Prevention of Menopausal Symptoms

As far as supplements for menopausal symptom management, there are many products and blends out there. There are virtually no clinical trials done on most menopausal combination formulas, so for these, we must resort to clinical experience and patient testimonials. But research does tell us several things. The natural substance with the most positive clinical research is Black Cohosh (Latin name: Cimicifuga or Actaea racemosa), which is a Native American herbal medicine that has been used historically for a wide range of women’s health issues. Black cohosh has shown consistent positive results with reducing the main symptoms of menopause, hot flashes and sleep and mood disturbance2,4,5. The American College of Obstetrics and Gynecology guidelines on the use of botanicals for the management of menopausal symptoms support this use of black cohosh for up to six months in perimenopausal women, especially in treating the symptoms of sleep and mood disturbance, and hot flushes.6 [Evidence level C, consensus/expert guidelines]

As with all herbal medicines, quality standards vary amongst products. It is important to have a “standardized extract” with the active ingredient to ensure the product is effective and high quality. (See our Vitanica Cimicifuga Extract Plus, standardized to 2.5% triterpine glycosides). Adverse effects with use of black cohosh are extremely uncommon, and there are no known significant adverse drug interactions4.

A new study in July 2007 found that normal intake of natural Vitamin E significantly reduced hot flashes in post-menopausal women after only 4 weeks treatment1. This is great news for natural alternatives to estrogen (HRT) therapy.

The association of a lower incidence of postmenopausal symptoms with high intake of soybeans in Asian women suggests that phytoestrogens are an alternative to estrogen therapy3. There have been positive results with reduction of menopausal symptoms from soy and phytoestrogen foods in dietary intake7. Use of various phytoestrogen combination formulas is also widely recommended as a natural treatment for menopausal symptoms, but has shown less consistent results in the research. Soy isoflavones are an especially controversial treatment, since the results have been so variable and there is also some question about the long-term safety of these products, as there are with conventional hormonal therapies. Since the quality standards of the soy products used in these clinical trials are so variable, it is difficult to determine if the products are not consistent enough to produce results or if all soy products are inconsistently effective. Phytoestrogen extracts, including soy foods and red clover, appear to have at best only minimal effect on menopausal symptoms but have positive health effects on plasma lipid concentrations and may reduce heart disease7.

St. John’s wort has been shown to improve mild to moderate depression in the general population and appears to show efficacy for mood disorders related to the menopausal transition7. St. John’s Wort (Latin name: Hypericum perforatum) is used often in combination formulas for this purpose.St. John’s Wort should be used in caution with any medications for depression or mood disorder. For more information on St. John’s Wort and drug interactions, see http://nccam.nih.gov/health/stjohnswort/sjwataglance.htm.

When other natural treatments fail to prevent symptoms, there are bioidentical plant-based hormones that may provide another alternative to conventional hormonal treatments7. There is unfortunately not sufficient evidence to determine if bio-identical hormones would be safer long-term than conventional hormones.

Resources:
1. Ziaei S, Kazemnejad A, Zareai M. The Effect of Vitamin E on Hot Flashes in Menopausal Women. Gynecol Obstet Invest. 2007 Jul 30;64(4):204-207 [Epub ahead of print] PMID: 17664882
2. Haimov-Kochman R, Hochner-Celnikier D. Hot flashes revisited: pharmacological and herbal options for hot flashes management. What does the evidence tell us? Acta Obstet Gynecol Scand. 2005 Oct;84(10):972-9. Review. PMID: 16167914
3. Cheng G, Wilczek B, Warner M, Gustafsson JA, Landgren BM. Isoflavone treatment for acute menopausal symptoms. Menopause. 2007 May-Jun;14(3 Pt 1):468-73. PMID: 17290160
4. Kligler B. Black cohosh. Am Fam Physician. 2003 Jul 1;68(1):114-6. Review. PMID: 12887117
5. Low Dog T. Menopause: a review of botanical dietary supplements.Am J Med. 2005 Dec 19;118 Suppl 12B:98-108. Review. PMID: 16414334
6. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Use of botanicals for management of menopausal symptoms. Obstet Gynecol 2001;97:suppl 1-11.
7. Geller SE, Studee L. Botanical and dietary supplements for menopausal symptoms: what works, what does not. J Womens Health (Larchmt). 2005 Sep;14(7):634-49. PMID: 16181020.

EXERCISE

Menopause and Exercise

Exercise has a profound effect on every system in the body. For this reason, it can be used to reduce or remove some of the common symptoms that many peri and post menopausal women report. A healthy menopausal woman can gain significant psychological benefit from a moderate-intensity exercise program. A well though out program can help reduce mood fluctuations, decrease anxiety, help you sleep better, and lower your risk for osteoporosis and heart disease.

Many middle-aged women experience decreases in their sleep quality during the menopausal transition. A long term, moderate exercise program will help improve both the quality of sleep and the duration. In turn, the increase in sleep helps to regulate patterns of mood fluctuation and decrease anxiety. However, exercise participation must continue for the long term to maintain these improvements. Two forms of exercise that have been shown to be effective in increasing quality of life are yoga and walking. Moderate-intensity exercise becomes even more critical as women age. Positive effects have been shown for reducing bone mineral density loss and, perhaps more importantly, reducing the frequency of falls.

Menopausal-related weight gain has major cardiovascular health implications for older women. In healthy women, weight gain during the peri- to postmenopause can be prevented with a long-term lifestyle dietary and physical activity intervention. A starting point for establishing the long term basis for cardiovascular health is moderate physical activity AT LEAST 4 hours per week. Once we have a reasonable exercise routine established, it should be continued indefinitely to maintain benefits, except in the case of injury.

Resources:
1. Asbury EA, Chandrruangphen P, Collins P., The importance of continued exercise participation in quality of life and psychological well-being in previously inactive postmenopausal women: a pilot study. Menopause. 2006 Jul-Aug;13(4):561-7.
2. Simkin-Silverman LR, Wing RR, Boraz MA, Kuller LH. Lifestyle intervention can prevent weight gain during menopause: results from a 5-year randomized clinical trial. Ann Behav Med. 2003 Dec;26(3):212-20.
3. Oken BS, Zajdel D, Kishiyama S, Flegal K, Dehen C, Haas M, Kraemer DF, Lawrence J, Leyva J. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Altern Ther Health Med. 2006 Jan-Feb;12(1):40-7.

HEALTHY EATING

Nutrition for Menopause

Whole foods, soy products and omega 3 fatty acids are great additions to your diet in the menopausal years. Not only can they help reduce the symptoms associated with menopause, but they are helpful for preventing

chronic disease and as general healthy habits. Soy has recently received a lot of attention as an alternative to conventional hormone replacement therapy (HRT). This is largely because of the risks involved in HRT and that soy contains unique isoflavones that have both hormonal and non-hormonal properties. The estrogen-like effects of isoflavones in combination with the low reported frequency of hot flushes in heavy soy consuming regions such as Japan has prompted investigation of the effect of soy on menopausal symptoms. Initial review of these studies reveals hot flush frequency decreased by about 5% (above placebo or control effects) in women whose initial hot flush frequency was five or more per day. Also, substituting soy nuts for non-soy protein in the diet and consumed three or four times throughout the day is associated with a decrease in hot flashes and improvement in menopausal symptoms.

Omega 3 fatty acids are also necessary, especially later in life, particularly for maintaining joint and cardiovascular health. Additionally, Omega 3s may reduce hot flashes. A proposed mechanism is through their influence on maintaining nerve membranes and/or the modulation of the neurotransmitter function in the brain.

Perhaps the most important and universally applicable dietary intervention for reduction of menopausal symptoms is to incorporate a whole foods diet. Whole foods are those that are not processed in any way and include vegetables, whole grains and legumes with the occasional addition of fish and/or meat. Sugar should be eliminated entirely and alcohol consumption minimized. A mostly whole foods diet keeps the blood slightly alkaline, which helps reduce calcium leeching out of bones, thus maintaining bone mineral density. Also, an alkaline diet helps keeps inflammation to a minimum, which will positive cardiovascular and joint pain reduction effects. The whole diet approach also seems particularly promising to reduce the inflammation associated with the metabolic syndrome, a pre-diabetic condition. The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease and to maintaining postmenopausal quality of life.

Resources:
1. Messina M, Hughes C. Efficacy of soyfoods and soybean isoflavone supplements for alleviating menopausal symptoms is positively related to initial hot flush frequency. J Med Food. 2003 Spring;6(1):1-11. Review.PMID: 12804015 [PubMed – indexed for MEDLINE]
2. Welty FK, Lee KS, Lew NS, Nasca M, Zhou JR. The association between soy nut consumption and decreased menopausal symptoms. J Womens Health (Larchmt). 2007 Apr;16(3):361-9.PMID: 17439381 [PubMed – indexed for MEDLINE]
3. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll. Cardiol. 2006 Aug 15;48(4):677-85. Epub 2006 Jul 24.

MINDFULNESS

Menopause and Mindfulness

Mindfulness activities, like deep breathing exercises and relaxation practices, have shown to reduce hot flash severity during menopause1, 2. A new study in July showed that Hatha yoga combined with relaxation improved both objective and subjective measures of menopausal symptoms3. We know that yoga can balance hormonal levels and still the mind, with both of these contributing to a relaxed mood. Yoga can also improve mood variation and insomnia that can occur during menopause. One study showed significant improvement in various types of insomnia by regular practice of yoga exercises4.

Breathing techniques, yoga and relaxation exercises are often recommended for women in transition, not only for benefit of reduced symptoms, but also for long-term disease prevention.

Resources:
1. McKee J, Warber SL. Integrative therapies for menopause. South Med J. 2005 Mar;98(3):319-26. PMID: 15813159
2. Tremblay A, Sheeran L, Aranda SK. Psychoeducational interventions to alleviate hot flashes: a systematic review. Menopause. 2007 Jun 21; [Epub ahead of print] PMID: 17589375
3. Booth-LaForce C, Thurston RC, Taylor MR. A pilot study of a Hatha yoga treatment for menopausal symptoms. Maturitas. 2007 Jul 20;57(3):286-95. Epub 2007 Mar 2. PMID: 17336473
4. Khalsa SB. Treatment of chronic insomnia with yoga: a preliminary study with sleep-wake diaries. Appl Psychophysiol Biofeedback. 2004 Dec;29(4):269-78. PMID: 15707256

 
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