Menopause supplements, herbs, vitamins, natural therapy, diet by Ray Sahelian, M.D. Natural supplements for remedy and cure for menopause symptoms

Plus: Passion Rx for low libido during or after menopause
Plus: Mind Power Rx for mind, mood and mental energy enhancement

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.
   The use of postmenopausal hormone therapy is associated with a higher risk of breast cancer.

Menopause natural remedy - exercise
Even moderate exercise can help relieve or reduce some of the problems of menopause in some women, including anxiety, insomnia and night sweats.

Menopause diet
Just as exercise can reduce symptoms of menopause, so can diet. I would recommend improving dietary habits by following some of the suggestions on this diet page. You may consider including more soy and flaxseed in your diet. A small study has found that flaxseed can reduce menopause symptoms. A few herbs and nutrients have been studied for menopause symptom relief. If you have an interest in eating less, consider Diet Rx appetite suppressant.

Herbs for menopause --  Herbal remedy for menopause
Herbal treatment for menopause is not as consistently effective as the use of estrogen, but herbs are often much safer than hormones. Herbs 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 estrogen replacement therapy.

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.
Soy isoflavonoids -- Four-week supplementation with soy isoflavone 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.
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;137(10):805-13. Another study showed the combination of black cohosh and St. Johns' wort was helpful in reducing symptoms of menopause.
Fish oil supplements may be helpful in improving mood.
St. John's wort for mood enhancement. The combination of St. John's wort and black cohosh has found to be helpful in easing menopause symptoms.
Chaste Berry herbal extract.
Ginseng use ginseng in low doses only, otherwise you could feel very stimulated and have trouble sleeping.
Red Clover extract may be helpful at times. Isoflavones and anticoagulant chemicals called coumarins are found in Red-Clover.

Source Naturals Hot Flash
Source Naturals Hot Flash 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.


Click here to purchase Hot Flash supplement or to sign up to a FREE supplement update newsletter

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

Minerals for Menopause
Calcium at about 600 to 1200 mg a day.
Magnesium supplement may be helpful

Fish oils for depression
Omega-3s reduce psychological distress and depressive symptoms often suffered by menopausal and perimenopausal women. Dr. Michel Lucas and colleagues divided 120 women age 40 to 55 into two groups. Women in the first group took three gel capsules containing a total of one gram of EPA every day for eight weeks. Those in the second group followed the same protocol, but took gel capsules containing sunflower oil without EPA. Omega-3s significantly improved the condition of women suffering symptoms of psychological distress and mild depression. Dr Michel Lucas reports that women with hot flashes had fewer sympoms after consuming omega-3s. At baseline, the number of daily hot flashes was 2.8 and dropped by an average of 1.6 in the group taking omega-3s and by 0.5 in the control group. The change that can be attributed to the use of omega-3s, i.e. a decrease of 1.1 hot flashes per day, is equivalent to results obtained with hormone therapy and antidepressants. February 2009 issue of The American Journal of Clinical Nutrition.

Over the counter hormones for menopause
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 or pregnenolone. DHEA and pregnenolone are natural over the counter hormones that have been evaluated in menopause. Hormone use can be risky and should one be done under medical supervision with very low dosages and frequent hormone holidays.

MIND POWER Rx - Formulated by Ray Sahelian, M.D.

Memory and Mood
Mental clarity
Concentration 
Alertness & Focus
The herbs in Mind Power Rx include: Ashwagandha, Bacopa, Fo-Ti, Ginkgo biloba, Ginseng, Mucuna pruriens, and Reishi.  The nutrients and vitamins in Mind Power Rx include Acetyl-l-carnitine, Carnitine, Carnosine, Choline, DMAE, Inositol, Methylcobalamin, Pantothenic acid, Trimethylglycine, Tyrosine, and Vinpocetine.

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Subscribe to a FREE Supplement Research Update newsletter. Twice a month you will receive an email with a review of several studies on various supplements and natural medicine topics, including menopause treatment, and their practical interpretation by Ray Sahelian, M.D.

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 a decrease in sex drive and in the amount of sex they are having since entering menopause. But, there is hope. Passion Rx could help.

PASSION Rx--- Formulated by Ray Sahelian, M.D. for Men and Women

How quickly does Passion Rx work?
Passion Rx provides results that are often seen within several days, and continue to improve over time. Our feedback thus far indicates more than 85% user satisfaction.

A UNIQUE FORMULA
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. The exact dosages and extract potencies of this UNIQUE aphrodisiac blend is a close kept secret only known to the doctor and his research staff. You will only find this exact combination in Passion Rx.

Maca herb as a natural menopause treatment
Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content.
Menopause. 2008 Sep 6. Brooks NA, Wilcox G, Walker KZ, Ashton JF, Cox MB, Stojanovska L. From the 1School of Biomedical and Health Sciences, 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; Nutrition and Dietetics Unit, Department of Medicine, Monash University, Clayton, Victoria, Australia; and Baker Heart Research Institute, Melbourne, Victoria, Australia; 4Sanitarium Development and Innovation, Cooranbong, New South Wales, Australia; and Border Biomedical Research Center and Department of Biological Sciences, University of Texas at El Paso, El Paso, TX.
To examine the estrogenic and androgenic activity of Lepidium meyenii (Maca) and its effect on the hormonal profile and symptoms in postmenopausal women. 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 Lepidium meyenii (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 hysterectomy
Menopause arrives nearly four years earlier on average for women who have had a hysterectomy compared with those who have not.

Menopause Research studies
Black cohosh and St. John's wort for climacteric complaints: a randomized trial.
Obstet Gynecol. 2006 Feb;107(2 Pt 1):247-55. Clinic of Psychiatry, Clinic of Gynecology and St. Gertrauden-Krankenhaus, University Hospital Charite of the Humboldt-University, Berlin, Germany.
To investigate the efficacy of the fixed combination of black cohosh (Cimicifuga racemosa) and St. John's wort (Hypericum perforatum) extracts in women with climacteric complaints with a pronounced psychological component. METHODS: In this double-blind randomized placebo-control study, 301 women experiencing climacteric complaints with psychological symptoms were treated with ethanolic St. John's wort extract and isopropanolic black cohosh extract or a matched placebo for 16 weeks. Climacteric complaints were evaluated by means of the Menopause Rating Scale mean score, and psychological complaints were evaluated using the Hamilton Depression Rating Scale sum score. RESULTS: The mean (+/- standard deviation) Menopause Rating Scale score decreased 50% in the treatment group and 20% in the placebo group. The Hamilton Depression Rating Scale total score decreased 41% in the treatment group, and 13% in the placebo group. The treatment was significantly superior to placebo in both measures. There were no relevant group differences regarding adverse events, laboratory values, or tolerability. CONCLUSION: This combination of black cohosh and St. John's wort is superior to placebo in alleviating menopausal complaints, including the related psychological component.

The prevalence of early menopause, also known as premature ovarian failure, among identical and fraternal twins is triple that of women in the general population.

Pairing up two commonly used herbal medicines, black cohosh and St. John's wort, helps ease physical and psychological symptoms of menopause. St. John's wort is widely used to treat mild to moderate depression, while women have traditionally taken black cohosh for menopausal complaints. 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. Source: Obstetrics & Gynecology, February 2006.

Hormone replacement therapy (HRT) for menopause is associated with an increased risk of severe stroke. The results of individual trials have produced inconsistent results, explain Drs. Philip M. W. Bath and Laura J. Gray of the University of Nottingham, UK, in the British Medical Journal. Their goal therefore was to systematically review evidence from completed clinical trials analyzing the relationship between stroke and HRT. The team identified 28 trials that included nearly 40,000 women whose average age ranged from 55 to 71 years. The subjects were followed for about 1 to 7 years. The pooled data showed that, overall, the menopause women who used hormone replacement had a 29 percent higher risk of stroke than those in comparison groups.

A woman's month of birth determines more than just her star sign, it also influences the age when menopause begins. Scientists from the University of Modena in Italy have discovered that women born in March have the earliest age of menopause, while those with an October birthday have the latest. The age of menopause is influenced by the season in which a woman is born.

Non-estrogen treatment modalities for vasomotor symptoms associated with menopause.
Ann Pharmacother. 2004 Sep;38(9):1482-99. Epub 2004 Aug 03.
To systematically review the literature regarding the efficacy and safety of nonestrogen treatments for menopause-associated vasomotor symptoms not due to cancer or chemotherapy.  Prescription medications reviewed for efficacy and safety in postmenopausal vasomotor symptoms include clonidine hydrochloride, danazol, gabapentin, methyldopa, mirtazapine, progestins, Inderal, selective serotonin-reuptake inhibitors (SSRIs), and venlafaxine. Nonprescription therapies reviewed include black cohosh, dong quai, evening primrose oil, physical activity, phytoestrogens, and red clover. CONCLUSIONS: According to this systematic literature review, postmenopausal vasomotor treatments that have been shown to be safe and effective in short-term use include black cohosh, exercise, gabapentin, medroxyprogesterone acetate, SSRIs (ie, paroxetine hydrochloride), and soy protein.

Estrogen pills appear to slightly increase the risk of Alzheimer’s disease and other forms of dementia in post menopausel women, a study found, echoing recent findings involving estrogen-progestin supplements. The findings contradict the long-held belief that estrogen pills can help keep older women’s minds sharp. The results came from a government study called the Women’s Health Initiative and were published in The Journal of the American Medical Association. The research involved nearly 3,000 women, ages 65 to 79, who had had hysterectomies and had taken daily estrogen-only pills, sold by Wyeth Pharmaceuticals as Premarin, for an average of about five years.

They say there's a season for everything, and that may even be true for menopause. In a small survey from Hungary, women were most likely to stop having their period soon after the spring and fall equinoxes. There was a peak after the spring equinox and a smaller one after the autumn equinox, according to a team led by Dr. Janos Garai at the University of Pecs. The findings suggest that factors other than the dwindling of a woman's egg supply influence when she enters menopause, the researchers note in the journal Human Reproduction.

Vitamin C Supplement Use and Bone Mineral Density in Postmenopausal Women
J Bone Miner Res 2001 Jan;16(1):135-40. Morton DJ; Barrett-Connor EL; Schneider DL . University of California, San Diego, La Jolla, USA.
Vitamin C is known to stimulate collagen and bone synthesis. Studies of dietary vitamin C intake and the relation with bone mineral density (BMD) have been conflicting, probably because of the well-known limitations of dietary nutrient assessment questionnaires. The purpose of this study was to evaluate the independent relation of daily vitamin C supplement use with BMD in a population-based sample of postmenopausal women. Subjects were 994 women from a community-based cohort of whom 277 women were regular vitamin C supplement users. Vitamin C supplement use was validated. Daily vitamin C supplement intake ranged from 100 to 5,000 mg; the mean daily dose was 745 mg. Average duration of use was 12.4 years; 85% had taken vitamin C supplements for more than 3 years. BMD levels were measured at the ultradistal and midshaft radii, hip, and lumbar spine. After adjusting for age, body mass index (BMI), and total calcium intake, vitamin C users had BMD levels approximately 3% higher at the midshaft radius, femoral neck, and total hip. In a fully adjusted model, significant differences remained at the femoral neck (p < 0.02) and marginal significance was observed at the total hip. Women taking both estrogen and vitamin C had significantly higher BMD levels at all sites. Among current estrogen users, those also taking vitamin C had higher BMD levels at all sites, with marginal significance achieved at the ultradistal radius, femoral neck, and total hip. Women who took vitamin C plus calcium and estrogen had the highest BMD at the femoral neck, total hip, ultradistal radius, and lumbar spine. Vitamin C supplement use appears to have a beneficial effect on levels of BMD, especially among postmenopausal women using concurrent estrogen therapy and calcium supplements.

What is Menopause?
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 ore even earlier. Regular menstrual cycles may continue up to menopause, but usually the last 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.

Symptoms of Menopause
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.

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.

Natural Remedies to the Rescue
There are a number of natural nutrients and herbs that have been studied for the therapy of menopausal symtoms. They include calcium, magnesium, St. John's wort, soy isoflavanoids, ginseng, black cohosh, red clover leaf, and chaste berry extract. Let's evaluate each one of these supplements.

Calcium and Magnesium
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.

St. John's Wort and menopause
One of the most common symptoms of menopause is mood changes, such as mood swings or depression. In a German study published in 1999, 111 women in a general medical practice were given St. John's wort daily for12 weeks. The patients, who were between 43 and 65 years old, had perimenopausal symptoms. The incidence and severity of typical psychological symptoms were recorded at baseline and after 5, 8, and 12 weeks of treatment. Substantial improvement in psychological symptoms was observed in the women treated with St. John's wort. Perimenopausal complaints diminished or disappeared completely in the majority of women. Of note, sexual well-being also improved after treatment with St. John's wort extract.

Soy Isoflavonoids and menopause
Isoflavones are types of flavonoids found in plants. The main sources for isoflavones are soy products, beans, peas, nuts, grain products, coffee, tea and certain herbs. Genistein is one of the best known and studied isoflavones and is found in high amounts in soy. Isoflavonoid ompounds in plants that have estrogen-like properties are called phytoestrogens. Isoflavones are proposed to have health benefits in a variety of human conditions, including coronary heart disease, menopause, osteoporosis, and endocrine-responsive cancers. Many isoflavones have estrogen-like properties and, because of a favorable side-effect profile, may be ideal alternatives to hormone replacement therapy with respect to cardiovascular benefits. Increased isoflavone intake affects estrogen metabolism by altering the steroid hormone concentrations and menstrual cycle length, thereby demonstrating a potential to reduce the risk for breast carcinoma.

Ginseng and menopause
The root of the ginseng plant has been used in China, Japan, and Korea for many centuries in the therapy of psychiatric and neurological disorders, and for enhancing vitality. Ginseng contains several saponins named ginsenosides that are believed to contribute to the adaptogenic properties. They are used in traditional Chinese medicine to improve stamina and combat fatigue and stress. Saponins are interesting natural compounds found in many plants, herbs, roots, and beans.
A randomized, double-blind, study was performed at the University of Bergen, in Norway to assess the effects of a standardized ginseng extract compared with those of a placebo on quality of life in symptomatic postmenopausal women. The study lasted 16 weeks and included 384 women.. The results showed the women who were on ginseng had improved their depression, and many of them reported a sense of well-being.

Black Cohosh and menopause
Black cohosh (cimicifuga racemosa), is native to eastern North America, and has historically been used by Native Americans for a variety of female conditions. Black cohosh contains a variety of phytoestrogens. The German Comminssion E has approved black cohosh for the treatment of menopausal symptoms, premenstrual syndrome, and dysmenorrhea. A survey of women done at the University of San Francisco published in 2002 indicated that women who used a combination of herbal remedies and estrogen were more satisfied in the outcome of their symptoms compared to women who used estrogen alone or herbs alone. The supplements mentioned in the study were black cohosh, ginkgo, and soy. Studies have demonstrated that this botanical medicine, when standardized properly to the terpene glycoside fraction, appears to be effective in alleviating menopausal symptoms. Adverse effects are extremely uncommon.

Red Clover Leaf
Red clover is a native plant of Europe, central Asia, and northern Africa. The flower head is the part of the plant used in herbal remedies. Scientists have identified estrogen-like substances called isoflavones and anticoagulant chemicals called coumarins in red clover. To investigate the effectiveness and safety of a red clover isoflavone dietary supplement versus placebo on the change in hot flush frequency in postmenopausal women, a randomized, double blind, placebo-controlled trial was done at Vrije University Medical Center in Amsterdam, The Netherlands. Women with more than 12 months without periods and experiencing more than five flushes per day were enrolled. All received placebo tablets for 4 weeks and were subsequently randomized to either placebo or 80 mg isoflavones for a further 12 weeks. Improvement was measured by the decrease in number of hot flushes per day. During the first 4 weeks of placebo the frequency of hot flushes decreased by 16%. During the subsequent double blind phase, a further, statistically significant decrease of 44% was seen in the isoflavone group, whereas no further reduction occurred within the placebo group.

Chaste Berry Extract and menopause
Chaste Berry (Vitex agnus-castus) is a tree native to creek beds and river banks of the Mediterranean and Central Asia. Its pointy-leafed branches bear clusters of lavender flowers that are followed by reddish-black pepper-sized fruits. These fruits have long been used as traditional medicine for female conditions.
Chaste berry contains several different constituents, including flavonoids, iridoid glycosides, and terpenoids. Chaste berry does not contain hormones. Chaste Berry is thought to be able to help regulate hormones because of its effects on pituitary function. When Chaste Berry is taken as a dietary supplement, the pituitary produces lutenizing hormone which then produces more progesterone at the second phase (luteal phase) of the woman's cycle. Chaste Berry also is able to decrease high levels of prolactin, a hormone that is normally produced in the second phase of a women's cycle. When prolactin is present in large amounts it produces breast tenderness. Chaste Berry is commonly used in Europefor hot flashes associated with perimenopause (the transition years into menopause). alternative therapy menopause natural treatment

Menopause has an influence on female sexual dysfunction

For information on male menopause, see Male Menopause andropause

Menopause natural treatment 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.

Q. Is there a natural product that a 40 year old should be taken to ease the effects of future menopause. I have heard of isoflavones.
   A. 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.

Q. 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. 
   A. 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.