Menopause

What is the Menopause?

You have reached the menopause if six months have passed since your last period. Around this time, the ovaries stop producing eggs. As the ovaries close down, they produce smaller quantities of the hormones that had been building up the lining of the womb every month to make the body ready for pregnancy. As well as regulating periods and maintaining pregnancy, the hormone oestrogen triggers all the changes in the female body that begin at puberty. So, as oestrogen production declines, the body starts to change.

When does the menopause usually start?

Nowadays, the average age for a woman's last period is 51, though changes quite often begin in the early forties. Many women have menopause symptoms and irregular periods for several years before their periods finally stop altogether. This time in a woman's life is called the climacteric, or 'perimenopause', when the ovaries gradually stop their normal functioning.

The experience of menopause can vary a great deal. It might feel like a blessing to some women. For most, it just means fewer, more irregular, lighter periods, with maybe a few mild menopausal problems, which gradually stop after two to five years. But there can be downsides. Though the menopause isn't a disease - in fact it's a natural, inevitable phase of life - for some women it can be a real challenge.

There are emotional and psychological changes to adjust to, as well as physical ones. A woman's sense of who she is, and her place in the world, may be changing as well. For as many as 4 in 10 women, some menopausal changes are bothersome but only a few have unpleasant symptoms that last many years after their periods have stopped.

What problems are common at the menopause?

Hot flushes and night sweats
usually lasting for just a few minutes. Your face, neck and chest may go red and blotchy. You might start to sweat and feel your heartbeat get faster. When these flushes happen at night, they are known as night sweats. As a rule, hot flushes are at their worst for a year or so after the last period.

Sleep problems
Not surprisingly, night sweats can make it difficult to sleep. Some women also feel more anxious during the menopause, and this may also disturb sleep. Poor sleep can affect your mood, memory and concentration.

Vaginal dryness and soreness
Oestrogen is a sex hormone. When there is less of it in the blood, the vaginal lining gets thinner and doesn't produce as much fluid. When there is less lubricating fluid and the vagina gets drier, it may feel itchy and sore. This inflammation - called atrophic vaginitis - may also affect the bladder and urethra, and make you more likely to get cystitis and thrush.

Sexual issues
Sex hormones have a lot to do with sex drive. Yet some women find their interest in sex is unaffected; or even that, once free of periods and the chance of pregnancy, their sex drive and enjoyment get stronger. But more often, interest in sex and the need for it reduce around the menopause. And of course if vaginal dryness and urinary problems make having sex uncomfortable, this will reduce interest all the more. Together, these changes may make the stress and discomfort some women feel around the menopause even worse.

Medical treatment for menopause problems

According to NHS Choices around one-third of women experience some or all of the above symptoms shortly after the menopause, and slightly more women have them later on - more than 10 years after their final period. These problems can be treated by your GP. But if left untreated, they tend to continue or get worse.

HRT or not HRT? That was the question
For years Hormone Replacement Therapy (HRT) was the treatment of choice for the discomforts of menopause. It wasn't a perfect answer but at first it looked like a 'win-win' treatment. (As women get older, they face a growing risk of having heart disease and a stroke; HRT was thought to prevent these problems.) Then the Women's Health Initiative found the opposite - that women on HRT were more likely to have a heart attack or a stroke, and more prone to get breast cancer.

HRT today
Because of these safety fears, the number of women in the UK taking HRT fell from 2 million to fewer than 1 million between 2003 and 2007. But lately medical opinion has changed about the balance of benefit compared to risk. Doctors now seem to be moving back towards offering HRT to women whose hot flushes and atrophic vaginitis are persistent and moderate to severe. Research has shown that low-dose oestrogen is effective for many women, although some require larger doses to relieve hot flushes.

But because HRT is not risk free, doctors recommend that patients should take the lowest dose that relieves their symptoms (possibly using a vaginal cream rather than a pill), and for the shortest amount of time (depending on the problem). It is also best used by women early on in their menopause. HRT is not recommended for women with a high risk of stroke, heart disease, blood clots or breast cancer. And HRT users should be re-assessed by their GP at least once a year.

To find out more about HRT treatment, visit Women's Health Concern

Looking on the bright side
Having hot flushes may cut your risk of developing breast cancer by as much as half, according to a recent US survey of 1,437 postmenopausal women. They were asked about various menopausal symptoms, including hot flushes, night sweats, insomnia, vaginal dryness, irregular or heavy menstrual bleeding, depression and anxiety. Those women who said they had suffered from hot flushes had the lowest risk of developing breast cancer.

Further information and advice

For more information visit:

• Health Talk Website
• Menopause Matters
• NHS Choices Menopause Information

When to see your doctor

Only 10% of women ask for medical advice during their menopause and many do not need treatment. But if your symptoms are severe and interfere with your daily life, your GP can suggest treatments that may help. For more information, visit NHS Choices.

If you have recently started taking new medication, speak to your pharmacist about whether this might be the cause of your problems.

Other information that might be helpful:

• If you think you might be suffering from stress or anxiety you might find our leaflet on Stress and Anxiety helpful.
• If you are feeling 'low' (particularly if you are waking early), or if you're feeling very down about yourself, you might find our leaflet on Depression helpful.
• If you think your problems might be caused by lack of sleep, you may find our leaflet on Sleep Problems helpful.
• If you are feeling exhausted, you might find our leaflet on Fatigue helpful.
Heavy bleeding can cause problems, until periods peter out and finally stop altogether. This leaflet does not deal with bleeding problems.

Spotting (light bleeding) after the menopause is not unusual. The cause is usually something minor but it occasionally it can be an early sign of a more serious problem, such as a tumour. Perhaps this is only the case in 5-10% of women who bleed after their periods have stopped but it is obviously important to see a doctor and find out the cause so it can be properly treated. Always seek medical advice if you notice spotting after periods have stopped.

Make Some Simple Changes

12 Menopause diet tips read more Overview There is still a lot more research to be done, but it looks as if the right foods could help reduce hot flushes and protect you from heart disease. This is important because after the menopause women become just as prone as men to heart disease. Here are 12 dietary tips that may ease menopause symptoms: 1 Eat more phyto-oestrogens. These are plant chemicals, found in some fruit, vegetables, beans and seeds, which act like weak forms of oestrogen. They might ease menopausal symptoms slightly if you eat enough of them and eat them regularly. 2 Eat more fruit and vegetables. As well as phyto-oestrogens, they contain vital vitamins and minerals, including boron, which seems to help the body keep hold of oestrogen and calcium. 3 Eat tofu and other soy products. This is not because they help prevent hot flushes, or (as it used to be said) reduce 'bad' cholesterol, but because they are very healthy, low-fat, high protein foods. Soy products are rich in fibre, omega-3 oils, and essential protein. They have more vitamins and minerals than meat or dairy proteins, and contain 'good' (polyunsaturated) fats, which are healthier than the saturated fats found in meat, butter and cheese. 4 Eat beans and sprouted seeds. They are full of fibre, contain phyto-oestrogens, and may help keep your blood sugar at an even level. (Sudden rises in blood sugar may encourage hot flushes.) 5 Eat more of the right fats. Some fats are harmful. Some, such as omega-3 oils (found in oily fish like mackerel and olive oil), help prevent heart disease and cancer. But saturated fats and trans fatty acids (found in manufactured baked goods, and deep-fried foods such as chips) make us more prone to heart disease, diabetes and possibly prostate and breast cancer. So it makes sense to switch to olive oil, and eat more fish and less animal fat. 6 Reduce alcohol and caffeine. As well as cutting down on tea, coffee and alcohol, you should increase your intake of fruit juices and vegetable juices because they are rich in phyto-oestrogens and anti-oxidants 7 Snack, don't feast. Eat frequent small meals to keep your blood sugar level even. Don't miss breakfast - it gives you the energy boost you need first thing in the morning. Have light lunches and no late-night big meals when you're about to rest and your body will store the surplus as fat. 8 Eat calcium-rich foods. You can get calcium not just from milk products but also from seeds and grains. Taking in enough calcium helps maintain strong bones. 9 Shun foods that are high in fat and sugar. Preventing weight gain is important. Women don't just 'naturally' gain weight when their periods stop. Keeping your fat and sugar intake low will help you control your weight. 10 Add ground-up flaxseed to your food. This is one of the richest plant sources of phyto-oestrogen and also provides the vegetable version of the omega 3 oil that helps prevent harmful blood clots. But note that bottled flaxseed oil does not contain phyto-oestrogens. 11 Take vitamin D supplements if you need them. Oily fish and dairy products are good sources of vitamin D, and sunlight helps the body make vitamin D. If your diet is poor and you don't get into the sun, ask your doctor about a vitamin D blood test. If it's normal, there's no point in taking vitamin D. If it's low, your GP will prescribe it for you. 12 Exercise so that your body burns fat faster. Exercising will help lower your blood cholesterol levels, improve your mood, reduce bone loss, boost your circulation and heart health, lower your risk of getting breast cancer and make your heart and lungs work better. Cutting down caffeine read more Overview It can be tempting to reach for stimulating drinks like tea, coffee, colas or so-called 'energy drinks' if you're tired and need a boost. They can give you a quick lift, but if you rely on them for long they only keep you going until your energy stores run down further. We didn't find any good studies linking caffeine and hot flushes, but since they both affect sleep it makes sense to avoid caffeine later in the day. Treatment Options: Cutting down on alcohol and stopping smoking read more Overview Since smoking and excessive drinking undermine your overall health (and can affect how tired you feel), there is every reason to cut down on them or, better still, cut out smoking completely. Red wine contains a substance called resveratrol, which is a phyto-oestrogen and has oestrogen-like effects. One small glass a day may be good for the heart. But alcohol pushes calcium out of the body, and three or more glasses of wine per day increases the risk of getting osteoporosis. And the more alcohol you drink, the greater your risk of developing breast cancer. Women who have 2 to 5 drinks a day have 1-2 times the risk of women who drink no alcohol. Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units. Evidence It does seem that alcohol and smoking may make hot flushes worse. A survey of 28,000 women in France found that smokers and drinkers were more likely to get menopausal symptoms. Safety There are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are cutting down from heavy drinking you may experience side-effects, including loss of appetite and difficulty sleeping. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you're cutting down. Cost There are no costs. In fact you will save money. Find out more For more information, see the NHS information sensible drinking. If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332. View References (2) Evidence: Cost: Safety: Alcohol Consumption and Risk of Postmenopausal Breast Cancer by Subtype: the Women’s Health Initiative Observational Study. Li CI et al. Published online August 23, 2010 in JNCI (Journal of the National Cancer Institute). doi:10.1093/jnci/djq316 Alcohol use may be more strongly associated with risk of hormone-sensitive breast cancers than hormone-insensitive subtypes, suggesting distinct etiologic pathways for these two breast cancer subtypes. Link to Abstract Risk factors for onset of menopausal symptoms: results from a large cohort study. Sabia S, Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F. Maturitas. 2008 Jun 20;60(2):108-21. Epub 2008 May 29. Large cohort study of 28,000 women in France. Findings: The risk (of onset of menopausal symptoms) was positively associated with smoking and alcohol consumption. Link to Abstract Exercise read more Overview Taking exercise does more than keep you fit. It makes your heart and lungs work better, tones your muscles, strengthens bones and joints. It also stimulates circulation to your brain and internal organs and boosts the immune system. It helps protect against osteoporosis, burns up body fat, triggers brain chemicals that lift your mood and can generate a glowing sensation of well-being. A researcher who studied the effects of exercise on women after menopause said, 'It doesn't always have to be sports! In our calculations we have also taken account of activities such as gardening, cycling or walking to the shops. Our advice to all women is therefore to stay or become physically active in the second half of your life. You will not only reduce your risk of breast cancer, but it has been proven that your bones, heart and brain also benefit from it.' Dr A. Heather Eliassen and her colleagues monitored the weight gain of 87,000 American women for 26 years. Based on their research, they calculated that gaining 22 pounds (10 kg) after the menopause increased the risk of developing breast cancer by 18%, but losing 22 pounds (10 kg) after the menopause reduced the risk by 57%. Note: Exercise training can include aerobic forms such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretches for flexibility. Other popular types of exercise are Tai Chi, Qigong and yoga. Evidence While exercise has huge benefits on general health and wellbeing, there has not been enough research to decide whether it helps to prevent hot flushes. But physical activity has been shown to improve all sorts of health problems. It reduces the risk of hormone-dependent breast cancer (the commonest kind after the menopause) and helps prevent heart disease. For mild to moderate depression, it can be as effective as anti-depressant medication. Safety If you're not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise. Cost No costs are involved if you are exercising at home, although you should get advice on the best exercises to do from a trainer or fitness professional first. There may be a small cost if you join an organised exercise programme. Find out more Natural England is one of several organisations that organise walking schemes designed to help people improve their health. The Walking for Health Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company. Check your local leisure centre for exercise classes. See also the Classes section for more information. View References (3) Evidence: Cost: Safety: Exercise for vasomotor menopausal symptoms. Daley A, Stokes-Lampard H, MacArthur C. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006108. DOI: 10.1002/14651858.CD006108.pub2. Cochrane SR of 6 trials. Conclusions: The existing studies provided insufficient evidence to determine the effectiveness of exercise as a treatment for vasomotor menopausal symptoms, or whether exercise is more effective than HRT or yoga. Link to Abstract Physical Activity and Postmenopausal Breast Cancer: Effect Modification by Breast Cancer Subtypes and Effective Periods in Life Schmidt et al. Cancer Epidemiology Biomarkers & Prevention, 2008; 17 (12): 3402 DOI: 10.1158/1055-9965.EPI-08-0479 Researchers assume that physical exercise reduces the risk of cancer through hormonal mechanisms instead merely by a reduction of body fat or other changes in physical constitution, as it has often been assumed. Link to Abstract Adult weight change and risk of postmenopausal breast cancer Eliassen AH. JAMA. 2006 Jul 12;296(2):193-201. These data suggest that weight gain during adult life, specifically since menopause, increases the risk of breast cancer among postmenopausal women, whereas weight loss after menopause is associated with a decreased risk of breast cancer. Thus, in addition to other known benefits of healthy weight, our results provide another reason for women approaching menopause to maintain or lose weight, as appropriate. Link to Abstract Healthy Diet read more Overview It is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. Your diet should also be low in fat, sugar and salt. Improving your diet could help with your mood. When your periods stop and your oestrogen levels go right down, your total cholesterol level rises. Research has shown that one type of cholesterol is bad for the body, while another type protects health. During the menopause, 'bad' cholesterol rises, while 'good' cholesterol levels fall. Previous research suggested that soy products could help lower cholesterol and so prevent heart disease. But later research has indicated that this might not be the case; at least not if you only eat 25 g of soy protein a day. Nevertheless, soy products (such as tofu, soy butter, soy nuts and some soy burgers) are healthy foods because of their polyunsaturated fats, fibre, vitamins, minerals and low saturated fat. Eating less animal protein (which contains saturated fat and cholesterol) and substituting soy foods should therefore be good for the health of your heart. Evidence It seems that some foods can make hot flushes worse. For instance, a survey of 28,000 women in France found that those who ate sugary snacks were more likely to get menopausal symptoms. Safety If you want to make big changes to what you eat, it is a good idea to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need. Cost Eating a healthy diet and reducing or excluding some foods need not cost you anything. This is especially true if you prepare your own healthy meals, rather than buying costly ready-meals, which often contain a lot of hidden fats, salt and sugar. But if you consult a dietician there will be a charge, unless this is a service provided by your GP's practice. View References (1) Evidence: Cost: Safety: Risk factors for onset of menopausal symptoms: results from a large cohort study. Sabia S, Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F. Maturitas. 2008 Jun 20;60(2):108-21. Epub 2008 May 29. Among dietary factors, rapidly absorbed sugars and snacking were positively associated with the risk of onset of menopausal symptoms. Link to Abstract Phytoestrogen-rich foods read more Overview Some plants contain substances called phyto-oestrogens, which act in a similar way to oestrogen and may help to ease menopausal symptoms. But these foods have a much weaker effect on the body than oestrogen, and some may even have an 'anti-oestrogenic' effect. So it is difficult to predict which ones will be helpful. There are three kinds of phyto-oestrogens: 1 Isoflavones - good sources are soy products and pulses (such as lima beans and lentils). 2 Lignans - good sources are fruit, vegetables, grains and oilseeds (such as linseed). 3 Coumestans - good sources are sprouting seeds (such as alfalfa). Many women now eat soy products as part of their everyday diet. The available evidence suggests that if you eat enough of them they might help mild to moderate hot flushes in early natural menopause. However, unlike synthetic HRT, none of the compounds researched so far seems to protect against breast cancer, bone fracture or heart disease. Though phyto-oestrogens might help ease menopausal symptoms if you eat enough of them regularly, we don't yet know how much is needed or how often. In fact the research to date has not proved that phyto-oestrogen foods or supplements are good for menopausal problem. Nevertheless, whole grains, ground flax and soy proteins are still great health-supporting foods, whether or not they have special benefits during the menopause. Evidence There have been lots of small studies of how different sorts of phyto-oestrogens affect menopausal symptoms. The results have been rather mixed, so we can't firmly recommend adding them to your diet. But they are definitely safe, inexpensive, low-fat, high-protein food items. Safety Eating normal quantities of phyto-oestrogen-rich foods is unlikely to have any harmful effects. in fact these foods are generally very healthy. Cost No extra costs are involved if you prepare your own healthy meals using tofu, soy milk, pulses, whole grains, seeds, vegetables and fruit, rather than buying costly ready-meals, which often contain hidden fats, salt and sugar. View References (1) Evidence: Cost: Safety: Phytoestrogens for vasomotor menopausal symptoms. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD001395. DOI: 10.1002/14651858.CD001395.pub3. Cochrane review of 30 trials. Conclusions: Most of the trials in this review were small, of short duration and poor quality. Some trials found a slight reduction in hot flushes and night sweats with phytoestrogen-based treatment but overall there was no indication that phytoestrogens worked any better than no treatment. There was no evidence of harm with short term use. Link to Abstract Relaxation techniques read more Overview Relaxation will help with sleep problems, and with managing stress and coping with the tension or anxiety that women experiencing hot flushes and other menopausal symptoms often feel. Relaxation techniques are useful during rest periods or for helping you sleep. Evidence Relaxation techniques have been found to help reduce hot flushes in several research studies. Safety These techniques are generally safe unless you have a severe or long-standing mental health problem. For more on this, see our leaflet on Stress and Anxiety. Cost You may need to buy a tape or book but this will be a one-off cost. Find out more Relaxation techniques can be learned from a book, CD, DVD or during exercise classes such as yoga classes. No costs are involved, although you may need to buy a CD, DVD or book. See the information about yoga in the Classes section and our leaflet on Stress and Anxiety. Visit The British Holistic Medical Association for podcasts and leaflets. View References (2) Evidence: Cost: Safety: Non-hormonal interventions for hot flushes in women with a history of breast cancer Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD004923. DOI: 10.1002/14651858.CD004923.pub2. Cochrane SR including 2 trials of relaxation therapies. One of two studies on relaxation therapy showed a significant benefit. Conclusions: Clonidine, SSRIs and SNRIs, gabapentin and relaxation therapy showed a mild to moderate effect on reducing hot flushes in women with a history of breast cancer. Link to Abstract Psychoeducational interventions to alleviate hot flashes: a systematic review. Tremblay A, Sheeran L, Aranda SK. Menopause. 2008 Jan-Feb;15(1):193-202. SR or 14 studies of various interventions involving 475 patients, 9 trials of relaxation techniques of which 5 were positive. Conclusions: Psychoeducational interventions, including relaxation, seem to alleviate hot flashes in menopausal women and breast cancer survivors; however, the methodological quality of published research is either fair or poor. Link to Abstract

Buy Something

Before You Buy read more Overview For safe use of over-the-counter medicines, herbal remedies and supplements: Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement: - if you have a serious medical condition - if you are breast-feeding, pregnant or planning to become pregnant - if you are already taking other medicines, herbal remedies or supplements - if you suffer from allergies Always read the package insert before taking any product. Avoid taking the product if you think you may be allergic to any of the ingredients. Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist). Seek advice from your doctor or pharmacist: - If your symptoms do not get better - if your symptoms get worse - if you get new symptoms or have a side effect The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children. Complementary and alternative treatments for hot flushes read more Overview Given the debate about the risks of HRT, it is not surprising that many women look for alternatives. Several surveys have shown that women are particularly likely to try complementary and alternative treatments during the menopause. Many of these therapies might be worthwhile but, if no clinical trials have been carried out, we can't be sure whether they really work. Many of these products may not always be manufactured as strictly as standard medical products. For example, there are some concerns about liver damage from black cohosh (see below). It appears that this this sort of liver damage is linked to inferior and possibly dangerous substitutes for black cohosh. Recent market surveys have shown that one-third of black cohosh products do not contain the real herb. This is an important reminder that you should only to buy products that have been independently certified as coming from reliable suppliers. Very large research projects have been carried out on HRT, so we know a lot about its side-effects. But some herbs may have side-effects too. Generally, it's best to be cautious. Treatments such as ginseng, black cohosh and red clover are supposed to be oestrogen-like in their effects. Although we do not know how they actually work, they ought not be used in women who need to avoid oestrogen (such as women with breast cancer). Nor are we clear about their long-term effects on the breast and uterus. Treatment Options: Black cohosh (Cimicifuga racemosa or Actaea racemosa) read more Overview This herbal medicine from North America is also known as Squaw Root. It contains a plant oestrogen, but studies have shown mixed results. Evidence Some research suggests that black cohosh may help with hot flushes but not all studies show this. Researchers have also found that black cohosh in combination with other herbs (including St John's wort) appeared more effective than black cohosh alone. Evidence for side-effects was uncertain. Safety There have been a few reports of liver disorders among women using black cohosh. Though these reactions in the liver appear to be rare, women taking black cohosh should be aware of this possible risk and take special care to use only high-quality black cohosh products from reputable suppliers. Cost View References (3) Evidence: Cost: Safety: Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A. Altern Ther Health Med. 2010 Jan-Feb;16(1):36-44. SR or 9 trials (7 in meta-analysis). Conclusions: Preparations containing black cohosh improved these symptoms overall by 26% (95% confidence interval 11%-40%); there was, however, significant heterogeneity between these trials. Link to Abstract Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review Cheema D, Coomarasamy A, El-Toukhy T. Arch Gynecol Obstet. 2007 Nov;276(5):463-9. Epub 2007 Jun 26. SR including 7 trials of black cohosh. Conclusions: There is evidence that clonidine, paroxetine, venlafaxine, gabapentin and black cohosh may be beneficial in the treatment of menopausal vasomotor symptoms in some women. Link to Abstract Botanical and dietary supplements for mood and anxiety in menopausal women. Geller SE, Studee L. Menopause 2007 - Volume 14 - Issue 3 - pp 541-549 doi: 10.1097/01.gme.0000236934.43701.c5 Five of seven trials of St. John's wort for mild to moderate depression showed a significant improvement. The one randomized, controlled trial of ginseng in postmenopausal women reported improvements in mood and anxiety. All three randomized, controlled trials of ginkgo found no effect on depression. In four of eight controlled trials, kava significantly reduced anxiety. Black cohosh significantly reduced depression and anxiety in all studies reviewed. St. John's wort and black cohosh appear to be the most useful in alleviating mood and anxiety changes during menopause. Ginseng may be effective, but more research needs to be done. Finally, ginkgo and valerian do not appear to be useful in reducing depression or anxiety in this population. Link to Abstract Dong quai (Angelica sinensis) read more Overview This traditional Chinese herbal 'tonic' for women has been promoted as a treatment for hot flushes but there is no supporting evidence for its effectiveness. Evidence Researchers have not found that dong quai helps hot flushes or other menopausal symptoms. Safety Do not take it if you are on blood-thinning drugs such as warfarin. Cost View References (1) Evidence: Cost: Safety: Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review. Cheema D, Coomarasamy A, El-Toukhy T. Arch Gynecol Obstet. 2007 Nov;276(5):463-9. Epub 2007 Jun 26 Link to Abstract Evening primrose oil (EPO) read more Overview Evening primrose is a yellow, flowering plant that blooms in the evening. It contains gamma-linolenic acid (GLA), an omega-6 essential fatty acid required by the body for growth and development. The body can't make GLA so we need to get it from our food. Evidence There is some evidence suggesting that evening primrose oil may help breast pain associated with the menstrual cycle, and premenstrual syndrome (PMS). But it does not appear to help menopausal problems. Safety EPO is generally safe in recommended doses. Reported side-effects are rare and mild. Stomach pain and loose stools may mean you are taking too much. If you get seizures (e.g. epileptic fits) be careful with omega-6 supplements such as EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder. Cost View References (1) Evidence: Cost: Safety: Botanical and dietary supplements for mood and anxiety in menopausal women Geller SE, Studee L. Menopause 2007 - Volume 14 - Issue 3 - pp 541-549 doi: 10.1097/01.gme.0000236934.43701.c5 Five of seven trials of St. John's wort for mild to moderate depression showed a significant improvement. The one randomized, controlled trial of ginseng in postmenopausal women reported improvements in mood and anxiety. All three randomized, controlled trials of ginkgo found no effect on depression. In four of eight controlled trials, kava significantly reduced anxiety. Black cohosh significantly reduced depression and anxiety in all studies reviewed. St. John's wort and black cohosh appear to be the most useful in alleviating mood and anxiety changes during menopause. Ginseng may be effective, but more research needs to be done. Finally, ginkgo and valerian do not appear to be useful in reducing depression or anxiety in this population. Link to Abstract Red clover (Trifolium pratense) read more Overview Research findings on how supplements made from red clover extracts affect hot flushes are mixed. Most studies say that taking them for up to a year does not help hot flushes or night sweats. There is also no evidence that taking red clover supplements for three months to a year will reduce 'bad' cholesterol or increase 'good' cholesterol or increase bone strength in women. Evidence According to two reviews of research, red clover supplements may produce a slight to modest reduction in the number of daily hot flushes. Safety Phyto-oestrogen supplements may contain far more phyto-oestrogens than foods. Long-term use of these supplements might possibly affect the risk of getting some types of cancer, particularly breast cancer. Cost View References (3) Evidence: Cost: Safety: Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis. Thompson Coon J, Pittler M H, Ernst E. Phytomedicine 2007; 14(2-3): 153-159 SR of Five RCTs (400 patients). Conclusions: There was evidence of a marginally significant effect of Trifolium pratense isoflavones in the treatment of hot flushes in menopausal women, but the clinical relevance of this effect was unclear. Adverse events during short-term use were not apparent but data on long-term administration were missing. Link to Abstract Isoflavone therapy for menopausal flushes: a systematic review and meta-analysis Howes L G, Howes J B, Knight D C Maturitas 2006; 55(3): 203-211 Seventeen RCTs (n=1,503) were included: 5 studies (n=458) of red clover and 12 studies (n=1,045) of soy. Authors conclusions: Isoflavone supplementation may result in a slight to modest reduction in the number of daily menopausal flushes, with greater reductions in women with a high number of daily flushes at baseline. DARE appraisal: …difficult to comment on the reliability of the authors’ conclusions. Note all authors had links to red clover manufacturer. Link to Abstract Phytoestrogen supplement use by women. Kurzer MS. J Nutr. 2003 Jun;133(6):1983S-1986S. Extracted phytoestrogens are marketed in numerous forms as dietary supplements. Consumers of phytoestrogen supplements tend to be peri- and postmenopausal women looking for an alternative to hormone therapy. Numerous claims are being made for benefits to heart, bone, breast and general menopausal health. The research supporting these claims are not strong. The strongest data show that phytoestrogens reduce the number and intensity of hot flashes, although the reduction is a modest 10-20%. The data on bone metabolism are suggestive of possible benefits whereas the effects on the breast are the most poorly understood. Although most animal studies have shown cancer-preventive effects, a few recent studies suggest that soy phytoestrogens may stimulate breast cancer cell growth under certain circumstances. Until safety with respect to breast cancer is established, phytoestrogen supplements should not be recommended, particularly for women at high risk of breast cancer. Link to Abstract Soya-based supplements read more Overview The active ingredients in soy are called isoflavones. Supplements containing concentrated isoflavones are available in pharmacies and health food shops. But there is no guarantee that the content shown on the label is accurate. Evidence A review of research compared women on HRT with women taking soy-based supplements. Women on HRT had 24 fewer hot flushes per month. Women on soy supplements had 12 fewer, and all had fewer than those who took a 'dummy pill'. The study did not look at whether eating soy rich foods has the same effect on hot flushes Safety Soy supplements may contain far more phyto-oestrogens than foods. Long-term use of these supplements might possibly affect the risk of getting some types of cancer, particularly breast cancer. Some women get nausea, bloating, and constipation when they take soy supplements. Cost A month's supply costs about ten pounds. View References (5) Evidence: Cost: Safety: The role of phytoestrogen therapy in relieving postmenopausal symptoms Szkutnik-Fiedler D, Jedrzejczyk M, Grześkowiak E, Bartkowiak-Wieczorek J, Seremak-Mrozikiewicz A, Drews K, Mrozikiewicz PM. Ginekol Pol. 2010 Dec;81(12):929-34. Link to Abstract Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis. Thompson Coon J, Pittler M H, Ernst E. Phytomedicine 2007; 14(2-3): 153-159 SR of Five RCTs (400 patients). Conclusions: There was evidence of a marginally significant effect of Trifolium pratense isoflavones in the treatment of hot flushes in menopausal women, but the clinical relevance of this effect was unclear. Adverse events during short-term use were not apparent but data on long-term administration were missing. Link to Abstract Isoflavone therapy for menopausal flushes: a systematic review and meta-analysis. Howes L G, Howes J B, Knight D C. Maturitas 2006; 55(3): 203-211 Seventeen RCTs (n=1,503) were included: 5 studies (n=458) of red clover and 12 studies (n=1,045) of soy. Authors conclusions: Isoflavone supplementation may result in a slight to modest reduction in the number of daily menopausal flushes, with greater reductions in women with a high number of daily flushes at baseline. DARE appraisal: …difficult to comment on the reliability of the authors’ conclusions. Note all authors had links to red clover manufacturer. Link to Abstract Soy extracts versus hormone therapy for reduction of menopausal hot flushes: indirect comparison. Bolaños-Díaz R, Zavala-Gonzales JC, Mezones-Holguín E, Francia-Romero J. Menopause. 2011 Mar 3. [Epub ahead of print] An indirect comparison of meta-analyses evaluating severity of hot flushes in postmenopausal women on HRT or soy extracts looked at 19 studies on how a treatment, either hormones or soy, compared to a placebo. It compared the average number of hot flashes in 760 women who had treatment with 770 who did not.. HT and soy interventions showed a significant difference in efficacy for the reduction of hot flushes in postmenopausal women when each treatment was compared with placebo. However, using indirect comparison, there is a statistically significant difference between HT and soy extracts in their effects on hot flushes. Link to Abstract Phytoestrogen supplement use by women. Kurzer MS. J Nutr. 2003 Jun;133(6):1983S-1986S. Extracted phytoestrogens are marketed in numerous forms as dietary supplements. Consumers of phytoestrogen supplements tend to be peri- and postmenopausal women looking for an alternative to hormone therapy. Numerous claims are being made for benefits to heart, bone, breast and general menopausal health. The research supporting these claims are not strong. The strongest data show that phytoestrogens reduce the number and intensity of hot flashes, although the reduction is a modest 10-20%. The data on bone metabolism are suggestive of possible benefits whereas the effects on the breast are the most poorly understood. Although most animal studies have shown cancer-preventive effects, a few recent studies suggest that soy phytoestrogens may stimulate breast cancer cell growth under certain circumstances. Until safety with respect to breast cancer is established, phytoestrogen supplements should not be recommended, particularly for women at high risk of breast cancer. Link to Abstract Wild yam (Dioscorea villosa) read more Overview Wild yam creams are advertised as a natural form of HRT to be rubbed into the skin. But, despite such claims, this plant does not contain any progesterone-like ingredient. The root and the bulb of the plant are used in laboratories to make progesterone and the contraceptive pill. Although wild yam (like black cohosh) contains oestrogen-like substances, the human body cannot convert them into female hormones. Evidence According to research carried out to date, using wild yam cream for three months doesn't help with hot flushes or night sweats. Safety Some commercial herbal wild yam products, especially those bought from Internet retailers, may contain illegal prescription progesterones. Cost View References (1) Evidence: Cost: Safety: Nonhormonal therapies for hot flashes in menopause. Carroll DG. Am Fam Physician. 2006 Feb 1;73(3):457-64. Link to Abstract

Attend Classes / Visit Practitioner

Dealing with psychological problems read more Overview Many women don't have mood problems during the years around menopause. But for others it can be a time of mood swings, sadness, irritability, unpredictability or anxiety and depression. It can sometimes be difficult to know whether these feelings are due to the menopause or to other changes occurring in your life. Feelings about ageing How do you feel about becoming an older woman? It can be hard to come to terms with ageing in a society that puts such a high value on youthfulness. Leaving fertility and child-bearing behind can feel like a real loss too. And your body may be changing in ways you don't like very much. But if getting older leaves you feeling sad or angry, it could be more about your attitude to aging than about hormonal changes. We are all living longer these days. If 'sixty is the new forty' there will certainly be life after the menopause - possibly for several more decades. Think about what you need to do to move forward, accept what's changed and explore new possibilities. Getting older may bring new opportunities as well as challenges. Hormonal irritability? Some women are very sensitive to changes in hormone levels. Problems such as premenstrual tension and post-partum depression aren't all in the mind; they may be linked to falling oestrogen levels. If you've been sensitive to hormone dips in the past then this may happen again around the menopause. Oestrogen also helps regulate production of serotonin, a brain chemical that helps stabilise mood. When your oestrogen levels start to drop, so might your supplies of mood-smoothing serotonin. If you think this might apply to you, ask your doctor about possible treatments including the possibility of trying HRT. Poor sleep? Night sweats can deprive you of refreshing sleep. And if you snore, sleep apnoea might be stopping you from getting as much sleep as you need. In addition, during the menopause years you are more likely to feel anxious or depressed, and this will disturb your sleep. Tiredness and irritability go hand in hand but these problems can be diagnosed and treated. Too much going on? Mid-life is often the busiest time of life. Changes are inevitable and they can feel stressful. House moves, children leaving, job changes, marital issues or loss of a partner, ageing parents; the list goes on. There may be no escaping major shifts in your life, but you can still learn to calm your body and mind down. Getting support, learning to relax and manage your time, and choosing a healthy lifestyle, will all help make you more resilient. Previous depression read more Overview If you have been treated for depression before, then you're more likely to feel this way again during the menopause. If you suspect that you are not just feeling low, but may be depressed, get advice from your GP or counsellor at an early stage. Symptoms of depression include: - sadness throughout the day, nearly every day - loss of interest in or enjoyment of your favourite activities - feelings of worthlessness - excessive or inappropriate feelings of guilt - thoughts of death or suicide - trouble making decisions - fatigue or lack of energy - sleeping too much or too little - change in appetite or weight - trouble concentrating - feelings of restlessness or being slowed down. Treatment Options: Acupuncture read more Overview Acupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief. Evidence Some studies suggest that acupuncture can help, but all the studies have been small and only a few have been carried out. The results overall don’t prove that acupuncture helps with hot flushes. Safety Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally). Cost A session may cost £35-£50. Frequency of treatment will depend on you and your practitioner. Find out more The following professional organisations can help you find a qualified practitioner: Acupuncture Association of Chartered Physiotherapists British Academy of Western Medical Acupuncture British Acupuncture Council British Medical Acupuncture Society View References (3) Evidence: Cost: Safety: Acupuncture for vasomotor menopausal symptoms: a systematic review. Cho SH, Whang WW. Menopause. 2009 Sep-Oct;16(5):1065-73. SR of 11 studies (764 participants). Conclusions: There is no evidence from RCTs that acupuncture is an effective treatment in comparison to sham acupuncture. Some studies have shown that acupuncture therapies are better than hormone therapy. However, the number of RCTs is small, and the methodological quality of some of the RCTs was poor. Link to Abstract Acupuncture for treating menopausal hot flushes: a systematic review. Lee MS, Shin BC, Ernst E. Climacteric 2009; 12(1): 16-25 SR of 6 RCTs (309 participants). Five studies found no difference in frequency, severity or frequency x severity of hot flushes between the intervention and control groups. Conclusions: There was no convincing evidence that acupuncture was beneficial for menopausal women who experienced hot flushes. Link to Abstract The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial. Sunay D, Ozdiken M et al. Acupunct Med 2011;29:27–31. RCT involving 53 postmenopausal women. Half were given sham acupuncture, half received traditional Chinese acupuncture twice a week for 10 weeks. After treatment, total MRS, and the somatic and psychological subscale scores were significantly lower in the acupuncture group than the sham group (all p=0.001). The severity of hot flushes was found to be significantly decreased after treatment in acupuncture group (p=0.001). In the acupuncture group LH levels were lower and oestradiol levels were significantly higher than sham group (p=0.046 and p=0.045, respectively) after treatment, but there was no difference in FSH levels. Link to Abstract Homeopathy read more Overview The basic principle of homeopathy is that 'like cures like'. Homeopaths use tiny amounts of medicine, which are supposed to jolt the body's self-healing processes into action. Homeopathy has been called 'unscientific' because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains. Evidence A large study carried out in eight countries seemed to show that treatment with homeopathy helped women with hot flushes. But the study did not prove this fully because homeopathy was not tested against another treatment. Homeopathy does not seem to be effective for flushes experienced by women being treated for breast cancer. Safety Homeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms at first but this generally only lasts a short time. Cost The monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £20-£50. Find out more It is important to find a practitioner who is registered with one of the following professional organisations: The British Homeopathic Association Faculty of Homeopathy The Society of Homeopaths View References (2) Evidence: Cost: Safety: Treating hot flushes in menopausal women with homeopathic treatment: results of an observational study. Bordet M., Colas A., Marijnen P., Masson J., Trichard M. Homeopathy. 97 (1) (pp 10-15), 2008. Open, multi-national prospective, pragmatic and non-comparative observational study (98 physicians in 8 countries, 438 patients). Conclusions: The results of this observational study suggest that homeopathic treatment for hot flushes in menopausal women is effective. Link to Abstract Non-hormonal interventions for hot flushes in women with a history of breast cancer. Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD004923. DOI: 10.1002/14651858.CD004923.pub2. Cochrane SR. Two studies of homeopathy showed no evidence of benefit. Link to Abstract Massage read more Overview There are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils that practitioners believe have special healing properties. Evidence We could not find any useful research on the effectiveness of massage or aromatherapy for hot flushes. Safety Massage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage. Cost Monthly cost will depend on how regularly you receive treatments. Finding a practitioner It is important to find a qualified practitioner such as someone registered The General Council for Massage Therapies No References Evidence: Cost: Safety: Psychological therapies read more Overview When people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS. Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural')". For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. CBT is effective for depression, but it also appears to help women with hot flushes. Evidence Psychological treatment may help symptoms of menopause. But women included in some of the studies also took medication so it is difficult to be certain. Safety These techniques are safe in most people if carried out by or under the guidance of a qualified counsellor or psychologist. Cost In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions. Finding out more It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society View References (1) Evidence: Cost: Safety: Psychoeducational interventions to alleviate hot flashes: a systematic review. Tremblay A, Sheeran L, Aranda SK Menopause. 2008 Jan-Feb;15(1):193-202. SR including 5 studies that evaluated psychoeducational interventions, including education, counseling, cognitive-behavioral strategies, and mindfulness-based stress reduction. All showed an improvement but in the two largest studies, participants also received drug therapy too. Link to Abstract Yoga read more Overview Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises and some types are much more strenuous than others. Others focus more on meditation, breathing and relaxation. Evidence It is not clear whether yoga will help with hot flushes but many yoga classes include relaxation, which is likely to be helpful. Safety Yoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries. Cost Once you have learned the techniques you can do this at home, at no cost. Find out more Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The British Council for Yoga Therapy and the The British Wheel of Yoga View References (2) Evidence: Cost: Safety: Mind-body therapies for menopausal symptoms: A systematic review. Innes K.E. Selfe T.K. Vishnu A. Maturitas. 66 (2) (pp 135-149), 2010. SR or 18 trials (12 RCTs) of various interventions (yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low-frequency sound-wave therapy). Conclusions: findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy. Link to Abstract Yoga for menopausal symptoms: A systematic review. Lee M.S., Kim J.-I., Ha J.Y., Boddy K., Ernst E. Menopause. 16 (3) (pp 602-608), 2009. SR of 7 studies. Conclusions: The evidence is insufficient to suggest that yoga is an effective intervention for menopause. Link to Abstract

References

1. Acupuncture for treating menopausal hot flushes: a systematic review.
Lee MS, Shin BC, Ernst E.
Climacteric 2009; 12(1): 16-25
SR of 6 RCTs (309 participants). Five studies found no difference in frequency, severity or frequency x severity of hot flushes between the intervention and control groups. Conclusions: There was no convincing evidence that acupuncture was beneficial for menopausal women who experienced hot flushes.

Link to Abstract

2. Acupuncture for vasomotor menopausal symptoms: a systematic review.
Cho SH, Whang WW.
Menopause. 2009 Sep-Oct;16(5):1065-73.
SR of 11 studies (764 participants). Conclusions: There is no evidence from RCTs that acupuncture is an effective treatment in comparison to sham acupuncture. Some studies have shown that acupuncture therapies are better than hormone therapy. However, the number of RCTs is small, and the methodological quality of some of the RCTs was poor.

Link to Abstract

3. Adult weight change and risk of postmenopausal breast cancer
Eliassen AH.
JAMA. 2006 Jul 12;296(2):193-201.
These data suggest that weight gain during adult life, specifically since menopause, increases the risk of breast cancer among postmenopausal women, whereas weight loss after menopause is associated with a decreased risk of breast cancer. Thus, in addition to other known benefits of healthy weight, our results provide another reason for women approaching menopause to maintain or lose weight, as appropriate.

Link to Abstract

4. Alcohol Consumption and Risk of Postmenopausal Breast Cancer by Subtype: the Women’s Health Initiative Observational Study.
Li CI et al.
Published online August 23, 2010 in JNCI (Journal of the National Cancer Institute). doi:10.1093/jnci/djq316
Alcohol use may be more strongly associated with risk of hormone-sensitive breast cancers than hormone-insensitive subtypes, suggesting distinct etiologic pathways for these two breast cancer subtypes.

Link to Abstract

5. Botanical and dietary supplements for mood and anxiety in menopausal women
Geller SE, Studee L.
Menopause 2007 - Volume 14 - Issue 3 - pp 541-549 doi: 10.1097/01.gme.0000236934.43701.c5
Five of seven trials of St. John's wort for mild to moderate depression showed a significant improvement. The one randomized, controlled trial of ginseng in postmenopausal women reported improvements in mood and anxiety. All three randomized, controlled trials of ginkgo found no effect on depression. In four of eight controlled trials, kava significantly reduced anxiety. Black cohosh significantly reduced depression and anxiety in all studies reviewed. St. John's wort and black cohosh appear to be the most useful in alleviating mood and anxiety changes during menopause. Ginseng may be effective, but more research needs to be done. Finally, ginkgo and valerian do not appear to be useful in reducing depression or anxiety in this population.

Link to Abstract

6. Botanical and dietary supplements for mood and anxiety in menopausal women.
Geller SE, Studee L.
Menopause 2007 - Volume 14 - Issue 3 - pp 541-549 doi: 10.1097/01.gme.0000236934.43701.c5
Five of seven trials of St. John's wort for mild to moderate depression showed a significant improvement. The one randomized, controlled trial of ginseng in postmenopausal women reported improvements in mood and anxiety. All three randomized, controlled trials of ginkgo found no effect on depression. In four of eight controlled trials, kava significantly reduced anxiety. Black cohosh significantly reduced depression and anxiety in all studies reviewed. St. John's wort and black cohosh appear to be the most useful in alleviating mood and anxiety changes during menopause. Ginseng may be effective, but more research needs to be done. Finally, ginkgo and valerian do not appear to be useful in reducing depression or anxiety in this population.

Link to Abstract

7. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis.
Shams T, Setia MS, Hemmings R, McCusker J, Sewitch M, Ciampi A.
Altern Ther Health Med. 2010 Jan-Feb;16(1):36-44.
SR or 9 trials (7 in meta-analysis). Conclusions: Preparations containing black cohosh improved these symptoms overall by 26% (95% confidence interval 11%-40%); there was, however, significant heterogeneity between these trials.

Link to Abstract

8. Exercise for vasomotor menopausal symptoms.
Daley A, Stokes-Lampard H, MacArthur C.
Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006108. DOI: 10.1002/14651858.CD006108.pub2.
Cochrane SR of 6 trials. Conclusions: The existing studies provided insufficient evidence to determine the effectiveness of exercise as a treatment for vasomotor menopausal symptoms, or whether exercise is more effective than HRT or yoga.

Link to Abstract

9. Exercise for vasomotor menopausal symptoms.
Daley A, Stokes-Lampard H, MacArthur C.
Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006108. DOI: 10.1002/14651858.CD006108.pub2.
Cochrane SR of 6 trials. Conclusions: The existing studies provided insufficient evidence to determine the effectiveness of exercise as a treatment for vasomotor menopausal symptoms, or whether exercise is more effective than HRT or yoga.

Link to Abstract

10. Isoflavone therapy for menopausal flushes: a systematic review and meta-analysis
Howes L G, Howes J B, Knight D C
Maturitas 2006; 55(3): 203-211
Seventeen RCTs (n=1,503) were included: 5 studies (n=458) of red clover and 12 studies (n=1,045) of soy. Authors conclusions: Isoflavone supplementation may result in a slight to modest reduction in the number of daily menopausal flushes, with greater reductions in women with a high number of daily flushes at baseline. DARE appraisal: …difficult to comment on the reliability of the authors’ conclusions. Note all authors had links to red clover manufacturer.

Link to Abstract

11. Isoflavone therapy for menopausal flushes: a systematic review and meta-analysis.
Howes L G, Howes J B, Knight D C.
Maturitas 2006; 55(3): 203-211
Seventeen RCTs (n=1,503) were included: 5 studies (n=458) of red clover and 12 studies (n=1,045) of soy. Authors conclusions: Isoflavone supplementation may result in a slight to modest reduction in the number of daily menopausal flushes, with greater reductions in women with a high number of daily flushes at baseline. DARE appraisal: …difficult to comment on the reliability of the authors’ conclusions. Note all authors had links to red clover manufacturer.

Link to Abstract

12. Mind-body therapies for menopausal symptoms: A systematic review.
Innes K.E. Selfe T.K. Vishnu A.
Maturitas. 66 (2) (pp 135-149), 2010.
SR or 18 trials (12 RCTs) of various interventions (yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low-frequency sound-wave therapy). Conclusions: findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy.

Link to Abstract

13. Non-hormonal interventions for hot flushes in women with a history of breast cancer
Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C.
Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD004923. DOI: 10.1002/14651858.CD004923.pub2.
Cochrane SR including 2 trials of relaxation therapies. One of two studies on relaxation therapy showed a significant benefit. Conclusions: Clonidine, SSRIs and SNRIs, gabapentin and relaxation therapy showed a mild to moderate effect on reducing hot flushes in women with a history of breast cancer.

Link to Abstract

14. Non-hormonal interventions for hot flushes in women with a history of breast cancer.
Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C.
Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD004923. DOI: 10.1002/14651858.CD004923.pub2.
Cochrane SR. Two studies of homeopathy showed no evidence of benefit.

Link to Abstract

15. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review
Cheema D, Coomarasamy A, El-Toukhy T.
Arch Gynecol Obstet. 2007 Nov;276(5):463-9. Epub 2007 Jun 26.
SR including 7 trials of black cohosh. Conclusions: There is evidence that clonidine, paroxetine, venlafaxine, gabapentin and black cohosh may be beneficial in the treatment of menopausal vasomotor symptoms in some women.

Link to Abstract

16. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review.
Cheema D, Coomarasamy A, El-Toukhy T.
Arch Gynecol Obstet. 2007 Nov;276(5):463-9. Epub 2007 Jun 26

Link to Abstract

17. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review.
Cheema D, Coomarasamy A, El-Toukhy T.
Arch Gynecol Obstet. 2007 Nov;276(5):463-9. Epub 2007 Jun 26

Link to Abstract

18. Nonhormonal therapies for hot flashes in menopause.
Carroll DG.
Am Fam Physician. 2006 Feb 1;73(3):457-64.

Link to Abstract

19. Physical Activity and Postmenopausal Breast Cancer: Effect Modification by Breast Cancer Subtypes and Effective Periods in Life
Schmidt et al.
Cancer Epidemiology Biomarkers & Prevention, 2008; 17 (12): 3402 DOI: 10.1158/1055-9965.EPI-08-0479
Researchers assume that physical exercise reduces the risk of cancer through hormonal mechanisms instead merely by a reduction of body fat or other changes in physical constitution, as it has often been assumed.

Link to Abstract

20. Phytoestrogen supplement use by women.
Kurzer MS.
J Nutr. 2003 Jun;133(6):1983S-1986S.
Extracted phytoestrogens are marketed in numerous forms as dietary supplements. Consumers of phytoestrogen supplements tend to be peri- and postmenopausal women looking for an alternative to hormone therapy. Numerous claims are being made for benefits to heart, bone, breast and general menopausal health. The research supporting these claims are not strong. The strongest data show that phytoestrogens reduce the number and intensity of hot flashes, although the reduction is a modest 10-20%. The data on bone metabolism are suggestive of possible benefits whereas the effects on the breast are the most poorly understood. Although most animal studies have shown cancer-preventive effects, a few recent studies suggest that soy phytoestrogens may stimulate breast cancer cell growth under certain circumstances. Until safety with respect to breast cancer is established, phytoestrogen supplements should not be recommended, particularly for women at high risk of breast cancer.

Link to Abstract

21. Phytoestrogen supplement use by women.
Kurzer MS.
J Nutr. 2003 Jun;133(6):1983S-1986S.
Extracted phytoestrogens are marketed in numerous forms as dietary supplements. Consumers of phytoestrogen supplements tend to be peri- and postmenopausal women looking for an alternative to hormone therapy. Numerous claims are being made for benefits to heart, bone, breast and general menopausal health. The research supporting these claims are not strong. The strongest data show that phytoestrogens reduce the number and intensity of hot flashes, although the reduction is a modest 10-20%. The data on bone metabolism are suggestive of possible benefits whereas the effects on the breast are the most poorly understood. Although most animal studies have shown cancer-preventive effects, a few recent studies suggest that soy phytoestrogens may stimulate breast cancer cell growth under certain circumstances. Until safety with respect to breast cancer is established, phytoestrogen supplements should not be recommended, particularly for women at high risk of breast cancer.

Link to Abstract

22. Phytoestrogens for vasomotor menopausal symptoms.
Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J.
Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD001395. DOI: 10.1002/14651858.CD001395.pub3.
Cochrane review of 30 trials. Conclusions: Most of the trials in this review were small, of short duration and poor quality. Some trials found a slight reduction in hot flushes and night sweats with phytoestrogen-based treatment but overall there was no indication that phytoestrogens worked any better than no treatment. There was no evidence of harm with short term use.

Link to Abstract

23. Phytoestrogens for vasomotor menopausal symptoms.
Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J.
Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD001395. DOI: 10.1002/14651858.CD001395.pub3.
Cochrane review of 30 trials. Conclusions: Most of the trials in this review were small, of short duration and poor quality. Some trials found a slight reduction in hot flushes and night sweats with phytoestrogen-based treatment but overall there was no indication that phytoestrogens worked any better than no treatment. There was no evidence of harm with short term use.

Link to Abstract

24. Psychoeducational interventions to alleviate hot flashes: a systematic review.
Tremblay A, Sheeran L, Aranda SK.
Menopause. 2008 Jan-Feb;15(1):193-202.
SR or 14 studies of various interventions involving 475 patients, 9 trials of relaxation techniques of which 5 were positive. Conclusions: Psychoeducational interventions, including relaxation, seem to alleviate hot flashes in menopausal women and breast cancer survivors; however, the methodological quality of published research is either fair or poor.

Link to Abstract

25. Psychoeducational interventions to alleviate hot flashes: a systematic review.
Tremblay A, Sheeran L, Aranda SK
Menopause. 2008 Jan-Feb;15(1):193-202.
SR including 5 studies that evaluated psychoeducational interventions, including education, counseling, cognitive-behavioral strategies, and mindfulness-based stress reduction. All showed an improvement but in the two largest studies, participants also received drug therapy too.

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26. Risk factors for onset of menopausal symptoms: results from a large cohort study
Sabia S, Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F.
Maturitas. 2008 Jun 20;60(2):108-21. Epub 2008 May 29.
Large cohort study of 28,000 women in France. Findings: Among dietary factors, rapidly absorbed sugars and snacking were positively associated with the risk of onset of menopausal symptoms.

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27. Risk factors for onset of menopausal symptoms: results from a large cohort study.
Sabia S, Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F.
Maturitas. 2008 Jun 20;60(2):108-21. Epub 2008 May 29.
Large cohort study of 28,000 women in France. Findings: The risk (of onset of menopausal symptoms) was positively associated with smoking and alcohol consumption.

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28. Risk factors for onset of menopausal symptoms: results from a large cohort study.
Sabia S, Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F.
Maturitas. 2008 Jun 20;60(2):108-21. Epub 2008 May 29.
Among dietary factors, rapidly absorbed sugars and snacking were positively associated with the risk of onset of menopausal symptoms.

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29. Soy extracts versus hormone therapy for reduction of menopausal hot flushes: indirect comparison.
Bolaños-Díaz R, Zavala-Gonzales JC, Mezones-Holguín E, Francia-Romero J.
Menopause. 2011 Mar 3. [Epub ahead of print]
An indirect comparison of meta-analyses evaluating severity of hot flushes in postmenopausal women on HRT or soy extracts looked at 19 studies on how a treatment, either hormones or soy, compared to a placebo. It compared the average number of hot flashes in 760 women who had treatment with 770 who did not.. HT and soy interventions showed a significant difference in efficacy for the reduction of hot flushes in postmenopausal women when each treatment was compared with placebo. However, using indirect comparison, there is a statistically significant difference between HT and soy extracts in their effects on hot flushes.

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30. The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial.
Sunay D, Ozdiken M et al.
Acupunct Med 2011;29:27–31.
RCT involving 53 postmenopausal women. Half were given sham acupuncture, half received traditional Chinese acupuncture twice a week for 10 weeks. After treatment, total MRS, and the somatic and psychological subscale scores were significantly lower in the acupuncture group than the sham group (all p=0.001). The severity of hot flushes was found to be significantly decreased after treatment in acupuncture group (p=0.001). In the acupuncture group LH levels were lower and oestradiol levels were significantly higher than sham group (p=0.046 and p=0.045, respectively) after treatment, but there was no difference in FSH levels.

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31. The role of phytoestrogen therapy in relieving postmenopausal symptoms
Szkutnik-Fiedler D, Jedrzejczyk M, Grześkowiak E, Bartkowiak-Wieczorek J, Seremak-Mrozikiewicz A, Drews K, Mrozikiewicz PM.
Ginekol Pol. 2010 Dec;81(12):929-34.

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32. Treating hot flushes in menopausal women with homeopathic treatment: results of an observational study.
Bordet M., Colas A., Marijnen P., Masson J., Trichard M.
Homeopathy. 97 (1) (pp 10-15), 2008.
Open, multi-national prospective, pragmatic and non-comparative observational study (98 physicians in 8 countries, 438 patients). Conclusions: The results of this observational study suggest that homeopathic treatment for hot flushes in menopausal women is effective.

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33. Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis.
Thompson Coon J, Pittler M H, Ernst E.
Phytomedicine 2007; 14(2-3): 153-159
SR of Five RCTs (400 patients). Conclusions: There was evidence of a marginally significant effect of Trifolium pratense isoflavones in the treatment of hot flushes in menopausal women, but the clinical relevance of this effect was unclear. Adverse events during short-term use were not apparent but data on long-term administration were missing.

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34. Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis.
Thompson Coon J, Pittler M H, Ernst E.
Phytomedicine 2007; 14(2-3): 153-159
SR of Five RCTs (400 patients). Conclusions: There was evidence of a marginally significant effect of Trifolium pratense isoflavones in the treatment of hot flushes in menopausal women, but the clinical relevance of this effect was unclear. Adverse events during short-term use were not apparent but data on long-term administration were missing.

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35. Yoga for menopausal symptoms: A systematic review.
Lee M.S., Kim J.-I., Ha J.Y., Boddy K., Ernst E.
Menopause. 16 (3) (pp 602-608), 2009.
SR of 7 studies. Conclusions: The evidence is insufficient to suggest that yoga is an effective intervention for menopause.

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