Due to increased life expectancy and the aging baby-boomer population, the percentage of women reaching menopause is increasing. According to naturopathic physician Tori Hudson, author of Women's Encyclopedia of Natural Medicine and medical director of A Woman's Time natural health clinic in Portland, OR, the average age of menopause is 50-52. Currently there are 40 million American women who are post menopausal and their numbers are expected to increase to 60 million by the year 2010. By the year 2015, nearly 50% of the women in the United States will be menopausal.
Menopause is comprised of four stages; premenopause, perimenopause, menopause and post menopause. The second stage can often be mistaken for actual menopause because some of the symptoms may be similar or identical to menopausal symptoms. Usually the perimenopausal stage will last four to five years before menopause actually begins. The onset of menopause will occur for women when 12 months has elapsed since their last period. Post menopause is exactly what it implies and is characterized by a decrease in the severity of menopausal symptoms.
The larger issues for menopausal women include hot flashes, night sweats, insomnia, depression, anxiety, memory and cognition difficulties, vaginal dryness and change in sexual response and sex drive. Many women choose to reduce these symptoms with hormone replacement therapy (HRT) or estrogen replacement therapy (ERT); however, there are nutraceutical options to be explored as well. Hormone replacement therapy has its pros and cons, with recent news stories focusing on HRT as a new risk factor for breast cancer.
In addition, experts like Dr. Derrick DeSilva, president of the American Nutraceuticals Association and a practicing medical doctor, note additional downsides. According to Dr. DeSilva, speaking at a recent conference in New York City, ERT can rob the body of vital nutrients like vitamin B6 and magnesium. He said, "The depletion of vitamin B6 can promote the onset of fatigue, water retention, irritability, sleep disturbance, arthritis and asthma." Magnesium depletion, he said, can cause muscle and nerve weakness, twitching, depression, dizziness and cardiac arrhythmias. However, Dr. DeSilva also noted although there are down sides to HRT, estrogen replacement therapy should not be counted out as a viable form of treatment for menopause. The decision is very personal depending on the individual.
In addition, women are not necessarily well informed on menopause. According to Medscape, a database of medical news and information, women are more likely to associate menopause with depression and irritability than heart disease and few were aware of an association between menopause and increasing risk for memory loss or Alzeihmer's disease. These misconceptions can make menopause even more complex for women.
Keep Your Options Open
As this life stage approaches and passes, women stand to lose a lot of nutrients needed to maintain optimal health. In order to make up for the deficit of nutrients, nutritional supplements have provided a necessary alternative for many women. In addition, there are a plethora of natural options to choose from.
Black cohosh (Cimicifuga racemosa). One ingredient that has been studied extensively for various menopausal symptoms is black cohosh. According to 1001herbs.com, "In addition to having effective amounts of calcium, potassium, magnesium and iron, black cohosh is an abundant source of estrogenic substances. It is because of black cohosh's strong estrogenic properties that it is used as an alternative to hormone replacement therapy." In a review in the Journal of Women's Health it was stated that the herb is a safe, effective alternative to ERT and according to the Women's Encyclopedia of Natural Medicine, "A special extract of black cohosh used in Germany is the most widely used and thoroughly studied natural alternative to hormone replacement therapy in menopause. Clinical studies have shown that this black cohosh extract relieves not only hot flashes but also depression and vaginal atrophy." Besides being a valuable phytoestrogen, black cohosh is also known to alleviate cramps that often accompany menstruation.
Dong quai (angelica sinensis). This herb is widely used for the treatment of hot flashes, menstrual cramps, lack of menstruation or frequent menstruation. According to Women's Health Interactive (WHI), it is also said to have a balancing effect on hormones.
Red clover (Trifolium praetense). This is another phytoestrogen that when used alone or in combination with other botanicals and phytoestrogen-containing plants can provide relief of menopausal symptoms, according to Women's Encyclopedia of Natural Medicine. The four isoflavones that are in red clover seem to have mild estrogenic activity.
Evening primrose oil (EPO). Evening primrose is popular for relieving hot flashes in menopausal women as well as treating premenstrual symptoms. About breast pain relief, the Women's Encyclopedia of Natural Medicine noted, "Results of research and clinical trials have consistently shown that EPO is effective in relieving breast pain and premenstrual cyclic breast pain."
Vitex (Agnus-castus). Also referred to as chaste tree, vitex includes indications such as significant bleeding problems and is used mainly for regulating the menstrual cycle. According to MotherNature.com, vitex has been shown to help re-establish the normal balance of estrogen and progesterone during a woman's menstrual cycle. This is important for women who suffer from PMS and other menstrual irregularities due to underproduction of the hormone progesterone during the second half of their cycle. Vitex also stimulates the pituitary gland to produce more luteinizing hormone, leading to greater production of progesterone. In addition, vitex has been shown to elevate mood, improve vaginal dryness and reduce hot flashes.
Ginseng (Panax ginseng). According to Women's Encyclopedia of Natural Medicine, "Whether it involves reducing mental or physical fatigue, enhancing your ability to cope with various physical and mental stressors by supporting your adrenal glands or treating the atrophic vaginal changes due to lack of estrogen, ginseng is a valuable tool for many menopausal women."
The following herbs have been used in treating menopausal symptoms as well as symptoms of PMS, but do not have as much notoriety or science behind them. Licorice (Glycyrrhiza glabra) is noted by Women's Encyclopedia of Natural Medicine for having estrogenic properties. Blue cohosh (Caulophyllum thalictroides) is known as an inducer of menstruation, according to Tyler's Honest Herbals. False unicorn root (Chamaelirium luteum) is said by Women's Health Interactive to reduce painful menstrual cycles, help for lack of a regular menstrual cycle and correct any other irregularities associated with menstruation.
Recent Studies
To date there has not been much activity in terms of human clinical studies on herbs and PMS and menopausal symptoms. What follows is a complation of studies that have been completed within the last year.
The investigation of St. John's Wort for the relief of psychological and vegetative symptoms of menopause was the focus of one study. The drug-monitoring study investigated 12 weeks of treatment with St. John's Wort, one tablet three times daily (900 mg Hypericum, Kira), in 111 women. The patients, who were between 43 and 65 years old, had climacteric symptoms characteristic of the pre- and postmenopausal state. Treatment outcome was evaluated by the Menopause Rating Scale, a self-designed questionnaire of assessing sexuality and the Clinical Global Impression scale. The incidence and severity of typical psychological, psychosomatic and vasomotor symptoms were recorded at baseline and after 5, 8 and 12 weeks of treatment. Substantial improvement in psychological and psychosomatic symptoms was observed. Climacteric complaints diminished or disappeared completely in the majority of women (76.4% by patient evaluation and 79.2% by physician evaluation). Of note, sexual well-being also improved after treatment with St. John's Wort extract (Adv Ther Jul-Aug 1999: 16; 177-186).
One study showed that red clover may improve systemic arterial compliance but not plasma lipids in menopausal women. In this study-which examined the heightened cardiovascular risk associated with menopause-researchers tested 17 women by measuring arterial compliance, an index of the elasticity of large arteries such as the thoracic aorta. Compliance diminishes with age and menopause. An initial three to four week run-in period and a five-week placebo period were followed by two five-week periods of active treatment with 40 mg and then 80 mg isoflavones derived from red clover containing genistein, daidzein, biochanin and formononetin in 14 and 13 women respectively, with three others serving as placebo controls throughout. Arterial compliance, measured by ultrasound as a pressure (carotid artery) and volume (outflow into aorta) relationship, was determined after each period; plasma lipids were measured twice during each period. Urinary output of isoflavones was also determined. Arterial compliance rose by 23% relative to that during the placebo period with the 80 mg isoflavone dose and slightly less with the 40 mg dose. Plasma lipids were not significantly affected. Arterial compliance was significantly improved with red clover isoflavones. As diminished compliance leads to systolic hypertension and may increase left ventricular work, the findings indicate a potential new therapeutic approach for improved cardiovascular function after menopause (J Clin Endocrinol Metab 1999 March 84; 895-8).
A study investigating "Promensil" red clover and its effect on hot flashes was also conducted. Menopausal women were either given Promensil or placebo. Women taking a single Promensil tablet daily experienced a reduction in the intensity and number of hot flashes. Hot flashes were reduced from an average of 8.1 per day to 3.6 per day after eight weeks and intensity decreased by 56%. The study also showed a 52% decrease in the intensity of night sweats (The Endocrine Society Meeting).
At the Center for Complementary and Alternative Medicine Research in Aging and Women's Health at Columbia University's College of Physicians and Surgeons, a study determining if Chinese herbs are effective for treating menopausal hot flashes will be conducted. This study is a collaboration between the Center at Columbia University, the Women's Health Research Center in Laurel, MD and the Taoist Health Institute in Washington D.C. Women participating in the study must be post-menopausal (at least one year from last menstrual period), having frequent hot flashes and not engaged in hormone replacement therapy (HRT). The study will last for one year and will have a placebo-controlled, cross-over design. Throughout the study participants will undergo blood tests, urinalyses, gynecological exams and physiological monitoring of hot flashes.
NW
