Natural treatments for the symptoms of menopause

by Elaine Gottlieb

Its somewhat ironic that menopause—which ultimately ends the discomforts associated with the menstrual cycle—can be preceded by years of the worst PMS-like symptoms you can imagine. Plus, menopause can cause new symptoms such as hot flashes and irregular bleeding, and can increase a womans risk for heart disease and osteoporosis.

For women seeking relief, conventional medicine offers hormone replacement therapy (HRT), which can be effective in relieving symptoms but can also increase the risk of breast cancer and blood clots and can cause side effects such as vaginal bleeding, nausea and headaches.

As a result, many women are turning to natural remedies to treat menopausal symptoms. According to the New York Times, sales of "all-in-one" menstrual formulas increased 197% in 1999.

"Philosophically, some women are not comfortable treating what they consider a natural life cycle phase with non-natural remedies," says Hope Ricciotti, MD, a gynecologist/obstetrician at Beth Israel Deaconess Medical Center in Boston, assistant professor at Harvard Medical School and co-author of The Menopause Cookbook.

With health food stores and drugstores full of all kinds of menopause remedies that promise major health benefits, its hard for a woman to know what really works. Many have not been thoroughly studied yet, so the evidence of their efficacy is often anecdotal.

Practitioners suggest that before trying natural remedies, women experiencing menopausal symptoms should consider lifestyle changes, such as diet, exercise, and stress management.

"Sometimes perimenopause [the period prior to menopause when changes begin] and menopause can be a good teaching moment. Its a time when women are interested and willing to make changes," says Ricciotti.

Menopause is an opportune time to evaluate your lifestyle and habits, because a healthful lifestyle can make a big difference in how menopause affects your overall functioning. For example, eating a diet high in processed foods and condensed sweets causes fluctuations in blood sugar levels that can lead to carbohydrate cravings and irritability, according to Deborah Morrill, a nurse practitioner specializing in womens health at the Marino Center for Progressive Health in Cambridge, Mass.

A diet that contains protein, fiber, fruits, vegetables and grains helps keeps blood sugar levels in balance. Reducing intake of alcohol, caffeine and spicy foods is also important, because these foods can aggravate hot flashes. By eliminating factors that intensify menopausal symptoms, you may be able to gain a clearer sense of what physical and emotional reactions are truly contributing to your menopause symptoms.

Dr. Ricciotti recommends that women walk at least three days a week and eat a well-balanced diet. "I think a lot of the mood irritability and fatigue symptoms can be reduced by these very natural means," she says.

Menopause often coincides with a demanding period of a womans life, when she is in the throes of child rearing, at the peak of her career, or taking care of parents. Stress management techniques—including yoga, meditation and learning to prioritize—can help a woman cope with the changes in her physical state.

For symptoms that arent alleviated by lifestyle changes, there are many remedies that can be effective. Its a matter of finding the ones that work for you. Morrill always has her patients try one remedy at a time so they can assess its effects and she therefore doesnt recommend the "all-in-one" remedies.

Soy foods contain isoflavones—plant sources of estrogen known as phytoestrogens—that can significantly reduce hot flashes. Ricciotti and Morrill strongly believe that soy should be consumed from food sources, because they often contain other substances that have a synergistic effect. And you dont need to eat vast quantities. One glass of soy milk or 1-2 ounces of tofu as part of a healthy diet is adequate, says Ricciotti.

Neither Ricciotti nor Morrill recommends the more potent soy isoflavone pills, because they have not been adequately studied and because there is concern they may pose the same health risks as synthetic estrogen. The greatest risk is for women who have had breast cancer. While most studies have shown soy supplements to be safe and possibly beneficial for women with breast cancer history, reports Ricciotti, a small number of other studies have indicated an increased risk of a recurrence. She tells her patients with breast cancer that they can safely consume soy foods in moderation to reduce hot flashes.

Soy has other preventive health benefits that are important during the menopausal years and beyond. It has been shown to lower cholesterol in both men and women. Soy is also a major source of calcium, which is important in preventing bone loss and, as such, is a good alternative to dairy products that may become harder to digest as people age. Some studies have shown that soy and phytoestrogens may reduce bone loss, but the data are still inconclusive.

There is evidence that a lifetime of eating soy foods may prevent breast cancer, based on the low incidence of the disease among Japanese women who consume a great deal of soy, and Ricciotti suggests including soy as part of your childrens diet.

Flaxseed also contains phytoestrogens thought to be effective in treating hot flashes, although it has not been studied. Like soy, it should be consumed in food form; flaxseeds can be sprinkled in yogurt or on salads and or used in baking (although it is not known if baking breaks down the beneficial components). The best bet is to grind whole flaxseeds—using a coffee grinder or mortar and pestle—before eating. (Note, however, that ground seeds should be refrigerated).

The herb black cohosh is commonly used in American Indian cultures and in Germany, where it has been extensively studied for more than 50 years. Research has found this herb to be fairly effective in treating hot flashes, mood changes and vaginal dryness. While black cohosh is considered safe, it is sold in doses of up to 250 milligrams in the United States, while the recommended dose in Germany is only 40 milligrams. Women are advised not to take it for periods longer than six months, since its long-term effects have not been studied.

Red clover is a potent phytoestrogen that can decrease hot flashes, but has no real scientific evidence to corroborate its effectiveness. Dong quai is used in Chinese medicine in combination with other herbs to treat hot flashes and may not be effective when taken alone. Evening primrose oil is also used to treat PMS symptoms. The oil may relieve breast tenderness and joint pain and decrease hot flashes.

Relief of hot flashes has a significant impact on other discomforts associated with menopause. Hot flashes disrupt sleep and contribute to fatigue and moodiness. Perimenopause and menopause are not considered primary mood disorders, according to Ricciotti, and most doctors, therefore, attribute the emotional symptoms of menopause to poor quality of sleep.

Morrill recommends three well-known herbs known for their relaxing and mood-altering properties: kava, valerian, and St. Johns wort.

Kava is thought to promote relaxation, increase REM sleep and reduce anxiety. It should not be taken with prescription antidepressants, tranquilizers or anti-anxiety drugs, such as Xanax.

Valerian is often combined with passion flower and commonly used as a sleep remedy. It is anecdotally reported to decrease hot flashes.

St. Johns Wort is an herbal antidepressant that is commonly used in Germany, where it has been extensively studied. Its popularity is growing in the United States as well.

To relieve symptoms caused by lack of progesterone, which begins to fluctuate during perimenopause, two remedies can be helpful: chasteberry and natural progesterone.

Chasteberry (also sold as vitex) may help to regulate periods and ease mood swings, by stimulating the production of progesterone. However, there is very little scientific evidence to support this. Morrill recommends 20 drops of chasteberry tincture twice a day.

Natural progesterone, when taken in cream, oil or prescription pill form, can help relieve hot flashes, headaches, irritability and water retention, among other symptoms. This type of progesterone is often derived from wild yams (which are different from sweet potato yams) and then processed into a form of the hormone that can be used by the body. Unprocessed wild yam extract, another common menstrual remedy, is not considered to be effective.

Several vitamins and minerals are particularly important during menopause, including calcium, magnesium, and zinc to strengthen bones; folate, a B vitamin important to a healthy heart that may also have anticancer benefits; and vitamin E, another anticancer agent that can also relieve hot flashes at doses of 800 milligrams per day. Citrus bioflavonoids, which are found in citrus and other fruits, and vitamin C supplements may help strengthen capillaries and can help prevent heavy, irregular menstrual bleeding.

Beyond natural remedies, alternative healing methods such as acupuncture and homeopathy can help treat menopausal effects. In addition, certain yoga positions can also decrease symptoms.

Not all "natural" remedies are safe, however. For example, ma huang, an ingredient found in some menopausal supplements, is a stimulant that can raise blood pressure, and is not recommended for women with high blood pressure, says Morrill.

Going natural can be fun. Dr. Ricciottis prescription for vaginal dryness is to have sexual intercourse once a week or more to maintain vaginal moisture—"use it or lose it," she says. With a prescription like that, combined with all the other options, the transition to menopause can be not only manageable but perhaps pleasurable too!