Complementary and Alternative Treatments for Menopause

Menopause is an important event in the aging process for all women. This physical transition from the reproductive years to non-reproductive years is clinically defined as having had no menstrual period for 12 consecutive months. The average age of menopause in the United States is 51, but it can be affected by such factors as smoking, alcohol use, having irregular cycles in the decade prior to menopause (all associated with earlier age at menopause), and mother's age at menopause.

While some women never experience any discomfort during menopause, the majority of women do. Hot flashes are the most common complaint, occurring in 70 percent to 85 percent of women. Night sweats are also common, and can be especially troubling for some women. Night sweats can occur several times each night and frequently cause interrupted sleep, leading to fatigue, irritability, and mood disturbances. Other signs of menopause include heart palpitations, urinary symptoms such as incontinence or frequent urinary tract infections, vaginal dryness, low libido, headaches, anxiety, and poor memory or "fuzzy" thinking.

While menopause is a natural part of aging, many women who suffer from severe or prolonged symptoms seek help. Today, that help can come from many directions, including conventional, complementary, or alternative medicine. Conventional medicine is practiced by medical doctors (M.D.s) or doctors of osteopathy (D.O.s), and affiliated health care professionals, such as nurses, physical therapists, and dietitians.

Complementary medicine is used along with conventional medicine, and may include a diverse group of medical and health care systems, practices, and products such as acupuncture, herbs, lifestyle changes, or dietary supplements. Alternative medicine is used instead of conventional medicine. Some practitioners of conventional medicine also use complementary or alternative methods.

Conventional Treatment--Hormone Replacement Therapy

The main conventional treatment for menopausal symptoms for several decades has been hormone replacement therapy (HRT).  Replacement hormones are available by prescription and include estrogen alone or in combination with another hormone, progestin.

Using hormone therapy is very effective for women who are having severe symptoms or symptoms that have lasted a long time, especially hot flashes and night sweats. In addition, hormone therapy protects against osteoporosis, a bone-thinning disease that occurs with age. Osteoporosis is more prevalent in women as they age than in men, and can be responsible for bone fractures, especially of the hip and back.

For decades, women with uncomfortable menopause symptoms were routinely prescribed hormone therapy by their physicians. However, in 2002, a large study, the Women's Health Initiative, was ended early because the researchers discovered increased risk for a number of serious health problems in women who had been taking hormones for several years. The researchers found greater risk for breast cancer, heart disease, stroke, and blood clots for women in the study who had been taking a combination of estrogen and progestin, and a heightened risk of stroke and blood clots for study subjects who were taking estrogen alone.

 As a result, hormone therapy is now cautiously prescribed on a case-by-case basis, taking into account each woman's risk factors for breast cancer and heart disease. In addition, doctors are advised to prescribe the lowest dose possible for the shortest time possible. For many women, the symptoms are not uncomfortable enough, or their risk factors are such that they choose not to take hormones. Consequently, many women and their health care providers are exploring complementary or alternative options that may help alleviate the discomforts associated with menopause.

 Phytoestrogens

Soy is perhaps the best-know phytoestrogen, or estrogen that is found naturally in food. Soy, chickpeas and other legumes are a source of isoflavones, one kind of phytoestrogen. Flaxseed, whole grain foods, and some fruits and vegetables are the source of lignans, also a plant form of estrogen.

Isoflavones came to the attention of scientists studying the diets of women in China and Japan. They found that the Asian women they were studying had diets high in soy isoflavones and reported fewer and less severe symptoms associated with menopause. In addition, the Asian women had a lower incidence of osteoporosis and heart disease than Western women.

The research on the effectiveness of phytoestrogens is inconclusive, and it is unclear whether the estrogens found in these foods are strong enough to relieve menopausal symptoms. However, some women find that supplementing their diets with these foods helps to alleviate or reduce their hot flashes. The research is still ongoing as to whether phytoestrogens affect the risk of breast cancer-some studies actually show phytoestrogens to be protective against breast cancer, and no studies suggest that eating soy products are harmful if you have breast cancer. However, women who are at an increased risk for diseases affected by hormones or women who are taking drugs that increase estrogen levels in the body should check with their physician before using phytoestrogens.

 Vitamin E

While there is little research yet to prove its effectiveness, some women find relief from hot flashes by taking Vitamin E. Vitamin E is known for its antioxidant effect, and is available in several forms, both natural and synthetic. Natural Vitamin E is signified by the letter d, for d-alpha-tocopherol. Synthetic Vitamin E has antioxidant activity, but may actually prevent the natural form from entering the cell membranes. Synthetic Vitamin E is signified by the letters dl, for dl-alpha-tocopherol.  Vitamin E is a fat-soluble vitamin, which means that excess is stored in the body. Consequently, taking more than 400 i.u. of Vitamin E a day is not recommended.

 Botanicals

Several herbs are being studied for effectiveness in relief of menopausal symptoms.

Black cohosh is perhaps the most commonly used herb for treating women's symptoms. For generations, Native Americans have called black cohosh "cramp bark" and used it for treating menstrual cramps. Black cohosh is a key herb in the practice of Chinese medicine, and is used extensively in Europe and the United States for relief of hot flashes. Due to its low risk for side effects, the American Menopause Society supports black cohosh for short-term use (less than six months). However, the National Institutes of Health has said that, although early evidence is encouraging, there is not enough data to recommend black cohosh for menopausal symptoms. The NIH's National Center for Complementary and Alternative Medicine is funding a scientific study to determine whether black cohosh can reduce the frequency and intensity of hot flashes and other menopausal symptoms.

Dong quai is also a frequently prescribed herb in Chinese medicine, especially to treat a variety of women's problems such as menstrual cramps, irregular periods, and heavy periods. In addition, dong quai is found in almost every Chinese herbal formula used to provide relief from menopausal symptoms. Other herbs used for menopause include red clover, ginseng, kava, and chaste berry.

 Acupuncture

Practiced in China for thousands of years, acupuncture is becoming popular in this country for a variety of conditions, including discomforts associated with menopause. Acupuncture is holistic in nature, and works by treating the source of the problem rather than just alleviating symptoms.

Acupuncture can be effective in treating hot flashes, night sweats, palpitations, insomnia, and other symptoms of menopause. In addition to acupuncture, a licensed acupuncturist may also incorporate dietary recommendations, an herbal formula, and lifestyle changes into an individualized treatment plan.

 Lifestyle Changes

Some women find they can alleviate or reduce menopause discomforts through lifestyle changes, such as diet, exercise, and stress management. Most women find that their hot flashes are worse when they are in stressful situations, and stress-reduction techniques like yoga, meditation, visualization or breathing techniques can be helpful.

Dietary changes that may be effective include avoiding caffeine, sugar, alcohol, and fatty foods, eating more fruits and vegetables, and drinking more water. Regular exercise is also recommended because it can elevate mood, reduce stress, and reduce the risk of developing osteoporosis and heart disease.

While there are a variety of options for women seeking relief from discomforts associated with menopause, there is no one clear answer as to what works best. Every woman needs to take into account her unique health history and personal preferences when choosing a conventional, complementary or alternative treatment for menopause symptoms.