From The Cleveland Clinic: Alternative Therapy

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Menopause: Complementary and Alternative Therapies

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Complementary and alternative therapies are medical treatments that are considered nontraditional. They include dietary and herbal supplements, acupuncture, chiropractic and massage therapy, biofeedback, homeopathy and eating certain foods that are thought to prevent disease or heal.

Alternative treatments are often used alone, while complementary treatments are alternative treatments that are used in combination with traditional treatments, such as drug treatments or surgery.

Women going through menopause may find relief from their symptoms if they include botanicals such as phytoestrogens in their diet. There are also other nutritional supplements that may relieve menopausal symptoms such as black cohosh and flaxseed.

What Are Botanicals?

Botanicals are medicines that are derived from plants. They have been used for centuries by "folk healers" and are the foundation for nearly half of prescription drugs used today. Botanicals in the form of herbs and nutritional supplements make up a large part of alternative therapies.

Can Botanicals Relieve Menopausal Symptoms?

Some botanicals, such as phytoestrogens, may help relieve menopausal symptoms. Phytoestrogens are substances found in plant-based foods that are thought to have weak estrogen-like effects. They may work in the body like a weak form of estrogen. Some may help lower cholesterol levels and have been suggested to relieve hot flashes and night sweats. Examples of plant estrogens include isoflavones. Isoflavones can be found in foods such as soy products (tofu, soymilk, soybeans).

Black cohosh is a botanical that is widely available. The most well known brand is Remifemin. The North American Menopause Society reports that black cohosh may be helpful in the very short term (6 months or less) for treatment of mild hot flashes, night sweats and vaginal dryness. Safety beyond six months of use is not known. Side effects are rare and include gastrointestinal upset.

Evening primrose oil is another botanical that is often used to treat hot flashes, although there is no scientific evidence to support this. Side effects include nausea and diarrhea. Many women with other conditions, or those that take certain medications, should not take evening primrose oil.

Flaxseed is an edible seed that contains lignans, another class of phytoestrogens. Although there is little scientific evidence to support this, flaxseed is thought to decrease the symptoms of menopause, particularly hot flashes. In addition, some studies show that flaxseed may lower breast cancer risk in women. Also known as linseed, flaxseed is available in whole seed, ground up meal and seed oil forms. However, only the crushed or ground forms of flaxseed contain lignans that your body can digest.

Dong quai is another botanical that is touted to relieve menopause symptoms such as hot flashes and night sweats and has been used in traditional Chinese medicine for over 2,000 years. There is little scientific evidence to support this claim, however, and more studies are needed to determine its effectiveness.

There are many other herbal supplements available. There is little evidence to support the use of any of the following supplements to treat the symptoms of menopause: fish oil, omega-3 fatty acids, red clover, ginseng, rice bran oil, wild yam, calcium, gotu kola, licorice root, sage, sarsaparilla, passion flower, chaste berry, ginkgo biloba and valerian root.

Are There Supplements That Help With Menopause-Related Conditions?

Most women experience accelerated bone loss during menopause. This increases their risk of developing osteoporosis. Adequate calcium (1200 to 1500 mg/day) and vitamin D (400 IU/day) can help reduce the loss of bone. A daily multivitamin and mineral supplement will provide vitamin D and other bone-protecting nutrients. Low-fat dairy foods are excellent sources of calcium. Calcium supplements may also be recommended for menopausal and post-menopausal women to ensure an adequate calcium intake.

Studies have shown that vitamin K, magnesium, and boron are among the nutrients that play a role in maintaining bone health. Dietary sources of these nutrients are best, although they are also available in supplement form. Check with your doctor before taking any of these supplements; they are not appropriate for everyone.

Menopause is also associated with an increased risk of heart disease. A heart-healthy diet is plant-based and low in fat. It is rich in whole grains, fruits, vegetables, legumes and nuts. These foods are also good sources of vitamin E, potassium and magnesium which may also provide heart health benefits. While food sources are best, supplementation may be recommended in select cases; check with your doctor to see if this applies to you.

Omega-3 fatty acids are known to have a favorable effect on heart health by decreasing cholesterol, decreasing inflammation, thinning blood, and decreasing the growth of plaque. Supplement sources of omega-3 fatty acids include fish oil capsules and flaxseed oil. Fatty fish such as salmon, tuna, mackerel, and sardines are excellent dietary sources of omega-3 fatty acids. Ground flax meal and walnuts are also good sources of omega-3s. Omega-3 fatty acids should not be taken before surgery and by those on blood-thinning medication such as Coumadin (warfarin). Check with your doctor to learn if omega-3 fatty acid supplements are right for you.

What Foods Have High Amounts of Isoflavones?

The following foods are high in isoflavone:

While safe when taken in moderate amounts through diet, the consumption of extraordinary amounts of soy and isoflavone supplements may be harmful to women with a history of estrogen-dependent cancer, like breast cancer, and possibly to other women as well.

More research is needed to determine the safety and effectiveness of botanical treatments. To make an informed decision about the use of these treatments, be sure to discuss them with your doctor.

Because little is known about many botanicals, the best way to evaluate their safety and effectiveness is to become an educated consumer. Here are some tips to consider when shopping for alternative therapies.

Ask yourself the following questions:

• What is the treatment?
• What does it involve?
• How does it work?
• Why does it work?
• Are there any risks?
• What are the side effects?
• Is it effective? (Ask for evidence or proof)
• How much does it cost?

Once you answer these questions, discuss the therapy with your doctor. Make sure your doctor knows what therapy you are considering in order to discuss possible interactions or side effects with your current treatment. Your doctor can also provide you with information on other people who may have tried the same therapy.

What Are Warning Signs That a Product May Not Be Legitimate?

When trying to determine whether or not a product is what it says it is, one of the elements you may want to look at is how the product is promoted. Be cautious of products promoted through:

• Telemarketers
• Direct mailings
• Infomercials
• Ads disguised as valid news articles
• Ads in the back of magazines

Additional red flags to look for include:

• Big Claims. If products claim to be a "cure" for your condition, or gives outrageous claims, be cautious.
• Source. Be wary if the product is only offered through one manufacturer.
• Ingredients. Make sure all of the active ingredients are listed, and don't trust "secret formulas."
• Testimonials. Remember that only people who are satisfied with a product give testimonials and that they may be getting paid for their endorsement. Also be cautious of testimonials given by people who are only listed by initials, locations or first names.

Reviewed by the doctors at Reviewed by the doctors at The Cleveland Clinic Women's Health Center.

Edited by Cynthia Haines, MD, WebMD, February 2006.

SOURCES: The Cleveland Clinic Department of Nutrition Therapy. National Center for Complementary and Alternative Medicine. North American Membrane Society. National Institutes of Health. American Academy of Family Physicians