Many women are confused about what alternatives are available to cope with many of the symptoms of menopause. Dr. Millicent 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 direction.
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 isoflavones.
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 six months.
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 percent 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 eight to 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 plant-derived hormones.
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 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 Menopause and You, 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 health care provider with your specific concerns and questions.
Membership on the medical staff of Main Line Health hospitals does not constitute an employment or agency relationship.