• Highlights
• Introduction
• Complications
• Symptoms
• Lifestyle Changes
• Medications
• Resources
• References

Menopause

Description

An in-depth report on the treatment of menopause-related symptoms.

Alternative Names

Estrogen; Hormone replacement therapy

Lifestyle Changes

Simple changes in lifestyle and diet can help control menopausal symptoms such as hot flashes. Avoid hot flash triggers like spicy foods, hot beverages, caffeine, and alcohol. Dress in layers so that clothes can be removed when a hot flash occurs. For vaginal dryness, moisturizers, and non-estrogen lubricants, such as KY Jelly, Replens, and Astroglide are available.

Healthy Diet

When women reach menopause, they are at increased risk for heart disease. A heart-healthy diet is an important way to control cholesterol and blood pressure levels. Everyone should maintain a healthy diet rich in fresh fruits, vegetables, whole grains, and low in saturated fats (found in dairy and animal products) and trans-fatty acids (found in shortening, commercial baked goods, and hard margarines). Reducing salt intake is also important as people age. [For more information, see In-Depth Report #42: Heart-healthy diet.]

Vegetables, fruits, whole grains, nuts, and legumes (beans and peas) contain fiber and many nutrients that are important for the heart and overall health. Vitamin supplements are not recommended in place of healthy foods. Research increasingly suggests that high vitamin doses may have harmful effects.

Mineral-Rich Fruits and Vegetables. Diets rich in fresh fruits and vegetables are high in potassium and magnesium and can help preserve bones and protect against heart disease. Potassium-rich fruits include bananas, oranges, prunes, and cantaloupes, and vegetables that contain potassium include carrots, spinach, celery, alfalfa, mushrooms, lima beans, potatoes, avocados and broccoli. Foods rich in magnesium include dairy products, spinach, potatoes, beets, nuts, sole, and halibut.

Avoid Fast Foods and Limiting Salts. Reducing salt is important for protecting both the heart and the bones. High sodium intake interferes with calcium retention. Limiting table salt is not sufficient, since most salt in the Western diet comes from fast foods and commercial food products. Such foods are often also high in dangerous fats called trans-fatty acids that are harmful to the heart.

Effects of Fiber . Fiber is important for the heart. Some studies report estrogen loss with high amounts of wheat bran (but not oat or corn) and calcium loss with any high-fiber diet. Calcium supplements can help offset this effect.

Healthy Protein Sources . The American Heart Association (AHA) recommends soy, legumes, poultry, and lean meats as good protein sources and recommends eating fish at least twice a week. Soy is an excellent food. It is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all essential proteins. Soy proteins have more vitamins and minerals than meat or dairy proteins. They also contain polyunsaturated fats, which are better than the saturated fat found in meat. The best sources of soy protein are soy products (tofu, soy milk, soybeans).

For many years, soy was promoted as a food that could help lower cholesterol and improve heart disease risk factors. But an important 2006 review of studies found that soy protein and isoflavone supplement pills do not really have any effects on cholesterol or heart disease prevention. The AHA still recommends soy foods, but not supplements, as a healthy food choice. The benefits of soy on menopausal symptoms are mixed (see below in Alternative Therapies).

Soy is high in estrogen-like plant chemicals called isoflavones , which may improve bone health in older women. A 2005 review of 15 clinical trials found that, although the results were mixed, isoflavones appeared to decrease bone loss, especially in younger postmenopausal women. Soy food products, such as tofu, that also contain calcium may be particularly beneficial.

Calcium and Vitamin D

Calcium. Women should be sure they have sufficient calcium and vitamin D in their diet by consuming low-fat dairy products or calcium-enriched orange juice. The standard recommended dose for older people is between 1000 and 1500 mg per day, depending on risk factors. Even doses of 1000 mg may help preserve bone in many postmenopausal women without osteoporosis, especially during winter months (when bone loss is greatest). In women who have already experienced osteoporosis-related fractures, however, 1000 mg daily may not add any protective benefits without bone-building medication. Calcium citrate (Citracal) is better absorbed than many other calcium compounds and was the first reported calcium supplement to preserve bone density after menopause.

High doses (over 2,500 mg per day) of calcium supplements may increase the risk for kidney stones. (Because many commercial foods are now fortified with calcium, this upper limit may be easier to reach than people think.)

Vitamin D. Vitamin D is necessary for the absorption of calcium in the stomach and gastrointestinal tract and is the essential companion to calcium in maintaining strong bones. Some studies suggest that vitamin D protects against osteoporosis only in combination with calcium.

Vitamin D is manufactured in the skin using energy from the ultraviolet rays in sunlight. It can also be obtained from dietary supplements. As a person ages, vitamin D levels decline. They also fall during winters months and when people have inadequate sunlight. Pollution may also contribute to less sunlight and declining vitamin D levels.

Current adult guidelines recommend:

• 400 IU (10 mcg) for people between ages 50 and 60
• 600 IU (15 mcg) for those over age 70 who do not have sufficient exposure to sunlight

Drinking milk fortified with vitamin D and sunlight exposure supply most people's need for vitamin D. (One cup of whole milk provides about 100 IU of vitamin D.) Oily fish (sardines especially, also salmon, fresh tuna, mackerel) are also important dietary sources of vitamin D.

Alcohol

Effect on the Heart. One drink a day in women who are not at risk for alcohol abuse may be beneficial for the heart. Red wine in particular contains a substance called resveratrol, which is classified as a phytoestrogen and has estrogen-like effects.

Effect on Bones. Alcohol has different effects on bones depending on how much is consumed. A 2004 study found that moderate wine consumption was linked to improved bone mineral density in postmenopausal women. Alcohol, in moderate amounts, may increase estrogen levels. Excessive drinking, however, has been associated with brittle bones.

Effect on Breast Cancer . Women who drink face an increased risk for breast cancer, but the risk associated with mild to moderate drinking is small.

Controlling Weight Gain

Many women need to increase physical activity and reduce caloric intake before and after menopause. Weight gain is common during these years, and it can be sudden and distressing, particularly when habitual exercise and eating patterns are no longer effective in controlling weight. Gaining weight around the abdomen (the so-called apple shape) is a specific risk factor for heart disease and diabetes and many other health problems.

Exercise

For protection against all aging diseases, women, whether or not they are taking hormone replacement therapy, should pursue a lifestyle that includes a balanced aerobic and weight resistance exercise program appropriate to their age and medical conditions. Brisk walking, stair climbing, hiking, dancing, and tai chi are all helpful. Several studies report that exercise can help control hot flashes. A healthy diet plus regular, consistent exercise can also help ward off the weight gain associated with the menopause. Weight-bearing exercises are specifically helpful for protecting against bone loss.

Quit Smoking

If a woman smokes, she should quit. Smoking is linked to a decline in estrogen levels. Women who smoke experience menopause about 2 years earlier than nonsmokers. Smoking doubles a woman’s odds of developing coronary heart disease and is a major risk factor for osteoporosis.

Alternative Therapies

There are many unproved methods for relieving menopausal symptoms, some more effective than others. Acupuncture, meditation, and relaxation techniques are all harmless ways to reduce the stress of menopause and some people report great benefit from these practices.

Women often try herbal or so-called natural remedies. Some may have proven benefits, but others have no value and can have adverse side effects.

Many studies have researched plant estrogens (phytoestrogens), which are generally categorized as isoflavones (found in soy and red clover) and lignans (found in whole wheat and flaxseed). No evidence to date indicates that phytoestrogen supplements provide any benefit for hot flashes or other menopausal symptoms. Nevertheless, foods containing them may be healthful.

Supplements containing specific isoflavones found in soy -- typically the estrogen-like compounds genistein and daidzein -- do not appear to provide any benefits compared to the whole soy protein. Taking them separately may, in fact, cause harm, including a possible increase in estrogen-related cancers.

The following herbs are sometimes use for menopausal symptoms and carry certain risks:

• Black cohosh ( Cimicifuga racemosa ), also known as squaw root, is the herbal remedy most studied for menopausal symptoms. Although it contains a plant estrogen, this substance does not act like an estrogen in the human body. Studies show mixed results in preventing hot flashes. Black cohosh has been used for decades in Germany and appears to be safe. Headaches and gastrointestinal problems are common side effects.
• Dong quai ( Angelica sinensis ) does not appear helpful for hot flashes or other menopausal symptoms. Do not use dong quai with blood-thinning drugs, such as warfarin, because it may cause bleeding complications.
• Ginseng ( Panax ginseng ) may help menopausal symptoms of depression and sleep problems, but it has no effect on hot flashes.
• Kava ( Piper methysticum ) may relieve anxiety but it does not help hot flashes. This herb is generally considered unsafe, due to several reports of liver failure and death, especially in people with liver disease.
• Wild yam ( Dioscorea villosa ) is an herb sometimes used for menstrual problems as well as menopausal symptoms. It contains a plant progesterone. However, like black cohosh, there is no evidence that the human body can convert this substance into a hormone. Patients should be aware that some commercial herbal wild yam products contain prescription progesterones.
• Dehydroepiandrosterone (DHEA) is a weak male hormone secreted by the adrenal gland. It is available as a dietary supplement. DHEA has no benefit for hot flashes and may increase the risk of breast cancer.

Herbs and Supplements Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Patients should check with their doctors before using any herbal remedies or dietary supplements.

• Review Date: 6/11/2006
• Reviewed By: Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.