Menopause

A double-blind trial found that Asian ginseng (200 mg per day of standardized extract) helped alleviate psychological symptoms of menopause, such as depression and anxiety, but did not decrease physical symptoms, such as hot flashes or sexual dysfunction, in postmenopausal women who had not been treated with hormones.¹ In another double-blind trial, supplementation with 3 grams per day of red ginseng (heated Asian ginseng) for 12 weeks significantly improved menopausal hot flashes, compared with a placebo.²

Some, but not all, double-blind trials support the usefulness of black cohosh for women with hot flashes associated with menopause.³ In a three-month study of postmenopausal women, 40 mg per day of an extract of black cohosh was as effective as estrogen therapy in the treatment of hot flashes.⁴ A review of eight trials concluded black cohosh to be both safe and effective.⁵ However, one double-blind trial found that black cohosh is ineffective as a treatment for menopausal symptoms.⁶ Many doctors recommend 20 mg of a highly concentrated extract taken twice per day; 2 to 4 ml of tincture three times per day may also be used.

In a double-blind study of postmenopausal women who were experiencing psychological symptoms, a combination of black cohosh and St. John's wort was significantly more effective than a placebo in improving both menopausal symptoms and depression. The product used in this study contained (per tablet) black cohosh standardized to 1 mg of triterpene glycosides and St. John's wort standardized to 0.25 mg of hypericin. The amount taken was two tablets twice a day for eight weeks, followed by one tablet twice a day for eight weeks.⁷

Natural progesterone supplementation has been anecdotally linked to reduction in symptoms of menopause.^11,12,13 In one trial, natural progesterone was found to have no independent effect on symptoms, and synthetic progestins were found to increase breast tenderness.¹⁴ However, a double-blind trial found that topical administration of natural progesterone cream led to a reduction in hot flashes in 83% of women, compared with improvement in only 19% of those given placebo.¹⁵ Preliminary research has found that oral, micronized progesterone therapy is associated with improved quality of life among postmenopausal women. However, oral micronized progesterone is available only by prescription in the United States.¹⁶ Hot flashes, anxiety, depression, sleep problems, and sexual functioning were among the symptoms improved in a majority of women surveyed. Synthetic progestins, also available only by prescription, have reduced symptoms of menopause.^17,18,19

Progesterone is a hormone and, as such, concerns about its inappropriate use (i.e., as an over-the-counter supplement) have been raised. The amount of progesterone in commercially available creams varies widely, and the progesterone content is not listed on the label because the creams are legally regulated as cosmetics, not dietary supplements. Therefore, a physician should be consulted before using these hormone-containing creams as supplements. Although few side effects have been associated with topical progesterone creams, skin reactions may occur in some users. Effects of natural progesterone on breast cancer risk remain unclear; research has suggested both increased and reduced risk.

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.²⁰ These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.²¹ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.²² A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.²³ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.²⁴ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.²⁵ An extract of red clover also decreased symptoms of anxiety and depression in postmenopausal women in a double-blind study. The extract provided 80 mg of isoflavones per day and was taken for 90 days.²⁶

Many years ago, researchers studied the effects of vitamin E supplementation in reducing symptoms of menopause. Most,^{30,31,32,33,34} but not all,³⁵ studies found vitamin E to be helpful, and the benefit of vitamin E was confirmed more recently in a double-blind trial.³⁶ Many doctors suggest that women going through menopause take 400 to 800 IU per day of vitamin E for a trial period of at least three months to see if symptoms are reduced. If helpful, this amount may be continued or a lower amount may be tried for maintenance.

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.³⁷ These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.³⁸ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.³⁹ A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.⁴⁰ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.⁴¹ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁴²

Blue vervain (Verbene hastata) is a traditional herb for menopause; however, there is no research to validate this use. Tincture has been recommended at an amount of 5–10 ml three times per day.

Preliminary evidence suggests that supplementation with St. John’s wort extract (300 mg three times daily for 12 weeks) may improve psychological symptoms, including sexual well-being, in menopausal women.⁴³

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.⁴⁴ These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.⁴⁵ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.⁴⁶ A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.⁴⁷ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.⁴⁸ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁴⁹

Aging in women is characterized by a progressive decline in blood DHEA (dehydroepiandrosterone) and DHEA-sulfate (DHEAS) levels. These levels can be restored with DHEA supplementation. This process also improves the response of some brain chemicals, called endorphins, to certain drugs.⁵⁰ These endorphins are involved in sensations of pleasure and pain; improving their response may explain why DHEA has an effect on mood symptoms associated with menopause. In one double-blind trial, however, menopausal women who took 50 mg of DHEA per day for three months had no improvement in symptoms compared with women taking placebo.⁵¹ Further study is needed to validate a role for DHEA in the management of menopausal symptoms.

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.⁵² These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.⁵³ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.⁵⁴ A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.⁵⁵ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.⁵⁶ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁵⁷

In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the flavonoid hesperidin taken over the course of the day helped relieve hot flashes.⁵⁸ Although placebo effects are strong in women with hot flashes, other treatments used in that trial failed to act as effectively as the flavonoid/vitamin C combination. Since then, researchers have not explored the effects of flavonoids or vitamin C in women with menopausal symptoms.

In a preliminary trial, supplementation with crushed flaxseeds for six weeks improved the average hot flash score (a measure of the frequency and severity of hot flashes) by 57% in postmenopausal women who were not receiving estrogen therapy. The treatment consisted of 2 tablespoons of flaxseeds (along with at least 10 ounces of liquid) twice a day. About one-fifth of the women discontinued treatment because of abdominal symptoms or other side effects.⁵⁹ In a double-blind trial, daily consumption of 25 g of partially defatted ground flaxseed significantly decreased the number of hot flashes and improved overall menopausal symptoms. However, the improvements were not greater than those in women given a placebo (wheat bran).⁶⁰ Because of these conflicting results, the effectiveness of flaxseed as a treatment for menopause remains uncertain.

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.⁶¹ These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.⁶² No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.⁶³ A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.⁶⁴ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.⁶⁵ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁶⁶

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.⁶⁹ These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.⁷⁰ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.⁷¹ A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.⁷² An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.⁷³ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁷⁴

Sage may reduce excessive perspiration due to menopausal hot flashes during the day or at night.⁷⁵ It is believed this is because sage directly decreases production of sweat. In a preliminary study, supplementation with a product containing extracts of the leaves of sage and alfalfa resulted in complete elimination of hot flushes and night sweats in 20 of 30 women, with varying degrees of improvement in the other ten cases.⁷⁶

A double-blind study of 78 postmenopausal women (average age, 49.5 years) were randomly assigned to receive 60 mg per day of soy isoflavones (as aglycone) or placebo for six months.⁷⁷ Then after a one-month break, each woman received the alternate treatment for an additional six months. Thinking (cognitive) performance and mood were assessed by tests at the end of each treatment period. Compared with placebo, people treated with isoflavones experienced significant improvement on 6 of 17 measures of cognitive function and 7 of 8 measures of mood. In another double-blind study, 177 postmenopausal women (average age, 55 years) who were experiencing five or more hot flushes per day were randomly assigned to receive soy isoflavones (50 mg per day total of an approximately equal mixture of isoflavones genistin and daidzin) or placebo for 12 weeks.⁷⁸ The average reduction in hot flash frequency after 6 weeks was significantly greater in the isoflavone group than in the placebo group; however, during the entire 12 weeks, the difference between the two groups was only marginally significant.

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market.⁷⁹ Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort.

Preliminary evidence suggests that supplementation with St. John’s wort extract (300 mg three times daily for 12 weeks) may improve psychological symptoms, including sexual well-being, in menopausal women.⁸¹⁸²

In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the flavonoid hesperidin taken over the course of the day helped relieve hot flashes.⁸³ Although placebo effects are strong in women with hot flashes, other treatments used in that trial failed to act as effectively as the flavonoid/vitamin C combination. Since then, researchers have not explored the effects of flavonoids or vitamin C in women with menopausal symptoms.

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.⁸⁴ These herbs include licorice, alfalfa, and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock, dong quai, wild yam, and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.⁸⁵ No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.⁸⁶ A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover, containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.⁸⁷ An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.⁸⁸ In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.⁸⁹