Menopause

Women vary tremendously in their experience of menopause.  One woman may barely notice that a year has passed since her last period while another suffers mightily with hot flashes, night sweats, sleep disturbance, vaginal dryness and brain fog.  Symptoms can be brief or last for many years.

The “change of life” also provides an opportunity to reconsider your overall health with a focus on prevention.  The goals of an integrative medicine consult for menopausal complaints are to provide relief from symptoms as well as to discuss health and plan for the next phase of life.  A wide spectrum of interventions are available to choose from including diet, exercise, breathing exercises, stress management, nutritional supplements, herbal therapies, and hormones.  While I do not usually start with a recommendation of hormone replacement, bio-identical hormones are extremely effective for women with moderate to severe menopausal symptoms.

Nutrition: nutrition plays a fundamental role in integrative medicine.  Advice includes a having a diet rich in whole,  unprocessed foods, with an emphasis on vegetables, whole grains, beans, seeds, nuts, fruits, lean proteins, and healthy fats.  I recommend most women keep their diet low in saturated fats, and avoid fried foods, simple carbohydrates, and sugars.

Some specific foods, such as soy and flax, have been studied for their beneficial effects on menopause related symptoms.

Soy: Soy foods may be useful in menopause primarily for its potential benefits for bone, cholesterol, blood pressure, and coronary artery disease.  There are hundreds of studies on soy for health conditions and dozens on soy for hot flashes, some showing effect and others not.  Women can add soy to their diets and see whether they perceive a reduction in hot flashes.

Flaxseed is a significant dietary source of phytoestrogens. Flaxseed contains lignans which increases the urinary 2α-hydroxyestrone/16α-hydroxyestrone ratio; this change in the metabolism of estrogen is associated with a lower risk of breast cancer.  A  2013 meta-analysis did not find benefit of flax beyond placebo for hot flashes. Flaxseed is also a source of dietary fiber and contains the omega 3 fatty acids (ALA) both healthy additions to the diet. Listen here to Dr Maizes and Dr Andrew Weil discuss menopausal symptoms on the Dr Oz show.

Exercise

The benefits of exercise for women of all ages, pre and postmenopausal, are clear.  Regular exercise can help women to reduce their risk of cardiovascular disease, breast cancer risk, and increase their bone density.  Even more significantly, women  experience an improved sense of well being when they exercise. For women who are not overweight, moderate exercise may be beneficial for hot flashes; more vigorous exercise may actually exacerbate them.

Stress Management

Diaphragmatic breathing has been shown to reduce hot flashes. Here’s two simple ways to learn how:

  • Lie on your back and put a book on your belly. Relax your stomach muscles and inhale deeply so the book rises when you exhale, and falls when you inhale. You can see the book rising and falling, which shows that you are bringing air into the lower part of your lungs.
  • Sit up straight with your right hand on your belly, left hand on your chest. Breathe in deeply so your right hand rises and falls, and your left hand stays relatively still.

Many studies have shown that depression in women is more common during menopausal years than any other time in life.  Developing a regular practice of meditation, yoga, breathing exercises, or mindful walks, can help.

Hormone Therapy

I always use “bio-identical” hormones when I prescribe hormones.  Hormonal therapies should be used in the lowest dose, for the shortest duration, and in the safest way possible. Often it is safer to use topical hormones (in part because much lower doses can be used) than oral forms.

Use of hormone therapy for more than five years has been associated with an increased risk of breast cancer.  The most recent study published in the July 2014 Annals of Internal Medicine reveals no increased risk of heart disease if hormone therapy begins at menopause. (Many criticized the findings of the Women’s Health Initiative, which found increased risk of heart disease, for beginning hormone therapy an average of ten years after menopause).

Vaginal dryness or atrophy is extremely responsive to topical vaginal hormones.

Dietary supplements:

A variety of herbs and supplements can be used to alleviate menopausal symptoms:

Hot flashes: Black Cohosh (Cimicifuga racemosa)  Historically, Black cohosh was primarily used for the relief of pain and melancholy. Research shows that it has SSRI and anti-inflammatory effects.

Irregular periods: Chasteberry (Vitex agnus-castus) can increase progesterone which may drop during the perimenopausal years.  Chasteberry can sometimes even out the cycle evening out cycles..

Stress: A variety of adaptogens including Ginseng, Rhodiola, Ashwaganda, and others can be of use

Sleep aids: Valerian, melatonin, and inositol can help the disordered sleep that sometimes accompanies menopause

Traditional Chinese Medicine:

Multiple studies reveal that acupuncture can help reduce the number and severity of hot flashes as well as increase a woman’s quality of life and her sense of well being.