Menopause Treatment Options

Are there treatments other than HT for the symptoms of menopause?
Some women decide not to take HT or ERT to relieve the symptoms of menopause, and turn to herbal remedies or to certain estrogen-like chemicals in plants (called phytoestrogens) for help. There are many over-the-counter and natural remedies to help women with menopausal symptoms, such as black cohosh, ginseng, dong quai, and evening primrose. There is limited, and sometimes conflicting, research on the safety and effectiveness of many of these popular herbal products that claim to help menopause. Discuss herbal remedies with your health care provider before taking them. You also should tell your provider if you are taking any other medications, since some of the herbal products can have harmful interactions with other drugs. Recently, the American College of Obstetricians and Gynecologists (ACOG) issued the following guidelines on the most popular "alternative" medicines for menopause:

1. Soy and Isoflavones (plant estrogens found in beans, particularly soybeans) - High isoflavone intake (about 50 grams of soy protein per day) may be helpful in the short term (2 years or less) to relieve hot flashes and night sweats. Taken over the long term, it also may have good effects on cholesterol and bones. While safe in dietary amounts, the consumption of extraordinary amounts of soy and isoflavone supplements may interact with estrogen and may be harmful to women with a history of estrogen-dependent breast cancer and possibly to other women as well.
2. St. John's wort - May be helpful in the short-term (2 years or less) to treat mild to moderate depression in women (when given in doses of less than 1.2 milligrams a day.) A recent study showed it is not effective in treating severe depression. It also can increase skin sensitivity to the sun and may interfere with prescription antidepressants.
3. Black cohosh - May be helpful in the short term (6 months or less) to treat hot flashes and night sweats. It seems to be extremely safe, although studies have been small and brief, none longer than six months.
4. Chasteberry (also known as monk's pepper, Indian spice, sage tree hemp, and tree wild pepper) - This may inhibit prolactin, a natural hormone that acts on the breast. It is touted for breast pain and premenstrual syndrome. There are very few studies in menopausal women. A study of women with premenstrual syndrome found they reported improvements in mood, anger, headache, breast fullness, but not bloating and other symptoms.
5. Evening primrose - This plant produces seeds rich in gamma-linolenic acid, which some experts believe is the nutritionally perfect fatty acid for humans. Although evening primrose capsules are taken for breast pain, bladder symptoms and menopausal symptoms, there is little or no evidence that they work. The one high quality study of effects on hot flashes found that evening primrose was no better than placebo.
6. Dong quai - A study aimed at reducing hot flashes found that dong quai was not better than placebo - although the 4.5-gram dose used in the study was lower than that typically given in Chinese medicine. The herb is potentially toxic. It contains compounds that can thin the blood, causing excessive bleeding, and make the skin more sensitive to sun, possibly increasing skin cancer risk.
7. Valerian root - This has traditionally been used as a tranquilizer and sleeping aid. But the U.S. Pharmacopoeia, which sets manufacturing standards for medicines, does not support its use, and there have been reports of heart problems and delirium attributed to sudden withdrawal from valerian.
8. Ginseng - Most of the many types of ginseng (including Siberian, Korean, and American, white and red), are promoted for relieving stress and boosting immunity. A study of menopausal women by the leading ginseng manufacturer found the product did not relieve hot flashes but did improve women's sense of well being. Analyses of ginseng products have found a troubling lack of quality control: some contained little or no ginseng, contained large amounts of caffeine, or were tainted by pesticides or lead.
9. Wild and Mexican yam - There are no published reports that show wild and Mexican yam cream is effective in helping menopausal symptoms. The hormones in wild and Mexican yam do not have any estrogenic or progestational properties, so they are not expected to help women with these symptoms.
10. Vitamin E- Interviewed in the Tuft’s Health & Nutrition Letter, Dr. Manson, professor of medicine at Harvard Medical School, recommended alternatives including soyfoods and Vitamin E. For soy, Dr. Manson suggests one to two servings a day. "Many women will get some relief with just one or two glasses of soy milk a day or increasing tofu," she said, "and that could be maintained safely in the diet very long- term." For Vitamin E, Dr. Manson recommended daily intake of 400 to 800 units. "Women might want to try this together with soy," she said, noting that it's probably best to combine the two.

What are some practical things women can do to help deal with the symptoms of menopause?
There are things you can do to help relieve some menopausal symptoms.

• Hot Flashes - Hot flashes are sometimes brought on by specific things, such as a hot environment; eating or drinking hot or spicy foods, alcohol, or caffeine; and stress. You can try to decrease hot flashes by avoiding these triggers. Dress in layers and keep a fan in your home or workplace. Some women find that a program of regular exercise brings relief of hot flashes and other symptoms.
• Vaginal Dryness - You can help vaginal dryness and irritation by using an over-the-counter vaginal lubricant. There are also prescription estrogen and replacement creams that your doctor may recommend to help relieve vaginal dryness and pain intercourse. If you have spotting or bleeding while using estrogen creams, you should see your health care provider.
• Difficulty Sleeping - One of the best ways to get a good night's sleep is to participate in regular exercise - such as walking 30 minutes a day. However, avoid vigorous exercise too close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. Many women find that they sleep better after drinking something warm, such as herb tea or a glass of warm milk. Try to keep your bedroom at a comfortable temperature. Also avoid napping during the day, and try to go to bed and get up at the same times every day.

What other steps can women take to help prevent osteoporosis and heart disease during menopause?
Besides taking HT, women can help prevent osteoporosis and heart disease by making sure they get enough calcium, doing regular weight-bearing exercises, and eating a low-fat balanced diet. Other healthy behaviors to prevent disease include stopping smoking and drinking alcohol only in moderation.

For more information...
You can find out more about menopause by contacting the National Women's Health Information center at 800-994-WOMAN (9662) or the following organizations:

• National Cancer Institute
  Phone: (800) 332-8615
  Internet Address: http://cis.nci.nih.gov
• National Institute on Aging
  Phone: (800) 222-2225, (800) 222-4225 (TTY)
  Internet Address: http://www.nih.gov/nia
• American College of Obstetricians and Gynecologists
  Phone: (800) 762-2264
  Internet Address: http://www.acog.org
• National Osteoporosis Foundation
  Phone: (202) 223-2226
  Internet Address: http://www.nof.org

This information was abstracted from fact sheets prepared by the National Institute on Aging and the National Cancer Institute, from the Centers for Disease Control and Prevention's (CDC) booklet, "To Be or Not to Be - On Hormone Replacement Therapy," and from ACOG's Practice Bulletin, "Use of Botanicals for Management of Menopausal Symptoms." January 2003