Menopause supplements, herbs, vitamins, diet, food, natural therapy for remedy and cure
August 6, 2014
by Ray Sahelian, M.D.

Menopause actually occurs at the end of a woman's last menstrual period. However, that fact is established only later, when a woman has had no periods for at least 12 months. The average age at which menopause occurs is about 50 years, but menopause may occur normally in women as young as 40 or even late 30s. Regular menstrual cycles may continue up to menopause but usually the last few periods tend to vary in duration and amount of flow. With age the ovaries become progressively less responsive to stimulation by luteinizing hormone and follicle-stimulating hormone, which are secreted by the pituitary gland. Consequently, the ovaries secrete smaller and smaller amounts of estrogen and progesterone, and egg release (ovulation) eventually stops. I am not aware of any natural products that can be taken to prevent or reduce the effects of future menopause. However, having a very healthy diet, keeping a steady weight, sleeping deeply, exercising regularly, maintaining a positive attitude and low stress can all help.

Which method of treatment to choose?
Each woman is unique in what works for her. Some women find herbal products to be of benefit, others prefer standard medical treatment with estrogen and progesterone. Still others try over the counter hormones such as
DHEA or pregnenolone. If the herbal supplements don't work and a woman needs hormones, it may be preferable to use natural ones, some call them bioidentical hormones, and the least dosage and time period that works.

Menopause natural remedy -  Physical activity, exercise, movement
Even moderate exercise can help relieve or reduce anxiety, insomnia and night sweats.
Walking half and hour to an hour a few times a week may help women in the "battle of the bulge" that often accompanies menopause, and at the same time improve overall well being.

Menopause diet
Just as exercise can reduce symptoms, so can diet. I would recommend improving dietary habits by following some of the suggestions on this diet page. You may consider including more flax seed and organic fermented soy in your diet. A few herbs and nutrients have been studied as natural menopause symptom relief.

Herbs for menopause --  Herbal remedy
Herbal treatment is not as consistently effective as the use of estrogen, but herbs are often much safer than hormones. Natural dietary supplements are  worth trying for a few weeks or months, and in some women, along with exercise, may be beneficial enough to avoid the need for estrogen. But, if they don't work, a woman can always fall back on hormone replacement therapy. There is no easy way to know, either through a medical exam or blood studies, which herbal treatment, if any, will be of benefit. The only way to know for certain is by trial and error.

Black cohosh -- A review of randomized, controlled trials found Black Cohosh extract and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Ann Intern Med 2002 Nov 19. Another study showed the combination of black cohosh and St. John's wort was helpful in reducing symptoms of menopause. However, other studies have not shown this herb to be helpful.
Chaste berry herbal extract.
Fish oil supplements may be helpful in improving mood. Omega-3s reduce psychological distress and depressive symptoms often suffered by menopausal and perimenopausal women.
Ginseng use in low doses only, otherwise you could feel very stimulated and have trouble sleeping.
Grape seed extract could be of help.
Maca supplement has been found to be helpful in women going through menopause. Maca herb is able to reduce anxiety and improve mood and sexual function.
Red clover extract may be helpful at times although the results of studies have been mixed.
Isoflavones and anticoagulant chemicals called coumarins are found in Red clover.
Soy isoflavonoids and phytoesrogens -- Four-week supplementation with soy
isoflavones has beneficial effects on bone metabolism and on serum lipids in perimenopausal women. These effects could have the potential to reduce risks of postmenopausal osteoporosis and of cardiovascular diseases in such women.
St. John's wort for mood enhancement. The combination of St. John's wort and black cohosh has been found to be helpful in easing menopause symptoms. St. John's wort, by itself, can be helpful in treating low mood during this period, but I suggest you take breaks from use.

Maturitas. Nov 19, 2013. Herbal preparations for the menopause: Beyond isoflavones and black cohosh. Complementary and alternative medicines (CAM) such as isoflavones and black cohosh are commonly used to deal with menopausal symptoms, but benefit a limited proportion of women. The aim of this minireview is to summarize the evidence of the efficacy and safety of other herbal preparations. Randomized controlled trials (RCTs) find that the extracts of Mediterranean pine bark (Pycnogenol), linseed, and Lepididium meyenii (Maca) reduce vasomotor symptoms. The results of RCTs of the hop flavonoid 8-prenylnaringenin are conflicting. Animal and human studies suggest that Dioscorea villosa (Wild yam),and Broccoli may protect against osteoporosis and breast and gynecological cancers but further evidence is required. Linseed may protect against breast cancer but the results are conflicting.

Minerals and vitamins
About age 30, men and women begin to slowly lose bone mass. A diet rich in calcium helps build strong bones and is an essential part of prevention and treatment of osteoporosis. Women who have gone through menopause lose bone mass more rapidly. Too much bone loss causes osteoporosis, which can lead to broken bones and other serious health problems. Calcium is found in many foods, including dairy products such as milk or yogurt. If you do not get enough calcium from the foods you eat, you may choose to take calcium supplements.
Magnesium is a naturally occurring mineral. Magnesium is important for many systems in the body especially the muscles and nerves. Calcium and magnesium are required in a good balance to be most effectively used by the body.
Calcium at about 400 to 800 mg a day.
Magnesium supplement may be helpful.
Vitamin C supplement use increases bone mineral density in postmenopausal women. J Bone Miner Res 2001.

Over the counter hormones
The conventional approach to menopause symptoms is the use of estrogen and other hormones such as progesterone. Some doctors are starting to recommend the temporary use of small amounts of a natural hormones called
DHEA
and pregnenolone which are natural over the counter hormones. Their use can be risky and should one be done under medical supervision with very low dosages and frequent hormone holidays.

Menopause and sex
If you have low libido associated with menopause, consider Passion Rx. When a woman enters menopause, her sex life and that of her partner may suffer. More than half of women report
sexual dysfunction since entering menopause. But, there is hope.

Passion Rx for Men and Women
This female enhancing formula provides results that are often seen within several days, and continue to improve over time. Dr. Sahelian and his research staff have tested various doses and extracts of dozens of herbs from a number or raw material suppliers to determine the ideal dosage and combination for optimal aphrodisiac properties with the fewest side effects. After years of trial and error, a proprietary blend with 11 herbal extracts from the best raw material suppliers has been created which works within hours. Passion Rx boosts:

 

The potent nutrients and herbs in Passion Rx include ashwagandha, acetylcarnitine, catuaba, choline, cnidium, dmae, horny goat weed, maca herb, mucuna pruriens herb, muira puama herb, passion flower, rehmannia, rhodiola, shilajit, suma, tribulus terrestris, tongkat ali. Another version of Passion Rx has yohimbe.

Maca herb as a natural menopause treatment
Beneficial effects of Lepidium meyenii on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content.
Menopause. 2008. Victoria University, St. Albans, Victoria, Australia; Monash University Department of Medicine, Clinical Nutrition and Metabolism Unit and Body Composition Laboratory, Monash Medical Centre, Clayton, Victoria, Australia.
Fourteen postmenopausal women completed a randomized, double-blind, placebo-controlled, crossover trial. They received 3.5 grams a day of powered maca for 6 weeks and matching placebo for 6 weeks, in either order, over a total of 12 weeks. At baseline and weeks 6 and 12 blood samples were collected for the measurement of estradiol, follicle-stimulating hormone, luteinizing hormone, and sex hormone-binding globulin, and the women completed the Greene Climacteric Scale to assess the severity of menopausal symptoms. In addition, aqueous and methanolic maca extracts were tested for androgenic and estrogenic activity using a yeast-based hormone-dependent reporter assay. No differences were seen in serum concentrations of estradiol, follicle-stimulating hormone, luteinizing hormone, and sex hormone-binding globulin between baseline, maca treatment, and placebo. The Greene Climacteric Scale revealed a significant reduction in scores in the areas of psychological symptoms, including the subscales for anxiety and depression and sexual dysfunction after maca consumption compared with both baseline and placebo. These findings did not correlate with androgenic or alpha-estrogenic activity present in the maca as no physiologically significant activity was observed in yeast-based assays. Preliminary findings show that maca (3.5 g/d) reduces psychological symptoms, including anxiety and depression, and lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity.


Isoflavone menopause treatment
When given in adequate doses to postmenopausal women, soy that contains isoflavone improves menopausal symptoms and related quality of life. Studies on the benefits of soy for relieving menopausal symptoms have produced mixed results. In a new study, a research group used a standardized soy product which contains 160 milligrams of total isoflavones, soy-derived antioxidants. 43 postmenopausal women were assigned to the soy product or placebo daily for three months. The average age of the women was 55 years and they had been off hormone replacement therapy for at least six months prior to entering the study. All of the women completed a menopause-specific quality-of-life questionnaire at the beginning of the study and again after 6 weeks and 3 months. Compared with placebo, soy therapy led to a 40-percent reduction in psychosocial complaints involving mood and depression, a 36-percent reduction in hot flashes and night sweats, as well as and a 30-percent reduction in other physical symptoms, primarily low energy.

Menopause and soy
Eating soy products protects the bones of older women, particularly those in early menopause, according to results of a large study in China.

Treating low mood or depression
Some women get benefits from St. John's wort, 5-HTP, SAM-e or the herb maca. It may take trial and error to find the right supplement with the right dosage.

Review
Maturitas. 2013 May. Prevalence of complementary and alternative medicine (CAM) use by menopausal women: a systematic review of surveys. Large proportions of women have turned to complementary and alternative medicine (CAM) for relief from their menopausal symptoms. This highlights the need for more rigorous research into CAM. This article is aimed at critically reviewing surveys that examine the prevalence of CAM use by menopausal women worldwide. Eleven databases were searched for peer-reviewed surveys published in any language between 01 January 2000 and 27 October 2012. The bibliographies of the retrieved articles and relevant book chapters were also hand searched. Twenty-six surveys were identified, and they included a total of 32,465 menopausal women. The majority of these surveys were of poor methodological quality. Based on 6 surveys, 32.9% of women stated they were current/regular CAM users. Based on 9 surveys, 50.5% of women reported that they used CAM specifically for their menopausal symptoms. The average 12-month prevalence of CAM use was 47.7% (range: 33-56). Fifty-five percent of women did not disclose their use of CAM to their healthcare professional. The majority of women sought information about CAM from the media. The most popular CAM modality was herbal medicine, followed by soy/phytoestrogens, evening primrose oil, relaxation and yoga. There are a large number of predominantly low-quality surveys monitoring the prevalence of CAM use among menopausal women worldwide. The available evidence suggests that the prevalence of CAM use is high.

Risk of hormone replacement therapy
Recent studies indicate that long term replacement with Premarin (horse derived estrogens) and synthetic progesterone for menopause increases the risk for heart disease, cancer, blood clots and gallbladder disease. Therefore, what alternatives are available? Estrogen pills appear to slightly increase the risk of Alzheimer’s disease and other forms of dementia in post menopausel women. The use of postmenopausal hormone therapy is associated with a higher risk of breast cancer.

Breast cancer rates fell sharply in 2003, and then held steady at the lower rate in 2004. The most likely reason for the sharp fall in rates was that large numbers of women stopped taking hormone therapy for menopause. More doctors are now realizing that the recommendation for estrogen and progestin use after menopause (which has gone on for the past few decades) may not have been such good advice after all.
   We would suggest we all accept the fact that it is going to take a long time to find out the answers to the following questions: When is hormone replacement therapy appropriate for women who are going through menopause? Which hormones should be used for the treatment for menopause and for how long? What dosages are appropriate? These may seem like simple questions but after decades of research there still is no general agreement in the medical community regarding guidelines to appropriate hormone replacement in women after menopause.
   First, do not use hormones, whether synthetic or natural, unless you have a good reason to and there are no other good options (such as nutrients and herbs along with exercise, deep sleep, yoga, etc). Second, if you do need to take hormones, use the least amounts that work. Third, whenever possible use natural hormones rather than synthetic or horse-derived. Fourth, reevaluate your need for these hormones, and the dosages that you are using, on a regular basis. Perhaps your required dosage could be reduced over time, or even stopped altogether.
   The beneficial dosages may be a fraction of what doctors normally prescribe or are available over the counter. Perhaps women may do well at half the estrogen and progesterone amount normally prescribed. DHEA and pregnenolone are sold at up to 100 mg a capsule. Any dosage above 5 to 10 mg could be harmful and dangerous.
   Interestingly, A new study provides preliminary evidence that black cohosh herb may reduce breast cancer risk. Dr. Timothy R. Rebbeck of the University of Pennsylvania School of Medicine in Philadelphia compared 949 women with breast cancer to 1,524 healthy controls. Women who reported taking black cohosh were at a lower risk of breast cancer. Previous studies have shown that black cohosh can block cell growth. The herb is also an antioxidant, and has been shown to have anti-estrogen effects as well. International Journal of Cancer, 2007.
   Comments: It is also possible that those who took black cohosh did not take estrogen or progesterone, and hence, had a lower rate of breast cancer when compared to women who took the hormones. For information on male menopause also called andropause.

Memopause symptoms -- hot flushes
During the time before menopause (technically called the climacteric, but more recently called perimenopause), symptoms may be nonexistent, mild, moderate, or severe. Hot flashes affect 75 percent of women. During a hot flash, the skin, especially on the head and neck, becomes red and warm (flushed), and perspiration may be profuse. Most women have hot flashes for more than a year, and 25 to 50 percent have them for more than 5 years. A hot flash lasts from 30 seconds to 5 minutes and may be followed by chills.

Hot flushes are associated with stressors such as anxiety, warm temperatures, caffeine, alcohol, spicy food, and physical contact, which may function to increase cortisol levels and body temperature. Additionally, researchers think that the marked reduction in estrogen levels associated with menopause may lead to significant reduction in blood serotonin levels, affecting thermoregulation by the hypothalamus.
   Psychological and emotional symptoms -- fatigue, irritability, insomnia, and nervousness -- may be caused by the decrease in estrogen levels. Night sweats may disturb sleep, making fatigue and irritability worse. A woman occasionally may feel dizzy, have tingling sensations (pins and needles), and be unusually aware of her heartbeat, which may seem to be pounding. Loss of bladder control, inflammation of the bladder or vagina, and pain during intercourse because of vaginal dryness may also occur. Sometimes muscles and joints ache. Complaints of memory loss are increasingly noted as part of the constellation of symptoms experienced in the menopause transition.

Source Naturals Hot Flash
This formula contains important herbs and compounds such as phytoestrogens, black cohosh, dong quai, licorice root, and vitex berry. I have not seen any studies with this formula.

Hot Flash Supplement Facts:
Genistein-Rich Soy concentrate ( SoyLife )  
Black Cohosh Root Extract ( CimiPure )
Dong Quai  Root Extract
Licorice Root Extract
Vitex Berry Extract


Early menopause -- Premenopause symptom and sign
There can be early signs in your 30's or 40's. One of the common signs of early menopause is an erratic menstrual cycle with some periods being heavier, some being lighter. If unbalanced estrogen production increases, another early sign could be swollen and tender breasts. Additional symptoms and signs could be mood swings or depression, water retention, fibrocystic breasts and sleep disturbances. Occasionally there is weight gain or weight loss. A test is not necessary to diagnose since the signs and symptoms are quite easy to identify. Menopause arrives nearly four years earlier on average for women who have had a hysterectomy compared with those who have not. Chemicals in cosmetics (using heavy makeup frequently), plastics and household cleaners -- phthalates -- could actually cause women to go through menopause earlier than their peers.

Post menopause treatment -- relief
It is clear that estrogen is the most effective treatment for menopause symptoms. But its risks are also clear. Many symptoms attributed to menopause may be natural consequences of aging. Reduced libido, higher risks of heart attack and forgetfulness may have little to do with hormone levels.
   Hormone replacement therapy used to menopause symptoms seems to accelerate the build-up of deposits in the coronary arteries of women who have abnormal glucose tolerance -- a sign of impending or full-blown diabetes.
   The use of estrogen - progestin hormonal therapy increases the risk of breast cancer among postmenopausal women regardless of racial differences.

Menopause research studies
Black cohosh and St. John's wort for climacteric complaints: a randomized trial.
Obstet Gynecol. 2006.
To see if a fixed combination of the herbal medicines could offer an alternative to hormone replacement therapy, the researchers studied 301 women who had been experiencing menopausal symptoms for at least three months, along with depressed mood. Half took the St. John's wort and black cohosh combo, while the other half took placebo pills. In each tablet, the black cohosh contained 1 milligram of the substances that are believed to be responsible for the herb's activity, triterpene glycosides, while the St. John's wort component contained 0.25 milligrams of the active ingredient hypericine. Study participants took the two tablets twice a day for the first eight weeks of the study, and once daily thereafter. After 16 weeks, women who took the two-herb combination showed a 50 percent reduction in symptoms such as hot flashes and sweating, compared to 19 percent for those on placebo. Scores measuring depression fell by 41 percent among women on the herbal medicines, compared to 12 percent for those on placebo. There was no significant difference between the groups in the number of adverse events or side effects seen from the medicine. The improvement in menopausal symptoms was similar to that seen among women taking hormone therapy for three months. Obstetrics & Gynecology, 2006.

Questions
Q. Is it safe for a healthy woman going through menopause to take flax seed oil and evening primrose oil daily? Can not understand if both oils offer the same benefit?
   A. Each woman is different and much depends on her diet and the amount of flax seed oil and evening primrose oil consumed. I can't see any problems with small amounts of these oils consumed on a regular basis, and I also think fish oils are healthy. I would also recommend the use of flaxseed for menopause symptoms.

The instructions on Estropause indicate up to 4 per day. Does this mean that smaller dosages might be sufficient sometimes? If so, how long a period of time should on a smaller dosage (say 1 or 2 or 3) be given before determining that more is needed. Have you had any experience with women taking Estropause at the same time as your Passion Rx (which btw is an excellent product!)? The individual is taking no medications at present and has no medical problems except symptoms expected after being removed from hormone replacement therapy. Physician has been consulted about taking herbs for the symptoms and has no problem. 
    It's difficult to give precise dosage instructions since each person is different. Usually 2 weeks or so is enough time to determine if something is working. Low doses of Passion Rx, such as 1/ 2 a capsule should not interfere with EstroPause, particularly since Passion Rx is not meant to be taken every day but 2 days on and 2 or more days off. Of course, it's prudent to do so under medical supervision.