Herbs and drugs - what works for hot flushes?
Research at the University of Exeter shows that 50.5% of women now use one or more complementary or alternative medicines to ease menopausal symptoms.
Hot flushes – suffered by seven out of ten women
Loss of libido
Vaginal dryness and pain, itching or discomfort during sex
Urinary tract infections
Their analysis of surveys found that six out of ten women rated their treatment as successful, and the five most popular therapies were herbal medicine, followed by soy, evening primrose oil, relaxation and yoga.
The rise in the popularity of complementary and alternative medicine has followed a decline in HRT use after reports of links between hormone therapy and increased risk of breast and endometrial cancer, heart disease and stroke although, for many women, the real increase is slight.
Personal factors such as age, weight, family and medical history will affect the level of risk, as will the duration of the treatment.
Nevertheless, research suggests that many women are attracted to alternative treatments in the belief that they are natural and safe – which may not always be the case – as well as being effective.
The challenge for women searching for a natural remedy is finding one that works. Relatively little research has been carried out, and sometimes the evidence is wanting or negative. According to a Yale University School of Medicine report, phytoestrogens (derived from plants), black cohosh and vitamin E
may be no better than a placebo in reducing hot flushes, while the Exeter team says the same about evening primrose.
However, a survey of 2,500 German gynaecologists who were asked to rate the effectiveness of each therapy based on observations of their patients found that most of the doctors believed in the effectiveness of at least one alternative therapy. Straightforward lifestyle changes were rated the best, with 54.4% saying that they were effective, while 35.7% reported that they worked sometimes. And alternative treatments that were rated as effective by the doctors were St John’s wort
(25%) and black cohosh
The best bets for managing menopause symptoms
Simple lifestyle changes have been shown to ease hot flushes, including maintaining a healthy weight
and stopping smoking
, as well as more obvious adjustments such as creating a cooler environment, wearing light and layered clothing and using fans when needed, according to one Yale University study.
Group relaxation therapy can work, according to a 2012 study by gynaecologists at Linköping University, Sweden. Postmenopausal women with seven or more moderate-to-severe hot flushes a day had either relaxation therapy or no treatment at all. In those who had the therapy, the number of hot flushes dropped by five a day compared with 1.9 in the other group after 12 weeks.
three times a week for three months can have a significant beneficial effect on some menopausal symptoms. One trial at Minnesota University showed improvements in sleep quality, insomnia and depression, but not in hot flushes.
A study at the University of California San Francisco showed that eight weekly 90-minute sessions of yoga
led to an average drop in hot flushes each week of 30.8%. The researchers say bigger trials are now needed.
According to one study at Keiju Medical Centre in Namao City, Japan, a supplement based on pine bark eased almost all menopausal symptoms, but was particularly effective against hot flushes, night sweats and insomnia. The study involved 170 women taking either 30mg of Pycnogenol French maritime pine bark extract or a placebo a day, and found significant improvements after four weeks in the women on the supplement.
St John’s wort
Better known for its use as an antidepressant, it has been shown to improve quality of life in women around the time of the menopause. The study, at the University Hospital of Quebec, found that after three months of taking St John’s wort
, women had significantly better quality of life and fewer sleep problems than those who were taking a placebo.
The jury is still out on these menopause remedies
Some studies have found black cohosh
effective, while others have not. A study funded by the US National Institutes of Health found it to be no better than a placebo for relieving hot flushes. However, a Swiss study based on more than 400 women showed that it was effective: ‘Treatment in patients with hot flushes and night sweats resulted in a significant improvement of symptoms,’ say the researchers. One in four German gynaecologists also considered black cohosh to be effective.
This ancient Chinese therapy can reduce the severity of symptoms of hot flushes according to a study at Stanford University in California, where postmenopausal women with moderate to severe hot flushes were given nine sessions of acupuncture or placebo needles. Acupuncture resulted in a significantly greater decrease in the severity, but not the frequency, of hot flushes. Other studies have found no effects.
Evening primrose oil
Some research shows that the third most popular natural remedy used by menopausal women is effective, but a report in the British Medical Journal
found that gamolenic acid – a major compound in primrose oil
– offered no benefit over a placebo in treating hot flushes. However, a study at Shahid Beheshti University in Iran involving the same number of women found primrose oil to be superior to a placebo, with a 42% improvement in the severity of symptoms.
A number of symptoms, including hot flushes, were eased among women taking an extract of hop flowers daily compared with those who had a placebo preparation. The research at Ghent University Hospital in Belgium found that the reduction in hot flushes was significant after six weeks.
Some trials show it is helpful, while others have found it ineffective. Its use is based on the idea that soy contains compounds called isoflavones, which have some small oestrogen-like effect. A study at the University of Minnesota concluded, ‘Consumption of 30mg/day of soy isoflavones reduces hot flushes by up to 50%’.
The supplement widely used in pregnancy to lower the risk of birth defects may also be a way to treat hot flushes. Improvement in hot flushes was reported by 65% of the women taking the active treatment (but also by 16% of the placebo group!) in a study at the University of Alexandria. Two weeks after stopping the tablets, hot flushes recurred in all women who had shown an improvement. Folic acid
may have an effect on the brain chemical serototin, which has been implicated in hot flushes.
Can you delay the menopause?
-eaters are up to 40% less likely to go through an early menopause, according to research at Demirel University Medical School, Turkey. In a group of women with an average age of 52, fish-eating delayed menopause the most, while lifelong sun exposure increased the risk of early menopause the most.
Women who drink red wine have a lower risk of an early start to the perimenopause, the two to eight years leading up to the menopause itself, according to Harvard University research based on around 500 women aged 36 to 45, who were monitored for more than five years. One theory is that it is down to a non-alcoholic compound in red wine, resveratrol, which has oestrogen-like actions.
Results of a 20-year study of 46,000 women show that the more low-fat dairy products a woman consumed the later her menopause. The Harvard University researchers say that cow’s milk contains compounds that appear to increase the amount of oestrogen and progesterone in a woman’s body, which might cause the delaying effects. Low-fat dairy products contain more of these compounds, which may explain why the same effects were not seen for full-fat dairy items.
Talk to your doctor before using complementary and alternative medicines. Some herbal therapies can be dangerous, and can interact adversely with prescription medications, yet in a study of users by Exeter University researchers, more than half of the women had not told their doctors about their use of complementary and alternative medicine.
Before you decide which menopause treatment to try
Before ruling out conventional treatments, it’s worth discussing HRT as well as other prescription medications with your doctor so you can weigh up the relative pros and cons of the different treatments and decide what’s best for you.
Medical treatments for menopause
Hormone replacement therapy is effective in treating a number of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and urinary tract infections, such as cystitis.
In the long-term, it can also reduce the risk of osteoporosis. It works by replacing oestrogen whose levels drop as the menopause approaches. It’s available as a cream or gel, a tablet, a skin patch or an implant.
A number of side effects can be associated with HRT, including weight gain, tender breasts, nausea, headaches and mood changes.
According to NHS Choices, HRT slightly increases the risk of developing breast cancer, endometrial cancer, ovarian cancer and stroke.
The balance of benefits and possible risks will be different for each individual woman, so it's worth having a full discussion of the pros and cons with your GP before making a decision about treatment.
Research at the Karolinska Hospital in Sweden shows that a gel rubbed on the skin boosts libido in post menopausal women. "Testosterone gel of 10 mg had positive effects on several aspects of sexual life such as frequency of sexual activity, orgasm, arousal, fantasies and sexual interest in postmenopausal women on HRT," say the researchers.
One study, based on more than 2,000 women, showed that compared with placebo, selective serotonin reuptake inhibitors (or SSRIs) such as Prozac were associated with a significant drop in frequency of hot flushes, and in their intensity. A second study showed that symptoms rapidly returned in more than a third of women after therapy was stopped.
A man-made hormone that works in the same way as HRT, it is effective in treating hot flushes and night sweats and it can also help prevent fractures of the spine. It may also improve sexual problems, such as a decreased sex drive. It has some risks, however, including a small increased risk of breast cancer, cancer of the womb and stroke. It is not suitable for women over 60.
A drug originally developed to treat high blood pressure, it has been found to reduce hot flushes and night sweats in some menopausal women.
An anti-convulsant, used for treating seizures and pain associated with shingles, it has been shown to reduce symptoms according to a Wayne State University School of Medicine report, but it is not known how. A study involving 59 women found a reduction of hot flush frequency of 45 per cent compared to 29 per cent for placebo treatment.
A handheld device with a small metal cold plate has been designed to stop hot flushes before they really start. It is held against the back of the neck at the first sign of symptoms, and is designed to re-set the body's natural heat controls whose malfunctioning is thought to be involved in hot flushes. The Menopod, which is being used in a clinical trial, is designed to be effective within one minute. A trial of the device at Queen’s University in Canada comes in the wake of anecdotal reports of women having immediate easing of hot flush symptoms when they place something cold on their neck, like a chilled soft drink can.
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