Your body, your choice: exploring menopause treatment options

Welcome to menopause

Between the ages of 48 and 55 most women experience body changes associated with menopause. About 60% experience mild symptoms, 20% no symptoms, and an unlucky 20% experience severe symptoms. These include hot flushes, night sweats, mood swings, aches and pains, vaginal dryness, loss of sex drive, forgetfulness, depression, itchy skin and tiredness.

Lifestyle options 

Women are more likely to tolerate menopausal symptoms if they improve their overall health by making simple lifestyle changes.

Eat a diet high in fruits, vegetables, wholegrains, low-fat dairy products, fish, chicken or lean meats and healthy fats (olive oil, nuts and seeds). Be wary of processed or refined foods (e.g. take-away meals, convenience food and sweets) that are high in sugar, salt or saturated fats. Limit caffeine and alcohol - drink water instead! Some women find eating foods high in phytoestrogens (plant oestrogens) can help reduce symptoms, with the added benefit of reducing cholesterol and blood pressure. Sources include soy flour (soy and linseed bread), soy beans, tofu, wholegrains, legumes and sprouts 

Aim for 30 minutes of moderate physical activity on most weekdays to maintain general health, control weight and keep bones healthy. A combination of aerobic, weight-bearing, strengthening and flexibility exercises is ideal. Studies show that physical activity affects the body’s hormones, releasing feel-good chemicals (endorphins). Exercise can help treat mild depression and anxiety, boost your metabolism and help you sleep.

Many women approaching menopause find their ability to cope diminishes; they frequently feel moody, irritable and emotional. Stress is often unavoidable but learning to cope with stress makes it more manageable and less overwhelming. Speaking to a qualified therapist or counsellor can help you change negative thinking patterns and identify ways to reduce stress. Activities like yoga, pilates, tai chi, meditation, massage and regular exercise can also help. Some women find wearing light, layered clothing, sleeping in a cooler room (alone if necessary) and carrying a fan or facial mist helps them cope with hot flushes.

About HRT

Hormone Replacement Therapy (HRT) involves taking hormones (oestrogen and progesterone, and sometimes testosterone) to help relieve severe menopausal symptoms. Many women find HRT improves their quality of life, reducing hot flushes, night sweats and vaginal dryness. Others choose not to use HRT, based on their medical history or personal preference. Like all treatments, HRT can cause side-effects and have potential risks, so it is important to discuss with your health practitioner whether HRT is appropriate for you. 

Who can't use HRT?

HRT is not generally recommended for women who have:

• family or personal history of breast cancer
• endometrial cancer
• unexplained vaginal bleeding
• clotting disorder
• history of blood clots in the veins
• history or increased risk of heart disease or stroke, including those with diabetes.

Women should discuss potential risks and benefits of HRT with a qualified health practitioner and make an educated decision based on their personal medical history and severity of their symptoms. If you decide against using HRT, a number of other options are available.

Other medications

Other medications, although not originally designed to treat menopausal symptoms, have been shown to offer relief in some cases. Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Noradrenalin Reuptake Inhibitors (SNRIs) are classes of antidepressant drugs. One side-effect is that they seem to reduce hot flushes in some menopausal women. How these drugs do this is unknown and further research is needed. Gabapentin is used to treat epilepsy, however one side-effect is a reduction in hot flushes in some women.

More research is needed to confirm if gabapentin is an appropriate treatment for hot flushes. Clonidine is a blood pressure medication but can also be used to reduce hot flushes.

It causes side effects such as dry mouth, dizziness and blurred vision. It is important to discuss the potential risks and benefits of using these treatments with a qualified health practitioner.

Natural therapies and complementary medicine

Natural therapies, often referred to as complementary medicines, may be used together with other treatments. Herbal remedies are the most popular form of natural therapy for treating menopausal symptoms. These include preparations prescribed by practitioners or over the counter (OTC) products. However some OTC remedies and formulations are not recommended by health practitioners, are in doses too low to be therapeutic or vary in quality. The best way to use herbal remedies is under the guidance of a trained natural therapist.

Black Cohosh is used for treating menopause symptoms including hot flushes, vaginal dryness, aches and pains, and formication (itchy, crawling skin). Most of the research on this herb was conducted on the commercially available form, ‘Remifemin’. In rare cases, black cohosh can cause liver damage. Consult your health practitioner before use and only use as long as menopause symptoms persist.

St John’s Wort is prescribed by herbalists as a treatment for hot flushes triggered by anxiety or stress. It is also used for mild to moderate anxiety and depression associated with menopause. St John’s Wort can cause adverse reactions when taken in conjunction with some Western medicines and should only be taken when prescribed by a qualified natural therapist.

Phytoestrogen (isoflavone) supplements contain extracts of soy or red clover and have been used to treat hot flushes. Research suggests they are no better than placebo in relieving menopausal symptoms. Consuming whole foods high in phytoestrogens (equivalent to the amount in Asian diets) may be useful for some women in relieving symptoms. This is achieved with 50mg of isoflavones ( ~25g soy protein) daily, which roughly equals either:

• 220g tofu
• ~3 cups soy milk
• ~56 g soy flour
• ~2 cups cooked soybeans
• 1 teaspoon of soy germ

Women with a history of breast cancer should not take phytoestrogen supplements, however eating whole foods containing phytoestrogens such as soy products, beans and linseeds is not dangerous.

Herbalists and naturopaths also use herbs for treating other menopausal symptoms, including sleep, mood changes and libido. Other complementary therapies include Traditional Chinese Medicine and acupuncture, homeopathy, and massage. Little evidence exists either way for these treatments, however many have been used extensively in traditional settings.

A preference for non-pharmaceutical therapy is sometimes based on the mistaken idea that natural therapies are safe and have no side effects. Before using any therapy, natural or pharmaceutical, consult with your health practitioner.

Bioidentical hormones

Recently, negative publicity surrounding traditional HRT has led some women to try ‘natural’ hormone preparations, often called bioidentical hormones. These hormones, although derived from soy or yams, are manufactured synthetically by a similar process to most hormones, including the pill. Compounded bioidentical hormone preparations are made by a compounding pharmacist and are not regulated by Medicines Australia, the Australian professional pharmaceutical body. There has been insufficient research regarding whether bioidentical hormone preparations are safe or effective. 

Further resources:

Managing Menopause www.managingmenopause.org.au

Australasian Menopause Society www.menopause.org.au

Fact sheets on menopause are available for download.

Content Updated November 23, 2009