Menopause Health Article

Designer estrogen

A new type of hormone therapy offers some of the same protection against degenerative diseases and bone loss as estrogen, but without the increased risk of breast cancer. This new class of drugs, known as designer estrogens. Under development for nearly a decade, new drugs like Evista are being approved to prevent and treat osteoporosis in 2001. Unfortunately, these drugs have not been effective in combating hot flashes.

Male hormones

The ovaries also produce a small amount of male hormones, which decreases slightly as a woman enters menopause. The vast majority of women never need testosterone replacement, but it can be important if a woman has declining interest in sex. Testosterone can improve the libido, and decrease anxiety and depression; adding testosterone especially helps women who have had hysterectomies. Testosterone also eases breast tenderness and helps prevent bone loss.

However, testosterone does have side effects. Some women experience mild acne and some facial hair growth, but because only small amounts of testosterone are prescribed, most women do not appear to have extreme masculine changes.

Birth control pills

Women who are still having periods but who have annoying menopausal symptoms may take low-dose birth control pills to ease the problems; this treatment has been approved by the FDA for perimenopausal symptoms in women under age 55. HRT is the preferred treatment for menopause, however, because it uses lower doses of estrogen.

Alternative treatment

Some women also report success in using natural remedies to treat unpleasant symptoms of menopause. Not all women need estrogen, and some women cannot take it. Many doctors do not want to give hormones to women who are still having their periods, however erratically. Indeed, only a third of menopausal women in the United States try HRT and of those who do, eventually half of them drop the therapy. Some are worried about breast cancer, some cannot tolerate the side effects, some do not want to medicate what they consider to be a natural occurrence.

HERBS. Herbs have been used to relieve menopausal symptoms for centuries. In general, most herbs are considered safe, and there is no substantial evidence that herbal products are a major source of toxic reactions. But because herbal products are not regulated in the United States, contamination or accidental overdose is possible. Herbs should be bought from a recognized company or through a qualified herbal practitioner.

Women who choose to take herbs for menopausal symptoms should learn as much as possible about herbal products and work with a qualified practitioner (an herbalist, a specialist in Chinese medicine, or a naturopathic physician). Pregnant women should avoid herbs because of unknown effects on a developing fetus.

The following list of herbs include those that herbalists most often prescribe to treat menstrual complaints:

• Black cohosh (Cimicifuga racemosa): hot flashes and other menstrual complaints.
• Black currant: breast tenderness.
• Chaste tree/chasteberry (Vitex agnus-castus): hot flashes, excessive menstrual bleeding, fibroids, and moodiness.
• Evening primrose oil (Oenothera biennis): mood swings, irritability, and breast tenderness.
• Fennel (Foeniculum vulgare): hot flashes, digestive gas, and bloating.
• Flaxseed (linseed): excessive menstrual bleeding, breast tenderness, and other symptoms, including dry skin and vaginal dryness.
• Gingko (Gingko biloba): memory problems.
• Ginseng (Panax ginseng): hot flashes, fatigue and vaginal thinning.
• Hawthorne (Crataegus laevigata): memory problems, fuzzy thinking.
• Lady's mantle: excessive menstrual bleeding.
• Mexican wild yam (Dioscorea villosa) root: vaginal dryness, hot flashes and general menopause symptoms.
• Motherwort (Leonurus cardiaca): night sweats, hot flashes.
• Oat (Avena sativa) straw: mood swings, anxiety.
• Red clover (Trifolium pratense): hot flashes.
• Sage (Salvia officinalis): mood swings, headaches, night sweats.
• Valerian (Valeriana officinalis): insomnia.

NATURAL ESTROGENS (PHYTOESTROGENS). Research in the efficacy of phytoestrogens, particularly soy products, have been mixed. Some trials suggest that the estrogen compounds in soy products can indeed relieve the severity of hot flashes and lower cholesterol. Others do not.

It is true that people in Asian countries who eat foods high in plant estrogens (especially soy products) have lower rates of breast cancer and report fewer "symptoms" of menopause. While up to 80% of menopausal women in the United States complain of hot flashes, night sweats, and vaginal dryness, only 15% of Japanese women have similar complaints. It is unclear whether this statistic is due to eating phytoestrogens alone or is a factor of genetics or culture.

The study of phytoestrogens is so new that there are not very many recommendations on how much a woman can consume. Herbal practitioners recommend a dose based on a woman's history, body size, lifestyle, diet, and reported symptoms. In one study at Bowman-Gray Medical School in North Carolina, women were able to ease their symptoms by eating a large amount of fruits, vegetables, and whole grains, together with 4 oz (113g) of tofu four times a week.

What concerns some critics of other alternative remedies is that many women think that "natural" or"plant-based" means "harmless." In large doses, phytoestrogens can promote the abnormal growth of cells in the uterine lining. Unopposed estrogen of any type can lead to endometrial cancer, which is why women on conventional estrogen-replacement therapy usually take progesterone (progestin) along with their estrogen. However, a plant-based progesterone product can sometimes be effective alone, without estrogen, in assisting the menopausal woman in rebalancing her hormonal action throughout this transition time.

YOGA. Some women find that yoga (the ancient meditation/exercise developed in India 5,000 years ago) can ease menopausal symptoms. Yoga focuses on helping women unite the mind, body, and spirit to create balance. Studies have found that yoga can reduce stress, improve mood, boost a sluggish metabolism, and slow the heart rate. Specific yoga positions deal with particular problems, such as hot flashes, mood swings, vaginal and urinary problems, and other pains.

EXERCISE. Exercise helps ease hot flashes by lowering the amount of circulating FSH and LH and by raising endorphin levels (which drop when having a hot flash). Even exercising 20 minutes three times a week can significantly reduce hot flashes.

ACUPUNCTURE. This ancient Asian art involves placing very thin needles into different parts of the body to stimulate the system and unblock energy. It is usually painless and has been used for many menopausal symptoms, including insomnia, hot flashes, and irregular periods. Practitioners believe that acupuncture can facilitate the opening of blocked energy channels, allowing the life force energy (chi) to flow freely. Blocked energy, they report, increases the symptoms of menopause.

ACUPRESSURE AND MASSAGE. Therapeutic massage involving acupressure can bring relief from a wide range of menopause symptoms by placing finger pressure at the same meridian points on the body that are used in acupuncture. There are more than 80 different types of massage, including foot reflexology, Shiatsu massage, or Swedish massage, but they are all based on the idea that boosting the circulation of blood and lymph benefits health, and relaxing the body and mind.