Tests and Procedures
There are no tests and procedures to confirm menopause. Women usually start to experience the symptoms of menopause before it arrives. When you first reach the 12 month mark without having a menstrual period you are in menopause.
If you start to experience the symptoms of menopause well before your midlife you may want to consult your physician and have them check the level of follicle-stimulating hormone (FSH) and estrogen in your blood. FSH increases as estrogen decreases in menopause. FSH levels above 30 with corresponding estrogen levels of 20 or below denote probable menopause.
You may also want to discuss getting a comprehensive medical evaluation with your doctor. Helpful tests might include blood tests, blood pressure, cardiac evaluation, breast cancer risk evaluation, examination of gastrointestinal complains etc… Getting the answers to these questions now can help you and your doctor identify progressive changes in the coming years, as well as tailor an individualized treatment plan that will address your specific needs.
Return to Top
Most conventional physicians prescribe hormone replacement therapy (HRT) or also called menopausal hormone therapy (MHT) for virtually all women entering menopause, whether or not they are experiencing symptoms. Their reasoning is that HRT will supply enough estrogen to prevent any of the uncomfortable symptoms of menopause, prevent osteoporosis (thus reducing the risk of hip and spinal fractures), and lessen the risk of developing atherosclerotic heart disease.
However, the HRT/ MHT regimen has both benefits and risks. The US Preventive Services Task Force (USPSTF) “recommends against the routine use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women.†The evidence offered by the large long-term Women's Health Initiative study provide evidence that the long term use of HRT/ HMT increases the chances of developing breast cancer, heart disease, blood clots, stroke and dementia in a number of women (1). The panel also recommends against the use of estrogen only supplements by women who have gone through menopause because of surgical hysterectomy. The Task Force however, did not evaluate the benefit of using HRT/ HMT to alleviate menopausal symptoms. They did note that the longer a woman continues treatment the greater her chance of adverse event such a cardiac disease and stroke. However, short term use of HRT/ HMT was not prohibited. The group stressed the need for each woman and her doctor to decide on a treatment plan together.
Physicians familiar with integrative medicine regard each woman as a unique individual and do their best to avoid the "one size fits all" thinking of their more conventional colleagues. If a woman has symptoms of menopause or is at risk for heart disease or osteoporosis, they may begin by suggesting dietary changes, nutritional supplements and herbs. They may recommend such therapies as an exercise program, acupuncture, yoga, aromatherapy or homeopathy. And if a woman really needs HRT, physicians may suggest gentler natural hormones that can be individually compounded to meet her specific needs instead of automatically turning to traditional hormone replacement therapy.
The herbs, vitamins and minerals suggested here may also help lower the risk of heart disease and osteoporosis after menopause. The use of these supplements may also allow you to use smaller doses of traditional hormone therapy. Their use of an adjunctive therapy has to be cleared with your doctor. Some of these supplements may have adverse interactions with other medications you are taking. Make sure to tell your doctor all supplements you are thinking about trying before you begin treatment. Your doctor may also have beneficial information as it relates to dosages and high quality brands. Remember the most successful treatment plans include the input of both you and your physicians.
Just a reminder: If you have a serious medical condition or are taking medication, it's always a wise idea to talk with your doctor before beginning a supplement program.
Return to Top
Black cohosh, a relative of the buttercup, has long been prescribed to treat menstrual problems, including hot flashes and vaginal dryness. Black cohosh also contains phytoestrogens, plant compounds that imitate the body's own estrogen. In fact researchers are finding that it may be as efficacious as Estrogen replacement therapy. These phytoestrogens may help with symptoms of vaginal dryness. Additionally, they may actually prevent breast cancer by keeping the body's own estrogen away from breast tissue. Adding some vitamin C and flavonoids can help reduce mood swings (2,3). If you are currently taking conventional medications for high blood pressure seek your physician's advice before beginning supplementation with black cohosh. Black cohosh may interact with conventional prescriptions for high blood pressure.
Siberian ginseng has been used for centuries in China as a general tonic for both men and women. This all-purpose herb not only helps relieve stress, boost mood, enhance immunity and increase mental alertness, but it may also alter hormone levels and reduce some of the symptoms of menopause. It is best used in combination or rotation with other herbs, and some caution may be needed as it can increase blood pressure.
Chasteberry, the fruit of the chaste tree (often called Vitex), is frequently recommended by European doctors to help with both PMS symptoms, and hot flashes. One study of a multi-herb formula containing chasteberry found that 87% of the 381 study participants reported significant improvement in hot flashes, headaches, heart palpitations, nervousness, irritability, sleep disturbances and depressive moods (4). Although the berry does not contain any hormones, it acts on the pituitary gland, the master gland in the body that controls the levels of hormones from the ovary.
Dong quai is often referred to as the "female ginseng." Although it is not a phytoestrogen and doesn't have any hormonelike effects on the body, this herb seems to have a balancing effect on the female hormone system (5). Like ginseng, dong quai is referred to as an adaptogen, a substance that can help increase energy, reduce the body's response to stress and enhance both physical and mental capabilities.
Soy isoflavones act as phytoestrogens and seem so potent that they not only prevent or relieve typical symptoms of menopause such as hot flashes and night sweats but also may prevent atherosclerotic heart disease, osteoporosis and does not add increase a woman's risk of endometrial cancer (2,3,6). Foods high in soy include chickpeas pinto beans, lima beans and lentils. Most of the research on soy has been done with women who ate soy products regularly, so foods such as soy milk and tofu are probably a good bet. Alternatively, the major isoflavones of soy, genistein and daidzein are now available in capsule form.
Flaxseed is also another beneficial dietary supplement to add to your diet at this time. Research has shown incorporating flaxseed into your diet may help reduce your chances of developing heart disease and colon cancer (7). Flaxseed comes in many forms, if you opt to add ground flax to your morning cereal or oatmeal, it is an excellent source of fiber which can also reduce your risk of developing heart disease and diabetes. Not only this, but it is also high in omega-3 fatty acids which have been shown to help reduce symptoms of mild depression. Just by adding flaxseed you can combat many of the conditions that plague women at this stage of life.
Another legume that is high in phytoestrogens is red clover. The natural plant derived estrogens in soy and red clover act as weak estrogens. This means that they are just strong enough to combat the symptoms of menopause without elevating the levels of estrogen in your body high enough to increase your risk of endometrial cancer. A small trial found that supplementation with red clover cut women's hot flashes by 44% (8). More large scale trials need to be done before scientists can adequately gauge the how much benefit red clover can offer to menopausal women.
The essential fatty acids found in evening primrose and borage oils help regulate natually occuring hormonelike chemicals called prostaglandins. They can help control the irregular menstrual bleeding so common during menopause, including heavy or scant flow and cramping. There is only minimal evidence of benefit from supplementation with evening primrose oil, further research is necessary before evening primrose oil can be accepted as a first line of defense against menopausal complaints (3).
Other supplements that may be helpful for reducing risks from heart disease and osteoporosis include vitamin E, calcium, magnesium, and vitamin D. Vitamin E stimulates the body's estrogen production and, as one of the antioxidant vitamins (along with the carotenes and vitamin C), acts to prevent LDL ("bad") cholesterol from precipitating along the inside of artery walls. Calcium, magnesium, and vitamin D help prevent osteoporosis and are often combined into a "bone-building" supplement. Even women on HRT should evaluate their calcium, magnesium, and vitamin D intake to make sure they are getting enough.
Get supplement dosages and tips in our WholeHealthMD Supplement Recommendations for Menopause.
Return to Top
Get regular exercise, which promotes heart health. Strength training with light weights protects bone strength. You should aim for 30 minutes a day three to four times a week. But, if running isn't your cup of tea try yoga, tai chi, or qui gong. There are so many exercise options available today at your local gym or on video that everyone can find an exercise modality that appeals to them. The key is to write it into your schedule on a weekly basis. To be effective exercise has to happen regularly.
Quit smoking. Smoking increases your risk of heart disease, stroke, and cancer. These risks increase after menopause anyway, so be proactive and lessen your chance of suffering from serious malady. Many health plans and employer assistance programs offer smoking cessation support. Ask your benefits administrator about these options. Take advantage of any stop smoking program offered through your health plan or employer group, or go to www.quitnet.com to join the largest online support group of former smokers and “ready to quit†health seekers. Taking on such a significant change can be much less scary in the context of a supportive group.
Increase your intake of calcium-rich foods and vitamin D to promote healthy bones. A woman's daily intake of calcium at this time of life should be 1,200 to 1,500 mg. If you are not getting enough dairy, try calcium supplements which now come in many forms such as flavored chewables. Also make sure that you are spending time out of doors. Sunlight is an essential ingredient in ensuring your body can produce adequate amounts of vitamin D. So get your exercise by taking a walk, or while doing work in the yard – just don't forget your sunscreen to protect from harmful UV rays!