Many women are confused about what alternatives are available to
cope with many of the symptoms of menopause. Dr. Zacher outlines options
for hot flashes as well as other symptoms that are common at this time
in a woman's life. — Beverly
Vaughn, MD, Medical Coordinator, Menopause and You Program
What Are Alternative Therapies?
Just when we thought we had the right formula for relieving menopausal
symptoms, we woke up one July morning to the Women’s Health Initiative
results. Hormone replacement therapy, in the doses we were using, had
enough adverse effects to make us rethink what we were doing.
Overnight, many women discontinued medications. Back were the hot
flashes, mood swings, vaginal dryness, sleep difficulties and decreased
libido. For centuries, women had been using herbs, acupuncture,
meditation, yoga, nutritional supplements, alone or in combination, to
ease the menopausal passage. Why not use these again? Are they safe? Do
they work? The National Institutes of Health (NIH) have been asking the
same questions; their studies are ongoing but are beginning to give us
Herbs and Plant Products: Botanicals
Approximately half of the medications we use come from plants or their
biological chemicals. Botanicals are the most frequently used
alternatives to synthesized hormones. When not prepared by
pharmaceutical companies, the therapeutic effects of plants are found in
natural bulk herbs that are raw or dried to make powders, teas or
capsules. Herbs can also be found as oils or tinctures (alcohol
extracted liquids). The fresher the herbs, the closer the product is to
its natural state, the more strength it will have. Plants do not make
estrogens as we have come to know them. Plants make chemicals which
exert weak estrogen effects. Some of these chemicals have been used by
pharmaceutical companies to make estrogen and progesterone compounds.
There are three groups of dietary plant estrogens or phytoestrogens. A
brief list of botanicals and their suggested uses is found below.
For hot flashes Soy products: Effects are variable. Soy foods are not
necessarily a reliable source of isoflavones, since processing may alter
biological strength. Effects occur by attaching to tissue with estrogen
activity. Women with estrogen-dependent cancers of the breast or uterus
should consult their doctor. Some studies suggest some benefit.
Fermented soy products, such as tofu, may be the best source of
Black Cohosh: This herb with estrogenic effects is
somewhat more beneficial than soy products. The same caution applies to
estrogen-dependent cancers. Found on its own or in teas and Lydia
Pinkham’s Vegetable Compound, it is the leading botanical in Europe and
the United States. A German pharmaceutical company manufactures it as
Remifemin. This is how it is commonly used in Europe. It is available in
the U.S. without prescription. There are no safety studies past 6
Dong Quai: Commonly used in Chinese medicine. No studies
suggest it is beneficial. Not to be used in pregnancy or when nursing.
Excessive amounts may cause bleeding.
Evening Primrose: Also used for breast pain and bladder
symptoms. Studies do not suggest benefit.
Ginseng: Of questionable benefit.
For mood disturbances St. John’s Wort and Valerian Root: Some mild
effects. These may interfere with other commercial mood-enhancing drugs
that positively help a brain chemical known as serotonin.
For vaginal dryness Wild and Mexican Yam products: These claim to be
progesterone substitutes. There are no human pathways to change yams
into progesterone. There are no studies to suggest benefit.
Be aware, botanicals are not regulated as drugs, but as dietary
supplements. Manufacturers are voluntarily responsible for the safety
and strength of their products. This allows considerable variation among
products. An excellent reference is Susan Weed’s Menopausal Years.
The familiar needle therapy is part of the larger Chinese medical
tradition based upon energy and body areas related to symptomatology.
Preliminary information from one study suggests a positive effect on hot
flashes. Further research is expected. Acupuncturists must be licensed
in Pennsylvania in order to practice in Pennsylvania.
Nutrition and Nutritional Supplements
In addition to phytoestrogens, a better sense of well being and body
image can be achieved with a balanced diet. Calcium and vitamin D, by
diet or supplements, have long been recognized for bone health. Vitamin
B complex, helpful for depression, is naturally found in green
vegetables, whole wheat and brewer’s yeast.
DHEA, a natural androgen produced by the adrenal gland, is sold as an
over-the-counter dietary supplement. As we age, this hormone normally
decreases. Studies have shown beneficial effects on hot flashes and on
mood in doses as low as 25 mg per day. DHEA is produced as tablets and a
10% cream. Further studies are needed.
Exercise, relaxation techniques, yoga, biofeedback and massage can
reduce both the severity and frequency of hot flashes. Further research
is needed to see if this is a placebo effect. Relaxation breathing,
however, has been shown to be beneficial. This technique involves deep
breathing from the abdomen and reducing your breaths to 8 – 10 per
minute. Relaxation is good for overall health. Avoiding spicy foods,
keeping the temperature low, reduction of alcohol and smoking cessation
are also helpful.
Other Pharmaceutical Agents
Replacing estrogens improves mood and hot flashes; the link with other
brain chemicals, such as serotonin, has long been thought to exist.
Serotonin loss causes mood changes and may be related to hot flashes.
Using agents that enhance serotonin can help with mood and give some
relief from hot flashes. These are prescription drugs given by your
doctor that can be used with other forms of therapy.
Bio-identical Hormone Therapy
For some women, estrogens are the only therapy that relieves hot
flashes, mood swings and vaginal dryness. Customizing treatment to
individual needs and utilizing non-pharmacologic doses of hormones, has
led to bio-identical hormone replacement. Taken as tablets, creams or
suppositories, they are produced by specialized pharmacies. Dosages are
based upon hormone levels and/or symptoms. As with commercial hormones,
there are patients who are not candidates for this treatment.
Traditional estrogen producers are beginning to utilize lower doses of
The American College of Obstetricians and Gynecologist suggest herbal
remedies do not alleviate hot flashes but serotonin related medications
do. The College also considers bioidentical hormones experimental since
there are no studies evaluating their benefits or side effects.
Estrogens help depression, but should not be used instead of
mood-changing medications. NIH health alerts for alternative therapies
are available at http://nccam.nih.gov/news/alerts/.
The FDA recommends estrogen therapy in the lowest dose for the shortest
period of time to alleviate symptoms. Alternative and traditional
therapies can be used in combination.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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