Menopause marks the end of a woman’s fertility and the cessation of both ovarian function and menstruation. Menopause is a normal event in a woman’s life, denoting a natural transition from the child-bearing years, to an end of that phase.
In normal cessation, when a woman has not had a menstrual period for 6 to 12 months, she has reached menopause. During menopause, there is a declining production of the sex hormones, estrogen and progesterone. These natural changes in a woman’s body usually occur between the ages of 45 and 55 years old. Younger women may also experience menopause caused by certain medical conditions or treatments, such as; the removal of ovaries, genetic predisposition, or cancer treatments (chemotherapy or radiation to the pelvic area).
The first signs of menopause may begin with perimenopause, a transitional stage that can occur for 10 or more years before actual menopause begins. Women in their mid to late thirties and early forties may experience irregular hormone levels and symptoms, like occasional bloating and insomnia, mood swings, and breast tenderness.
The long-term health risks associated with menopause and the decline of estrogen, may include weight gain, cardiovascular disease, osteoporosis, and Alzheimer's disease. Menopausal women can effectively manage the majority of symptoms and risk factors by choosing and developing lifestyle habits that promote and maintain proper health. [1-3]
According to the Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services :
- About 37.5 million women, ages 40 to 59, are reaching or are currently at menopause
- The onset of menopause typically occurs between the ages of 45 and 55
- A woman has reached menopause when she has not had a period for 12 consecutive months
Menopausal symptoms caused by certain hormonal imbalances commonly occur around the ages of 45-55, and can include;
- hot flashes (flushing in the face, neck, or chest)
- night sweats
- mood swings (anxiety and depression)
- muscle and joint stiffness and pain
- diminished libido (sexual drive)
- vaginal dryness
- heart palpitations
- water retention (edema)
- decreased metabolism leading to weight gain
- bone demineralization leading to osteoporosis
- changes in the skin and hair; leading to skin wrinkling and loss of tone, hair loss on the scalp, and hair growth on the face
- increased risk of cardiovascular disease
- increased risk of Alzheimer’s disease
Until the results of the Women’s Health Initiative (WHI) were reported in the July 2002 issue of the Journal of the American Medical Association (JAMA), hormone replacement therapy (HRT) was the main method for treating the symptoms of menopause.  HRT, a combination of synthetic estrogen and progesterone (progestogen), was also believed to reduce the risk of conditions such as bowel cancer and osteoporosis. However, during the course of the WHI study, which involved more than 16,000 women, researchers found significant increases in the risks of heart disease, stroke, blood clots, and breast cancer among the participants. This caused a premature stoppage of the study.
Researchers concluded that the harm from the use of synthetic hormones, far exceeded their benefits; which included, the reduction in bowel cancers, fractures, and menopausal symptoms. Other large studies, including the Heart and Estrogen/Progestin Replacement Studies, have demonstrated similar risks as the WHI study. [5-7] Given the risks associated with synthetic HRT, there has been a strong search by both the medical community and menopausal women to find safe and effective natural approaches to treating menopause.
Calcium, the body’s most abundant mineral, is critical for bone health and strength. Studies have shown that calcium supplementation helps to reduce the bone loss, and fractures, in menopausal women. [8-10] Experts suggest that calcium citrate is the best form of calcium supplementation. This may be, in large part, due to cal. citrate’s enhanced absorption percentages within the body, and the decreased risk of kidney stone development. 
Magnesium aids calcium bone absorption and is as important as calcium in maintaining the integrity of developed bones, as well as in decreasing the risk of bone fractures. Studies show that low levels of magnesium are associated with decreased bone density and osteoporosis. [12-14] Magnesium may also have a mild relaxing effect on muscles.  Experts suggest that magnesium aspartate or magnesium citrate be used for supplementation because of its assimilation within the body.  Magnesium should always be taken in a two-to-one ratio with calcium (take half as much magnesium as calcium).
Vitamin D aids in calcium bone absorption and is an important nutrient for the maintenance of strong and healthy bones. Studies show that low levels of vitamin D are associated with decreased bone density in menopausal women. [17-21]
Bioflavonoids and Vitamin C
Citrus bioflavonoids, such as hesperidin, in combination with vitamin C have been shown to improve many symptoms common in menopause. Among these are; an improvement in venous strength and function, and relief from hot flashes.  Studies also suggest that vitamin C supplementation may help maintain bone strength. [23-26]
Vitamin E supplementation may be effective in relieving hot flashes and vaginal problems associated with menopause. 
Soy isoflavones, such as genistein and daidzein, contain phytoestrogens that may relieve menopausal symptoms, including hot flashes and atrophic vaginitis. They may also be equally effective in helping to maintain bone strength and providing a reduction the risk of heart disease and certain cancers (including breast cancer). [27-32]
Phytoestrogens produce a weak estrogenic action, similar to the natural estrogens found in the body. Although numerous studies have found that soy may reduce the risk of breast cancer, some research suggest that soy isoflavones may stimulate estrogen-dependent breast cancer cells by raising estrogen levels. [33-35] As a result, women with estrogen-positive breast cancer, or women at high risk for breast cancer, should take isoflavones only under the supervision of a health care practitioner.
Gamma oryzanol is a natural antioxidant found in grains and other foods. This ester of ferulic acid is produced, largely, from rice bran oil. Gamma oryzanol has been used medicinally by the Japanese for the treatment of menopause. Several Japanese studies found that treatment with gamma oryzanol improved symptoms in menopausal women, including hot flashes, insomnia, and anxiety. [36-37] Gamma oryzanol’s beneficial effects appear to be due to its ability to reduce the secretion of leutinizing hormones (LH) by the pituitary, and by increasing excretion of endorphins by the hypothalamus gland.
Flaxseed oil contains essential fatty acids that may reduce the risk of heart disease and regulate hormonal metabolism in menopausal women. [38-39]
Dong quai, or Angelica sinensis, is an Asian botanical that has been traditionally used to treat menstrual and menopausal symptoms. Dong quai has weak estrogen-like activity that may be helpful in relieving hot flashes.  However, some studies question dong quai’s effectiveness in treating menopausal symptoms. [41-44]
Black cohosh, or Cimicifuga racemosa, is a Native American botanical that has been used for centuries, in the treatment of both menstrual and menopausal symptoms. RemifeminÂ®, a medication for the treatment of menopause, is a standardized extract of black cohosh that contains the phytoestrogen, formononetin. Formononetin has demonstrated estrogen-like activity and has been used in Europe as an alternative to hormone replacement therapy. Studies have shown that black cohosh improves symptoms in menopausal women, including hot flashes, insomnia, and anxiety. [40, 45-48]
Chasteberry, or Vitex agnus-castus, is a Mediterranean botanical that has been studied in the natural treatments of premenstrual and menopausal symptoms. Chasteberry’s beneficial effects appear to be due to its ability to stimulate the secretion of leutinizing hormone (LH) by the pituitary. It may also produce a reduction in the excretion of follicle-stimulating hormone, or FSH. [40, 49-53]
Red clover extract, containing the hytoestrogens biochanin A, fomonontein, genistein, and daidzein, has weak estrogenic effects that may be a potential treatment option for menopause sufferers. Studies involving Promensil Â®, a standardized extract of red clover, have reported mixed results in the treatment of various menopausal symptoms. [54, 55]
DHEA, an adrenal hormone, may produce similar hormonal effects as hormone replacement therapies. DHEA may also be effective in relieving menopausal symptoms, including; reduced libido, depression, decreased bone density, and increased cardiovascular risk. [56-62] Studies show that low levels of DHEA are directly associated with greater symptoms of depression in menopausal and post-menopausal women. [56-58]
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