Menopause

Change in Life

 

Menopause, also called the "change of life," is a natural part of aging. It is the point in a woman’s life when her periods stop and she is no longer able to have children. The average age of menopause onset is 45 to 64. During menopause, women experience physical, emotional and lifestyle changes. The Affinity Women & Families Center helps women through this stage of life by offering compassionate care, programs and information resources.

Irregular periods are often the first symptom.  Other symptoms include hot flashes, vaginal dryness, decreased libido, night sweats, fatigue, sleep disturbances, incontinence, difficulty concentrating, forgetfulness, irritability, anxiety and depression.  There are many different treatments for these symptoms, including conventional medications, nutritional supplements, herbals, massage therapy, acupuncture and biofeedback.  The following ideas are helpful for many women.

Lifestyle modifications:

  • Avoid triggers of hot flashes: alcohol, caffeine, hot or spicy foods, stress, hot drinks and warm environments.
  • Dress in layers, preferably cotton clothing.
  • Lose weight if you are overweight.  Women who are overweight have significantly more hot flashes than normal weight women.
  • Stop smoking.  Aside from the risks of smoking with heart and lung disease and cancer, smoking also worsens menopausal symptoms and osteoporosis.
  • Exercise regularly—aim for 30-60 minutes most days of the week.  Include some weight bearing exercise to keep your bones strong.  Exercise has been shown to improve mood in menopausal women.
  • Use a relaxation technique daily.  Meditation, yoga or breathing exercises are common methods of reducing stress.

Nutritional recommendations:

  • Eat a whole food diet with five to nine servings of fresh fruits and vegetables per day, and include whole-grain carbohydrates.
  • Avoid processed food and fast food.
  • Minimize intake of animal fats, sugar, caffeine and alcohol.
  • Use olive oil as your main source of fat.
  • Include flaxseeds as a source of fiber, omega-3 fatty acids and phytoestrogens (do not take phytoestrogens if you have had breast cancer).
  • Add two to four servings of soy foods per day.  Consider trying soy milk, edamame (soybeans in the pod), tofu or soy-based meat substitutes.

Over-the-counter remedies:

There are a variety of supplements available, ranging from vitamin formulations to natural hormones.  It’s important to know that these products are not regulated by the FDA, and proof of purity of content or effectiveness is not required.   Some products may have moderately helpful effects; others are harmless but ineffective or expensive.  A few can cause serious health problems.  Just because something is “natural” does not mean it is safe.  Be sure to let your doctor know everything you are taking.

Vitamins and Minerals:

  • Take a general multivitamin daily.  This contains vitamin D, which is essential for your bones.
  • Be sure to get 1,500 mg calcium per day.  Estimate your daily intake by reading food labels—if the nutrition facts label says 20 percent USRDA for calcium, it’s equal to 200 mg (just add a zero).  Add calcium supplements to get 1,500 mg.
  • Vitamin E has been shown to modestly help hot flashes in breast cancer survivors only. However, it has also been shown to increase overall mortality, so is not recommended. 

Herbal medicines and supplements:

Phytoestrogens are substances found in plants that are similar in structure to estrogen, and may help with menopausal symptoms.  The major classes of phytoestrogens include isoflavones (soy, lentils and other legumes), lignans (highest in flaxseed but also found in other whole grains) and coumestans (found in addition to isoflavones in red clover, sunflower seeds and bean sprouts).  If you have had breast cancer, discuss the use of any herbals with your physician and do not take phytoestrogens.   Of the herbal remedies, soy and black cohosh are the most promising.

  • Soy—consuming soy protein, 20-60 grams per day containing 30-70 mg isoflavones, seems to modestly decrease the severity and frequency of hot flashes.  It is also healthy for the heart and may benefit the bones.  Soy foods are preferable to soy supplements.
  • Black cohosh has been shown to be effective for reducing hot flashes, sweating, headache, dizziness, low libido, vaginal dryness and sleep disturbances associated with menopause.  It may take three to four weeks before a response is seen; do not use for longer than six months at a time and allow several weeks between uses.  The dose that has been most studied is 20-80 mg twice per day of the brand Remifemin.  Safety in women who have had breast cancer is unknown.
  • Red clover is a popular supplement for the treatment of menopausal symptoms.  It is a rich source of phytoestrogens, but it has not been proven to be any more effective than placebo for hot flashes.  Do not take this if you are on blood thinners.
  • Flaxseed is a good source of lignan phytoestrogens, as well as omega-3 fatty acids and fiber.  Two tablespoons per day of freshly ground flaxseed may help with menopausal symptoms.  This contains healthy fats, but is also high in calories, so substitute for other sources of fat.
  • Dong quai does not seem to relieve hot flashes.  It is often used in combination with other herbs in traditional Chinese medicine, but alone it does not seem to be effective for hot flashes, and may promote cancer.
  • Evening primrose oil is not recommended.  It does not seem to work.
  • Natural progesterone derived from wild yams is promoted as a safe natural alternative. The amount of progesterone in the creams varies, so you cannot be sure what you are getting.  Furthermore, it is not proven effective for hot flashes.
  • DHEA is also synthesized from wild yams and promoted for treatment of menopause, claiming to boost mood, energy and libido and delay aging.  These claims have not been proven, and the use of DHEA has not been studied long-term.  It has the potential to cause serious side-effects, and should only be used with your doctor’s knowledge and care.
  • Chasteberry has not been shown to help menopausal symptoms.  In addition, if you have had breast cancer you should not use this.
  • Panax ginseng may help symptoms of fatigue, insomnia and depression, but there’s not much evidence for other symptoms.
  • Valerian can be effective for menopause-related sleep problems.  The usual dose is 400-900 mg at bedtime.  Occasionally, this can cause headaches, excitability and heart irregularities.
  • St. John’s wort has been shown to be effective for mild and moderated depression, but it has not been studied for depression related to menopause.  It also has many medication interactions, so check with your doctor before taking this.
  • Other herbs like kudzu, alfalfa, hops and licorice are sometimes promoted for treatment of menopausal symptoms, but there’s no reliable evidence that they work.
  • Ginseng—may improve mood and well-being, but it does not seem to relieve hot flashes.

Conventional medicines:

Talk with your physician about other medicines if the lifestyle and nutrition changes do not help.  In addition to hormones, the SSRI antidepressants, gabapentin and clonidine, have been shown to decrease hot flashes.

Mind-body therapies:

Meditation, breathing exercises, journaling, guided imagery and hypnosis are examples of mind-body therapies.  Some small studies of various relaxation techniques have shown decreases in hot flashes.  Mind-body therapies have the advantage of being very safe, and often inexpensive.  

Other treatments:

Acupuncture has been shown to improve mood and hot flashes in menopausal women.  Studies of the use of magnets and reflexology did not show benefit above placebo.  Energy therapies like Reiki or healing touch help to rebalance the energy of the body, and can help some women with menopausal symptoms, although no studies have been done.  Ayurvedic medicine (a system of healing from India), homeopathy and traditional Chinese medicine have all been used to treat menopause symptoms.

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