Menopause Management

Officially, the onset of menopause is marked by the one-year anniversary of the last day of your last period. But you might start to feel the effects of dwindling hormones during perimenopause, the months and even years leading up to that time. Almost a decade ago, when studies linked hormone-replacement therapy to an increased risk of heart problems, many women turned to supplements to alleviate hot flashes, mood swings, sleeplessness, and other symptoms. No doubt many of those women have been disappointed with the results.

The good news about the concerns over replacement hormones is that it forced us to do more and better quality research on alternatives. The bad news is that overall the studies show that supplements are not more effective than placebos.

However, some people try supplements marketed for menopause relief that contain estrogen-like plant compounds known as phytoestrogens, such as soy. And there’s some evidence that herbs, such as black cohosh, can reduce menopausal symptoms, may also ease hot flashes, as well as certain psychological symptoms associated with menopause in ways similar to antidepressants, which are also sometimes prescribed when a woman can’t take hormone therapy.

The evidence is strongest for black cohosh and St. John’s wort, but even then, the largest, best quality trial to date for black cohosh showed no effect. We’re still looking for something that really helps with menopause. Based on what we know, herbal products don’t relieve symptoms better than hormone therapy.

On the flip side, there are patients who have found supplements to be effective. Why the discrepancy? One reason might be the placebo effect. Menopause symptoms tend to wax and wane and eventually dissipate, even without treatment. In general, clinical trials that compare an active menopause remedy with a placebo find that 30 to 40 percent of women taking the fake pill report improvement. Women who have milder symptoms might have better luck with supplements than those who suffer from severe hot flashes or mood disturbances. And the formulation of herbal supplements varies widely, which might affect the results you get.

Pill-free remedies

Fortunately, the news isn’t all bad. There are simple lifestyle measures that can make a big difference. For PMS, start with regular aerobic exercise, which research has shown may minimize symptoms. A diet rich in complex carbs (think whole-wheat bread, not doughnuts) might improve mood swings and reduce cravings. Cutting salt intake can help reduce fluid retention and bloating.

Lifestyle changes can also help women cope with menopause, especially with hot flashes. Aerobic exercise or losing weight might be beneficial. Relaxation techniques can ease anxiety, a trigger for hot flashes. And two recent trials found that paced respiration – taking slow, deep breaths – helped prevent hot flashes. It’s also smart to avoid triggers such as alcohol, caffeine, smoking, and spicy foods; wear loose-fitting, layered cotton clothing; take cool showers; sleep on cotton sheets; and consider keeping a frozen ice pack under your pillow at night.

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