Menopause. Overview and Natural Therapy Options
Like puberty, menopause is a normal transition for a woman. The good news is that lifestyle choices improve bothersome symptoms for many women. Unfortunately, nearly a third of woman have severe symptoms that can last for years, so clearly they need help and support as outlined below.
Menopause Background Facts
- Menopause occurs on average at 52 years of age, but can happen between late 30s to early 60s.
- Menopause is defined when menses and hormonal cycling stops for at least 12 months, and specific pituitary hormones (FSH and LH from a blood test) are noted. Obviously, many women don’t need 12 months or a blood test to figure this out.
- 25% of women enter menopause surgically (they have their ovaries removed)
- ~30% of women take synthetic hormone replacement therapy (HRT)
- ~50% of women who start synthetic HRT stop in 1 year
- Menopause occurs when the ovaries stop producing estrogen, with estrogen level decreasing by 50%. Estrogen still produced by the adrenal glands and from fat cells.
- Many women have menopausal symptoms before menopause starts if they don’t ovulate and their progesterone production drops (Peri-menopause)
Menopause symptoms vary greatly but typically include hot flashes, night sweats, insomnia, cognitive dysfunction (sometimes described as brain fog), and vaginal dryness. Most of my patients can tolerate the hot flashes and night sweats to some degree, but the insomnia and slowed thinking are the most bothersome.
50% of women rate their symptoms as severe, 33% moderate, and 17% mild to none. 18% report their symptoms resolve after 1 year, 56% that they last 1-5 years, and 26% >5 years.
Natural Treatment Options for Menopause–Ideally You Won’t Need HRT!
Hormone replacement therapy (HRT) is effective, but has clear medical risks, such as heart attacks and strokes, so treatment should only occur when symptoms are fairly severe and over time attempts to wean off therapy are warranted.
What natural menopause therapies are shown to work? None are as effective as estrogen therapy, but add all these up and the combination can be nearly as effective for many women.
- Daily exercise (30-40 minutes can lower symptoms 20-30%
- Meditation 30 minutes 3+ times per week lowers symptoms 20-30%
- Yoga 1 hour daily has been shown to improve symptoms
- 2 servings of soy products consumed daily lower symptoms 20-30%
- Siberian rhubarb (not American rhubarb root that causes diarrhea) can lower menopause symptoms by 60-70%
Soy foods include edamame, soy milk, tofu, and various soy food products (like soy sausage, soy burgers, soy chick nuggets). the latest evidence on soy food intake and breast cancer is that soy decreases the risk of getting breast cancer, especially if consumed by teenage women, and if you have breast cancer, moderate soy food intake decreases the risk of dying from breast cancer too.
For menopause-induced insomnia, cognitive dysfunction, emotional ups and downs, and anxiety symptoms, Siberian rhubarb extract is very effective. I have had excellent results using a standardized extract of Siberian rhubarb, ERr-731 (sold as Estrovera) which has been studied in several clinical outcome trials. It has been shown to be very safe and effective. Of interest, Estrovera stimulates Beta estrogen receptors, not alpha estrogen receptors that are associated with uterine and breast cancer.
What hasn’t been shown to be effective? Studies using Black Cohosh and yams at best have shown mixed results and large randomize trials suggest they are not better than placebo. Dong quai is used commonly, but we don’t have randomized trials showing that it is effective and safe.
If for some reason none of these natural therapies control your menopause symptoms and you are considering pharmaceutical hormone replacement therapy, I have 3 strong recommendations, but every woman is special so please discuss these options with your doctor.
- Use the lowest dosage that is effective and try weaning off your treatment every 6-12 months as able.
- If you use estrogen, insist on topical estradiol. Topical estradiol comes in various FDA approved patches and is safer than taking oral estrogen.
- If you use progesterone, insist on micronized progesterone, using 100 to 200 mg orally in a pill taken daily. Don’t use Provera (medroxyprogesterone) or other synthetic progestins as they are associated with both heart attacks & strokes and breast cancer.