Alternatives for Menopause (May 2004)

”Alternative treatments for menopause” are the most recent medical buzzwords. Why? By 2015, nearly 50% of the women in the U.S. will be menopausal, known as the so-called “boomerpause”. The increased risks associated with hormone replacement therapy have been all over the medical literature and media. Further, surveys show that over 75% of women aged 45-60 report having used nonprescription therapies to manage their symptoms. The frightening statistic is that over 46% of nonprescription use in America occurs without consulting a medical practitioner. “Natural” is not an assurance of safety or efficacy, and potentially dangerous side effects and drug-herb interactions can occur. Fortunately, high-quality medical research is underway due to the increased demand by consumers. Here is an overview of what is safe and effective for menopausal symptoms.

Healthy lifestyle counteracts risks
The first step in one’s approach to menopause is the understanding that it is a natural process, not a diseased state requiring “treatment”. It is a beautiful bridge from fertility to menstrual freedom, and each woman’s path is different. The relatively estrogen-deficient state can be quite uncomfortable for many. Understanding some of the emotional components of that transition for women can help the severity of symptoms. Second, maintaining a healthy lifestyle has not only been proven to drastically reduce menopausal symptoms, but also counteracts some of the risks associated with lower estrogen levels (such as cardiac disease, osteoporosis, stroke, and urinary incontinence) as well. Regular exercise (both aerobic and weight bearing) should be included in every treatment plan. Studies show that women exercising 3.5 hours/week have 50% less hot flashes. Caffeine and nicotine should be eliminated, as they are both stimulants that may exacerbate symptoms. Alcohol should be limited since it interferes with the metabolism of estrogen by the liver. Stress management with yoga, tai chi, meditation, or any form enjoyable for the woman allows for a smoother transition both physically, psychologically, and emotionally.

Nutrition is key
General nutrition is the cornerstone for menopausal health. Each woman is encouraged to follow a healthy diet, with specific alterations based on her individual risks. All women should take in adequate calcium (averaging 1600 mg/day divided into three doses), Vitamin D (600-800 IU/day), minimal animal protein, dark green leafy vegetables, and low fat dairy products. For heart health, total fat should be less than 30% of the diet, and should predominantly consist of omega-3 fatty acids found in cold-water fish (salmon, mackerel, herring, halibut) and monounsaturated fats like olive oil. Fiber, both soluble and insoluble, is extremely important as well. For bone health, osteoporosis is linked to not only insufficient calcium intake and Vitamin D deficiency, but also to high protein diet, high phosphorous intake (as in soda), excess salt intake, refined sugar and refined grains and flours (which are stripped of vitamin B6, folic acid, calcium, magnesium, manganese, copper, and zinc). These foods should be avoided if possible. Phytoestrogens, like those found in soy foods, have been studied extensively and shown to improve cholesterol and blood pressure, decrease the risk of osteoporosis, and reduce menopausal symptoms. The FDA now claims that “25gm/day of soy protein may reduce the risk of heart disease” due to the current research. However, purified isoflavones have less of an effect on lipids and blood pressure than soy foods. And since there is very little regulation on soy and isoflavone supplements, whole food sources of soy are by far the best source. Women with estrogen-dependent cancers as well as those with thyroid dysfunction should be cautious with their intake of phytoestrogens.

Several nutritional supplements can be beneficial for menopausal women. Bioflavenoids have antioxidant and anti-inflammatory properties. For example, a combination of 1200mg of hesperidin with 1200 mg of vitamin C was found to reduce hot flashes. Similarly, vitamin E (400-800IU mixed tocopherols/day) has been shown to reduce hot flashes and vaginal dryness.

Herbal therapies and natural hormone replacement
Although few well-designed studies exist on herbal therapies for menopausal symptoms, the efficacy of black cohosh extract has been demonstrated in medical literature with few side effects. Use cautiously if you have a history of iron deficiency or breast cancer, and use should be limited to less than 6 months (due to the lack of long-term studies). The minimal research available on other therapies such as dong quai, licorice root, evening primrose oil, and red clover has not demonstrated effectiveness in relieving menopausal symptoms, yet they are widely utilized in Eastern medicine. Further investigation is necessary in this rapidly evolving field. Natural hormone replacement therapy is another option for severe and debilitating menopausal symptoms and is only available by prescription.

For women who decide to use an alternative either due to dissatisfaction with conventional treatment or because they regard the complementary agents as more congruent with their own values, beliefs, and philosophical orientations toward health, there are several effective therapies available for menopausal symptoms. It is important to weigh how a woman’s quality of life may be improved and what risks are increased for her in particular. Consult your physician to explore these in more detail.

Resources: www.menopause.org, www.consumerlabs.com, www.nccam.nih.gov.

by Anne Stewart, M.D.

Dr. Anne Stewart is a holistic family physician specializing in integrative approaches to fibromyalgia, chronic fatigue, arthritis, IBS, hypertension, diabetes, PMS, menopause management and healthy aging.