Menopause: An Integrative Health Approach
So you’re waking up drenched in sweat. More irritable than normal. Finding yourself stripping down to your camisole in the dead of winter, then bundling back into your sweater, then tossing it aside again. An uninterrupted night of sleep has become a distant memory. Your back and joints ache. Sex…well, not so much. And what the heck is going on with your periods? One month you’re like a gushing geyser; the next month it’s gone missing altogether; the next month you spend two weeks spotting.
Welcome to menopause. Actually, you’re probably in perimenopause, that time just before you actually hit menopause, which is defined as the day you’ve gone 12 months without a period. Perimenopause can last a year or more (up to 10 years in some women) and no, it’s not a fun time. Honestly, though, even the postmenopausal years can be fraught with hot flashes, sleepless nights, moodiness, and other menopausal symptoms. 1
It all comes down to shifting hormones that, in the end, signals the end of your reproductive years. But even as one chapter ends, another begins, one many women view positively. In one study, researchers asked 393 women to share their thoughts about passing through menopause. More than half mentioned positives about the transition, including relief that their periods and menstrual-related symptoms were over and that they didn’t have to worry about pregnancy any longer. Many cited the personal growth and freedom to focus on themselves they felt. They talked about feeling stronger, having a greater connection with their inner feelings, experiencing fewer inhibitions, and feeling more confident in expressing themselves. 2
Voices of Menopause 2
“Physically I have obtained a great strength passing the menopause — my sexual life has become more fun — I know for sure what I want — I look forward to becoming a granny soon, I am about to change my job, and I look forward to it.”
“I really experience some wonderful years just now.”
“I experience it as a new phase in my life — without children, and more time to do what I want”
DEALING WITH THE DOWNSIDE
Most of what we hear about menopause has to do with life-disrupting symptoms. That’s because they’re real. The most prevalent are vasomotor symptoms – hot flashes and night sweats, which about 80 percent of women experience. A third classify them as frequent, severe, and having a “profound impact” on their quality of life. 3 Hot flashes often occur several times per day, with about 1 out of 11 perimenopausal and 1 out of 14 postmenopausal women experiencing more than seven a day.4 The good news is that they typically taper off within a few a years after menopause. 4 5
Vaginal atrophy, defined as the thinning and drying of the vaginal lining, affects nearly half of all menopausal women. It also has a profound negative impact on quality of life and self-image, and can persist long after other menopause-related symptoms fade. 6-9 In addition to making sex painful, it can also increase susceptibility to vaginal and urinary infections. 6
Other common symptoms include anxiety, tiredness, stiff or painful joints, back pain, urinary incontinence, headaches, and heart palpitations, weight gain, and memory and other cognitive problems. 10
GOING THE MEDICAL ROUTE
Menopause is a natural process, not a disease. Seeking relief from the medical route depends on how bothersome or severe your symptoms are. A common treatment for menopausal symptoms is hormone replacement therapy (HRT), patches, creams, or oral tablets that replace estrogen, progesterone, or both. 3 11 It’s excellent at improving hot flashes and has an additional benefit in its ability to prevent bone loss, or osteoporosis. However, it may also increase the risk of breast cancer, endometrial cancer, and blood clots in some women. 3 12 13 That’s why women with a history of cancer or an increased risk of cancers like uterine or ovarian shouldn’t use it. 3 Hormone therapy is also available in a cream or tablet to counteract vaginal dryness.
In 2013, the Food and Drug Administration approved the antidepressant paroxetine (Paxil), sold under the brand name Brisdelle, for hot flashes. It is taken once daily before bed, but don’t use it if you’ve had breast cancer or are taking tamoxifen. Other non-hormonal medications that may have some benefits are gabapentin (Neurontin), venlafaxine (Effexor), desvenlafaxine (Pristiq), citalopram (Celexa), and escitalopram (Lexapro). None are FDA-approved for hot flashes, however.
INTEGRATING THE TRADITIONAL AND ALTERNATIVE
These are not all your options, however. The growth in women’s search for alternatives to hormone therapy really gained momentum in the early 2000s, after the release of results from the Women’s Health Initiative, which involved 27,347 postmenopausal women. The study found higher risks of coronary heart disease, breast cancer, stroke, pulmonary embolism, dementia, gallbladder disease, and urinary incontinence in women using a particular oral form of estrogen/progesin. 11
Although the study and its findings were controversial, millions of women immediately stopped taking their hormones, only to find their hot flashes return. In one study of 6,383 women who had used hormone therapy, 80 percent of whom had stopped using it, most said they turned to one or more types of complementary or alternative medicine (CAM) approaches for their symptoms. 14
The literature is rich with studies on alternative options to traditional medications for this most bothersome of menopausal symptoms. And many of these approaches also help with other menopausal symptoms. Not surprisingly, women who experience hot flashes are more likely to turn to CAM than women who don’t. 15
In this section, we provide you with an overview of complementary and alternative medicine (CAM) to safely manage your menopausal symptoms. If you go this route, you’re not alone. One study estimated that slightly more than half (53 percent) of menopausal women used at least one type of CAM to help manage their symptoms. 16 Another found a similar number of women used CAM and 60 percent said it helped their symptoms. 17
Talk to Your Doctor
Whether it’s supplemental vitamins or minerals, or herbal remedies, please tell your healthcare professionals, including pharmacists, about it. While generally safe, some can interfere with other medications you’re taking or your doctor wants to prescribe. Unfortunately, most women don’t tell their doctors when they opt for alternative therapies. 17
When it comes to CAM for menopausal symptoms, there are three main categories: 18
- Mind-body practices, including hypnosis, cognitive behavioral therapy, [CBT], relaxation, biofeedback, meditation, and aromatherapy
- Natural products, such as herbs, vitamins, minerals, and dietary supplements.
- Whole system approaches, such as acupuncture, reflexology, homeopathy, and traditional Chinese medicine
Let’s take a quick look at some.
Hypnosis. No, we’re not talking about making you do silly things. Medical hypnosis puts you into a deep state of relaxation, making you more susceptible to suggestions – including your own. Two studies involving five sessions of hypnosis for hot flashes among breast cancer survivors found a significant reduction in their frequency and severity, about the same as with hormone therapy. 18 Other studies find hypnosis can also improve sleep quality and sexual function. Even the North American Menopause Society (NAMS) recommends hypnosis for menopausal symptoms. 19 You can find a medical hypnotist through the American Society of Clinical Hypnosis.
Cognitive behavioral therapy (CBT). Cognitive behavioral therapy is short-term therapy in which you work with a therapist to reframe how you think about and react to your symptoms. One study found a 52 percent reduction in the impact of hot flashes on breast cancer survivors who received CBT compared to 25 percent in women who did not receive the intervention, even though the frequency of hot flashes felt about the same in both groups. 20
Cognitive behavioral therapy is another intervention that NAMS recommends for reducing the impact of hot flashes and night sweats on quality of life, even if it doesn’t reduce the frequency. 20
Mindfulness training. This approach involves learning to recognize and discriminate more accurately between the thoughts, feelings, and sensations of an experience so you can be less reactive to them and observe them in a more dispassionate manner. In one randomized trial, 110 late perimenopausal and early post-menopausal women experiencing an average of five or more moderate or severe hot flashes (including night sweats) a day were randomized to attend eight weekly classes on biofeedback and relaxation, and one all-day class, or to no intervention.
After 20 weeks, women attending the classes saw the “bothersomness” of their symptoms fall 22 percent compared to 10.5 percent for those who didn’t get the training. The women in the first group also demonstrated significant improvements in quality of life, sleep quality, anxiety, and perceived stress, all of which persisted at least three months (the time period they were followed) after the intervention. 21
Yoga. The emphasis on being in the moment as well as the movements and deep breathing inherent to yoga are likely behind the benefits that studies on yoga often find when it comes to the psychological symptoms of menopause, including quality of life, sexuality, and fatigue, although not hot flashes and other vasomotor symptoms. 18
Aromatherapy. You may know that lavender can improve sleep (spray some on your pillow), but did you know it can also improve hot flashes. One 12-week study in 100 women, in which half received lavender essential oil and half a placebo for six weeks, after which they switched, found that the essential oil slashed the number of hot flashes in half compared to a less than 1 percent reduction with the placebo. 22 A simple and safe procedure.
Black cohosh. Black cohosh, or cimicifuga racemosa, is possibly the most-studied herbal remedy for hot flashes. But here’s the thing; although most studies show significant improvements in menopausal symptoms, the improvements aren’t much different from that of placebo.
Nonetheless, the authors of a review of 16 studies concluded that while there wasn’t enough evidence to recommend the use of black cohosh for menopausal symptoms, there was enough evidence to suggest more studies should be conducted. 23 We should point out, however, that the findings in that review were considered somewhat controversial. 24 Plus, as the North American Menopause Society notes, black cohosh is “relatively low risk.”
Meanwhile, a study focused only on the effects of black cohosh on sleep in 42 women just after menopause found significant improvements in sleep in the women who received the herb versus those who received placebo. 25 As with any herbal treatment, be sure to talk with your physician, nurse practitioner or pharmacist before trying it, especially if you are on other medications, to be sure it does not interact or interfere with those medications.
Phytoestrogens. Phytoestrogens are plant-based estrogens found in soy and red clover. They are often touted as “natural estrogens” and, indeed, they can contain large amounts of the isoflavones genistein and daidzein that may produce “estrogen-like” effects. While clinical trials are mixed, often showing no difference between placebo and the phytoestrogen on menopausal symptoms, NAMS notes that they can reduce menopausal symptoms with no evidence of increased risk of breast or endometrial cancer. In fact, diets high in soy are associated with a lower risk of breast and endometrial cancer. 19 26
Acupuncture. Acupuncture is an ancient Chinese healing system used throughout the world. Practitioners insert hair-thin needles into specific points along the meridians or at the tender points in the body. A year-long, federally funded study found that acupuncture may significantly reduce hot flashes and other menopause-related symptoms, including memory, anxiety, and sleep quality, with the benefits lasting at least 6 months after the acupuncture treatments ended. 27 Numerous other studies also show benefits for hot flashes, sleep, and somatic symptoms such as pain and fatigue. 18
Other herbs with some potential benefits for various menopausal symptoms include St. John’s wort for hot flashes and sleep; 28 29 ginseng for hot flashes and overall well-being, including depression and sexual dysfunction; 29 and flaxseed for hot flashes. 29
Lifestyle Changes for Hot Flashes 30
Lifestyle changes, including nutrition and exercise, are an integral part of any integrative health approach. When it comes to hot flashes, here are some things you can try:
- Dress in layers, which can be removed at the start of a hot flash.
- Carry a portable fan to use when a hot flash strikes.
- Avoid alcohol, spicy foods, and caffeine, which can make hot flashes worse.
- Quit smoking, not only for menopausal symptoms, but for your overall health.
- Maintain a healthy weight. Women who are overweight or obese may experience more frequent and severe hot flashes.
Parsing the Placebo Effect
The placebo effect means that using an inert substance like a sugar pill results in similar benefits to a real drug when the person goes through the ritual of getting and taking it. Placebos are used in clinical trials to determine of a therapy has greater effect that the ritual of therapy whether it involves a drug, a surgery, or an herbal remedy or other integrative approach. The reality, however, is that using even a “fake” intervention can result healing properties, particularly when it comes to subjective conditions like pain, depression, anxiety, and yes, hot flashes. 31 3
So just because, say, black cohosh (or any other treatment) doesn’t perform better than placebo, doesn’t mean that using it is not going to work. If your symptoms improve, there’s nothing wrong with trying a treatment, provided it is safe, does not adversely interact with other treatments you are using, or is too expensive for you.
While this section primarily focused on the downsides of the menopausal transition and how to manage them, I don’t want you to focus only on the negatives. Definitely find the help you need to improve menopausal symptoms and restore your quality of life. But also look within yourself to identify and embrace the positives of this next phase of your life and the new opportunities now available to you.
- Hasper I, Ventskovskiy BM, Rettenberger R, Heger PW, Riley DS, Kaszkin-Bettag M. Long-term efficacy and safety of the special extract ERr 731 of Rheum rhaponticum in perimenopausal women with menopausal symptoms. Menopause. 2009;16(1):117-131.
- Hvas L. Positive aspects of menopause: a qualitative study. Maturitas. 2001;39(1):11-17.
- Heger M, Ventskovskiy BM, Borzenko I, et al. Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled
trial. Menopause. 2006;13(5):744-759.
- Williams RE, Kalilani L, DiBenedetti DB, et al. Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States. Climacteric. 2008;11(1):32-43.
- Pinkerton JV, Stovall DW, Kightlinger RS. Advances in the treatment of menopausal symptoms. Womens Health (Lond Engl). 2009;5(4):361-384; quiz 383-364.
- North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888-902; quiz 903-884.
- Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause. 2013;20(10):1043-1048.
- Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013;10(7):1790-1799.
- Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009;6(8):2133-2142.
- Sussman M, Trocio J, Best C, et al. Prevalence of menopausal symptoms among mid-life women: findings from electronic medical records. BMC Womens Health. 2015;15:58.
- Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. Jama. 2013;310(13):1353-1368.
- Keiler AM, Papke A, Kretzschmar G, Zierau O, Vollmer G. Long-term effects of the rhapontic rhubarb extract ERr 731(R) on estrogen-regulated targets in the uterus and on the bone in ovariectomized rats. J Steroid Biochem Mol Biol. 2012;128(1-2):62-68.
- Papke A, Kretzschmar G, Zierau O, Kaszkin-Bettag M, Vollmer G. Effects of the special extract ERr 731 from Rheum rhaponticum on estrogen-regulated targets in the uterotrophy model of ovariectomized rats. J Steroid Biochem Mol Biol. 2009;117(4-5):176-184.
- Gentry-Maharaj A, Karpinskyj C, Glazer C, et al. Use and perceived efficacy of complementary and alternative medicines after discontinuation of hormone therapy: a nested United Kingdom Collaborative Trial of Ovarian Cancer Screening cohort study. Menopause. 2015;22(4):384-390.
- Peng W, Adams J, Hickman L, Sibbritt DW. Longitudinal analysis of associations between women’s consultations with complementary and alternative medicine practitioners/use of self-prescribed complementary and alternative medicine and menopause-related symptoms, 2007-2010. Menopause. 2016;23(1):74-80.
- Peng W, Adams J, Sibbritt DW, Frawley JE. Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision making, and communication. Menopause. 2014;21(5):536-548.
- Posadzki P, Lee MS, Moon TW, Choi TY, Park TY, Ernst E. Prevalence of complementary and alternative medicine (CAM) use by menopausal women: a systematic review of surveys. Maturitas. 2013;75(1):34-43.
- Johnson A, Roberts L, Elkins G. Complementary and Alternative Medicine for Menopause. Journal of evidence based integrative medicine. 2019;24:2515690×19829380.
- Shifren JL, Gass ML. The North American Menopause Society recommendations for clinical care of midlife women. Menopause. 2014;21(10):1038-1062.
- Mann E, Smith MJ, Hellier J, et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. The Lancet Oncology. 2012;13(3):309-318.
- Carmody JF, Crawford S, Salmoirago-Blotcher E, Leung K, Churchill L, Olendzki N. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause (New York, NY). 2011;18(6):611-620.
- Kazemzadeh R, Nikjou R, Rostamnegad M, Norouzi H. Effect of lavender aromatherapy on menopause hot flushing: A crossover randomized clinical trial. J Chin Med Assoc. 2016;79(9):489-492.
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. The Cochrane database of systematic reviews. 2012(9):Cd007244.
- Beer AM, Osmers R, Schnitker J, Bai W, Mueck AO, Meden H. Efficacy of black cohosh (Cimicifuga racemosa) medicines for treatment of menopausal symptoms – comments on major statements of the Cochrane Collaboration report 2012 “black cohosh (Cimicifuga spp.) for menopausal symptoms (review)”. Gynecol Endocrinol. 2013;29(12):1022-1025.
- Jiang K, Jin Y, Huang L, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric : the journal of the International Menopause Society. 2015;18(4):559-567.
- The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010). Menopause. 2011;18(7):732-753.
- Avis NE, Coeytaux RR, Isom S, Prevette K, Morgan T. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause. 2016;23(6):626-637.
- Al-Akoum M, Maunsell E, Verreault R, Provencher L, Otis H, Dodin S. Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 2009;16(2):307-314.
- Ghazanfarpour M, Sadeghi R, Latifnejad Roudsari R, et al. Effects of flaxseed and Hypericum perforatum on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women: a systematic review and meta analysis. Avicenna journal of phytomedicine. 2016;6(3):273-283.
- National Institute on Aging. Hot Flashes: What Can I Do? 2019; https://www.nia.nih.gov/health/hot-flashes-what-can-i-do. Accessed May 20, 2019.
- Pozgain I, Pozgain Z, Degmecic D. Placebo and nocebo effect: a mini-review. Psychiatria Danubina. 2014;26(2):100-107.
- Price DD, Finniss DG, Benedetti F. A comprehensive review of the placebo effect: recent advances and current thought. Annu Rev Psychol. 2008;59:565-590
ABOUT THE AUTHORS
DR. WAYNE JONAS
Dr. Jonas is a practicing family physician, an expert in integrative health and whole person care delivery, and a widely published scientific investigator. Dr. Jonas is the president of Healing Works Foundation. Additionally, Dr. Jonas is a retired lieutenant colonel in the Medical Corps of the United States Army.
Dr. Jonas was the director of the Office of Alternative Medicine at the National Institutes of Health (NIH) from 1995-1999, and prior to that served as the Director of the Medical Research Fellowship at the Walter Reed Army Institute of Research. He is a Fellow of the American Academy of Family Physicians.
His research has appeared in peer-reviewed journals, such as the Journal of the American Medical Association, Nature Medicine, Journal of Family Practice, Annals of Internal Medicine, and The Lancet. Dr. Jonas received the 2015 Pioneer Award from the Integrative Healthcare Symposium, the 2007 America’s Top Family Doctors Award, the 2003 Pioneer Award from the American Holistic Medical Association, the 2002 Physician Recognition Award of the American Medical Association, and the 2002 Meritorious Activity Prize from the International Society of Life Information Science in Chiba, Japan.
DEBRA GORDON, MS
Debra Gordon, MS is a seasoned health care communications professional who specializes in researching and writing content on the US healthcare system and medical issues for clinicians, businesses, and consumers. She has more than 30 years of experience in the health care world, including a decade as a newspaper reporter covering medicine and 20 years as a freelance medical writer.
She received her bachelor’s degree in English from the University of Virginia and her Masters in Biomedical Writing from the University of the Sciences in Philadelphia.
Topics: Complementary Medicine