There is so much information and controversy about managing menopause symptoms that it all gets very confusing. Today I thought it would be good to take a look at the evidence for different treatments. The hormones estrogen, progesterone and testosterone affect our mood, weight, food cravings, sex drive and overall wellbeing and quality of life. Throughout our lives the levels of these hormones change, notably at menopause.
After twelve months without a menstrual period, you are considered to be in menopause. The ovaries stop releasing eggs and levels of estrogen and progesterone drop in the body. Most commonly, women experience this around 52 years of age with symptoms of:
- Hot flushes
- Racing heart
- Mood swings
- Sleep disturbances
- Vaginal dryness
80% of women will experience symptoms, generally lasting only for a couple of years. Unfortunately, around 15% of women will suffer severe menopause symptoms that can go on for many years.
The question of Hormone Replacement Therapy (HRT)
The use of HRT has changed over time, with a peak use in the late 1990s. Then the results of the Women’s Health Initiative study were published, finding an increased risk of stroke, heart attack and breast cancer amongst HRT users. Despite benefits in the prevention of osteoporosis and fractures, HRT was then recommended to only be used by healthy women suffering debilitating menopause symptoms for short term treatment.
In February 2015, a review of previous studies was published in the Lancet describing an increased risk of ovarian cancer in women taking HRT. It is important that if you are thinking about using HRT, that you are informed of the risks and benefits and discuss them with your doctor.
Understandably, many women are looking for alternatives to HRT and the good news is that there a few. A class of anti-depressants called Selective serotonin re-uptake inhibitors (SSRIs) block the uptake of our feel good chemical, serotonin, in the brain. This increases the amount of serotonin available which is thought to improve symptoms of depression. Serotonin is also thought to have a role in regulating body heat so an increase in levels seems to improve mood swings, irritability and hot flushes in some women in menopause.
Three complementary medicines that have shown in studies to have some benefit in relieving menopausal symptoms are red clover, soy and black cohosh. Red clover and soy are both phytoestrogens or plant compounds that are structurally similar to estrogen so can act like estrogen in our bodies. They have been shown to offer slight to modest reduction in hot flushes with few side effects. Some gut upset can occur and they should not be used by ladies with breast cancer or taking tamoxifen. They can take two to three months to have their full effect so if you are trying red clover or soy, it is worth doing so for a trial of three months or more.
Black cohosh is a phytosterol that regulates hormones, is anti-inflammatory and affects serotonin and dopamine levels in the body. Some studies have shown an improvement of hot flushes and is generally well tolerated. Black cohosh should not be taken if your liver is impaired. Go Healthy Meno-Free 1-a-day capsules contain a combination of black cohosh, red clover and other herbs that may help temperature balance, mood and disrupted sleep.
Clinical trials are limited on other herbal remedies in menopause, but there is a small amount of evidence showing positive results with valerian in insomnia and St John’s wort in mood disturbances and sexual wellbeing. Again this should be trialled for three months or more for full effect.
Lifestyle changes may also offer relief. Reduce stress and practice relaxation techniques like meditation, yoga or a nice walk in the fresh air. Walking and other weight-bearing exercise is good for your bones and mood too.
Make a special effort to eat a healthy diet, low in saturated fat and high in calcium and fibre. Balance your blood sugar levels by eating small amounts often and include protein in each meal. Smoking of course is a no no and try to limit tea, coffee and alcohol. A lubricant can be helpful if vaginal dryness is bothering you and please ask for help if you are feeling emotionally distressed.
Our hormones are so complicated and affect all areas of our bodies. Your health professional of choice can order blood tests of hormone levels and help to determine what needs to be addressed.