive tissue (for example, in the breast and uterus).
• Soy. The scientific literature includes mixed results on soy extracts for hot flashes. Some studies find benefits, but others do not. Although information on adverse effects is limited, soy extracts appear to be generally safe when taken for short periods of time. However, long-term use of soy extracts (which also contain phytoestrogens) has been associated with thickening of the lining of the uterus. Phytoestrogens occur naturally in plants and act like estrogens in some tissues, including bone and cardiovascular tissue. Plants rich in phytoestrogens have been studied for treating menopause symptoms. However, much remains to be learned about these plant products, including their effects in the human body. Doctors caution that certain women need to be particularly careful about using phytoestrogens, especially:
  • Women who have had or are at increased risk for diseases or conditions that are affected by hormones, such as breast, uterine, or ovarian cancer
  • Women who are taking medications that increase estrogen levels in the body, such as birth control pills; menopausal hormone therapy; or a type of cancer drug called selective estrogen receptor modulators (SERMs), such as tamoxifen.

Dietary supplements. Certain dietary supplements can help to restore deficiencies that may occur as a result of decreased estrogen and progesterone production. These include:

• DHEA. DHEA is a naturally occurring substance that is changed in the body to the hormones estrogen and testosterone. DHEA is manufactured and sold as a dietary supplement. A few small studies have suggested that DHEA might possibly have some benefit for hot flashes and decreased sexual arousal, although small randomized controlled trials have shown no benefit. Because levels of natural DHEA in the body decline with age, some people believe that taking a DHEA supplement can help treat or prevent conditions related to aging; however, there is no scientific evidence to support this notion. Concerns have been raised about whether DHEA is safe and effective. Its long-term effects, risks, and benefits have not been well studied, and it remains unclear whether it might increase the risk for breast or prostate cancer. There is the possibility that even short-term use of DHEA supplements might have detrimental effects on the body. Before using DHEA for any purpose, people should talk to their health care provider about potential benefits and risks.
• Calcium.Calcium helps protect against osteoporosis and bone loss. Women 51 and older need 1,200 mg of calcium per day. Calcium can be found in milk, fortified cereals and soy milks, dairy products, green leafy vegetables, and tofu.
• Vitamin D. Vitamin D helps your body absorb calcium, so it is just as important as calcium when it comes to bone health. Sunlight is the best source of vitamin D. While it protects you from harmful rays that can cause skin cancer, sunblock can also block out the rays needed for vitamin D production. Only a couple of minutes of exposed sun exposure are needed to absorb the right amount of sunlight for normal vitamin D levels. Make sure that for time longer than that you protect yourself with sunblock. Vitamin D can also be found in food (fortified milks, cheese, tuna) and can be taken in pill form.

Bioidentical Hormone Replacement Therapy or BHRT, is a marketing term that is not recognized by the FDA. It is a term used to describe medications that are prepared in specialized pharmacies. BHRT may contain any variation of hormones including estrone, estradiol, estriol, progesterone, and testosterone. Compounded bioidentical hormones are often marketed as natural and safe alternatives to conventional hormone therapy prescription medications. However, compounded formulas are often inconsistent and can vary depending on the batch or the pharmacist. While FDA-approved hormone preparations have been tested for efficacy, purity, safety, and potency, there is a lack of scientific evidence surrounding BHRT and the safety and efficacy of these compounds. As a result, compounded bioidentical hormones are not approved by the FDA. For additional information, see the FDA publication Bio-Identicals: Sorting Myths from Facts

Acupuncture. Studies have shown that acupuncture, which aims to restore the bodily flow of energy through the insertion of needles into acupuncture points around the body, can help to reduce the severity of hot flashes and night sweats. Research on the efficacy of acupuncture as a menopause treatment is limited, and patients should talk to their general practitioners before beginning treatment.