The “M”-Word – Let’s Talk Menopause
Most Common Treatments
During the last installment of this series, I introduced you into the basics of what menopause is. But I know that what you want is solutions. How can I make these hotflashes stop? Is there something I can take to help with the insomnia? Help me with these mood swings before I kill someone!
So I dug into the research and found lots of great information. It is important to note that thousands of studies have been published on this topic and of course I haven’t read all of them but I tried my best to consolidate the most recent results so you can make a more informed decision. This article is designed to give you unbiased and factual information obtained from peer-reviewed articles and reviews published in reputable journals. It is not meant to provide clinical advice on which treatments are better or which to choose. Talk to a menopause specialist if you have specific questions about any treatments.
The big kahuna – the mother of all menopause treatments
To date, HRT is both the most common and most controversial form of treatment for menopausal symptoms. After the results of the Women’s Health Initiative (WHI) were published, the use of HRT dropped significantly because they showed an association of HRT use with greater breast cancer incidence and heart disease1. But there is much more to the story. The results were oversimplified and overgeneralized. Without going into too much medical detail, you should know that the study had two components: the estrogen plus progestin (E+P) trial for women with an intact uterus and the estrogen only (ET) trial for women with a history of hysterectomy. The published results that caused such a big backlash where only for the E+P trial but generalized to the entire study population. According to a recent study published in the American Journal of Public Health, “Over a 10-year span, starting in 2002, a minimum of 18,601 and as many as 91,610 postmenopausal women died prematurely because of the avoidance of estrogen therapy”2. In 2011, the post-intervention data of the ET were published indicating a reduced risk of mortality due to cardiovascular disease and invasive breast cancer.
The moral of the story: get clear and accurate information about HRT that is dependent on your own situation. One size does not fit all.
Here is HRT at a glance based on both types of HRT:
- Relieves vasomotor symptoms (hot flashes, night sweats)
- Relieves vaginal dryness
- Risk of bone fracture
- Improved Cholesterol
- Reduces risk of colon cancer
- Reduced risk of cardiovascular mortality (ET)
- Reduction in mortality because of invasive breast cancer (ET)
Does not cause significant changes in:
- Overall cognitive function
- Increased risk of stroke
- Increased risk of serious blood clots
- Increased risk of breast cancer (E+P)
- Unpleasant side effects such as bloating
- Increased risk of heart disease
Note: It is very important to mention that the risks associated with HRT are heavily dependent on personal factors, family history, as well as type of HRT and time of initiation of HRT.
Bioidentical Hormone Therapy (BHT)
Bioidentical hormones explained:
- Endocrine society defines bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.”3
- FDA approved BHT are available in pills, patches, creams, gels, and vaginal tablets.
- These are controlled and regulated preparations that are manufactured under strict standards3
- Various studies have documented their beneficial effects on hot flashes
- Compounded bioidentical hormones are not FDA approved4
- They are specifically compounded for an individual patient by a pharmacist
- There is no scientific evidence to support the claim that they are superior to conventional HRT
- They are not required to provide information about risks, contraindications, dosage, purity and potency
- They carry some of the same benefits and risks as HRT
Phytoestrogens are plant-derived chemicals that exhibit weak estrogen-like effects.
Isoflavones, originated from soy, are the most common form of phytoestrogens and have received a lot of scientific attention because of the possible benefits it may have in treating menopausal symptoms as well as the concern that they might stimulate the growth of existing estrogen-sensitive breast tumors7. The majority of studies researching the association between soy consumption and breast cancer risk, have found an inverse relationship between the two. Studies show that the soy intake during early life may both reduce breast cancer risk and risk of recurrence and that a diet rich in isoflavones from soy products also reduces the risk of postmenopausal breast cancer5-6. Promising research studies also show the potential benefit of increased soy consumption on bone health especially for postmenopausal women but more research is needed.
I was not able to find any credible evidence to suggest that consumption of traditional soy products high in isoflavones has adverse effects in healthy individuals. The latter (healthy individuals) is very important. You should always consult a health professional before increasing your soy consumption considerably as it may have adverse affects depending on your particular health condition. As with everything, moderation is key. Don’t replace every protein source with soy and when consuming soy products, be sure they are quality products. Beware of many commercial soy products as they have little or no isoflavones but are high in sugars and fillers. Another factor to take into account is that a large number of soy crops in the United States are genetically modified and therefore can have significantly different effects.
Here is a list of foods that contain phytoestrogens. These items are also high in other nutrients and make a great addition to any diet.
||Soy foods (tempeh, tofu, edamame)
In addition to bioidentical hormones, botanical alternatives have received a lot of attention in regards to their potential benefits in helping with menopausal symptoms.
Although there is a lot of research in regards to botanical alternatives, there is not much consensus on what works. Black Cohosh seems to be the most effective but more research is needed for conclusive evidence8. Below is a list of botanical alternatives that have been mentioned in the scientific literature as possible treatments for menopausal symptoms.
||Possible symptoms relief for
||Notes/Possible side-effects/Words of caution
|Black Cohosh (Actaea racemosa or Cimicifuga racemosa)
||Insomnia, anxiety, hot flashes
||Does not act like estrogen (hormone-sensitive tissue such as uterus and breasts are not negatively affected).
|Studies are still out on possible liver problems; do not take if you have known liver problems
|Red clover (Trifolium pratense)
||Contains phytoestrogens and might therefore negatively affect hormone-senstive tissue
|Dong Quai (Angelica sinensis)
||heart palpitations, anxiety, night sweats,
||Possible effect on blood clotting; women with fibroids, blood-clotting problems or taking medications that affect clotting, should not take Don Quai
|Ginseng root (Panax ginseng or Panax quinquefolius)
||Mood and sleep disturbances, headaches, gastrointestinal disorders
||Some types of ginseng may affect blood sugar. Use caution if diabetes is of concern
||stimulates pituitary gland, general well-being
||mood swings, depression
|St. Johns worth
||mood swings, depression
|Kava (Piper methysticum)
||Potential damage to liver
Note: studies on all botanical alternatives listed in this table (besides Black Cohosh) were inconclusive or inconsistent. This table merely describes those mostly listed in scientific studies.
As mentioned before, the menopausal transition is a highly subjective and individual experience and there is not a one-size-fits-all answer. I wrote this article to give you unbiased information about treatments that may help with menopause symptoms. It is meant to be a guide and by no means do I advocate the use of any of them. Always consult your health care provider before experimenting with any of these supplements. In the next installment of this series, I will talk about the dreaded menopausal belly fat. Why does it happen? What can help?
Stay happy and healthy – Dr. Maria
Note: If you are interested in finding a health care provider that specializes in menopause, here is a great starting point – The North American Menopause Society: http://www.menopause.org/for-women/find-a-menopause-practitioner
1 Yang, X.P., & Reckelhoff, J.F. (2011). Estrogen, hormonal replacement therapy and cardiovascular disease. Current Opinion in Nephrology and Hypertension, 20(2), 133-8.
2 Sarrel, P.M., Njike, V.Y., Vinante, V., Katz, D.L. (2013). The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years. American Journal of Public Health, 103(9), 1583 – 1588. doi:10.2105/AJPH.2013.301295
3 Files, J., Ko, M., Pruthi, S. (2011). Bioidentical Hormone Therapy. Mayo Clinic Proceedings, 86(7):673-680. Doi10.4065/mcp.2010.0714
4 Pfeifer, S., Goldber, J., Lobo, R., McClure, RD, Thomas, M., Widra, E, et. al. Compounded bioidentical hormone therapy. Fertility and Sterility, 98(2):308-12.
5Goodman MT, Shvetsov YB, Wilkens LR, Franke AA, Le Marchand L, Kakazu KK, Nomura AM, Henderson BE, Kolonel LN. (2009). Urinary phytoestrogen excretion and postmenopausal breast cancer risk: the multiethnic cohort study. Cancer Prev Res., 2(10):887-94.
6 Guha N, Kwan ML, Quesenberry CP Jr, Weltzien EK, Castillo AL, Caan BJ. (2009). Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study. Breast Cancer Res Treat., 118(2):395-405
7 Song WO, Chun OK, Hwang I, Shin HS, Kim BG, Kim KS, Lee SY, Shin D, Lee SG. (2007). Soy isoflavones as safe functional ingredients. Journal of Med. Food;10(4):571-80.
8 Mohammad-Alizadeh-Charandabi, S., Shahnazi, M., Nahaee, J., & Bayatipayan, S. (2013). Efficacy of black cohosh (cimicifuga racemosa L.) in treating early symptoms of menopause: A randomized clinical trial. Chinese Medicine, 8 doi:http://dx.doi.org/10.1186/1749-8546-8-20