Sharon Salomon, M.S., R.D.s

Environmental Nutrition Newsletter

With age comes wisdom. And for many women, age also brings hot flashes, vaginal dryness and moodiness. This is menopause, the time in a woman's life when her menstrual periods stop. That's something many women would look forward to if the change were swift and uneventful. Alas, that is not usually the case.

During perimenopause (the time leading up to menopause) and menopause, women may experience hot flashes, moodiness, sleep disturbances, declining sexual desire and weight change. Declining levels of estrogen, along with other hormonal changes, are usually responsible for the discomfort women suffer.

Some women barely feel a thing and get through the "change of life" with few complaints. Others live with symptoms so severe that the impact on quality of life is enormous. Symptoms attributed to declining estrogen levels include:

-- Vasomotor problems, including hot flashes

-- Somatic issues, such as muscle and joint pain, headache, dizziness, tingling and urinary frequency

-- Psychological changes, including problems with sleep and concentration, depression and mood swings

-- Sexual problems, such as low libido and vaginal dryness


The easiest way to alleviate symptoms is to replace waning levels of estrogen with drugs. Hormone replacement therapy (HRT) may be an easy solution but it's not without controversy. Since the 2002 release of data from the long-term health study, Women's Health Initiative (WHI), which suggested an increase in cancer, heart disease and other health problems related to HRT, more and more women are reluctant to rely on HRT.

Yet, some of the results of the WHI have been called into question. In a 2009 article in the Bulletin of the New York University Hospital for Joint Diseases, the authors report design flaws in the WHI study, including study subjects that were older and sicker than normally would be treated for menopausal symptoms. Flawed study notwithstanding, many women still prefer to use "natural" means of dealing with their symptoms. Alternatives to HRT do exist, although they are not necessarily safer or produce the same level of relief.


Soyfoods like tofu and edamame contain beneficial phytoestrogens (plant estrogen-like substances) called isoflavones that appear to reduce the risk of certain kinds of cancer and heart disease, as well as ameliorate hot flashes. The research results have been strong in some studies, but uncertain in others.

Mark Messina, Ph.D., M.S., a soy expert and nutrition professor at Loma Linda University in California, reports, "In an analysis that includes 17 studies, we found that in about 80 percent of the studies that evaluated the efficacy of isoflavones there was a statistically significant improvement in hot flashes; severity and frequency was reduced by about 50 percent. My view, therefore, is that isoflavones represent an alternative to estrogen for the treatment of hot flashes."

On the other hand, a 2004 meta analysis published in Obstetrics and Gynecology found that the evidence from studies done between 1966 and 2004 to assess the efficacy of phytoestrogens for the treatment of menopause suggests that those found in soy foods and extracts do not improve hot flashes or other menopausal symptoms.

Why are the findings inconsistent?

"Individuals differ dramatically in their metabolism of isoflavones," explains Messina. Belinda Jenks, Ph.D., R.D., Director of Scientific Affairs and Nutrition Education at Pharmavite, LLC, studies equol, a metabolite of a soy isoflavone. She adds, "Approximately 50 percent of Asians and 20 to 30 percent of North Americans and Europeans have the ability to produce equol in their gut. Studies in Japan have documented an association between milder menopausal symptoms in equol producers compared to non-equol producers."

Although the evidence for soy seems inconclusive, there is enough to suggest that some women may benefit from eating it. Messina suggests that 50 milligrams--the amount in two servings (about 3-4 ounces each) of soyfoods such as tofu or soyburgers--are needed daily to alleviate hot flashes in most women.

Remember that whole soyfoods, such as soybeans and tofu, are healthful and offer benefits beyond reducing menopausal discomforts--they are high in fiber and protein, and isoflavones also appear to protect against cancer and heart disease.


There are many plant-based foods that contain components that may have a favorable effect on menopausal complaints. Positive reports for botanicals are often anecdotal--women reporting that a particular remedy was helpful. Scientific research for most botanicals, on the other hand, has not supported their effectiveness.

Be aware also that just because something is "natural," that doesn't mean it's safe. Some plant-based treatments can damage organs or interfere with traditional prescription medications, and few have gone through extensive safety testing.

The botanical with the strongest research is black cohosh, an herb in the buttercup family. In a 1996 to 2002 review of complementary and alternative therapies for menopausal symptoms published in Annals of Internal Medicine in 2002, researchers concluded that black cohosh showed promise for the treatment of menopausal symptoms, though the research was not conclusive at that time.

According to a current report from the National Institutes of Health Office of Dietary Supplements, the evidence on black cohosh's efficacy is encouraging and it's probably safe for short-term use, but the science is not yet sufficient to warrant recommending it. Because dietary supplements are regulated as foods and not drugs, composition may vary from product to product, which may explain why black cohosh works for some women and not for others.

Dong quai, a traditional Chinese medicine, has not been shown to reduce symptoms associated with menopause, nor has evening primrose oil, vitamin E or chasteberry. Yet their effectiveness continues to be touted in articles and advertisements.

Maca, a derivative of a plant found in the Andes, has shown promising results in preliminary trials, but scientists reported in International Journal of Biomedical Science in 2005 that, although there was a decrease in symptoms among subjects taking maca, a significant placebo effect occurred, casting doubt on the strength of the results.

Why is there no consensus? There are many theories about why research on natural treatments to beat menopausal symptoms has been so equivocal. Some doctors believe that it is difficult to differentiate among symptoms of menopause and those resulting from normal aging. Others point to the "placebo effect," as some studies show an improvement in symptoms in the placebo group almost equal to the treatment group.

According to an article published in 2001 in Social Science and Medicine, when controlling for age, education, health and economic status, Caucasian women reported significantly more psychosomatic (associated with the body and the mind) symptoms than other racial groups, whereas African-American women reported more vasomotor symptoms like hot flashes.

The authors believe that this pattern of results argues against a universal menopausal syndrome.

While you're waiting for scientific research to spell out the answers, check out EN's Best Advice for Menopausal Symptom Relief.

Before you try HRT or alternative treatments:

Exercise daily to keep bones and heart strong.

Try yoga or meditation for relaxation.

Avoid caffeine and alcohol before bedtime, especially of you have trouble sleeping.

Drink plenty of fluids throughout the day.

Be sure to get enough calcium, Vitamin D and protein.

If you smoke, stop.

Try vaginal lubricants.

Practice Kegel exercises (contracting and relaxing pelvic muscles).

Dress in layers

Use a fan at night to keep cool.

Consult your healthcare provider about depression, sleeplessness and mood swings.


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Health - Managing Menopause Naturally