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Menopause

 

Menopause Introduction

:menopause.jpg 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]

Menopause Statistics

According to the Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services [1]:

  • 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

Menopause Symptoms

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
  • insomnia
  • 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

Menopause Treatment

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. [4] 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.

Supplements helpful for Menopause

Calcium

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. [11]

Magnesium

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. [15] Experts suggest that magnesium aspartate or magnesium citrate be used for supplementation because of its assimilation within the body. [16] Magnesium should always be taken in a two-to-one ratio with calcium (take half as much magnesium as calcium).

Vitamin D

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. [22] Studies also suggest that vitamin C supplementation may help maintain bone strength. [23-26]

Vitamin E

Vitamin E supplementation may be effective in relieving hot flashes and vaginal problems associated with menopause. [22]

Soy isoflavones

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

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

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

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. [40] However, some studies question dong quai’s effectiveness in treating menopausal symptoms. [41-44]

Black cohosh

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. Remifemin®, 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

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

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 ®, a standardized extract of red clover, have reported mixed results in the treatment of various menopausal symptoms. [54, 55]

DHEA (Dehydroepiandrosterone)

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]

References

1. CDC, Centers for Disease Control and Prevention, “Women’s Reproductive Health: Menopause. Available at:

http://www.cdc.gov/reproductivehealth//WomensRH/Menopause.htm

2. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 628-644.

3. Stoppard M. Family Health Guide, New York: DK Publishing, 2002: 497-503.

4. Writing Group for the Women’s Health Initiative Investigators. Women’s Health Initiative. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. Jul2002;288(3):321-33.

5. Hulley S et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study follow-up (HERS). JAMA. 1998;280:605-613

6. Grady D et al, HERS Research Group. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. Jul2002;288(1):49-57.

7. Schairer et al. Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA. Jul2000;283: 485-491.

8. Lee CJ et al. Effects of supplementation of the diets with calcium and calcium-rich foods on bone density of elderly females with osteoporosis. Am J Clin Nutr 1981; (34):819-823.

9. Reid IR et al. Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: A randomized controlled trial. Am J J Med 1995;(08):331-335

10. Wishart JM, Clifton PM, Nordin BE. Effect of perimenopause on calcium absorption: a longitudinal study. Climacteric. Jun2000;3(2):102-8.

11. Murray MT. Encyclopedia of Nutritional Supplements, NY: Three Rivers Press, 1996: 156.

12. Cohen L et al. Infrared spectroscopy and magnesium content of bone mneral in osteoporotic women. Isr J Med Sci 1981;(17):1123-1125

13. Sojka JE, et al. Magnesium Supplementation and Osteoporosis. Nutr Rev. 1995;53(3):71-74.

14. Tranquilli AL, et al. Calcium, Phosphorus, and Magnesium Intakes Correlate with Bone Mineral Content in Postmenopausal Women. Gynecol Endrocrinol. 1994;8(1):55-58.

15. Altura BM, et al. Role of Magnesium in Patho-physiological Processes and the Clinical Utility of Magnesium Ion Selective Electrodes. Scand J Clin Lab Invest. 1996;224S: 211-34. 16. Murray MT. Encyclopedia of Nutritional Supplements, NY: Three Rivers Press, 1996: 162.

17. Villareal DT, et al. Subclinical Vitamin D Deficiency in Postmenopausal Women with Low Vertebral Bone Mass. Journal of Clinical Endocrinology and Metabolism. 1991;72(3):628-34.

18. Rassouli A, Milanian I, Moslemi-Zadeh M. Determination of serum 25-hydroxyvitamin D(3) levels in early postmenopausal Iranian women: relationship with bone mineral density. Bone. Nov2001;29(5):428-30.

19. Mezquita-Raya P, Munoz-Torres M, Luna JD, et al. Relation between vitamin D insufficiency, bone density, and bone metabolism in healthy postmenopausal women. J Bone Miner Res. Aug2001;16(8):1408-15.

20. Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP, Sorensen OH. Vitamin D status and its adequacy in healthy Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Br J Nutr. Aug2001;86(Suppl 1):S97-103.

21. Mezquita Raya P, Munoz Torres M, Lopez Rodriguez F, et al. Prevalence of vitamin D deficiency in populations at risk for osteoporosis: impact on bone integrity. Med Clin (Barc). Jun2002;119(3):85-9.

22. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 638.

23. Morton DJ, Barrett-Connor EL, Schneider DL. Vitamin C supplement use and bone mineral density in postmenopausal women. J Bone Miner Res. Jan2001;16(1):135-40.

24. Hall SL, Greendale GA. The relation of dietary vitamin C intake to bone mineral density: results from the PEPI study. Calcif Tissue Int. Sep1998;63(3):183-9.

25. Wang MC, Luz Villa M, Marcus R, Kelsey JL. Associations of vitamin C, calcium and protein with bone mass in postmenopausal Mexican American women. Osteoporos Int. 1997;7(6):533-8.

26. Leveille SG, LaCroix AZ, Koepsell TD, Beresford SA, Van Belle G, Buchner DM. Dietary vitamin C and bone mineral density in postmenopausal women in Washington State, USA. J Epidemiol Community Health. Oct1997;51(5):479-85.

27. Kritz-Silverstein D, Goodman-Gruen DL. Usual dietary isoflavone intake, bone mineral density, and bone metabolism in postmenopausal women. J Womens Health Gend Based Med. Jan2002;11(1):69-78.

28. Adlercreutz H. Soybean phytoestrogen intake and cancer risk. J Nutr. 1995 Mar;125(3 Suppl):757S-770S.

29. Cotroneo MS, Wang J, Fritz WA, Eltoum IE, Lamartiniere CA. Genistein action in the prepubertal mammary gland in a chemoprevention model. Carcinogenesis. Sep2002;23(9):1467-1474.

30. Wu AH, Wan P, Hankin J, Tseng CC, Yu MC, Pike MC. Adolescent and adult soy intake and risk of breast cancer in Asian-Americans. Carcinogenesis. Sep2002;23(9):1491-6.

31. Ishimi Y, et al. Selective effects of genistein, a soybean isoflavone, on B-lymphopoiesis and bone loss caused by estrogen deficiency. Endocrinology. 1999;140:1893-1900.

32. Setchell KD, et al. Dietary isoflavones: biological effects and relevance to human health. J Nutr. 1999;129:758S-767S.

33. Allred CD, Allred KF, Ju YH, et al. Soy diets containing varying amounts of genistein stimulate growth of estrogen-dependent (MCF-7) tumors in a dose-dependent manner. Cancer Res. Jul2001;61(13):5045-50.

34. Hsieh CY, Santell RC, Haslam SZ, Helferich WG. Estrogenic effects of genistein on the growth of estrogen receptor-positive human breast cancer (MCF-7) cells in vitro and in vivo. Cancer Res. Sep1998;58(17):3833-8.

35. Ju YH, Doerge DR, Allred KF, Allred CD, Helferich WG. Dietary Genistein Negates the Inhibitory Effect of Tamoxifen on Growth of Estrogen-dependent Human Breast Cancer (MCF-7) Cells Implanted in Athymic Mice. Cancer Res. May2002;62(9):2474-7.

36. Ishihara M. Effect of of gamma-oryzanol on serum lipid peroxide levels and climacteric disturbances. Asia Oceania J Ostet Gynecol 1984; 10:317

37. Ishihara M, Ito Y, Nakakita T, et al. Clinical effect of gamma-oryzanol on climacteric disturbance -on serum lipid peroxides. Nippon Sanka Fujinka Gakkai Zasshi. Feb1982;34(2):243-51.

38. Lucas EA, Wild RD, Hammond LJ, Khalil DA, Juma S, Daggy BP, et al. Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women. J Clin Endocrinol Metab. Apr2002;87(4):1527-32.

39. Hutchins AM, Martini MC, Olson BA, Thomas W, Slavin JL. Flaxseed consumption influences endogenous hormone concentrations in postmenopausal women. Nutr Cancer. 2001;39(1):58-65.

40. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 639.

41. Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. Dec1997;68(6):981-6.

42. Willhite LA, O’Connell MB. Urogenital atrophy: prevention and treatment. Pharmacotherapy. Apr2001;21(4):464-80.

43. Hardy ML. Herbs of special interest to women. J Am Pharm Assoc (Wash). Mar2000;40(2):234-42.

44. Shaw CR. The perimenopausal hot flash: epidemiology, physiology, and treatment. Nurse Pract. Mar1997;22(3):55-6, 61-6.

45. Lieberman S. A Review of the Effectiveness of Cimicifuga racemosa (black cohosh) for the Symptoms of Menopause. J Womens Health. Jun1998;7(5):525-29.

46. Dog TL, Powell KL, Weisman SM. Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Menopause. Jul2003;10(4):299-313.

47. McKenna DJ, et al. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med. May2001;7(3):93-100.

48. Liske E, et al. Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. Mar2002;11(2):163-74.

49. Milewicz A, et al. Vitex Agnus castus Extract in the Treatment of Luteal Phase Defects Due to Latent Hyperprolactinemia. Results of a Randomized Placebo-controlled Double-blind Study. Arzneim Forsch/Drug Res. 1993;43(7):752-56.

50. Bhargava SK. Antiandrogenic Effects of a Flavonoid-rich Fraction of Vitex Negundo Seeds: A Histological and Biochemical Study in Dogs. J Ethnopharmacol. 1989;27(3):327-39.

51. Jarry H, et al. In Vitro Prolactin But Not LH and FSH Release Is Inhibited by Compounds in Extracts of Agnus castus: Direct Evidence for a Dopaminergic Principle by the Dopamine Receptor Assay. Exp Clin Endocrinol. 1994;102(6):448-54.

52. Makwana HG, et al. General Pharmacology of Vitex leucoxylon Linn Leaves. Indian J Physiol Pharmacol. 1994;38(2):95-100.

53. Liu J, Burdette JE, Xu H, Gu C, van Breemen RB, Bhat KP, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem. May 2001;49(5):2472-9.

54. Knight DC, Howes JB, Eden JA. The effect of Promensil, an isoflavone extract, on menopausal symptoms. Climacteric. Jun1999;2(2):79-84.

55. van de Weijer P, Barentsen R. Isoflavones from red clover (Promensil(R)) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas. Jul2002;42(3):187.

56. Morrison MF, et al. DHEA-S levels and depressive symptoms in a cohort of African American and Caucasian women in the late reproductive years. Biol Psychiatry. Nov2001;50(9):705-11.

57. Wolkowitz OM, et al. Dehydroepiandrosterone (DHEA) Treatment of Depression. Biol Psychiatry. Feb1997;41(3):311-18.

58. Nagata C, et al. Serum concentrations of estradiol and dehydroepiandrosterone sulfate and soy product intake in relation to psychologic well-being in peri- and postmenopausal Japanese women. Metabolism. Dec2000;49(12):1561-4.

59. Hackbert L, Heiman JR. Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women. J Womens Health Gend Based Med. Mar2002;11(2):155-62.

60. Takayanagi R, et al. Dehydroepiandrosterone (DHEA) as a possible source for estrogen formation in bone cells: correlation between bone mineral density and serum DHEA-sulfate concentration in postmenopausal women, and the presence of aromatase to be enhanced by 1,25-dihydroxyvitamin D3 in human osteoblasts. Mech Ageing Dev. Apr2002;123(8):1107-14.

61. Lasco A, Frisina N, Morabito N, et al. Metabolic effects of dehydroepiandrosterone replacement therapy in postmenopausal women. Eur J Endocrinol. Oct2001;145(4):457-61.

62. Genazzani AD, et al. Oral dehydroepiandrosterone supplementation modulates spontaneous and growth hormone-releasing hormone-induced growth hormone and insulin-like growth factor-1 secretion in early and late postmenopausal women. Fertil Steril. Aug2001;76(2):241-8.