Menopausal Symptoms (Other Than Osteoporosis)
• Hot Flashes/Flushes
The hormonal changes of menopause can produce a wide variety of symptoms, ranging from hot flashes and vaginal dryness to anxiety, depression, and insomnia. Many of these symptoms are undoubtedly caused by the natural decrease in estrogen production that occurs at menopause; however, the human body is so complex that other hormonal factors undoubtedly also play a role.
Menopause is not a disease. It is clearly a natural process, but one that many women prefer not to experience. No longer do women accept as merely part of life the decrease in libido, pain during intercourse, years of hot flashes, and other uncomfortable problems that may accompany menopause. This raises an important point: How close to nature do we want to live? One of the most valued ideals of alternative medicine is the desire to trust nature, but sometimes we may want to draw a line. For example, in a state of nature, infant and maternal mortality is high. This process of survival of the fittest helps humanity as a species to be stronger, but it is not something that a compassionate society can tolerate. Thus, no matter what our ideals, we frequently find ourselves tampering with nature. The treatment of menopause is simply one example among many.
Estrogen-replacement therapy can alleviate many of the problems associated with menopause. However, it creates counterbalancing risks. The most frightening issue is the increased risk of breast cancer that appears to be associated with replacement estrogen. In addition, estrogen therapy can cause blood clots in the legs, and it appears to raise the risk of heart disease rather than prevent it (as previously thought). The decision whether to use estrogen-replacement therapy for menopausal symptoms should involve a careful examination of the risks and benefits in consultation with a physician.
Principal Proposed Natural Treatments
Several natural treatments may reduce menopausal symptoms, as compared to placebo. (The latter comparison is essential, as placebo itself is dramatically effective for menopause, generally reducing the rate of hot flashes by 50%!) 28
We do not know for sure whether any of these reduce the risk of osteoporosis. See the full article on
Soy and Soy (or Other Source) Isoflavones
Improvements in hot flashes as well as other symptoms, such as vaginal dryness and mood, have been seen in many studies of soy, mixed soy isoflavones, aglycone isoflavones, and the isoflavone genistein alone.
For example, a double-blind study of 247 women suffering from menopausal hot flashes compared the effects of placebo and genistein over a period of one year.
In addition, isoflavones from red clover have shown inconsistent results in studies, with the best and largest study finding no benefit.
What can one make of this mixed evidence? One problem here is that placebo treatment has a strong effect on menopausal symptoms. In such circumstances, statistical noise can easily drown out the real benefits of a treatment under study. Unlike estrogen, which has such a powerful effect on hot flashes and other menopausal symptoms that its benefits are almost always clear in studies, soy or concentrated isoflavones likely have a more modest effect, one that does not always show itself above the background noise of statistical variation. It has also been suggested that the placebo used in many of these studies, polyunsaturated fatty acids, may have efficacy of its own; this would tend to hide actual benefits.
Another explanation may be that certain women benefit from soy isoflavones more than others. In about one-third of people, isoflavones are converted by intestinal bacteria into a substance called equol. At least two studies suggest that these equol producers may experience greater reduction in their menopausal symptoms than non-equol producers.
Evidence regarding whether soy or soy isoflavones are helpful for
Interestingly, one small but long-term study suggests that
For more information, including dosage and safety issues, see the full
The herb black cohosh is widely used for treatment of menopause, but the evidence that it works remains incomplete and inconsistent.
The best study was a 12-week,
Promising results were also seen in a 3-month, double-blind study of 120 menopausal women.
Previous smaller studies have found improvements not only in hot flashes but also in other symptoms of menopause. For example, in a double-blind, placebo-controlled study, 97 menopausal women received black cohosh, estrogen, or placebo for 3 months.
One study, too small to have reliable results from a statistical point of view, found black cohosh equally effective as 0.6 mg daily of conjugated estrogens.
A study reported in 2006 found that black cohosh has weak estrogen-like effects on vaginal cells and possible positive effects on bone (specifically, stimulating new bone formation).
A substantial (244-participant) double-blind study published in 2007 compared black cohosh against the synthetic hormone tibolone and found them equally effective for treating menopausal symptoms.
One interesting double-blind study evaluated a combination therapy containing black cohosh and
In contrast, there have been several studies that failed to find benefit. For example, in a 12-month double-blind, placebo-controlled study of 350 women, participants were given either black cohosh, a supplement containing 10 herbs, the multibotanical plus soy, standard hormone replacement therapy, or placebo.
The bottom line: Black cohosh may be modestly effective for reducing hot flashes and other symptoms of menopause, but doubts remain.
Some interesting information has developed regarding
black cohosh might work. In the past, the herb was described as a
For more information, including dosage and safety issues, see the full
Other Proposed Natural Treatments
, which contains numerous phytoestrogens, has recently been promoted as an effective treatment for menopausal symptoms. In one double-blind study, the herb showed promise for improving vaginal dryness.
In addition, another double-blind study found benefit with a combination product containing standardized extracts of
For many years, the hormone
A small double-blind study conducted in Iran reported that vitamin E (400 IU daily) was more effective than placebo for treating menopausal hot flashes.
An extract made from human placenta (HPE) is used in South Korea and other areas of East Asia as a treatment for numerous conditions. One study compared HPE against normal saline solution for treatment of menopause.
Evidence far too weak to be relied upon at all has been quoted in support of
Evidence regarding whether
It has been suggested that
The herb alfalfa contains strong phytoestrogens.
One double-blind, placebo-controlled study failed to find
In a randomized, controlled trial, 8 weeks of daily supervised
Estriol: A Safer Form of Estrogen?
For over a decade, some alternative medicine practitioners have popularized the use of a special form of estrogen called estriol
There is no real doubt that estriol is effective. Controlled and double-blind trials have found oral or vaginal estriol effective for reducing hot flashes, night sweats,
Estriol might cause less vaginal bleeding as a side effect than other forms of estrogen, but this has not been proven.
However, like other forms of estrogen, oral estriol stimulates the growth of uterine tissue. This leads to a risk of uterine cancer.
In a placebo-controlled study of 1,110 women, uterine tissue stimulation was seen among women given estriol orally (1 mg to 2 mg daily) as compared to those given placebo.
In contrast, a 12-month, double-blind trial of oral estriol (2 mg daily) in 68 Japanese women found no effect on the uterus.
Additionally, test tube studies suggest that estriol is just as likely to cause breast cancer as any other form of estrogen.
The bottom line: If you are considering using estriol, think of it as equivalent to any other form of estrogen.
9. Fanti O, Faugere MC, Gang Z, et al. Systematic administration of genistein partially prevents bone loss in ovariectomized rats in a nonestrogen-like mechanism [abstract]. Am J Clin Nutr. 1998;68(suppl):1517S-1518S.
14. Malochet S, Picherit C, Horcajada-Molteni MN, et al. Do endurance training and soy isoflavones exhibit additive effects on ovariectomy-induced osteopenia in the rat? [abstract]. J Bone Miner Res. 1999;14(suppl 1):S536.
20. Liske E, Hanggi W, Henneicke-Von Zepelin HH, et al. Physiological investigation of a unique extract of black chosh ( Cimicifugae racemosae rhizoma ): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. 2002;11:163-174.
26. Lehmann-Willenbrock VE, Riedel H-H. Clinical and endocrinologic examinations about therapy of climacteric symptoms following hysterectomy with remaining ovaries [in German; English abstract]. Zentralbl Gynakol. 1988;110:611-618.
27. Liske E, Hanggi W, Henneicke-Von Zepelin HH, et al. Physiological investigation of a unique extract of black cohosh ( Cimicifugae racemosae rhizoma ): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. 2002;11:163-174.
46. Shemesh M, Lindrer HR, Ayalon N. Affinity of rabbit uterine oestradiol receptor for phyto-oestrogens and its use in a competitive protein-binding radioassay for plasma coumestrol. J Reprod Fertil. 1972;29:1-9.
51. Itoi H, Minakami H, Sato I. Comparison of the long-term effects of oral estriol with the effects of conjugated estrogen, 1-alpha-hydroxyvitamin D3 and calcium lactate on vertebral bone loss in early menopausal women. Maturitas. 1997;28:11-17.
55. van der Linden MC, Gerretsen G, Brandhorst MS, et al. The effect of estriol on the cytology of urethra and vagina in postmenopausal women with genito-urinary symptoms. Eur J Obstet Gynecol Reprod Biol. 1993;51:29-33.
56. Holland EF, Leather AT, Studd JW. Increase in bone mass of older postmenopausal women with low mineral bone density after one year of percutaneous oestradiol implants. Br J Obstet Gynaecol. 1995;102:238-242.
57. Nozaki M, Hashimoto K, Inoue Y, et al. Usefulness of estriol for the treatment of bone loss in postmenopausal women [in Japanese; English abstract]. Nippon Sanka Fujinka Gakkai Zasshi. 1996;48:83-88.
60. Granberg S, Ylostalo P, Wikland M, et al. Endometrial sonographic and histologic findings in women with and without hormonal replacement therapy suffering from postmenopausal bleeding. Maturitas. 1997;27:35-40.
72. Upmalis DH, Lobo R, Bradley L, et al. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause. 2000;7:236-242.
73. Messina M, Gardner C, Barnes S. Gaining insight into the health effects of soy but a long way still to go: commentary on the fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease. J Nutr. 2002;132:547S-551S.
78. Wiklund IK, Mattsson LA, Lindgren R, et al. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Int J Clin Pharmacol Res. 1999;19:89-99.
79. Penotti M, Fabio E, Modena AB, et al. Effect of soy-derived isoflavones on hot flushes, endometrial thickness, and the pulsatility index of the uterine and cerebral arteries. Fertil Steril. 2003;79:1112-1117.
81. Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas. 2003;44(suppl 1):S67-S77.
83. Nesselhut T, Schellhase C, Dietrich R, et al. Investigation into the growth-inhibitive efficacy of phytopharmacopia with estrogen-like influences on mammary gland carcinoma cells [translated from German]. Arch Gynecol Obstet. 1993;254:817-818.
84. Freudenstein J, Dasenbrock C, Nisslein T. Lack of promotion of estrogen dependent mammary gland tumors in vivo by an isopropanolic black cohosh extract [abstract]. Phytomedicine. 2000;7(suppl 2):13.
88. Wren BG, Champion SM, Willetts K, et al. Transdermal progesterone and its effect on vasomotor symptoms, blood lipid levels, bone metabolic markers, moods, and quality of life for postmenopausal women. Menopause. 2003;10:13-18.
89. Kraft K, Coulon S. Effect of a standardized acupuncture treatment on complaints, blood pressure and serum lipids of hypertensive, postmenopausal women: A randomized, controlled clinical study. Forsch Komplementarmed. 1999;6:74-79.
90. Chen LC, Tsao YT, Yen KY, et al. A pilot study comparing the clinical effects of Jia-Wey Shiau-Yau San, a traditional Chinese herbal prescription, and a continuous combined hormone replacement therapy in postmenopausal women with climacteric symptoms. Maturitas. 2003;44:55-62.
91. Crisafulli A, Marini H, Bitto A, et al. Effects of genistein on hot flushes in early postmenopausal women: a randomized, double-blind EPT- and placebo-controlled study. Menopause. 2004;11:400-404.
96. Lydeking-Olsen E, Beck-Jensen JE, Setchell KD, et al. Soymilk or progesterone for prevention of bone loss. A 2 year randomized, placebo-controlled trial. Eur J Nutr. 2004 Apr 14. [Epub ahead of print]
97. Dalais FS, Ebeling PR, Kotsopoulos D, et al. The effects of soy protein containing isoflavones on lipids and indices of bone resorption in postmenopausal women. Clin Endocrinol (Oxf). 2003;58:704-709.
98. Kreijkamp-Kaspers S, Kok L, Grobbee DE, et al. Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women. JAMA. 2004;292:65-74.
99. Yoles I, Yogev Y, Frenkel Y, et al. Tofupill/Femarelle (DT56a): a new phyto-selective estrogen receptor modulator-like substance for the treatment of postmenopausal bone loss. Menopause. 2003;10:522-525.
100. Chen YM, Ho SC, Lam SS, et al. Soy isoflavones have a favorable effect on bone loss in chinese postmenopausal women with lower bone mass: a double-blind, randomized, controlled trial. J Clin Endocrinol Metab. 2003;88:4740-4747.
104. Genazzani AD, Stomati M, Bernardi F, et al. Long-term low-dose dehydroepiandrosterone oral supplementation in early and late postmenopausal women modulates endocrine parameters and synthesis of neuroactive steroids. Fertil Steril. 2003;80:1495-501.
105. Somjen D, Knoll E, Vaya J, et al. Estrogen-like activity of licorice root constituents: glabridin and glabrene, in vascular tissues in vitro and in vivo. J Steroid Biochem Mol Biol. 2004;91:147-155.
107. Macgregor CA, Canney PA, Patterson G, et al. A randomised double-blind controlled trial of oral soy supplements versus placebo for treatment of menopausal symptoms in patients with early breast cancer. Eur J Cancer. 2005;41:708-714.
108. Kok L, Kreijkamp-Kaspers S, Grobbee DE, et al. A randomized, placebo-controlled trial on the effects of soy protein containing isoflavones on quality of life in postmenopausal women. Menopause. 2005;12:56-62.
112. Hartley DE, Elsabagh S, File SE, et al. Gincosan (a combination of Ginkgo biloba and Panax ginseng ): the effects on mood and cognition of 6 and 12 weeks' treatment in post-menopausal women. Nutr Neurosci. 2005;7:325-333.
114. Hidalgo LA, Chedraui PA, Morocho N, et al. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: A randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005;21:257-264.
115. Campagnoli C, Abba C, Ambroggio S, et al. Polyunsaturated fatty acids (PUFAs) might reduce hot flushes: an indication from two controlled trials on soy isoflavones alone and with a PUFA supplement. Maturitas. 2005;51:127-134.
116. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006;13:185-196.
120. Verhoeven MO, van der Mooren MJ, van de Weijer PH, et al. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause. 2005;12:412-420.
122. Winther K, Rein E, Hedman C, et al. Femal, a herbal remedy made from pollen extracts, reduces hot flushes and improves quality of life in menopausal women: a randomized, placebo-controlled, parallel study. Climacteric. 2005;8:162-170.
123. Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III Double-Blind, Randomized, Placebo-Controlled Crossover Trial of Black Cohosh in the Management of Hot Flashes: NCCTG Trial N01CC1. J Clin Oncol. 2006;24:2836-2841.
124. Heger M, Ventskovskiy BM, Borzenko I, et al. Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial. Menopause. 2006 Aug 4. [Epub ahead of print]
125. Wuttke W, Raus K, Gorkow C. Efficacy and tolerability of the black cohosh (actaea racemosa) ethanolic extract BNO 1055 on climacteric complaints: A double-blind, placebo- and conjugated estrogens-controlled study. Maturitas. 2006 Aug 21. [Epub ahead of print]
126. Huang MI, Nir Y, Chen B, et al. A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertil Steril. 2006;86:700-710.
131. Sammartino A, Tommaselli GA, Gargano V, et al. Short-term effects of a combination of isoflavones, lignans, and cimicifuga racemosa on climacteric-related symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Gynecol Endocrinol. 2006;22:646-650.
133. D'Anna R, Cannata ML, Atteritano M, et al. Effects of the phytoestrogen genistein on hot flushes, endometrium, and vaginal epithelium in postmenopausal women: a 1-year randomized, double-blind, placebo-controlled study. Menopause. 2007 Jan 23. [Epub ahead of print]
134. Cancellieri F, De Leo V, Genazzani AD, et al. Efficacy on menopausal neurovegetative symptoms and some plasma lipids blood levels of an herbal product containing isoflavones and other plant extracts. Maturitas. 2007 Jan 30. [Epub ahead of print].
135. Zaborowska E, Brynhildsen J, Damberg S, et al. Effects of acupuncture, applied relaxation, estrogens, and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies. Climacteric. 2007;10:38-45.
142. Bai W, Henneicke-von Zepelin HH, Wang S, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibolone. Maturitas. 2007 Jun 21. [Epub ahead of print]
143. Yang HM, Liao MF, Zhu SY, et al. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol® on the climacteric syndrome in peri-menopausal women. Acta Obstet Gynecol Scand. 2007;86:978-985.
149. Dodin S, Lemay A, Jacques H, et al. The effects of flaxseed dietary supplement on lipid profile, bone mineral density and symptoms in menopausal women: a randomized double-blind wheat germ placebo-controlled clinical trial. J Clin Endocrinol Metab. 2004 Dec 21. [Epub ahead of print]
151. Kong MH, Lee EJ, Lee SY, et al. Effect of human placental extract on menopausal symptoms, fatigue, and risk factors for cardiovascular disease in middle-aged Korean women. Menopause. 2007 Oct 10. [Epub ahead of print]
152. Chandeying V, Sangthawan M. Efficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: phase III study. J Med Assoc Thai. 2007;90:1720-1726.
154. Reed SD, Newton KM, LaCroix AZ, et al. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. 2008;15:51-58.
Last reviewed April 2009 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.