by Jackie Hart, MD
Q: My friends mother has been using traditional methods of estrogen replacement with several unwanted symptoms such as weight gain and mood swings. I know that some women have been turning to certain alternatives such as herbs and supplements. What particular methods would you recommend?
A: Like your friends mother, many women who experience unpleasant side effects stop or want to stop their hormone replacement therapy (HRT). In fact, a large percentage of women who are prescribed HRT stop taking it within one year of starting. Side effects and concerns about breast cancer are the most common reasons for discontinuing HRT.
Although HRT remains the method with the most documented evidence for prevention of heart disease and osteoporosis, other options for control of menopausal symptoms and prevention of the long-term risks associated with menopause are available. These include:
In addition to helping control hot flashes, vaginal dryness, and other symptoms of menopause, new evidence suggests that phytoestrogens may also help prevent the development of osteoporosis and/or further bone loss once osteoporosis has been established. Soys bone-protective properties are particularly effective in combination with supplemental calcium (1,000 to 1,500 mg/day) and vitamin D (400 IU). Research also suggests that soy may reduce the risk of heart disease by improving the cholesterol profile, stabilizing blood vessels, and decreasing the risk of blood clot formation.
There is some concern about using soy and flax together. This combination may provide too many phytoestrogens and therefore increasethe risk of breast cancer, as synthetic estrogens may do. Until more information is available it is probably safest to take either flax or soy, not both. Another option is to have one serving of soy and 1 to 2 tablespoons of flaxseed per day. Work with your health care provider, who can assess your breast cancer risk, to determine the combination that is best for you.
Other natural substances that have been proposed to control menopausal symptoms include DHEA, red clover, and two herbal ingredients of traditional Chinese remedies called dongquai and black cohosh. The evidence regarding DHEA, in my opinion, is weak, and its safety has not yet been established. At this point, I would not recommend it for menopausal symptoms or any other condition.
A recent study of isoflavones derived from red clover suggests this herb may reduce the number and intensity of both night sweats and hot flashes; however, there were only 25 women in this study and they only used the supplement for eight weeks. Therefore, more research is needed before conclusions can be drawn about the benefits of red clover. For the time being, as I stated above, it is safest and most effective to obtain phytoestrogens such as isoflavones from food sources.
Regarding dong quai and black cohosh, there are mixed reports. Studies have not been convincing, but some women swear by one or both of these herbal treatments for control of their menopausal symptoms. In my clinical practice many women have reported some improvement at first, but the menopausal symptoms return after just a few weeks of use of either dong quai or black cohosh. Black cohosh was approved in Germany for the control of menopausal symptoms, but this supplement is not recommended for more than six consecutive months.
Another new finding to consider in weighing the pros and cons of HRT is that a lower dose of estrogen may be just as valuable for control of menopausal symptoms and prevention of osteoporosis and heart disease as the dose that is generally prescribed. You might want to discuss lowering your estrogen dose, as well as the option of natural estrogens such as estradiol, with your healthcare provider.
Finally, exercising regularly and practicing stress management in the form of yoga, meditation, tai chi, etc., can help stabilize menopausal symptoms and/or side effects of HRT such as weight gain and mood swings. These healthful lifestyle practices may also reduce the risk of osteoporosis and heart disease.
Q: My friends mother has been using traditional methods of estrogen replacement with several unwanted symptoms such as weight gain and mood swings. I know that some women have been turning to certain alternatives such as herbs and supplements. What particular methods would you recommend?
A: Like your friends mother, many women who experience unpleasant side effects stop or want to stop their hormone replacement therapy (HRT). In fact, a large percentage of women who are prescribed HRT stop taking it within one year of starting. Side effects and concerns about breast cancer are the most common reasons for discontinuing HRT.
Although HRT remains the method with the most documented evidence for prevention of heart disease and osteoporosis, other options for control of menopausal symptoms and prevention of the long-term risks associated with menopause are available. These include:
- Soy
In addition to helping control hot flashes, vaginal dryness, and other symptoms of menopause, new evidence suggests that phytoestrogens may also help prevent the development of osteoporosis and/or further bone loss once osteoporosis has been established. Soys bone-protective properties are particularly effective in combination with supplemental calcium (1,000 to 1,500 mg/day) and vitamin D (400 IU). Research also suggests that soy may reduce the risk of heart disease by improving the cholesterol profile, stabilizing blood vessels, and decreasing the risk of blood clot formation.
- Flax
There is some concern about using soy and flax together. This combination may provide too many phytoestrogens and therefore increasethe risk of breast cancer, as synthetic estrogens may do. Until more information is available it is probably safest to take either flax or soy, not both. Another option is to have one serving of soy and 1 to 2 tablespoons of flaxseed per day. Work with your health care provider, who can assess your breast cancer risk, to determine the combination that is best for you.
- Vitamin E
Other natural substances that have been proposed to control menopausal symptoms include DHEA, red clover, and two herbal ingredients of traditional Chinese remedies called dongquai and black cohosh. The evidence regarding DHEA, in my opinion, is weak, and its safety has not yet been established. At this point, I would not recommend it for menopausal symptoms or any other condition.
A recent study of isoflavones derived from red clover suggests this herb may reduce the number and intensity of both night sweats and hot flashes; however, there were only 25 women in this study and they only used the supplement for eight weeks. Therefore, more research is needed before conclusions can be drawn about the benefits of red clover. For the time being, as I stated above, it is safest and most effective to obtain phytoestrogens such as isoflavones from food sources.
Regarding dong quai and black cohosh, there are mixed reports. Studies have not been convincing, but some women swear by one or both of these herbal treatments for control of their menopausal symptoms. In my clinical practice many women have reported some improvement at first, but the menopausal symptoms return after just a few weeks of use of either dong quai or black cohosh. Black cohosh was approved in Germany for the control of menopausal symptoms, but this supplement is not recommended for more than six consecutive months.
Another new finding to consider in weighing the pros and cons of HRT is that a lower dose of estrogen may be just as valuable for control of menopausal symptoms and prevention of osteoporosis and heart disease as the dose that is generally prescribed. You might want to discuss lowering your estrogen dose, as well as the option of natural estrogens such as estradiol, with your healthcare provider.
Finally, exercising regularly and practicing stress management in the form of yoga, meditation, tai chi, etc., can help stabilize menopausal symptoms and/or side effects of HRT such as weight gain and mood swings. These healthful lifestyle practices may also reduce the risk of osteoporosis and heart disease.