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Menopause: What Are My Natural Options? Part 1

Menopause is a normal, natural and inevitable event that affects all women reaching middle to late adulthood. In a very basic sense, menopause occurs as a result of aging. Changes in the structure and function of the female ovaries  lead to a drastic drop in estrogen  levels and permanent cessation of menses. Unfortunately, its associated symptoms can make this process quite uncomfortable for many women and can negatively impact their social life, psychological health and overall well- being.1

The most common concern in postmenopausal women are hot flashes; these cause an episodic feeling of heat, intense sweating and flushing of the face and chest and are experienced by as many as 75% of menopausal women.2 Night sweats and difficulty sleeping appear to be the next most common concerns,3 although psychological distress, anxiety, mood changes, concentration difficulties and bone loss are all frequent concerns as well. The average age of onset is 51, but there is quite a wide age range (40-58 years of age) for any individual woman to enter menopause.1

The most common conventional treatment used to address the concerns of menopause is hormone replacement therapy (HRT). While this therapy may provide relief for symptoms such as hot flashes and night sweats and protection against bone loss, evidence exists to suggest that HRT may also increase the risk of heart attacks, coronary attacks, strokes and even breast cancer (see page 17 for information on breast cancer). An online survey of 166 menopausal women showed that 27% of respondents stopped or didn’t use HRT at all because of these safety concerns.5

With all of this in mind, it’s no surprise that menopausal women experiencing discomfort want safe and alternative solutions. The good news is that there are many effective options. Let’s take a closer look at some of the best alternative  therapies  available  for the most common menopausal symptoms:

Exercise

Exercise has long been considered  a beneficial treatment  for  easing  the   transition   into   menopause, most   notably    through    reducing the   frequency   and   intensity    of hot flashes. It is proposed that the exercise-induced production of beta- endorphins (the “happy” chemical associated with a sense of euphoria) combats the natural decrease in β-endorphins seen with decreasing estrogen levels in aging women.6 These peptides act on many areas of the brain and ultimately may help to stabilize the thermoregulatory centre of the hypothalamus, an area crucial to temperature regulation.6

Multiple studies have reported that physical activity has positive effects on
various menopause-related symptoms and overall health. As many people  are aware, these improved health outcomes include better cognitive function, sleep patterns, mood, bone density, cardiovascular function and energy levels.6 Observational studies confirm this notion.

In a survey of over 66,000 menopausal women in Italy, those that reported the lowest level of regular exercise were significantly more likely to experience more severe symptoms such as hot flashes.7 A recent 2012 study found that symptoms of anxiety and depression experienced by menopausal women could be alleviated by a controlled physical exercise regimen.8

A 2008 study examined the effects of physical exercise and HRT on “health-related quality of life” (HR-QOL) in 44 post-menopausal women. Only 3 hours per week of moderate aerobic exercise led to an increased HR-QOL and decreased severity of menopausal symptoms (including hot flashes, insomnia, nervousness, headaches and joint pains) after a period of six months. While the groups  receiving  only  HRT and no exercise showed similar decreases in menopausal symptoms, they did not experience the similar increase in HR-QOL that exercising women exhibited.2

Finally, there is also strong evidence that menopausal symptoms such as  hot flashes may be reduced and a more positive mental outlook obtained with the increased sense of accomplishment and self-esteem associated with exercise.6,9 This is supported by the idea that yoga, an exercise form that equally requires physical activity and mental focus, has also been suggested to improve menopausal symptoms when practiced regularly.10 Regardless of the mechanism, all forms of regular exercise should be considered safe  and effective methods to reduce the frequency and intensity of hot flashes, improve sleep and balance mood throughout menopause.

Diet

It’s no secret that diet affects many aspects of our health. Menopausal symptoms are no exception to this rule and many women have seen firsthand that dietary factors can influence menopausal symptoms for better or for worse. A very recent 2013 prospective cohortstudyfoundthisexactassociation between diet and menopause symptom complaints by monitoring 6040 women over a period of 9 years (from 2001 to 2010). After gathering baseline dietary data, researchers were able to define six distinct dietary patterns and allocated each woman into a category for subsequent analysis. Both night sweats and hot flashes were assessed for each woman every 3 years throughout the follow-up.11

Findings of this study identified one specific type of diet that appeared to aggravate menopause symptoms, and two diet types that decreased the risk of menopause symptoms. Diets  high in fat and sugar noticeably worsened hot flashes, while  diets  higher  in fruit and diets closely resembling a Mediterraneandiet(greaterproportions of garlic, peppers, mushrooms, salad greens, pasta and red wine) appear to be protective of the same symptom. Diets high in meat, dairy and vegetables did not show any trend in either direction.11 Other studies have also found that  high fibre and low fat intakes may be associated with reduced menopause symptoms.11

Many other modifiable lifestyle factors that are closely tied to diet
have shown to be risk factors for increased vasomotor symptoms as well. Specifically, women with a higher body mass index (BMI, a measure of body weight relative to height) are at an increased risk.11 A 2012 study actually showed that menopausal women who lost 10 lbs or more through increased fruit and vegetable intake and reduced fat intake were more likely to eliminate their hot flashes and night sweats completely after 1 year.12 Interestingly, many women who adopted this new dietary regimen but did not lose weight also found some benefit in the form of reduced hot flashes and night sweats. This shows that dietary interventions and weight loss both independently improve these menopause concerns.12

As a final note on dietary and lifestyle factors, women who smoke cigarettes regularly and those with a higher consumption of alcohol have both shown to be at an increased risk for experiencing hot flashes.11 If you have been trying to quit smoking or reduce your alcohol consumption, here is yet another reason why it may be time!

Black Cohosh

Black Cohosh (also known as Actea racemosa  or  Cimicifuga   racemosa)  is one of the most promising herbal preparations for reducing menopausal symptoms and which also has a long history of use in traditional medicine for treating menstrual irregularities and pain associated with childbirth.13 Unlike other commonly used herbs to treat menopausal discomforts, black cohosh is not just a  phytoestrogen  (see page 10 for an explanation of Phytoestrogens) but rather a substance that increases dopamine and serotonin levels in the body. Additionally, it appears that black cohosh has an affinity for bone protection as it selectively activates estrogen receptors in the skeletal system.14 In a randomized, double-blind, placebo-controlled  trial   involving 304 healthy, postmenopausal women in Germany, a  standardized  extract  of black cohosh was found to be beneficial in alleviating menopausal concerns after 12 weeks of treatment. Specifically, improvements in sleep disorders, hot flashes, memory, irritability, depression and vaginal dryness were seen. It should be noted that concomitant use of HRT or any other herbal supplements were prohibited during the study. With this in mind, the positive results can be solely attributed to the black cohosh.13 The safety profile of black cohosh has been a controversial  issue  over the years, with previous case reports suggesting a possible relationship between black cohosh use and liver toxicity. However, review of these reports has determined that  these cases were not properly assessed for causality and, in fact, there were many confounding variables present that may have been responsible for the unwanted side effect.15 A much larger body of evidence  exists to  suggest that black cohosh is extremely safe,15 however, the monitoring of liver health by physicians prescribing black cohosh is still a prudent approach.

REFERENCE

1. Shapiro M. Menopause practice: a clinician’s guide.. 4th ed. Mayfield Heights, Ohio: North American Menopause Society, 2010.

2. Moriyama C et al. A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women. Menopause 2008;15(4):613–18.

3. Wylie-Rosett J. Menopause, micronutrients, and hormone therapy. Am J Clin Nutr 2005;81(suppl):1223S-1231S.

4. Huntley Aand Ernst E. Asystematic review of herbalmedicinal products for the treatment ofmenopausalsymptoms. Menopause 2003;10(5):465- 476.

5. Pitkin J. Alternative and complementary therapies for menopause. Menopause Int 2012;18:20-27.

6. Daley A et al. Exercise for vasomotor menopausal symptoms (Review). The Cochrane Library 2011.

7. Di Donato P et al. Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy. Maturitas. 2005;52(3-4):181-9.

8. Villaverde G et al. Influence of exercise on mood in postmenopausal women. J Clin Nurs. 2012;21(7-8):923-8.

9. Bedell S et al. The pros and cons of plant estrogens for menopause. J Steroid Biochem Mol Biol. 2013.

10. Joshi S et al. Effect of yoga on menopausal symptoms. Menopause Int. 2011;17(3):78-81.

11. Herber-Gast G and Mishra G. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flashes in midlife: results from a prospective cohort study. Am J Clin Nutr 2013;97(5):1092-9.

12. Kroenke C et al. Effects of a dietary intervention and weight change on vasomotor symptoms in the Women’s Health Initiative. Menopause 2012;19:980–8.

13. Ross MR. A stanbdardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract 2012;26(1):58-61.

14. Volker V et al. Black cohosh: just another phytoestrogen? TRENDS in Endocrinology and Metabolism 2005; 16(5): 214-221.

15. Thomsen M and Schmidt M. Hepatotoxicity from Cimicifuga racemosa? Recent Australian case report not sufficiently substantiated. J Altern Complement Med. 2003;9(3):337-40.

16. Baumelou A et al. Perspectives in clinical research of acupuncture on menopausal symptoms. Chin J Integr Med. 2011;17(12):893-7.

17. Darsareh F et al. Effect of aromatherapy massage on menopausal symptoms: a randomized placebo-controlled clinical trial. Menopause. 2012;19(9):995-9.

18. Lucas M et al. Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Am J Clin Nutr 2009;89:641–51.

19. Wirklund I et al. Effects of a standardized ginseng on the quality of life and physiological parameters in a symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Int J Clin Pharm Res 1999; XIX: 89-99.

20. Yeh S and Chang M. The effect of Qigong on menopausal symptoms and quality of sleep for perimenopausal women: a preliminary observational study. J Altern Complement Med. 2012;18(6):567-75.

21. Cramer H et al. Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2012.

22. Akazawa N et al. Curcumin ingestion and exercise training improve vascular endothelial function in postmenopausal women. Nutr Res. 2012;32(10):795-9.

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