A Must Read: Dig Deep in Menopausal Stage in our Life

Menopause is the time when a woman’s menstrual periods stop permanently. It usually occurs naturally, at an average age of 51, but surgery or the use of certain medications can make it happen earlier. During the years around menopause (a time called perimenopause or menopausal transition), some women have hot flashes, night sweats, difficulty sleeping, or other troublesome symptoms.

Conventional Treatment for Menopause Symptoms

• Hormone therapy, using either estrogen alone or estrogen and progestin, is the most effective therapy for menopausal hot flashes. However, hormone therapy may increase the risk of breast cancer, blood clots, and other serious medical problems. Therefore, if it’s used at all, it should be used at the lowest dose and for the shortest period that will control symptoms. Women with certain medical conditions (such as breast cancer, liver disease, or a history of blood clots) shouldn’t use hormone therapy.

• Non-hormonal medicines may also be used to treat menopause symptoms. In 2013, the U.S. Food and Drug Administration (FDA) approved a non-hormonal treatment for hot flashes and a treatment for vaginal symptoms associated with menopause.

What the Science Says About Complementary Health Approaches for Menopause Symptoms

Natural Products

Many natural products have been studied for menopause symptoms. However, none has clearly been shown to be helpful. There’s little information on the long-term safety of natural products, and some can have harmful side effects or interact with drugs. The sections below give more detail about several natural products studied for menopause symptoms.

Phytoestrogens

Phytoestrogens are substances from plants that have chemical structures similar to those of the female hormone estrogen. The isoflavones found in soy and red clover are examples of phytoestrogens. Flaxseed is another phytoestrogen source.

Studies that tested isoflavones from soy or red clover for their ability to relieve menopause symptoms have had inconsistent results. Studies of flaxseed products found them to be no more effective than a placebo (an inactive substance) in reducing hot flashes.

Phytoestrogens appear to be safe for short-term use, but their long-term safety hasn’t been established. Because phytoestrogen supplements may have effects like those of the hormone estrogen, they may not be safe for women who shouldn’t take estrogen.

Black cohosh is an herb native to North America. The roots and rhizomes (underground stems) of the plant are used in dietary supplements.

Studies that tested black cohosh for menopause symptoms have had inconsistent results. A 2012 research review concluded that there’s not enough evidence to support its use for menopause symptoms.

Black cohosh generally has only mild side effects, if any. However, rare cases of liver damage—some of them very serious—have been reported in people taking commercial black cohosh products. It’s uncertain whether black cohosh was responsible for the liver damage. Nevertheless, people with liver disorders should consult a health care provider before taking black cohosh products. Anyone who develops symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice, while taking black cohosh should stop using it and consult a health care provider.

Dehydroepiandrosterone (DHEA) is a substance that’s naturally made in the body, where it’s converted into the hormones testosterone and estrogen. DHEA production decreases as people grow older, but the significance of this change, including whether it affects aging and menopause symptoms, is unclear.

It’s uncertain whether DHEA is useful in treating menopause symptoms.

The long-term safety of taking DHEA supplements is unknown. Some evidence suggests that even short-term use of these supplements may have harmful effects, including liver damage.

Dong Quai

In traditional Chinese medicine, the herb dong quai is often used for women’s health problems, including menopause. However, very little research has been done on dong quai for menopausal symptoms, so no conclusions can be reached about its effects.

Dong quai may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin).

Vitamin E

A few studies have suggested that vitamin E supplements might be helpful for menopause symptoms. However, the amount of research is small, and the effect is also small. For example, in one study, women taking vitamin E averaged one fewer hot flash per day.

Vitamin E, in the high doses found in supplements, may increase the risk of bleeding (including strokes due to bleeding in the brain) and interact with anticoagulant (blood-thinning) medications such as warfarin (Coumadin).

Other Natural Products

Other natural products that have been studied for menopause symptoms include evening primrose oil, ginseng, kava, melatonin, and wild yam. However, very little research has been done on these products for menopausal symptoms, so no conclusions can be reached about their effectiveness. Kava supplements have been linked to a risk of severe liver disease.

Mind and Body Practices

Only a small amount of research has been done on most mind and body practices for menopause symptoms. However, the limited evidence currently available suggests that some of these practices might help to relieve symptoms or make them less bothersome.

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.

In studies that compared acupuncture to no treatment, acupuncture reduced the frequency and severity of hot flashes. However, studies that compared acupuncture with simulated acupuncture, including a 2016 study from Australia, showed no difference between the effects of the two treatments. Acupuncture appears to be less effective than hormone therapy in reducing the frequency of hot flashes.

Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

Hypnotherapy

Hypnotherapy is the use of hypnosis for health-related purposes. Hypnosis is a state in which a person’s attention is concentrated and focused. In this hypnotic state, people have a heightened responsiveness to verbal messages (suggestions).

In a study funded by the National Center for Complementary and Integrative Health (NCCIH), hypnotherapy reduced the frequency of hot flashes in menopausal women who had hot flashes often. The women in the study also said that hot flashes didn’t interfere with their lives as much and they slept better.

Hypnosis is generally safe when practiced by trained, licensed health care providers. Side effects are rare, but hypnosis might worsen some types of psychological problems.

Mindfulness Meditation

Mindfulness meditation is a type of meditation that involves completely focusing on experiences on a moment-to-moment basis.

In an NCCIH-funded study, mindfulness meditation training reduced the bothersomeness of hot flashes in menopausal women and led to improvements in anxiety, perceived stress, self-reported sleep quality, and quality of life. However, the intensity of hot flashes did not change.

Meditation is generally considered to be safe for healthy people. However, there have been reports that it might worsen symptoms in people with certain chronic physical or mental health problems. If you have an ongoing health issue, talk with your health care provider before starting meditation.

Yoga

Yoga is a mind and body practice with historical origins in ancient Indian philosophy. Various styles of yoga typically combine physical postures and movement, breathing techniques, and meditation or relaxation.

An evaluation of five studies concluded that yoga can provide short-term relief of some symptoms associated with menopause, but it doesn’t decrease hot flashes.

Overall, people who practice yoga have a low rate of side effects. However, injuries—some of them serious—have been reported. People with health conditions may need to modify or avoid some yoga poses.

Other Complementary Approaches
Bioidentical Hormones

Bioidentical hormones are hormones from plant sources that are chemically similar or identical to hormones produced in the human body. Two kinds of bioidentical hormone products are used to treat menopause symptoms: (1) those that have gone through the same FDA approval process as other types of hormone therapy, and (2) custom-mixed preparations that compounding pharmacies prepare individually for patients. This fact sheet discusses only the custom-mixed products.

It’s been claimed that custom-mixed bioidentical hormone preparations are more effective and safer than conventional hormone therapy, but scientific evidence to support this idea is lacking. Custom-mixed bioidentical hormones may actually be riskier than conventional treatment because less is known about their safety. Also, no regulatory agency oversees their preparation, and therefore their content may vary from batch to batch.

Clinical Practice Guidelines for Treating Menopause Symptoms

Several professional organizations have issued guidelines for health care providers on how to treat menopause symptoms. The guidelines discuss certain complementary health approaches.

A 2015 position statement from the North American Menopause Society recommends hypnotherapy but acknowledges that the evidence favoring it is limited, conditionally recommends mindfulness-based therapies, and does not recommend acupuncture, yoga, or any natural products for managing hot flashes.

Guidelines from the American College of Obstetricians and Gynecologists say that conventional hormone therapy is preferred over custom-mixed bioidentical hormones, and that phytoestrogens and herbal supplements have not been shown to be helpful for treating hot flashes.

Guidelines from the American Association of Clinical Endocrinologists recommend against the use of custom-mixed bioidentical hormones and advise caution in the use of dietary supplements because of possible side effects and drug interactions. The guidelines also say that the effects of phytoestrogens are inconsistent and caution that women with a personal or strong family history of blood clots, cardiovascular disease, or breast, uterine, or ovarian cancer should not use soy-based treatments.

Guidelines issued by a task force from several professional societies recommend against the routine use of DHEA.

NCCIH-Funded Research

NCCIH-funded researchers are studying a variety of topics related to menopause, including:

The effects of acupuncture on hot flashes

Whether hypnotherapy is a practical way to improve sleep in women with menopause symptoms

The actions of phytoestrogens at the molecular and cellular level.

More to Consider

Keep in mind that although many dietary supplements come from natural sources, “natural” does not always mean “safe.” Also, a manufacturer’s use of the term “standardized” (or “verified” or “certified”) does not necessarily guarantee product quality or consistency. For more information, see NCCIH

Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Key References

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstetrics and Gynecology. 2014;123(1):202–216.

Carmody J, Crawford S, Salmoirago-Blotcher E, et al. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause. 2011;18(6):611–620.

Cramer H, Lauche R, Langhorst J, et al. Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine. 2012;2012:863905.

Dodin S, Blanchet C, Marc I, et al. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews. 2013;(7):CD007410. Accessed at www.cochranelibrary.com(link is external) on February 17, 2016.

Ee C, Xue C, Chondros P, et al. Acupuncture for menopausal hot flashes. A randomized trial. Annals of Internal Medicine. 2016;164(3):146–154.

Elkins GR, Fisher WI, Johnson AK, et al. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause. 2013;20(3):291–298.

Files JA, Ko MG, Pruthi S. Bioidentical hormone therapy. Mayo Clinic Proceedings. 2011;86(7):673–680.

Goodman NF, Cobin RH, Ginzburg SB, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice. 2011;17(Suppl 6):1–25.

Kelley KW, Carroll DG. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. Journal of the American Pharmacists Association. 2010;50(5):e106–e115.

Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. 2012;(9):CD007244. Accessed at www.cochranelibrary.com(link is external) on February 17, 2016.

Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews. 2013;(12):CD001395. Accessed at www.cochranelibrary.com(link is external) on February 17, 2016.

Scheffers CS, Armstrong S, Cantineau AEP, et al. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database of Systematic Reviews. 2015;(1):CD011066. Accessed at /www.cochranelibrary.com(link is external) on February 17, 2016.

The North American Menopause Society. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015;22(11):1155–1172.

Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2014;99(10):3489–3510.

All Other References

Barton DL, Loprinzi C, Atherton PJ, et al. Dehydroepiandrosterone for the treatment of hot flashes: a pilot study. Supportive Cancer Therapy. 2006;3(2):91–97.

Birdee GS, Legedza AT, Saper RB, et al. Characteristics of yoga users: results of a national survey. Journal of General Internal Medicine. 2008;23(10):1653–1658.

Chiu H-Y, Pan C-H, Shyu Y-K, et al. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause. 2015;22(2):234–244.

Dew TP, Williamson G. Controlled flax interventions for the improvement of menopausal symptoms and postmenopausal bone health: a systematic review. Menopause. 2013;20(11):1207–1215.

Elraiyah T, Sonbol MB, Wang Z, et al. The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism. 2014;99(10):3536–3542.

Ernst E. Acupuncture–a critical analysis. Journal of Internal Medicine. 2006;259(2):125–137.

Fabricant DS, Krause EC, Farnsworth NR. Black cohosh. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. New York, NY: Informa Healthcare; 2010:60–74.

Innes KE, Selfe TK, Vishnu A. Mind-body therapies for menopausal symptoms: a systematic review. Maturitas. 2010;66(2):135–149.

Kim M-S, Lim H-J, Yang HJ, et al. Ginseng for managing menopause symptoms: a systematic review of randomized clinical trials. Journal of Ginseng Research. 2013;37(1):30–36.

Lao L. Safety issues in acupuncture. Journal of Alternative and Complementary Medicine. 1996;2(1):27–31.

Lipton L. Using yoga to treat disease: an evidence-based review. JAAPA. 2008;21(2):34–36, 38, 41.

Lustyk MK, Chawla N, Nolan RS, et al. Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine. 2009;24(1):20–30.

Menopause: menopause basics. Office on Women’s Health Web site. Accessed on February 17, 2016.

National Institute on Aging. Menopause: Time for a Change. National Institute on Aging Web site. Accessed on February 17, 2016.

National Institute on Aging. Menopause: Treatment for Symptoms: Tips from the National Institute on Aging. National Institute on Aging Web site. Accessed on February 17, 2016.

Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Alternative Therapies in Health and Medicine. 2006;12(1):40–47.

Office of Dietary Supplements. Black Cohosh: Fact Sheet for Health Professionals. Office of Dietary Supplements Web site. Accessed at https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/ on February 17, 2016.

Office of Dietary Supplements. Vitamin E Fact Sheet for Consumers. Office of Dietary Supplements Web site. Accessed at https://ods.od.nih.gov/pdf/factsheets/VitaminE-Consumer.pdf on February 17, 2016.

U.S. Food and Drug Administration. Menopause & Hormones. Common Questions. U.S. Food and Drug Administration Web site. Accessed at https://www.fda.gov/downloads/ForConsumers/ByAudience/ForWomen/FreePublications/UCM383404.pdfon February 17, 2016.

Upton R. Dong quai. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. New York, NY: Informa Healthcare; 2010:208–216.

Vickers A, Zollman C, Payne DK. Hypnosis and relaxation therapies. Western Journal of Medicine. 2001;175(4):269–272.

Xu S, Wang L, Cooper E, et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine. 2013;2013:581203.

Acknowledgments

NCCIH thanks Lanay Mudd, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their technical expertise and review of the 2016 update of this publication.

source: NCCIH