Non-Hormonal Treatments for Menopause

A friend of mine in her mid-40s called me up the other week asking for assistance in dealing with her starting menopause. I was startled at first as I had never considered before what menopause would mean to me and I’m a bit older. You might think 41 is a bit early for menopause but the fact is perimenopause, or menopause transition, begins several years before menopause. It’s the time when the ovaries gradually begin to make less oestrogen. It usually starts in a woman’s 40s, but can start in her 30s or even earlier.

In the last 1 to 2 years of perimenopause, this drop in oestrogen speeds up. At this stage, many women have menopause symptoms.

Menopause, medically defined as the absence of a menstrual period for a year, is due to a decline in oestrogen and progesterone production by the ovaries. About 60% to 80% of women experience menopause symptoms, most commonly hot flashes and vaginal dryness. Studies indicate that menopause symptoms can last a decade or longer, affecting substantial numbers of women in their 60s.

Although randomized clinical trials indicate that hormone therapy can be safe and effective way to control most menopause symptoms, it’s not considered a first line approach. Dr. JoAnn Manson, Michael and Lee Bell Professor of Women’s Health at Harvard Medical School, suggests trying lifestyle modifications for at least three months after symptoms begin before trying hormone therapy.

Let’s look at hot flashes and vaginal dryness a bit closer:
What are hot flashes?
• Hot flashes are one of the most common complaints of menopause, as the periods of intense heat, warm skin, and sweating are uncomfortable.

How do hot flashes feel like?
Hot flashes can appear suddenly, or you may feel them coming on. You may experience:
• tingling in your fingers
• your heart beating faster than usual
• your skin feeling warm, suddenly
• your face getting red or flushed
• sweating, especially in the upper body

Hot flash triggers
Each woman’s triggers for hot flashes may be a little different, but some common ones include:

• drinking alcohol
• consuming products with caffeine
• eating spicy foods
• being in a hot room
• feeling stressed or anxious
• wearing tight clothing
• smoking or being exposed to cigarette smoke

You may want to start keeping a journal about your symptoms. Write down what you were doing, eating, drinking, feeling, or wearing when each hot flash began. After several weeks, you may begin to see a pattern that can help you avoid specific
triggers. Some women are able to manage their hot flashes with some simple tools or techniques. Here are some simple ways to find relief:
• dressing in layers, even on the coldest days, so you can adjust your clothing to how you’re feeling
• sipping ice water at the start of a hot flash
• wearing cotton night clothes and using cotton bedlinen
• keeping an ice pack on your bedside table

Non-hormonal treatments for hot flashes
The following have been found effective in reducing the discomfort from hot flashes, both those that interrupt daily life and those that disturb sleep:

Mind and body approaches
Cognitive behavioural therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing hot flashes. There is also growing evidence that mindfulness based stress reduction can reduce the severity of hot flashes. Some women find acupuncture done by a certified practitioner helpful.

Weight loss
Women who are overweight or obese tend to report greater discomfort from hot flashes, compared with women of normal weights. A few studies have shown that losing weight helps lower the intensity of hot flashes.

Soy
There is quite a bit of evidence that soy products can alleviate hot flashes, but the degree of relief provided varies widely. In general, soy high in diadzein is most effective. Diadzein is a compound that can be converted in the intestines to equol, a chemical that attaches to oestrogen receptors to duplicate some of oestrogen’s effects in the body. However, because only about 50% of Asian and 25% Caucasian women carry the intestinal bacteria necessary to produce equol from daidzein, equol supplements may be more effective than soy. There is early evidence that a 10 milligram S-equol supplement taken twice a day may control hot flashes with no harmful side effects. However, more studies are needed to better determine its effectiveness.

Lifestyle changes
Lifestyle choices can make as much of an impact on your body as any medication or supplement you take. Living a healthy lifestyle can reduce the incidence and/or severity of hot flashes and help reduce the risk of heart disease and osteoporosis. Be mindful of the following ways you can improve your health:
• eating a well-balanced diet, eating smaller portions 5 times
a day
• exercising regularly, at least 30 min a day
• stop smoking, if you do, reduce alcohol consumption to no
more than 3 glasses a week.

Vaginal dryness
Vaginal dryness is very common in women going through menopause and for postmenopausal women as well. The most
common cause:

Decreased oestrogen
Oestrogen is a hormone that’s essential to keeping vaginal tissues healthy. This hormone helps to maintain the vagina’s normal lubrication, acidity levels, and elasticity. Therefore, when oestrogen levels decline, the lining of the vagina becomes thinner and less elastic, and the vagina produces less lubrication. Oestrogen levels drop during and/or after menopause, during childbirth, and during periods of breastfeeding. You may also experience a loss of oestrogen if you smoke cigarettes, have had your ovaries removed, have been treated for cancer, or if you have certain immune disorders.

Alternative treatments for vaginal dryness
Hormone therapy may not be the right treatment for everyone. Replacing natural oestrogen can help with dryness, but can also trigger side effects. These include:
• weight gain
• fluid retention
• nausea
• headaches
• breast tenderness
• spotting of the skin
• increased risk of stroke, blood clots and breast and ovarian cancers There are several alternatives to oestrogen therapy, which work very well and are often worth trying before using oestrogen therapy. They include:
• Water based lubricants, which can help add moisture to the vaginal lining. Their effectiveness can last for hours at a time, making them a good alternative when dryness causes discomfort during sexual intercourse. Lubricants are not absorbed into the skin so don’t provide long lasting relief. They should be applied right before having sex.
• Vaginal moisturisers. These products adhere to or are absorbed by vaginal tissues, so they provide longer lasting relief from itching and pain. Unlike lubricants they are designed to be applied regularly.
• Compounds in soybeans and soy products mimic the effects of oestrogen. If you add soy to your diet, you may experience some relief from vaginal dryness.
• Black Cohosh is an herbal supplement that’s considered by some to relieve menopausal symptoms. There are no significant clinical studies that show its effectiveness.
• Wild yam is another supplemental ingredient that promises to relieve dryness, but evidence from research is lacking.