Expired CME Article

Integrative Therapies for Menopause

Authors: Julie McKee, MD, Sara L. Warber, MD

Abstract

Menopause is a transitional time for women. This gives practitioners an opportunity to focus on recommending healthy lifestyle changes. Hormone replacement therapy (HRT) has been the mainstay of therapy for menopausal symptoms. With recent research findings, women and their physicians are seeking alternatives that do not carry the risks associated with HRT. Exercise has been shown to help some women with symptoms of hot flashes, as have relaxation techniques and deep breathing. Dietary changes to incorporate whole foods and soy are thought by some to help with menopausal symptoms, and are recommended because of a positive impact on heart disease and obesity; soy isoflavones may also help with menopausal symptoms. Botanicals such as black cohosh and red clover have been shown in some studies to decrease severity and frequency of hot flashes. We recommend that HRT be prescribed when other measures have failed to adequately control symptoms. Bioidentical hormones are preferred in our practice.


Key Points


* This report is a topical review of several therapeutic approaches to menopausal symptoms.


* The focus is on holistic and integrative medicine therapies, including mind-body skills, exercise, dietary changes, nutritional supplements, botanicals, and bioidentical hormones.

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References

1. Stenchever M, Droegemueller W, Herbst A, et al. Comprehensive Gynecology. St Louis, MO, Mosby, 2001.
 
2. Kass-Annese B. Alternative therapies for menopause. Clin Obstet Gynecol 2000;43:162–183.
 
3. Bair Y, Gold E, Greendale G, et al. Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants. Am Public Health Assoc2002;11:1832–1840.
 
4. Kam I, Dennehy C, Tsourounis C. Dietary supplement use among menopausal women attending a San Francisco health conference. Menopause 2002;9:72–78.
 
5. Newton K, Buist D, Keenan N, et al. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol 2002;100:18–25.
 
6. Keenan N, Mark S, Fugh-Berman A, et al. Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies. Menopause 2003;10:507–515.
 
7. Hunter M. Predictors of menopausal symptoms: psychosocial aspects. Baillieres Clin Endocrinol Metab 1993;7:33–45.
 
8. Hunter M, O’Dea I. An evaluation of a health education intervention for mid-aged women: five year follow-up of effects upon knowledge, impact of menopause and health. Patient Educ Counsel1999;38:249–255.
 
9. Balk J. Mind-body approaches to menopausal symptoms. Altern Ther Womens Health 2003;5:9–12.
 
10. Swartzman L, Edelberg R, Kemmann E. Impact of stress on objectively recorded menopausal hot flushes and on flush report bias. Health Psychol 1990;9:529–545.
 
11. Geramaine L, Freedman R. Behavioral treatment for menopausal hot flashes: evaluation by objective methods. J Consult Clin Psychol 1984;52:1072–1079.
 
12. Stevenson D, Delprato DJ. Multiple component self-control program for menopausal hot flashes. J Behav Ther Exp Psychiatry 1983;14:137–140.
 
13. Freedman R, Woodward S. Behavioral treatment for menopausal hot flashes: evaluation by ambulatory monitoring. Am J Obstet Gynecol 1992;167:436–439.
 
14. Hunter M, Liao K-M. Determinants of treatment choice for menopausal hot flashes; hormonal versus psychological versus no treatment. J Psychosom Obstet Gynecol 1995;16:101–108.
 
15. Irvin J, Domar A, Clark C, et al. The effects of relaxation response training on menopausal symptoms. J Psychosom Obstet Gynecol 1996;17:202–207.
 
16. Wijma K, Melin A, Nedstrand E, et al. Treatment of menopausal symptoms with applied relaxation: a pilot study. Pergamon 1997;28:251–261.
 
17. Younus J, Simpson I, Collins A, et al. Mind control of menopause. Womens Health Issues2003;13:74–78.
 
18. Bass S, Pearce G, Bradney M, et al. Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. J Bone Mineral Res1998;13:500–507.
 
19. Beck B, Snow C. Bone health across the lifespan: exercising our options. Exerc Sport Sci Rev2003;31:117–122.
 
20. Eden K, Orleans C, Mulrow C, et al. Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;137:E208–E215.
 
21. Slaven L, Lee C. Mood and symptom reporting among middle-aged women: the relationship between menopausal status, hormone replacement therapy, and exercise participation. Health Psychol1997;16:203–208.
 
22. Stadberg E, Mattsson L, Milsom I. Factors associated with climacteric symptoms and the use of hormone replacement therapy. Acta Obstet Gynecol Scand 2000;79:286–292.
 
23. Aiello E, Yasui Y, Tworoger S, et al. Effect of a yearlong, moderate-intensity exercise intervention on the occurrence and severity of menopause symptoms in postmenopausal women. Menopause2004;11:382–388.
 
24. Finn S. Women in Midlife: A nutritional perspective. J Womens Health Gender-Based Med2000;9:351–356.
 
25. Albert A, Altabre C, Baro F, et al. Beneficial effects and good tolerability of soy for menopausal symptoms. Phytomedicine 2002;9:85–92.
 
26. Han X, Soares J, Haidar M, et al. Benefits of soy isoflavone therapeutic regimen on menopausal symptoms. Obstet Gynecol 2002;99:389–394.
 
27. Van Patten C, Olivotto I, Chambers K, et al. Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. J Clin Oncol2002;20:1449–1455.
 
28. Albertazzi P, Pansini F, Bonaccorsi G, et al. The effect of dietary soy supplementation on hot flushes. Obstet Gynecol 1998;91:6–10.
 
29. Murkies A, Lombard C, Strauss B, et al. Dietary flour supplementation decreases post-menopausal hot flushes: effect of soy and wheat. Maturitus 1995;21:189–195.
 
30. Chen Y, Ho S, Lam S, et al. Soy Isoflavones have a favorable effect on bone loss in Chinese postmenopausal women with lower bone mass: a double-blind, randomized, controlled trial. J Clin Endocrinol Metab 2003;88:4740–4747.
 
31. Kritz-Silverstain D, Von Muhlen D, Barrett-Connor E, et al. Isoflavones and cognitive function in older women: the SOy and Postmenopausal Health In Aging (SOPHIA) Study. Menopause 2003;10:196–202.
 
32. Cassidy A, Griffin B. Phyto-oestrogens: a potential role in the prevention of CHD? Proc Nutr Soc1999;58:193–199.
 
33. Horn-Ross P, John E, Canchola A, et al. Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst 2003;95:1158–1164.
 
34. Kurzer M. Phytoestrogen Supplement Use by Women. Paper presented at NIH Dietary Supplement Use in Women: Current Status and Future Directions; January 28-29, 2002; Bethesda, MD.
 
35. Gass M, Taylor M. Alternatives for women through menopause. Alt J Obstet Gynecol2001;185:S47–S56.
 
36. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002;137:805–813.
 
37. Lowdog T. Menopause. Foundations Herb Med 2000;47–54.
 
38. Harvey J, Zobitz M, Pak C. Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. J Bone Miner Res 1988;3:253–258.
 
39. Heaney R, Dowell M, Barger-Lux M. Absorption of calcium as the carbonate and citrate salts, with some observations on method. Osteoporos Int 1999;9:19–23.
 
40. Reid I. Therapy of osteoporosis: calcium, vitamin d, and exercise. Am J Med Sci 1996;312:278–286.
 
41. Sakhaee K, Poindexter J, Griffith C, et al. Stone forming risk of calcium citrate supplementation in healthy postmenopausal women. J Urol 2004;172:958–961.
 
42. Ruml L, Sakhaee K, Peterson R, et al. The effect of calcium citrate on bone density in the early and mid-postmenopausal period: a randomized placebo-controlled study. Am J Ther 1999;6:303–311.
 
43. Lemay A, Dodin S, Kadri N, et al. Flaxseed dietary supplement versus hormone replacement therapy in hypercholesterolemic menopausal women. Obstet Gynecol 2002;100:495–504.
 
44. Lehmann-Willenbrock E, Riedel H. Clinical and endocrinologic examinations about therapy of climacteric symptoms following hysterectomy with remaining ovaries. Zentralbl Gynakol 1988;110:611–618.
 
45. Liske E, Wustenberg P. Therapy of climacteric complaints with cimicifuga racemosa: herbal medicine with clinically proven evidence. Menopause 1998;5:250.
 
46. Stoll W. phytopharmacon influences atrophic vaginal epithelium: double-blind study: cimicifuga vs estrogenic substances. Therapeuticum 1987;1:23–31.
 
47. Warnecke G. Influence of a phytopharmaceutical on climacteric complaints. Die Meizinisch Welt1985;36:871–874.
 
48. Duker E, Kpanski L, Jarry H, et al. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med 1991;57:420–424.
 
49. Jacobson J, Troxel A, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001;19:2739–2745.
 
50. Munoz G, Pluchino S. Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas 2003;44(Suppl 1):S59–S65.
 
51. McKenna D, Jones K, Humphrey S, et al. Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med 2001;7:93–98.
 
52. Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999;56:1400–1402.
 
53. Borrelli F, Izzo A, Ernst E. Pharmacological effects of Cimicifuga racemosa. Life Sci 2003;73:1215–1229.
 
54. Klein K, Janfaza M, Wong J, et al. Estrogen bioactivity in fo-ti and other herbs used for their estrogen-like effects as determined by a recombinant cell bioassay. J Clin Endocrinol Metab2003;88:4077–4079.
 
55. Bodinet C, Freudenstin J. Influence of marketed herbal menopause preparations on MCF-7 cell proliferation. Menopause 2004;11:281–289.
 
56. Tice J, Ettinger B, Ensrud K, et al. Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study. JAMA 2003;290:207–214.
 
57. Baber R, Templeman C, Morton T, et al. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women. Climacteric 1999;2:85–92.
 
58. Jeri A. the use of an isoflavone supplement to relieve hot flashes. Female Patient 2002;27:35–37.
 
59. Knight D, Howes J, Eden J. The effect of Promensil, and isoflavone extract, on menopausal symptoms. Climacteric 1999;2:79–84.
 
60. van de Weijer P, Barentsen R. Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas 2002;42:187–193.
 
61. Nestle P, Pomeroy S, Kay S, et al. Isoflavones from red clover improve systemic arterial compliance but not plasma lipids in menopausal women [erratum appears in J Clin Endocrinol Metab1999;84:3647]. J Clin Endocrinol Metab 1999;84:895–898.
 
62. Clifton-Bligh P, Baber R, Fulcher G, et al. The effect of isoflavones extracted from red clover (Rimostil) on lipid and bone metabolism. Menopause 2001;8:259–265.
 
63. Howes J, Bray K, Lorenz L, et al. The effects of dietary supplementation with isoflavones from red clover on cognitive function in postmenopausal women. Climacteric 2004;7:70–77.
 
64. Atkinson C, Warren R, Sala E, et al. Red-clover-derived isoflavones and mammographic breast density: a double-blind, randomized, placebo-controlled trial [ISRCTN42940165]. Breast Cancer Res2004;6:R170–R179.
 
65. Hirata J, Swiersz L, Zell B, et al. does dong quai have estrogenic effects in post menopausal women? Fertil Steril 1997;68:981–986.
 
66. Chenoy R, Hussain S, Tayob Y, et al. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. BMJ 1994;308:501–503.
 
67. Chopin L. Vitex agnus castus essential oil and menopausal balance: a research update. Comp Ther Nurs Midwife 2003;8:148–154.
 
68. Lucks B, Sorensen J, Veal L. Vitexagnus-castus essential oil and menopausal balance: a self-care survey. Comp Ther Nurs Midwife 2002;8:148–154.
 
69. Komesaroff P, Black C, Cable V, et al. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric 2001;4:114–150.
 
70. Rakel D. Menopause, in Bralow L, Merahn S (eds): Integrative Medicine. Philadelphia, PA, Saunders, 2003, pp 367–370.
 
71. Taylor M. Unconventional estrogens: Estriol, Biest, and Triest. Clin Obstet Gynecol 2001;44:864–879.
 
72. Fugate S, Church C. Nonestrogen treatment modalities for vasomotor symptoms associated with menopause. Ann Pharmacother 2004;38:1482–1499.
 
73. Morelli V, Naquin C. alternative therapies for traditional disease states: menopause. Am Fam Physician 2002;66:129–134.
 
74. USDA, Iowa State University. Database on the Isoflavone Content of Foods.http://www.nal.usda.gov/fnic/foodcomp/Data/isoflav/isfl_tbl.pdf. Accessed November 9, 2004.
 
75. USDA, Iowa State University. Database on the Protein Content of Foods.http://www.nal.usda.gov/fnic/foodcomp. Accessed November 9, 2004.