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Menopause Treatment Options
There are three primary treatment options
for menopause: lifestyle management (exercise, especially weight
bearing, proper diet, stopping smoking, and routine checkups),
hormone replacement therapies (prescription treatments of estrogen
or estrogen plus progestin) and alternative therapies.
Since the cancellation of the NIH study,
more women want to know about alternative therapies. Many women
are currently using some form of alternative therapy. According
to a 1997 study conducted by the North American Menopause Society,
more than 30 percent of women use acupuncture, natural estrogen(s),
herbal supplements, or so-called plant estrogens (phytoestrogens).
Botanical products containing or acting like estrogens may provide
some of the benefits of estrogen in relieving menopausal symptoms.
"Natural" Alternatives to HRT
Women wishing to consider alternative
treatments to HRT to alleviate the symptoms often experienced
concurrent with menopause frequently find themselves searching
through volumes of sometimes confusing and contradictory information.
Often it is difficult to identify health care professionals
who are willing to explore treatment options. The following
information is provided as a beginning resource for women who
wish to familiarize themselves with natural alternatives. The
resources provided here should be used for education only and
are not in any way intended to be complete. Any decisions regarding
medical treatment, including supplements and herbal extractions
should be made in consultation with a qualified health professional.
Nutritional Supplementation
Calcium—Calcium is a number-one
consideration for women before, during, and after menopause.
Calcium's importance for maintaining strong, healthy bones and
slowing bone loss cannot be overstated.
Magnesium—While calcium gets
the most attention when it comes to mineral nutrition for bones,
magnesium is also vitally important. Magnesium is required for
calcium to work properly: magnesium helps bone absorb calcium.
Gamma Oryzanol—Gamma oryzanol
is a natural substance found in the bran of grains such as rice.
The body converts gamma oryzanol into a compound called "ferulic
acid," which acts as an antioxidant and as a hormone regulator.
Soy Isoflavones—In Asia and other cultures where soy
products are consumed in abundance, women's health problems,
certain cancers, and cardiovascular disease are reported to
be less prevalent. Soy isoflavones (genistein and daidzein)
are rich in phytoestrogens and are thought to reduce the symptoms
of menopause, decrease the loss of bone, and decrease the risk
of certain cancers.
Melatonin—Melatonin levels decrease
as we age with a distinct difference noted between premenopausal
women and postmenopausal women. Some medical literature suggests
a beneficial role of melatonin in menopausal women experiencing
insomnia.
Vitamin C and Vitamin D—Bone
loss and decreases in bone mineral density is inevitable as
we age. It is important to slow this process, maintain strong
healthy bones and thus decrease the risk of bone fractures.
According to the National Osteoporosis Foundation, over half
of Americans older than 50 have low bone mineral density and
80 percent of them are women. Especially when used with other
therapies, numerous studies have supported the use of vitamin
C to help support bone mineral density. Vitamin D is one of
the primary regulators of calcium absorption. Deficiencies are
frequently found in postmenopausal women with or at risk for
osteoporosis. Considering this relationship, vitamin D insufficiency
may have an effect on bone strength.
Flaxseed Oil—Flaxseed oil is one
of the greatest sources of essential fatty acids. These fatty
acids have several important functions and may potentially have
a valuable role in protecting against cardiovascular risks in
postmenopausal women.
Herbal Supplementation
Black Cohosh—A tall perennial plant, Black Cohosh
was valued by Native Americans as an herbal remedy. The herb
became known in colonial days for relieving menstrual cramps.
Its usage then spread to Europe, where it still remains popular
today as an alternative to Hormone Replacement Therapy in European
phytotherapy.
Chasteberry—The chasteberry tree
originated in the Mediterranean. Harvested and dried for its
medicinal value, chasteberry fruit has a long folk history of
use for women's health issues. Chasteberry has been recommended
for mild to moderate conditions, especially in endometriosis,
menopausal discomforts, and PMS.
Red Clover—Red clover has been
used traditionally as a medicinal herb in the Orient, in Europe,
and among Native American tribes. Red clover's isoflavones bind
to estrogen receptors on cells surfaces
The American College of Obstetricians and
Gynecologists
Physicians are beginning to educate themselves
on non-medical treatments. A recent Practice Bulletin, Botanicals
for Management of Menopausal Symptoms, developed by
the ACOG Committee on Practice Bulletins was published June
2001 (NUMBER 28). It was designed to aid practitioners who are
members of the the American College of Obstetricians and Gynecologists
in making decisions about appropriate obstetric and gynecologic
use of botanicals.
Their cautious recommendations based
primarily on consensus and expert opinion follow:
Soy and isoflavones may be helpful in the
short-term (<=2 years) treatment of vasomotor, sleep disturbance,
"hot flashes", vaginal dryness and dyspareunia,
although sources of isoflavones and beneficial amounts are
not standardized. Given the possibility that these compounds
may interact with estrogen, these agents should not be considered
free of potential harm in women with estrogen-dependent cancers.
St. John's wort may be helpful in the short-term (<=2 years)
treatment of mild to moderate depression in women.
Black cohosh may be helpful in the short-term (<=6 months)
treatment of women with vasomotor symptoms.
Soy and isoflavone intake over prolonged
periods may improve lipoprotein profiles and protect against
osteoporosis. Soy in foodstuffs may differ in biological activity
from soy and isoflavones in supplements.
More Study Needed
Additional studies are needed to define
the possible benefits of these botanical products in promoting
bone, heart, and brain health, as well as the potential risks
of increasing breast, endometrial, or other cancers in diverse
populations of postmenopausal women. Much current verification
of benefit is based on anecdotal information or small study
groups. Long-term studies, conducted under strictly controlled
conditions are needed to provide reliable and consistent conclusions.
Regulation
An additional complication encountered
with use of non-prescription treatment is the lack of regulation
commonly depended upon to assure purity, consistency and uniformity.
Natural supplements and herbal extractions are not regulated
as medication, therefore may be measured in differing units
and may be of inconsistent quality.
To make an educated decision about whether
to use or not use HRT and/or alternative therapies, do extensive
reading and talk with your health care provider to develop an
individualized plan. Together you and your health care provider
discuss options, discuss individual risks and benefits, and
watch for side effects and monitor outcomes.
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