Menopause marks the end of a woman’s reproductive years. It is a normal biological event (except with surgery). Women begin menopause at the average age of 51. Although women now live longer, the age at which menopause begins has not changed. This means most women will live a third of their lives after menopause.

Signs and Symptoms of Menopause

- Menstrual bleeding slows and then stops; process takes about four years
- Hot flashes—flushing of face and upper trunk; may occur with heart palpitations, dizziness, headaches
- Night sweats—depression and irritability may result from insomnia
- Cold hands and feet
- Vaginal symptoms—dryness, bleeding after intercourse, itching
- More frequent urination, burning, nighttime urination
- Depression, irritability, tension; usually occurs with sleep disturbances
- Facial hair growth and wrinkles
- Osteoporosis—bone breaks become more likely
- Coronary heart disease (CHD)—twice as many women die from CHD than cancer

What Causes Menopause?

Lower estrogen and progesterone production–as the result of fewer functioning follicles (the cell structure that houses the eggs)–leads to the end of menstruation. There may be a genetic link for the age of onset. Smoking lowers the age at which menopause begins.

What to Expect at Your Health Care Provider’s Office

Your health care provider will give you an examination that includes a Pap smear and will describe the benefits and risks of different treatments.

Treatment Options for Menopause

Treatment Plan

Your health care provider will discuss with you the various drugs available for the symptoms of menopause. There are potentially serious side effects from these drugs. Careful consideration of alternatives is justified.

Drug Therapies for Menopause

Prescription

- Estrogen helps hot flashes and vaginal symptoms. It can slow osteoporotic bone loss and fractures. It may prevent CHD and Alzheimer’s. Estrogen increases your risk of getting breast cancer, gallbladder disease, and blood clotting. Side effects include bloating, nausea, adult-onset asthma, and breast tenderness.
- Estradiol is a type of estrogen. It brings the estrogen directly into your blood stream. Estradiol is available in a patch or gel.
- Vaginal estrogen creams help vaginal and urinary symptoms. It takes four to six weeks for the cream to work. There is a new intravaginal ring that slowly releases estrogen.
- Progesterone prevents uterine cancer that can occur with estrogen therapy.
- Methyltestosterone increases libido and may decrease osteoporosis of the spine. Facial hair growth is a side effect.
- Alendronate is equally as effective as estrogen in preventing osteoporosis.
- Lipid-lowering drugs and aspirin are alternate treatments for CHD.

Over the Counter
N/A

Complementary and Alternative Therapies for Menopause

Alternative medicine has much to offer for improving cardiovascular health and preventing osteoporosis. Relaxation techniques, stress management, yoga, and meditation can help with perimenopausal symptoms. Exercise increases endorphin release, which helps relieve pain and elevates mood. Walking, swimming, and biking are less stressful on the joints.

Nutrition for Menopause

- Soy (25 to 50 mg soy a day) contains soy isoflavones (phytoestrogens), which may relieve hot flashes and vaginal symptoms and offer increased protection from osteoporosis and breast cancer.
- Vitamin E (400 to 1,600 IU a day) can balance vasomotor instability, decrease hot flashes, and is cardioprotective. High doses are not recommended for women with high blood pressure.
- Take calcium/magnesium (1,000/500 mg a day for women taking estrogen and 1,500/750 mg a day for those who are not) with meals. Citrate or citramate forms may be the most absorbable forms.
- Avoiding smoking, alcohol, caffeine, and spicy foods may help decrease hot flashes.
- A combination of vitamin C (1,200 mg), hesperidin (900 mg), and hesperidin methyl chalcone (900 mg) may relieve hot flashes.
- Gamma-oryzanol (from rice bran oil) 300 mg per day gives partial or total relief of hot flashes in over 80 percent of users.

Herbal Remedies for Menopause

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers; 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

- Black cohosh (Cimicifuga racemosa) relieves vasomotor symptoms and depression; Remifemin is the most tested extract of black cohosh. Long-term use is safe; 2 mg a day
- Chaste tree (Vitex agnes-castus) for irregular menstrual cycles; may take up to six months for full therapeutic effect
- Angelica (Angelica archangelica) relieves vasomotor symptoms.
- Licorice (Glycyrrhiza glabra), an estrogen-balancing herb especially for chronic stress; do not use if you have high blood pressure; 250 mg three times a day, 30 to 60 drops tincture three times a day, or 1 cup of tea three times a day
- Ginkgo (Ginkgo biloba) improves circulation to cold hands and feet; also used to treat depression; may take up to 12 weeks for full effect; 120 mg two to three times a day

Homeopathy for Menopause

Some of the most common remedies used are listed below. Usually, the dose is 12X to 30C every one to four hours until your symptoms get better.

- Mulimen—German combination remedy (chasteberry, black cohosh, St. John’s wort, cuttlefish ink) for hot flashes
- Homeopathic estrogen—by prescription only
- Ferrum phosphoricum, graphites, lycopodium—for symptoms occurring during sexual intercourse
- Amyl nitrosum, lachesis, sulphur—for hot flashes

Physical Medicine

Kegel exercises increase pelvic muscle tone, helping to prevent incontinence and bladder or uterine prolapse.

Acupuncture for Menopause

Acupuncture enhances endorphin release and stimulates kidney function. It may also help to balance hormones and relieve vasomotor symptoms.

Massage

Massage increases circulation. Use water-soluble, nonestrogen lubricants, vegetable oil, or vitamin E oil for vaginal atrophy.

Supporting Research on Menopause

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:291–292.

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:108, 466.

Devine A, Dick IM, Heal SJ, et al. A 4-year follow-up study of the effects of calcium supplementation on bone density in elderly postmenopausal women. Osteoporosis Int. 1997;7:23–28.

Gruenwald J, Brendler T, Jaenicke C et al, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998:647–648, 871–872.

Kistner RW, ed. Kistner’s Gynecology: Principles and Practice. 6th ed. St. Louis, Mo: Mosby-Year Book; 1995.

Murray MT. The Healing Power of Herbs: The Enlightened Person’s Guide to the Wonders of Medicinal Plants. Rocklin, Calif: Prima Publishing; 1995:163–164.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin, Calif: Prima Publishing; 1998.

Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 1998;179:444–452.

Villa ML, Packer E, Cheema M, et al. Effects of aluminum hydroxide on the parathyroid-vitamin D axis of postmenopausal women. J Clin Endocrinol Metab. 1991;73:1256–1261.

Vorberg G. Treatment of menopause symptoms—Successful hormone-free therapy with Remifemin®. ZFA. 1984;60:626–629.

Weiss RF. Herbal Medicines. Beaconsfield, England: Beaconsfield Publishers; 1998:317–319.

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