Finding Natural Ways To Minimize The Side Effects of Menopause

As they face 50, women feel forced to deal with a difficult choice: An increased risk of breast cancer versus the possibility of several years of night sweats, hot flashes, memory problems, depression, weight gain, palpitations, anxiety, insomnia or incontinence, followed by an increased risk of osteoporosis and heart disease.

The differing consequences hinge on whether a woman takes hormone replacement therapy (HRT), the standard solution to boost declining levels of estrogen and prevent menopause. Even though most women don’t develop breast cancer and many are not bothered by side effects, HRT is still a decision millions face at midlife.

But what about alternatives? One question in many women’s minds today is whether diet and herbal remedies are safe and effective options.

The Double-Edged Sword of HRT.

Hormone replacement therapy, a combination of estrogen and progesterone (hormones involved in the menstrual cycle), keeps hormone levels steady, reducing the effects of menopause. HRT appears to have health costs, however. Women no longer take estrogen by itself because that increases the risk of uterine cancer. Yet research now suggests a link between HRT and breast cancer.

“We have no idea what’s going to happen to women who are on HRT for 15 to 20 years,” says Tieraona Low Dog, M.D., director of the New Mexico School of Herbal Medicine and Research, “especially if those are the same women who were taking birth control pills when they were younger. Their lifetime exposure to estrogen is going to be quite high.”

So it’s not surprising that many women are looking for natural ways to make it through their menopausal years. What is there to offer them?

At the top of the list of natural options are phytoestrogens, plant substances found in soy foods and herbs that act as estrogens in the body but exert a much weaker effect than the estrogens in HRT. Researchers believe phytoestrogens are actually protective, because they bind to receptors meant for estrogen, therefore blocking estrogens from doing so.

Soy Foods to the Rescue? Recent research offers promise for women who eat soy foods. In one well-controlled study of 104 postmenopausal women, those who ate isolated soy protein (in soy protein powder) experienced fewer hot flashes.

For all the attention soy has gotten lately, it’s surprising this is the first study to find significant improvement in menopausal symptoms from eating soy. Soy experts are reserving judgment.

“The studies are conflicting,” admits Mark Messina, Ph.D., who studies the health benefits of soy. “Still, I wouldn’t disagree that soy might have a modest effect,” he adds. “If a woman doesn’t want to take HRT, she should try soy foods. She can quickly tell if it’s reducing symptoms like hot flashes. And there is no disadvantage to trying it. It may even protect against osteoporosis and heart disease.”

Experts think what’s needed to reduce menopausal symptoms is a daily dose of about 60 milligrams of isoflavones, the phytoestrogens in soy. That’s the amount in about six to eight ounces of tofu. Or try other soy foods. (Check for isoflavone content; it might be listed.)

Herbs That May Help. Several herbs contain substances that have hormonal effects. Many practitioners claim their clients are helped by the following herbs:

  • Black Cohosh (Cimicifuga racemosa) is among the best documented scientifically. Look to it to help relieve hot flashes, night sweats, headaches, palpitations and vaginal drying. It may also help relieve depression, though other herbs are probably more effective. (See kava.) Get a standardized preparation (see sidebar); nonstandardized products may not even contain the herb. And be careful not to take too much. Large doses can cause frontal headaches, flushing, low blood pressure and slowing of the heart rate. Commonly recommended dose: 40 milligrams a day.

  • Chasteberry (Vitex agnus-castus) is said to help relieve a variety of menopausal symptoms. Herbalist physician Low Dog recommends it during early menopause because it boosts progesterone in proportion to estrogen levels. Progesterone helps the uterus shed its lining each month, resulting in menstruation. “In women whose periods are just becoming irregular,” says Low Dog, “Vitex helps them become regular again for a year or two.” It may trigger a rash in some people, however. Commonly recommended dose: 20 milligrams a day.

  • Kava (Piper methysticum) is the herb Low Dog recommends during menopause to ward off depression. “It’s a relaxing plant—very effective for women who just aren’t sleeping or feeling well, and have a blab, dull, dark mood,” she says. “I’ve had more success with kava than with St. John’s wort during menopause,” she adds. Commonly recommended dose: 100 milligrams three times a day.

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Getting Help from Pills…Naturally

Several herbal supplements specifically marketed for menopause are now available. Here’s the scoop on three popular products:

Estroven contains a combination of phytoestrogens from soy, kava and black cohosh. It also contains B vitamins, vitamin E, calcium, selenium and boron—a curious combination of nutrients. (800) 722-3476

Promensil contains an extract of red clover leaf and stem. The maker claims the herb offers complementary benefits of the four main estrogenic isoflavones found in foods, compared to only two found in soy. It contains 40 milligrams of isoflavones per dose. (888) 668-6436

Remifemin contains a standardized extract of black cohosh. It is often recommended by herbal practitioners, because it is a reliable source of the herb. (800) 783-2286

  • Red Clover (Trifolium pratense) is gaining much attention. A recent, small, uncontrolled study of 30 women suggests it is effective in reducing hot flashes. “It definitely worked,” says Lila Nachtigall, M.D., an expert in menopause at New York University. “It took about four weeks in most cases, but it worked 100% of the time.” Commonly recommended dose: 200 milligrams a day.

  • More Hype Than Help. The following herbs, though often touted to ease menopause, are not your best bets:

    • Dong quai has received wide attention for its potential to quash hot flashes. But a recent study found it ineffective. Moreover, perimenopausal women experiencing heavy bleeding should avoid it, as it can cause even heavier bleeding.

    • Ginseng may be warranted for women experiencing fuzzy thinking and memory loss during menopause. But its use has been linked with “spotting” in postmenopausal women. That might prompt investigation with an endometrial biopsy—no small matter.

    • Licorice root has estrogenic effects and therefore may help ease a variety of menopausal symptoms. But if taken for extended periods, it can cause high blood pressure and loss of potassium.

    • Wild yam, another popular alternative therapy, is often an ingredient in creams touted for menopause. Although wild yam contains a substance that can be converted into progesterone in a laboratory, the human body cannot do the same thing. Many creams labeled as containing wild yam also contain synthetic progesterone.

    Making the Decision:  Hormone replacement therapy may be a useful temporary strategy for women who are seriously debilitated by symptoms that overwhelm the subtle effects of herbal remedies. Short-term use of HRT (six months or so) doesn’t appear to be linked to serious health problems.

    Before deciding whether to use HRT or natural remedies to manage menopausal symptoms long-term, women should weigh their individual risks and benefits. Women at high risk for osteoporosis may want to consider HRT, unless they have a family history of breast cancer. It’s less clear if those at risk for heart disease will benefit. A definitive answer is still 10 years away.

    Until then, even though there’s little scientific proof of effectiveness, EN believes it’s worth trying soy foods and certain herbal remedies to see if they might work for you.

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