However, finding a safe and effective alternative treatment is no easy task. One of the favourites is so-called 'natural' progesterone, championed by the late Dr John Lee. But, as WDDTY reported in 2006, it is far from natural. There are even some concerns that it might cause cancer, just like HRT (see WDDTY vol 17 no 2). Similar concerns have been raised about soy and isoflavone supplements (see WDDTY vol 16 no 8), which are also among the more popular alternative remedies for menopause. So what's a girl to do?
Happily, research shows that there are a number of simple, safe steps you can take to help make the transition into menopause a smooth one.
o Exercise regularly. Growing evidence suggests that being physically active is one of the best things you can do to keep menopausal symptoms under control. A recent study of 336 menopausal women found that those who were the most physically active had less severe symptoms and generally felt better than their less-active counterparts (Climacteric, 2010; 13: 355-61).
In another study, 36 post-menopausal women were split into two groups: an aerobic-exercise group and a resistance-exercise group. Both groups exercised three times a week for eight weeks under the super-vision of a physiotherapist. At the end of the study, both types of exercise were found to have positive effects on the symptoms of menopause, although aerobic exercise had a slightly greater impact. In addition, both exercise groups saw improvements in their psychological health, depression and quality of life (Obstet Gynecol Int, 2010; 2010. pii: 274261).
Regular exercise can also reduce the risk of postmenopausal breast cancer, osteoporosis and cardiovascular disease-an important considera-tion, as the risk of developing these diseases increases after the menopause (Arch Intern Med, 2010; 170: 1758-64; Aust J Public Health, 1993; 17: 23-6). Aim for at least 30 minutes of moderate-intensity physical activity on most days.
o Boost your intake of omega-3 fats. A new study has found that omega-3 fatty-acid supplements can help fight depression and
hot flushes in women going through the menopause. The study involved 20 women with major depressive disorder given 2 g/day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for eight weeks. The results showed that 70 per cent
of the women saw a reduction of at least 50 per cent in their Montgomery-Asberg Depression Rating Scale (MADRS) scores. Moreover, hot flushes decreased in both number and severity (Menopause, 2010 Oct 27; Epub ahead
In addition, like exercise, omega-3 supplements can also help to prevent postmenopausal osteoporosis, breast cancer and heart disease (Obstet Gynecol Surv, 2004; 59: 722-30).
o Take vitamin E. A randomized controlled trial found that daily doses of vitamin E (400 IU) significantly reduced the frequen-cy and severity of hot flushes in postmenopausal women (Gynecol Obstet Invest, 2007; 64: 204-70). Previous research carried out more than 50 years ago also suggests that vitamin E may help mood swings and vaginal dryness (NY State Med; 1952; 52: 1289).
o Consider aromatherapy. This form of treatment uses essential oils extracted from the flowers, leaves, fruit, bark and roots of medicinal plants. Aromatherapy massage works on the nervous system through the senses of both smell and touch.
In a small study carried out in Japan, 15 women with menopausal symptoms were examined by a gynaecologist before receiving a 30-minute aroma-therapy session, involving a consultation, massage and home-massage guidance. After one month of at-home care and a second aromatherapy session, all reported significant improvements in their symptoms (J Altern Complement Med, 2005; 11: 491-4).
Intriguingly, another study discovered that aromatherapy massage, with an additional focus on the abdomen, can reduce abdominal fat and improve body image in post-menopausal women (Taehan Kanho Hakhoe Chi, 2007; 37: 603-12).
o Take up yoga. A systematic review of 18 clinical trials from six countries found that yoga-based and certain other mind- body therapies can be benefic-ial by alleviating a range of menopausal symptoms. Eight out of nine studies of yoga, tai chi and meditation-based prog-rammes reported improvement in overall menopausal and vasomotor symptoms (such as hot flushes and night sweats); six of seven trials using yoga-based programmes indicated improvement in mood and sleep, and four studies reported reduced musculoskeletal pain.
Results from the other trials suggest that breath-control-based and other relaxation therapies are also promising for relieving menopausal symptoms (Maturitas, 2010; 66: 135-49).
o Consider acupuncture. One small Swiss study showed that acupuncture was able to significantly reduce vasomotor symptoms and physical disturbances in menopausal women. What's more, the effects were still evident three months after the last session (J Altern Complement Med, 2001; 7: 651-8).
More recently, a randomized controlled trial of 175 women reported that acupuncture, in addition to the usual care, was associated with marked clinical improvement in hot flushes and other menopause-related symp-toms (Menopause, 2010; 17: 269-80).
o Try the herbal supplement Femal. This "unique blend of pollen extracts from seven organically cultivated flowers grown in . . . Sweden" also contains vitamin E. In one Danish study, 54 menopausal women were randomly given either two Femal tablets each morning, or two identical placebo tablets, for three months. The results showed that 65 per cent of the Femal group enjoyed a reduction in hot flushes compared with 38 per cent in the placebo group.
On looking at 15 other menopausal "quality-of-life" symptoms, Femal again came out on top (Climacteric, 2005; 8: 162-70).
Femal is available from Boots and independent chemists.
o Lose weight. If you're overweight or obese, losing weight can help to keep hot flushes under control, according to a recent study. University of California at San Francisco researchers studied 338 overweight or obese women and found that those who followed an intensive weight-loss programme showed greater improvements in bothersome hot flushes compared with those following a structured health-education programme (controls) (Arch Intern Med, 2010; 170: 1161-7).
o Stop smoking. The results of one study suggest that women who suffer from hot flushes are more likely to be smokers (J Womens Health, 1998; 7: 1149-55). Another study found that women taking HRT for relief of menopausal symptoms were more likely to be current smokers.
"This relation between HRT use and smoking could result from an anti-oestrogen effect of smoking, intensifying meno-pausal symptoms," said research-ers (J Epidemiol Community Health, 1987; 41: 26-9).
o Investigate allergies. According to Dr Ellen Grant, author of The Bitter Pill and Sexual Chemistry, hot flushes could be due to an allergic reaction to common foods or chemicals. In her study of 60 migraine sufferers, a variety of foods and drinks, including wheat, eggs, sugar, tea and coffee, commonly caused vascular reactions such as flushing, headaches, and pulse or blood pressure increases. The most common chemical allergens were cigarette smoke and domestic gas (Lancet, 1979; 313: 966-9; WDDTY vol 17 no 2). So, if you suffer from hot flushes, keep a diary to try to pinpoint any possible triggers.
o Consider black cohosh. This herb has a long history of traditional use for a variety of 'female complaints', including menstrual problems and childbirth. Scientific studies have found it to be a safe and effective remedy for a number of menopausal symptoms, but mainly hot flushes and mood swings. Indeed, Germany's governmental regulatory agency Commission E has approved the use of 40 mg/day of black cohosh (sold as Remifemin) for six months for the relief of such symptoms.
Although early studies suggested that the herb has oestrogenic effects, more recent evidence shows that black cohosh does not have an oestrogenic mechanism of action but, instead, acts on serotonin rec-eptors to relieve menopausal symptoms (J Womens Health [Larchmt], 2005; 14: 634-49).
Nevertheless, there have been concerns (from animal studies, which may not apply to humans) as to its potential to increase the spread breast cancer, so it's generally not recommended for patients or women with a family history of the disease (Cancer Res, 2008; 68: 8377-83).
If you do wish to try black cohosh, it's best to do so only under the supervision of a registered naturopath or medical herbalist.
o Give Ginkgo a go. Several studies show that Ginkgo biloba can help to boost memory and concentra-tion, which can suffer during the menopause. One study found that 120 mg/day for just one week significantly improved memory and attention compared with a placebo in postmenopausal women (Pharmacol Biochem Behav, 2003; 75: 711-20).
When combined with other herbs, Ginkgo may also boost the libido. A herbal formulation (Herbal vX) of Ginkgo and Muira puama was tested in 202 healthy pre- and postmenopausal women complaining of low sex drive. After one month of treatment, statistically significant improve-ment was found in frequency of sexual desire, sexual intercourse and sexual fantasies, as well as in satisfaction with sex life in gen-eral, intensity of sexual desires, excitement of fantasies, ability to reach orgasm and intensity of orgasm (Adv Ther, 2000; 17: 255-62). However, as the trial was uncon-trolled, we don't know to what extent the results are down to the 'placebo effect'.
In one double-blind, placebo-controlled trial, the supplement ArginMax (from www.arginmax. com and www.virilityhealth.co. uk), which contains Ginkgo, plus
l-arginine, ginseng, damiana, multivitamins and minerals, was tested in just over 100 women, aged 22-73 years, who reported a lack of sexual desire.
In those going through the menopause, the supplement increased the frequency of inter-course, satisfaction with the sexual relationship and vaginal dryness.
In postmenopausal women, half reported increased sexual desire compared with only 8 per cent with the placebo. Moreover, the formulation has been shown to exhibit no oestrogenic activity (J Sex Marital Ther, 2006; 32: 369-78).
o Eat healthily. Keeping to a balanced diet that includes a variety of fruit and vegetables can protect against bone loss, cancer and premature death (Am J Clin Nutr, 2000; 71: 142-51; Cancer Epidemiol Biomarkers Prev, 2004; 13: 1485-94; JAMA, 2000; 283: 2109-15). The nutrients that are especially important for menopausal women are calcium, vitamins D, C and the Bs, and potassium, zinc, copper and magnesium. Aim to get these from your diet, and supplement when necessary.
Signs of menopause
Officially, you're not in the menopause until it's been a whole year since your last menstrual period. However, the signs and symptoms of menopause may well appear long before that. These include:
o hot flushes
o night sweats
o mood swings
o impaired memory or concentration
o loss of libido
o vaginal dryness
o increased abdominal fat.
VOL. 21 NO. 10