Menopause Frequently Asked Questions
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Are there "natural" treatments available for menopause?
Yes. They include a wide range of therapies such as herbal medicine, homeopathy, acupuncture, chiropractic, osteopathy and naturopathy.
Various vitamins and mineral products also claim success in treating menopausal symptoms.
Before you use such therapies to treat menopausal symptoms, you should attempt to find out if:
• There are studies showing the product is effective for its recommended purpose.
• The risks of taking the product are known
• There are contraindications – risks for specific health conditions, or conflicts with certain pharmaceutical drugs – for taking the product that apply.
Some women try herbal or other plant-based products to help relieve hot flushes. Some of the most common ones are:
• Soy
Soy contains phytoestrogens (estrogen-like substances from a plant). But, there is no proof that soy — or other sources of phytoestrogens — really do make hot flashes better. And the risks of taking soy — mainly soy pills and powders — are not known. The best sources of soy are foods such as tofu, tempeh, soymilk, and soy nuts.
Other sources of phytoestrogens.
These herbs include:
• Black Cohosh (Latin name: Cimicifuga racemosa - or more currently, Actaea racemosa)
• Chaste Tree (Vitex agnus-castus)
• Red Clover (Trifolium praetense)
• Ginkgo (Ginkgo biloba)
• Dong Quai
• Wild Yam
• Valerian Root
Products that come from plants may sound like they are safe, but there is no proof that they really are. There also is no proof that they are helpful at easing symptoms of menopause. Make sure to discuss these types of products with your doctor before taking them. You also should tell your doctor about other medicines you are taking, since some plant products can be harmful when combined with other drugs.
What is "bioidentical" hormone therapy?
This term means different things to different people. It’s really manmade hormones that are just the same as the hormones the body makes. There are several products with hormones like this that are on the market and are well-tested. But this term is most often used to mean drugs that are custom-made from a doctor’s order. These custom-made products are also known as bioidentical hormone replacement therapy (BHRT). Despite product claims, there is no proof that BHRT products are better or safer than other HRT drugs and also they can be expensive as many insurance and prescription programs do not pay for these drugs because they are viewed as experimental.
Will exercise/physical activity help me in any way?
An active lifestyle can lower your risk of early death from a variety of causes and help you maintain a healthy weight. It also might improve your mood and help you to sleep better. For older adults, activity can improve mental function.
Are there alternative ways of preventing osteoporosis?
To reduce your chances of getting osteoporosis (a condition in which the bones become thin and fragile and break easily), it is best to start preventative measures early in life. But there are also self-help measures which women can take during or after the menopause to maintain bone strength.
Take regular weight-bearing exercise
• Maintain weight
• Eat a balanced calcium-rich diet
Milk and dairy products have high calcium levels. Other calcium containing foods include tinned fish with bones (but the bones need to be eaten) almonds, tofu, also fruit and green leafy vegetables.
• Bone Robbers
Avoid excess alcohol, caffeine and smoking all of which reduce calcium. Too much animal protein (meat and cheese) can affect calcium absorption and too much salt can increase the amount of calcium lost as can phosphoric acid (a preservative used in many canned fizzy drinks).
• DXA Scan (Dual Energy X-Ray Absorptiometry)
Women who have a high risk of developing osteoporosis e.g. past fractures after a minor fall, an early menopause before the age of 45, long-term steroid treatment or have a mother who has had osteoporosis, need to discuss whether it is worth having this type of scan which can help to show the likelihood of future fractures.
• Treating osteoporosis
HRT is no longer the treatment of first choice for osteoporosis because of safety concerns. Drugs such as calcitonin, bisphosphonates and raloxifene (Evista) a Selective Estrogen Receptor Modulator (SERMs) can be used as first choice treatments for post-menopausal women. Forsteo (teriparatide) is also now available for post-menopausal women who have severe osteoporosis of the spine. But it is important to note that the National Institute for Clinical Excellence (NICE), the NHS medical watchdog, is reviewing the use of these drugs, which may be restricted.
I'm having a hysterectomy soon. Will this cause me to enter menopause?
Sometimes, younger women need a hysterectomy to treat health problems such as endometriosis or cancer. A hysterectomy is an operation to remove a woman’s uterus ( womb ). Often one or both ovaries ( female sex organs ) are removed at the same time the hysterectomy is done. If you haven’t reached menopause, a hysterectomy will stop your period. But, you will reach menopause only if both ovaries are removed, called surgical menopause. Because surgical menopause is instant menopause, it may cause more severe symptoms than natural menopause. Menopause that is natural occurs as part of the natural aging process. You should talk with your doctor about how to best manage these symptoms.
Women who have a hysterectomy but have their ovaries left in place will not reach menopause at the time of surgery because their ovaries will continue to make hormones. But, because the uterus is removed, they will no longer have their periods and they cannot become pregnant. Later on, they might reach natural menopause a year or two earlier than expected.
What is postmenopause?
Postmenopause is the term for all the years beyond menopause. It begins after you have not had a period for 12 months in a row, whether your menopause was natural or brought on by treatment for a condition.
I have been on HRT for ten years and have been thinking about ending this treatment. What is the best way to stop and what kind of symptoms should I expect?
Gradual reduction of HRT over many months is recommended for those who have taken HRT for an extended period of time and wish to stop. Stopping HRT suddenly will not cause serious harm, but troublesome symptoms of menopause, such as hot flashes, may reappear. Slowly decreasing the dose of hormones over four to six months (or more if menopausal symptoms are still a problem at this time) is a wiser approach and more closely approximates what the body does naturally when it is going through menopause. Decreasing the dose of hormones by one half every month is a reasonable way to wean yourself from HRT. If you find your symptoms are a problem at any time, then don't decrease your dose so quickly.
If you are on pills, you can ask your doctor for a lower dose pill to use in this process. Once you are on the lowest dose pill you can start taking a pill every other day, and then every third day, etc. until four to six months have passed.
Useful links for further information
Is HRT Right For You? by Dr Anne MacGregor (Sheldon Press, 2003). Written by a doctor with a special interest in women’s hormones, this is a comprehensive and balanced guide to the risks and benefits of HRT, with lots of information on the various HRT products.
The New Natural Alternatives to HRT by Dr Marilyn Glenville (Kyle Cathie) written by a psychologist and nutritionist, this takes a critical look at HRT and offers much information on alternative approaches.
For details of the guidance from The Medicines and Healthcare Products Regulatory Agency (MHRA) and the Committee on Safety of Medicines (CSM), see: www.mhra.gov.uk
The National Osteoporosis Society
Camerton
Bath BA2 OPJ
helpline: 0845 450 0230
Women’s Health enquiry line: 0845 125 5254 or the NHS information line: 0800 665544
The Pros and Cons of Hormone Replacement Therapy: Making an Informed Decision, written by the Women's Health Clinic.
You can find this resource online at:
• http://www.cwhn.ca/resources/hrt/index.html
• www.nhs.uk/conditions/Hormone-replacement-therapy
If you have any queries regarding topic raised within this article please do not hesistate to contact the Women's Health Clinic via the email form at the bottom of the page or by calling our London clinic on 020 8947 9877.
