Menopause

Natural Solutions for Hot Flashes--And More

For many women in their forties and early fifties, the approach of menopause presents one of the biggest health decisions that they'll make at midlife: to take hormone replacement therapy or not to take hormone replacement therapy.

Since puberty, your body has been generously producing estrogen (the female hormone associated with functioning ovaries) and progesterone (the hormone secreted after ovulation, triggering menstruation and enabling the uterus to nourish a fertilized egg). At around age 50, your body begins to secrete fewer and fewer of these hormones, so you no longer menstruate.

Officially, menopause is that moment in time when you haven't had a period for 12 months. Tampons become a thing of the past--but so does your natural protection against heart disease and weakening bones. And beginning several years before your last period, your ovaries produce ever-smaller amounts of estrogen and progesterone. As hormone production wanes and you approach what our mothers called the change, you may experience hot flashes, insomnia, irregular bleeding, mood swings, vaginal dryness and other changes.

NOT A PROBLEM FOR EVERYONE

Menopause doesn't bother everyone. Only about 15 percent of us will experience severe menopausal symptoms, says Margery Gass, M.D., director of the University Hospital Menopause and Osteoporosis Center at the University of Cincinnati. "We estimate that 25 percent of women will sail through menopause with no trouble whatsoever, while some 60 percent will experience hot flashes, mood swings, vaginal dryness and other discomforts associated with menopause." The remainder experience occasional but not significant discomfort.

For women with severe or bothersome concerns associated with menopause, medical science offers hormone replacement therapy (HRT). Both synthetic hormones and "natural" estrogen (collected either from the urine of pregnant mares or from plants) will compensate for the decline in estrogen production at midlife. They're also prescribed after surgical removal of both ovaries. But hormone replacement therapy is not the perfect solution for every woman. Many doctors consider HRT inadvisable for women who've had breast cancer or who are at an increased risk of breast cancer due to their family histories, for example.

Other women resist hormone replacement therapy because they object to taking what they consider "medication" for a condition that is not a disease but a natural transition.

Among women who decide to go on HRT, 38 percent (roughly one out of three) stop using it by the end of the first year, due to side effects. Half of all women who go on HRT experience one or more problems, including menstrual bleeding, bloating, premenstrual irritability, cramps and breast tenderness. Some women also report headaches and weight gain, depression, abnormal uterine bleeding and hair and skin changes. And estrogen use can double your chances of developing gallbladder disease.

WHAT NATURE HAS TO OFFER

Figuring that since menopause is a natural transition, nature just may offer some natural solutions to discomforts associated with the change, many women bothered by menopausal changes started experimenting with the use of herbs, vitamins and other alternative approaches to meno-pause--with promising results. And a growing number of women's health care practitioners followed suit.

In fact, many natural options are so effective that mainstream women's doctors have begun to incorporate them as part of their treatment programs for menopausal patients. Here's what practitioners say are the best alternative options for treating menopausal problems.

Food Therapy: Soy Makes Sense

Diets abundant in soy products contain a group of natural chemical compounds called phytoestrogens because they possess estrogen-like activity, says Wulf Utian, M.D., Ph.D., director of the Department of Reproductive Biology at Case Western Reserve University in Cleveland and executive director of the North American Menopause Society.

Phytoestrogens come in two general forms: isoflavones and lignans. Isoflavones are found in soy foods like tofu and soy milk; lignans are found in whole grains, flaxseed and, to a lesser extent, fruits and vegetables.

What's their benefit to menopausal women? "If a woman wants to relieve her menopausal symptoms and doesn't want to go on hormone replacement therapy, certainly one or two daily servings of soy products is a reasonable approach," says Mark Messina, Ph.D., nutritionist in Port Townsend, Washington, participant in the Asian food conference and author of The Simple Soybean and Your Health. (One small study of six-month duration showed that soy did increase bone strength, adds Dr. Messina. But until phytoestrogens are studied further, he says that women at risk for osteoporosis shouldn't assume that phytoestrogens have the same bone-protecting benefits as hormone replacement therapy.)

"Soy foods, the richest food source of phytoestrogens, may be the reason why Asian women have fewer menopausal symptoms than American women do. I recommend adding two servings of soy foods four or five days a week," says Jane Guiltinan, doctor of naturopathy, clinical professor and medical director of the teaching clinic at Bastyr University of Naturopathic Medicine in Seattle. Dr. Guiltinan also suggests that you add flaxseed, walnuts and oats to your diet for rich sources of plant estrogen.

"There are lots of benefits that we already know about to eating less animal protein," says Gregory L. Burke, M.D., vice-chairman and professor in the Department of Public Health Sciences at the Bowman Gray School of Medicine of Wake Forest University in Winston-Salem, North Carolina. "I say 'go ahead' to women who ask if they should replace animal protein with soy protein as they near menopause."

Experts offer these easy, tasty ways to add soy to your diet.

Add soy milk to your cereal. Admittedly, soy milk doesn't taste like cow's milk. But when chilled, it's perfect for pouring over your cereal. Look for calcium-added nonfat or low-fat soy milk in health food stores.

When cooking, substitute soy milk for cow's milk. Replace cow's milk with equal amounts of soy milk in practically any recipe, including cream sauces, shakes, baked goods and puddings, suggests Dr. Messina.

Whip up a breakfast smoothie. For a delicious, satisfying breakfast treat, combine ½ cup unsweetened orange or apple juice, 1 medium banana and 3 ounces tofu in a blender and blend until smooth. If you like, add frozen strawberries or substitute them for the banana.

Use soy cheese. An excellent substitute for cow's milk cheese, soy cheese is lower in fat and salt and is available in some grocery stores and health food stores in an ever-growing variety of flavors, including mozzarella (try in lasagna or on pizza), Cheddar, American and Monterey Jack.

Try soy protein. Textured vegetable protein is made from defatted soy flour and found in health food stores and some grocery stores. Its meaty texture makes it a ringer for ground beef when used in spicy taco, chili or sloppy-joe recipes. You can substitute some, even all, of the meat in a recipe and your family is unlikely to be the wiser.

Yoga: Assume the Lotus Position

"For many women, menopause is a time of dramatic changes: children leaving home, worries about your sexual attractiveness and changing relationships with your parents and/or spouse--any one of which can be highly stressful," says Judith Lasater, Ph.D., a physical therapist and yoga instructor in San Francisco and author of Relax and Renew: Restful Yoga for Stressful Times.

"One of the lovely things about yoga for women in transition is the way that it makes you listen to your body more," says Dr. Lasater. "Our bodies are very wise and when we listen to them carefully, they'll often tell us what to do."

In addition, says Dr. Lasater, with the practice of yoga comes the "awareness of the moment" that allows us to heal ourselves. "You learn to anticipate what tenses your shoulders and how to untense them. You learn to rest when you're exhausted, how to improve your posture when you slouch and how to release anger when it builds up."

TAMING THE WILD HOT FLASH

Of all the changes heralding menopause, most women agree that the hot flash is the most notorious. Most research or experimentation with natural remedies for menopause has focused on this symptom.

Hot flashes arise when estrogen levels fall, says Nancy Lee Teaff, M.D., in her book Perimenopause--Preparing for the Change. Estrogen affects the hypothalamus, your brain's "thermostat." When estrogen levels begin to ebb, your body's ability to regulate your temperature goes haywire. As a result, blood vessels may dilate inappropriately.

Starting as a sudden warmth in your face, head or chest, a hot flash can spread like wildfire in just seconds, and as your body tries cooling itself off, you start sweating. The kicker to a reddening, drenching, hot flash can be a bout of shivering chills, as your body reacts to your wide-open pores and dampened skin.

If you're among the estimated 75 to 85 percent of women who experience hot flashes, alternative practitioners offer these time-tested natural strategies for relief.

Vitamin Therapy to Cool the Surge

Vitamin E improves the stability of your blood vessels and wards off the erratic dilation of the superficial blood vessel walls that cause hot flashes when estrogen levels fall, according to Dr. Guiltinan. By taking 400 to 1,200 international units (IU) of vitamin E daily, you may be able to prevent these power surges. (If you are considering taking amounts above 600 IU, talk to your doctor first since high doses can cause side effects in some people.)

Evidence that vitamin E may be useful for menopausal women emerged in the 1940s when women who couldn't take estrogen for their debilitating hot flashes and mood swings were given vitamin E. After treatment, their symptoms were markedly improved.

Start with lower doses and increase gradually. Vitamin E may take a few weeks to a few months to become effective. Also, if you have high blood pressure, diabetes or a rheumatic heart condition, don't take more than 200 IU of vitamin E without checking with your physician, according to Dr. Guiltinan. Vitamin E is absorbed only in the presence of fat, so it should be taken with foods that contain fat.

Herbs Can Cool Hot Flashes and Night Sweats

Certain herbs have a cooling effect on your body and can put a chill on hot flashes and night sweats, says Susun S. Weed of Woodstock, New York, in her book Menopausal Years: The Wise Woman Way. Weed, who writes, teaches and lectures extensively about herbs, says that you should work regularly with one herb at a time for three or more months. Some herbs work very quickly, while other herbs work slowly and have a cumulative effect over time.

With that said, here's what herbal medicine has to offer for menopausal discomfort.

Black cohosh. Black cohosh (Cimicifuga racemosa) has been proven to be as effective as estrogen for the relief of hot flashes, according to Varro E. Tyler, Ph.D., professor emeritus of pharmacognosy at Purdue University in West Lafayette, Indiana, and author of Herbs of Choice: The Therapeutic Use of Phytomedicinals. (You may need to use it for up to four weeks before you feel better, however.)

To find the best dosage, Weed suggests starting with ten drops twice a day and increasing the dose by five drops every other day until you are satisfied with the results. Some women take black cohosh daily, others take it simply when needed and some take it for any two consecutive weeks each month.

Motherwort. Weed calls motherwort (Leonurus cardiaca) a magnificent herbal ally for moderating menopausal symptoms such as hot flashes and night sweats. She dilutes 5 to 15 drops of the tincture of motherwort, made from fresh, flowering tops, in a little water or tea. Take it as needed to cool hot flashes--or several times a day to prevent them.

Common chickweed. Weed says chickweed (Stellaria media) has provided hot-flash relief for many women. She uses 25 to 40 drops of fresh plant tincture once or twice a day to reduce the severity and frequency of hot flashes. Most women get results within a week or two of regular use.

Elder flower. This herb (Sambucus canadensis) specifically resets the body's thermostat, says Weed. For women who have frequent hot flashes or night sweats, 25 to 50 drops of fresh elder blossom tincture several times a day should bring rapid results, she adds.

Violet. Violets (Viola odorata) can also cool hot flashes, says Weed. Eat the fresh leaves in your salad (violets grow in many lawns), or brew a strong tea by steeping one ounce (by weight) of dried violet leaves in a quart of boiling water overnight. Strain, refrigerate and drink within 48 hours. She suggests drinking at least a cup a day. (You can find these dried leaves at many herb stores.)

Help Yourself to Exercise

In a study of 79 women, moderate and even severe menopausal symptoms, such as hot flashes and sweating, were reduced when the women exercised for three to four hours a week. But it's wise to start before you're menopausal: Later, unaccustomed exertion may trigger hot flashes.

Breathe Deeply

Researchers speculate that women who don't take hormone replacement therapy may benefit from doing deep breathing exercises. In a small study done among women who had at least five hot flashes a day, participants who practiced slow, deep breathing had half as many hot flashes.

If you want to try this technique, aim for 10 to 20 minutes of deep breathing, says Linda Ojeda, Ph.D., author of Menopause without Medicine. Here's how.

* Sit comfortably.

* Close your eyes and relax your muscles.

* Slowly breathe in and out through your nose.

* Become aware of each breath.

* Disregard distractions.

Chill Out with Biofeedback

Thermal biofeedback can help you learn to gain control when you're caught in the midst of a hot flash, says Barry L. Gruber, Ph.D., a psychologist with Health Professionals in Chevy Chase, Maryland. "Women who have hot flashes are taught how to warm their hands via biofeedback, which seems, through some strange mechanism, to actually help them remain cool."

According to Dr. Gruber, learning how to control hot flashes with biofeedback involves weekly sessions for eight to ten weeks, following which biweekly, monthly and finally annual refresher visits are necessary. (For more information on biofeedback, see page 61.)

Traditional Chinese Medicine: Wisdom from the East

Practitioners of Traditional Chinese Medicine (TCM) say that the intricate healing system from the East provides excellent relief for hot flashes and other menopausal problems.

"For many women, a combination of acupuncture and Chinese herbs can ease hot flashes as effectively as estrogen can, yet without the side
effects," says Christina Stemmler, M.D., a Houston physician who integrates TCM and acupuncture with Western medicine and previously headed the American Academy of Medical Acupuncture. As Dr. Stemmler explains it, hot flashes are a release of yang energy produced because your body has a yin deficiency. (For a more complete explanation of the role of yin and yang in Traditional Chinese Medicine, see page 278.)

To combat the yin deficiency, says Dr. Stemmler, each woman needs to be evaluated by her TCM practitioner, who is likely to prescribe an individualized regimen of Chinese herbs, dietary changes and acupuncture. "What's important to know is that the path through menopause is completely different for each woman, depending on the dysfunctions that she's acquired during her life as well as her diet, her love life, her parents and her lifestyle," says Dr. Stemmler.

A small Swedish study of 21 women appears to confirm the use of acupuncture for hot flashes, indicating that hot flashes could be relieved via regular acupuncture treatments. In this study, 30-minute acupuncture treatments were given twice a week for two weeks and then once a week for another six weeks. The number of hot flashes experienced by the women decreased and remained noticeably reduced for up to three months after the treatments stopped.

Homeopathy May Help

Homeopathic practitioners offer effective, highly individualized treatments for hot flashes as well as menopausal discomforts, including irregular bleeding, mood swings and insomnia (often triggered by hot flashes).

"Each woman's hot-flash experience will be different," says Joyce Frye, D.O., an osteopath who uses homeopathy in her obstetrics and gynecology practice, chairperson of the gynecology department at Presbyterian Medical Center and a clinical faculty member at Jefferson Medical College, all in Philadelphia. "Some women will get hot faces, others will have hot chests and others will wake up during the night drenched in sweat. Classical homeopathy can help make menopause a peaceful transition with treatment tailored to the individual."

EASING VAGINAL DISCOMFORT

During menopause, the lining of your vagina may become drier, thinner and less flexible, due to lessening amounts of estrogen. You probably notice it most during sex--you may find that you don't become as lubricated when you're aroused, so sex is uncomfortable (or even impossible).

Here's what healers say you can do to remedy the situation.

Have sex regularly. Regular sexual activity promotes better circulation to the vagina and can increase lubrication, says Adriane Fugh-Berman, M.D., former head of field investigations for the Office of Alternative Medicine at the National Institutes of Health in Bethesda, Maryland. So a good way to protect yourself against menopausal vaginal dryness is to have regular sex--and it doesn't have to be with a partner.

Open sesame! Not all alternatives involve preventive sex. "Some women report having great success using sesame oil to relieve vaginal dryness," says Dr. Fugh-Berman. Soak a Coets (quilted cotton cosmetic square) in sesame oil, squeeze out the excess oil, insert it into the vagina and leave it in overnight. Remove the Coets the next morning, and that night, replace it with a new one also dipped in sesame oil. Repeat every day for a week, then once a week for as long as necessary. "The sesame oil is supposed to induce an estrogen-like effect," says Dr. Fugh-Berman.

Apply vitamin E. Some women find that vitamin E oils, when used regularly, ease vaginal dryness.

Use an herbal salve. Herbal salves or ointments containing St.-John's-wort and calendula will ease a dry, irritated vagina, says herbalist Rosemary Gladstar, author of Herbal Healing for Women. In her book Gladstar offers this recipe for a soothing medicinal paste: Mix enough slippery elm powder with aloe vera gel to form a paste; apply inside the vaginal lips and vagina.

Try a water-based lubricant. If you aren't lubricated, drugstore remedies such as Astroglide, K-Y Jelly and Replens (which lasts for up to three days per application) can also reduce the friction and discomfort of intercourse.

LIFTING THOSE MOODY BLUES

If you're approaching menopause, mood swings may be cause for reflection. For example, say you practically burst into tears over a trivial incident at the office. Or you're stuck in traffic and start yelling at the driver in front of you. Are hormones playing havoc with your emotions, or what?

"There's no simple answer about whether menopause causes mood disorders," says Mary Morrison, M.D., assistant professor of psychiatry and medicine in the Department of Psychiatry at the University of Pennsylvania in Philadelphia. "My sense, though, is that some women are particularly sensitive to hormonal changes. To those women, being in their forties may unmask depressive symptoms, like mild depression, irritability, memory problems and sleep disturbances."

Here are some options to try.

Choose a relaxation technique that works for you. Dr. Morrison recommends relaxing exercises such as yoga and meditation to the menopausal women that she counsels. Other tactics that may be helpful, say Dr. Morrison and other experts, include deep breathing, visualization and exercise. Keep a journal of what you try and how it works, to help you select the most effective technique, she says.

Try a calming herb blend. "For women whose hot flashes combine with irritability, I have great success using a formula made of equal parts of tincture of chickweed, dandelion root, motherwort and valerian," says Kathleen Maier, a physician's assistant, herbalist and director of Dreamtime Center for Herbal Studies in Flint Hill, Virginia, and former adviser on botanical medicine to the National Institutes of Health in Bethesda, Maryland.

Get some help. Women who can't shake off their sadness at the time of menopause--as well as women who have mood impairments or memory problems--should seek expert help by talking to a qualified therapist, physician or psychologist, says Dr. Morrison.