The changes that arise around the time of menopause may be predictable, but that certainly doesn’t make them comfortable. Hot flashes and night sweats are just the beginning. Women may also experience vaginal dryness, loss of sex drive, mood swings, depression, and a host of related problems. If you’re experiencing uncomfortable menopausal changes that prompt you to see a conventional doctor, he may recommend hormone replacement therapy (HRT). Many women, however, fear the increased risks of breast cancer that go along with the therapy or find that they can’t tolerate the side effects, says Lauri Aesoph, N.D., a health-care consultant in Sioux Falls, South Dakota.
If you fall into this group, you should discuss your menopausal changes with your regular doctor. In addition, there are lifestyle alterations that you can make to ensure a smoother transition and help reduce the risks of heart disease and osteoporosis that increase after menopause. Among these strategies are exercising (including weight training); keeping coffee, alcohol, sugar, and salt consumption to a minimum; eating lots of fruits, vegetables, and soy-based foods; and cutting down on stress, suggests Dr. Aesoph.
Many alternative practitioners will endorse these suggestions, and they may have others that involve diet, exercise, and lifestyle. They’re also likely to recommend a number of supplements. Some address the whole range of discomforts, while others take aim at specific problems such as vaginal dryness or low sex drive. Here’s an overview of what these many supplements can do and what we know about how they work.
The Estrogen Mimics
Menopause is kind of like puberty in reverse. With puberty, your body started producing larger quantities of the hormones estrogen and progesterone, among others, and you started to menstruate. In menopause, your body produces fewer of these hormones, so you stop menstruating.
By the time you get to this time of life, your body has gotten used to higher hormone levels. Thus, for some women, menopause is like going through some kind of withdrawal. To help take the pain out of the process, you can give your body a little of what it may be lacking: estrogen.
There are 300 to 400 plants, called phytoestrogens, that have estrogenic characteristics, says Dr. Aesoph. The most well researched phytoestrogen is soy, but there are also two widely used estrogen-mimicking herbs: black cohosh, and licorice.
Phytoestrogens are weaker than the body’s own form of estrogen. Nevertheless, they are often powerful enough to provide some relief from hot flashes, vaginal dryness, and depression, says Willow Moore, D.C., N.D., a chiropractor and naturopathic doctor in Owings Mills, Maryland.
Getting Your Balance
Plant estrogens have a balancing effect on your body’s hormones, says Dr. Aesoph. When levels are low, as they are during menopause, the phytoestrogen attaches to little cell receptors that would normally be occupied by the body’s estrogen. The cell reacts as if it were receiving estrogen, and problems like hot flashes and mood swings are minimized.
"During menopause, your hormones can fluctuate dramatically," says Dr. Moore. Hot flashes and night sweats, for example, occur when estrogen levels go down and then come back up. These big swings cause your blood vessels to dilate, which in turn makes your body flush and sometimes even sweat profusely. "Women who are prone to hot flashes would probably find great relief from having balanced hormone levels," Dr. Moore says.
One way to achieve hormone balance is to eat a lot of foods that contain soy, such as tofu, soy milk, soy cheese, miso, and foods made with soy flour, says Dr. Aesoph.
Soy contains a class of phytoestrogens called isoflavones, and there are also supplements that contain these compounds. "As we learn more about the biochemistry of soy, supplement manufacturers are rushing forward to offer isoflavones in pill form. But you’re still probably better off if you get your isoflavones from soy foods," says Dr. Aesoph.
Genistein is a soy isoflavone that seems to provide a benefit in addition to helping menopausal discomforts. One study suggests that it has value for helping to improve cardiac health, which often declines with the onset of menopause.
At the Baker Medical Research Institute in Melbourne, Australia, women who took 45 milligrams a day of genistein over 5- to 10-week periods had improved elasticity of their arteries—a primary indicator of cardiac health. The degree of this improvement was on a par with that of women who took conventional hormone replacement therapy.
Herbs to the Rescue
Black cohosh has a long history of use for menopausal discomfort, says Dr. Moore. A good dose to take is 40 milligrams twice a day, she says. You probably won’t feel relief until about two to four weeks after you start taking it. Also, you should continue taking black cohosh even after menopause ends, says Dr. Moore. She recommends taking it for six-month periods, with a month off in between.
Like other estrogenic herbs, licorice has an active ingredient that seems to increase levels of estrogen when they are low and decrease them when they are high. A safe daily dose of licorice is 5,000 milligrams, or less than ¼ ounce of powdered root, in divided doses, says Dr. Aesoph. Since taking high doses of licorice for more than four to six weeks can result in health problems, talk to your doctor before taking it. A Chinese Remedy
Dong quai is yet another great all-around supplement to take for menopausal problems. "Many women in China and Japan who take a dose of dong quai every day, from the time they start menstruating all the way through menopause, have a reduced incidence of menstrual problems," says Dr. Moore.
Dong quai is thought to be good for relieving all kinds of female troubles, from premenstrual syndrome to heavy periods to menopausal problems, says Dr. Moore. For best results during menopause, follow the dosage directions on the package you buy, she says. The instructions for a product from Gaia Herbs, for example, are to put 30 to 40 drops in a small amount of warm water and take it three or four times a day between meals.
| Dong Quai: A Versatile Helper Dong quai is an herb that has been used for centuries in China. In fact, it is Chinese medicine’s leading remedy for gynecological ailments, including hot flashes and vaginal dryness during menopause. While no scientific studies have proven its effectiveness, dong quai has gotten a lot of mileage out of tradition and word-of-mouth recommendations. In addition to its gynecological powers, it has been used for other health problems. It’s said by Chinese herbal practitioners to improve liver function in people who have cirrhosis, relieve the back pain and inflammation of sciatica, and lessen the residual pain of shingles, a skin condition. It’s also considered a mild sedative, and according to Chinese practitioners, it has anti-inflammatory and pain-relieving properties as well. Because of this herb’s increasing popularity, it is available alone or in combination with other herbs used to reduce common symptoms of women’s ailments. You can find it at most health food stores. |
Replenishing Progesterone
The most effective way, by far, to impact progesterone levels is to supplement with a natural form of the hormone, says Samantha Brody, N.D., a naturopathic doctor specializing in women’s health in Portland, Oregon. "In addition to changing a woman’s diet and exercise patterns, this is one of the best things I’ve found to help with menopausal discomforts," she says.
Progesterone is the hormone that affects the endometrial lining—that is, the tissue that lines the inside of the uterus. Before menopause, this hormone plays a role during ovulation, helping to prepare the endometrial lining to receive the egg. If there’s no egg, progesterone helps shed the lining, which is important because more rapid shedding helps lower the risk of endometrial cancer.
Natural progesterone is usually derived from wild yam and is available over the counter as a body cream. You have to be careful, though, since wild yam must be chemically altered in the laboratory for it to be effective. Some products on the market have not been altered, so they won’t be as beneficial, Dr. Brody says. "A company by the name of Emerita makes a natural pro gesterone cream that I recommend to my patients," she says. The product is Pro-Gest Body Cream, and it can be found in health food stores.
| Hormone Replacement Therapy— The Natural Way In conventional hormone replacement therapy (HRT), the estrogen that’s given to menopausal women is often collected from the urine of a pregnant horse. That fact alone might prompt you to go another route. You might want to try natural hormones that are manufactured from soybeans and wild yam in the laboratory and are identical to the estrogen and progesterone in the body, says Lauri Aesoph, N.D., a health-care consultant in Sioux Falls, South Dakota, who specializes in helping doctors and their patients find safe and effective ways to use and integrate natural therapies. Plant-derived hormones have actually been around and in use for a long time. When compared to HRT, the hormones used in natural hormone replacement (NHR), offer similar relief from symptoms, says Dr. Aesoph. She notes as well that the number and severity of side effects is often lower with the natural hormones. When a woman uses NHR as opposed to conventional HRT, she usually takes two or three types of estrogen. These are the same two or three estrogens that a woman’s body makes on its own. The working names for these combinations are Bi-est and Tri-est. Both the combinations and the estrogens used to mix them are prescription items that are prepared by a compounding pharmacist—that is, they are mixed in much the same way that old-fashioned pharmacists once formulated medications. If you can’t locate a compounding pharmacist in your area, your doctor or practitioner can call in a prescription to one of several mail-order pharmacies. The hormones come in many different forms but are most commonly in capsules or drops. Natural hormones are not as strong as the hormones used in HRT, so the dosages prescribed will be stronger. Dr. Aesoph advises that you work closely with your doctor for the first few months, making adjustments as necessary until you find the dose that’s right for you. Also be aware that like any custom-designed product, NHR prescriptions can vary from pharmacy to pharmacy. Hormones taken by mouth lose some of their effectiveness because they pass through the digestive system, says Dr. Aesoph. A special type of progesterone, called oral-micronized progesterone, solves this problem. Prometrium (a natural oral progesterone pill) is one brand. Some doctors also use natural estrogen or progesterone drops placed under the tongue, which is another way to bypass the digestive tract. “Many women tolerate and like natural hormones better,” says Dr. Aesoph, “so they stick with them, which is just one way that these hormones can be more effective than conventional therapy.” |
Natural progesterone is also available as an oil that can be absorbed under the tongue, in pill form, and as vaginal suppositories, but these are not available over the counter.
Treating the Discomforts
Some studies have found vitamin E to be effective for relieving hot flashes and vaginal complaints in menopausal women. In one, researchers found that vitamin E supplements relieved discomfort and also improved vaginal blood supply when taken for four weeks or longer, but supporting research is lacking, so we really don’t know how it might work.
Despite this, anecdotal evidence suggests that it’s worth a try. You can take vitamin E capsules orally or use vitamin E oil topically inside your vagina once a day, says Dr. Aesoph. The combination of topical and oral vitamin E, including what may be in your multivitamin, should not exceed 1,200 international units (IU) a day, she says. Take 800 IU a day orally in two separate doses until your discomfort starts to decrease, then scale back to 400 IU a day, which you can take every day for the rest of your life. You should discuss taking this amount with your doctor first, though.
You may also need vitamin C, which is important during menopause because it helps boost adrenal gland function, says Dr. Moore. Your adrenal glands, located above your kidneys, pretty much take over most of the estrogen production when your reproductive system stops, she adds. If your adrenal function is good, you might make enough estrogen to satisfy your body during menopause, which might make menopause a breeze, she says.
Experts suggest taking vitamin C along with bioflavonoids, which help strengthen veins. The recommended dose is 1,200 milligrams a day of vita min C with hesperidin once a day during menopause. Together, these nutrients can help relieve hot flashes, regulate heavy bleeding, and reduce constipation, say herbal experts. Vitamin C and flavonoids can help put menopause in its place, adds Dr. Aesoph.
Researchers gave 94 women who had hot flashes a formula of 900 milligrams of hesperidin, 300 milligrams of hesperidin methyl chalcone (another citrus flavonoid), and 1,200 milligrams of vitamin C a day. After one month, hot flashes were reduced or relieved in 87 percent of the women. The reviews weren’t entirely favorable, however, as the women reported a slightly increased body odor and sweat that discolored their clothing.
You can find vitamin C supplements with hesperidin at health food stores and drugstores.
Other Forms of Assistance
Another adrenal function booster is pantothenic acid, a B vitamin, says Dr. Moore. Taking 500 milligrams a day can help reduce depression, fatigue, and insomnia, she suggests. Continue to take it until you feel relief.
For low sex drive, you might want to try the herb Siberian ginseng, says Dr. Brody. It has been shown in some animal studies to block stress-induced decreases in sexual activity, she says. Since recommendations vary, you should talk to your doctor about how much Siberian ginseng is right for you.
Some women experience anxiety with menopause. If you are one of them, the first thing you should do is avoid caffeine and sugar, says Dr. Brody. Then, if you still find yourself wrestling with nervous tension, you might want to try kava kava, she suggests. For depression try St. John’s wort, which has been shown in many studies to have a significantly positive impact for many women. Both herbs have few side effects and are safe to take for an extended period if you follow the dosage directions on the packages.
