Menopausal Health - A Nonhormonal Approach HF#5351

  What is Menopause?

 

Menopause refers to the end of menstrual periods.  The average age at which this occurs is 51.  Your genes and family history often play a role in the age you reach menopause.  Other factors are listed below

 

• Smoking.
• Prior removal of the ovaries.
• Treatments such as chemotherapy (chemo) and radiation.

 

Symptoms

 

Symptoms of menopause can vary with each woman.  They may occur slowly over time while hormone levels change.  For some women the onset of symptoms can be sudden and severe.  Lifestyle, coping methods, and stress may also play a role in how you can manage these symptoms.  The symptoms are listed below.

 

• Hot flashes
• Night sweats
• Irregular menstrual bleeding
• Muscle aches and pains
• Sleeplessness
• Mood swings

 

Other common symptoms

• Vaginal dryness and itching
• Pain with intercourse
• Loss of urine with coughing, sneezing, or laughing
• Frequent vaginal and urinary tract infections

 

You may prefer to try to manage your symptoms and promote health through diet and lifestyle changes. Or, you may choose the use of alternative medicine.  If your symptoms are a problem for you, talk to your health care team.  They will help you decide if hormone therapy is an option for you.

 

In this booklet, we will discuss lifestyle changes you can make to promote long-term health.  We will also suggest things you can do to relieve symptoms.

 

What You Should Know About Medical Alternatives

 

Alternative therapy can be used to relieve symptoms.  Some of these are listed below.

• Megavitamins
• Massage therapy
• Acupuncture
• Biofeedback and relaxation techniques
• Healing touch
• Herbal medicine. 

 

The value of these is not yet known.  Using large amounts of herbal products or using them together may be harmful. 

 

How herbal products work in the body is not known.  These products are not produced to comply with a standard.  We do not know how herbs may work with or against each other or other medicines.

 

Women using herbal products should be under the care of their health care team and should be aware of the guidelines listed below.

 

• Do not take while pregnant or breast feeding.
• Do not take a large quantity of any one herbal product.
• Buy only products when the plants and their amounts are listed on the packet (not a guarantee of safety).
• Use the advice and knowledge of qualified herbalists or your health care team when choosing these products.
• Be sure to inform your health care team if you are using both prescription and herbal products.

 

Taking Care of Menopausal Symptoms

 

Menstrual Changes

 

You may have noticed a change in your normal menses over the past few months or years.  Very few women have an abrupt end of menses without symptoms.  Your menses may be light, or heavy, or occur more often.  You may miss a cycle for a few months and then start your menses again.  If you have received chemotherapy, you may have stopped having a menses or your menses occur unevenly.  The younger the age you receive chemotherapy, the more severe the symptoms or menstrual changes.

 

Hot Flashes or Night Sweats

 

The hot flash or night sweat is a sudden onset of warmth in the face or neck.  You may notice a short period of rapid heart rate.  Your skin may appear flushed and you may begin to perspire.  You may feel dizzy or have headaches.  Causes of hot flashes are listed.

• Stress
• Anxiety
• Spicy foods
• Hot drinks
• Alcohol
• Caffeine
• Warm environment
• Synthetic clothing

 

Tips to reduce hot flashes are listed.

• Exercise regularly (daily if possible) 30 - 40 minutes to help reduce stress.
• Try daily relaxation and meditation.
• Avoid alcohol, caffeine, and spicy foods.
• Use only cotton clothing or clothing that “breathes” and wear in layers.
• Avoid a warm environment.

 

Vitamins

 

• Vitamin E - 400 - 800 IU a day.  It may take 6-8 weeks for relief.

Good food sources: wheat germ oil, corn oil, soybean oil, soybeans, sunflower seeds, sweet potatoes, asparagus, peanuts, almonds.  Vitamin C will help how much vitamin. E you absorb.  If symptoms are not relieved add:

• Vitamin B₆ - 200 mg daily - can be taken along with Vitamin E.  It may take 6-8 weeks before you notice any changes.

 

Prescription medicines

 

Clonidine – Use a 0.1 mg patch and change it once a week.  It must be prescribed by your doctor.

Side effects are dry mouth, constipation, drowsiness, hypotension, or severe rebound hypertension.

Bellergal -S^® – It must be prescribed by your doctor.  Take 1 tablet at bedtime.  This is for short term use only.

Paxil^® – It must be prescribed by your doctor.  Take 10mg.  It is a SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant.

Zoloft^® – It must be prescribed by your doctor.  Take 25 – 50mg.  It is a SSRI antidepressant.

Effexor^® – It must be prescribed by your doctor.  Take 37.5 mg or cut the tablet in half. It is an antidepressant.

 

Herbs

 

Ginseng

Uses:  To reduce vaginal dryness and hot flashes and may increase energy and improve concentration. 

Dosage:  Take two 100mg capsules with 4% active ingredient; or one cup of tea made by steeping one teaspoon of dried herb 10-15minutes.

Side effects are increased blood pressure, headache, vomiting, insomnia, nose bleed, endometrial growth and bleeding.  If you notice unusual bleeding, see your health care team.

Avoid ginseng if you are taking aspirin, ibuprofen, or drugs to prevent blood clotting such as warfarin.  

Warning:  Do not use ginseng if you have been told not to use estrogen or are taking an antidepressant.

 

Black Cohosh

Dosage:  Take 40mg a day.  It may take 3 - 4 weeks before a response is seen, but do not use it longer than 6 months at any time.  Allow 2-3 weeks between uses.  The best brand has been found to be Remifemin^®. 

Warning:  Do not use Black Cohosh if you have been told not to use estrogen, have high blood pressure, or have heart problems.

 

Chasteberry

Uses:  It may help reduce hot flashes, night sweats, headaches, heart palpitations, and vaginal drying and thinning, or treat PMS.

Dosage – Take 20mg a day 

Side effects are that it may reduce sex drive or cause a rash.

 

Oil of evening primrose

Uses:  It may help to relieve hot flashes. 

Dosage:  Take 80 – 100mg a day.  Take one 40mg tablet twice per day.

 

Phytoestrogens, (isoflavones)

Uses:  These are substances found in plants – such as legumes.  They have a structure close to estrogen. It may help to relieve hot flashes.  

Dosage:  Take 30 – 50mg a day not to exceed 100mg.  Include foods in your diet that add isoflavones at least 3 times a week to help reduce symptoms.

Warning:  Do not use Phytoestrogens in excess of normal dietary intake if you have been told not to use estrogen products.

 

Food sources are soybeans and soy-based foods.  Isoflavones may not be found in soy products that are processed such as soy burger, soy hot dogs, soy sauce, etc.

 

Food	Serving	Isoflavones (mg)	Calories	Fat (g)
low fat tofu	½ cup	35	45-75	1.5-2.5
tempeh	½ cup	35	165	6
soy milk (regular)	1 cup	30	130-150	4
soy mild (low-fat)	1 cup	20	90-120	2
roasted soy nuts	¼ cup	60	195	9.5
roasted soy butter	2 tbsp.	17	170	11

 

 

Other foods that contain isoflavones are Mexican yams, alfalfa, garlic, celery, sprouted green peas, black and green beans, cashews, peanuts, almonds, flax seeds, and whole grains such as wheat, oats, corn, brown rice, and citrus fruits.  One cup of soybeans = 300mg isoflavones.

 

There are many new products on the market that contain isoflavones in tablet form.  These include Promensil^® and Estroven^® to name two.  They are best used by the body when taken along with at least 20mg of soy protein, i.e. soy milk.  There is some concern that taking them in a concentrated form may have adverse affects on tissues in the body.  If you wish to increase your soy intake, you should try to use foods that contain soy such as those listed in the above table.

 

Acupuncture may reduce or eliminate hot flashes, muscle aches and joint pain. 

 

Massage & Relaxation Therapy may reduce hot flashes

 

 

Sleeplessness

 

Exercise

 

Exercise may help you to sleep better if done daily for 20 – 40 minutes.  The exercise you do needs to be aerobic such as those listed below.

• brisk walking
• hiking
• jogging
• aerobic dance
• biking
• swimming
• racket sports
• cross-country skiing.

 

As a basic rule, you should take a brisk walk of 2-3 miles, 3-4x a week.  Your goal should be to walk about one mile in 15 minutes.  Avoid exercise within two hours before bedtime. 

 

Nutrients

 

Calcium

Uses:  This can provide a calming effect.

Dosage:  Use 1500mg daily, split into at least two doses, after meals and at bedtime. 

 

Melatonin

Uses:  It controls the sleep-wake schedule (jet lag).  It may help shorten the time it takes to fall asleep. 

Side effects are decreased fertility, hypothermia, and eye damage.  High doses may cause excess sleepiness, confusion, and headache the next morning.  Long term effects are unknown.  Use as directed.

 

Vitamin B Complex

Uses:  It helps promote a restful state.

Dosage:  Take as directed on label. 

 

Herbs

 

Valerian root (Passion flower)

Uses:  It is known to have a calming effect.  It may ease tension and reduce irritability.

Doses:  Use capsules (1-1.5% valtrate or 0.8% valeric acid); 450 – 900mg a daily at bedtime.  Long term effects are unknown.

Side effects are headache, uneasiness, insomnia, and heart palpitations

 

Kava Kava

Uses:  It may reduce anxiety, insomnia, and pain. 

Dosage: Take 50 - 240mg a day.

Drug interactions:  Kava interacts with alcohol and psychoactive medicines.  Also, it may cause slowed motor reflexes and skin disorders.

 

Hops

Uses:  It is a sleep aid.

Dosage:  Take as directed.

Side effects have not been reported.

 

Chamomile or Catnip

Uses:  It has a calming effect and can be used as a sleeping aid. 

Dosage:  It can be purchased as a tea. 

Side effects are abdominal cramps, tongue thickness, swelling of lips, hives, blockage of airway, mild allergic reaction in those persons allergic to ragweed. 

 

Other Recommendations  

 

Take time to relax before bedtime.  Drink a cup of warm milk, listen to soft music or read a book.  Do activities that help calm your body and allow it to get ready for rest.  Avoid caffeine, alcohol, chocolate, tobacco, or other stimulants before bedtime.

 

Create a set of habits and follow them on a routine basis. 

• Go to bed only when you are sleepy.
• Do not stay in bed if you are not sleepy.  Get up and move to another room and read, watch TV, or some other quiet activity.
• Use the bedroom only for sleeping and sex.  Don’t work, eat, or watch TV in the bedroom.
• Keep the bedroom comfortable and quiet.
• Do not nap during the day if this is not a normal thing that you do.
• Take a hot bath (not a shower) an hour or two before bedtime.

 

Fatigue and Depression

 

Fatigue and depression are frequent symptoms.  A lack of REM (rapid eye movement) sleep will often cause fatigue.  This may lead to increased irritability, tension, trouble with coping in daily routines, and the “blues”. 

 

Exercise

 

Exercise will help to form better sleep habits.  It will also raise serotonin and dopamine levels to help treat mild depression.  See above.

 

 

DHEA

Uses:  It improves mood, energy, and sex drive, lowers the effects of stress hormones, boosts fat loss, preserves muscle mass and strengthens the immune system.

Dosage:  Take 5 – 50mg a day.

Side effects are acne, hair growth, low energy, irritability, trouble sleeping, headache, menstrual irregularity, increased eye pressure, adverse lipid changes, and rapid heart rate.

 

Testosterone Uses:  It maintains muscle mass, lowers total cholesterol, and boosts energy and sex drive.

Side effects are that, in high doses, it may cause harmful cholesterol levels, psychological problems, infertility, and acne.  It may cause an increased risk for stroke.  It must be prescribed by your doctor.

 

Herbs

 

Ginseng

Uses:  It boosts energy and relieves slight depression.  It promotes feelings of well being.  

Dosage:  Take two 100mg capsules daily that contain a 4% active ingredient.  It may be purchased in capsules, drops, teabags, or dried herbs.  A tea may be made using one teaspoon of dried herb and steeped for 10-15 minutes once per day.  The type of ginseng most studied is Panax Ginseng.

Warning:  If you have been told not to use estrogen, you should not use this herb.

 

Chasteberry

Uses:  It may reduce symptoms of PMS and depression. 

Dosage:  Use it in capsule form once a day or steep a pinch of powder 10-15 minutes to make one cup of tea.

 

St John’s Wort

Uses:  It may ease slight or moderate depression, anxiety or nervous excitement. 

Dosage:  Take 2 – 4g. per day.

Side effects are that it may cause stomach upset and sensitivity to light in high doses.  Do not use with other antidepressants.  It may act as an MAO inhibitor, so avoid foods high in tyramine or tryptophan.

 

Ginkgo biloba

Uses:  It may help with resistant depression, mild memory loss, dizziness.

Dosage:  Take 120 – 160mg a day split into a few doses.  It may take 4-6 weeks before you notice effects.

Side effects are mild GI upset (1% of cases), or headache. 

Do not take with aspirin, ibuprofen, or drugs to prevent blood clotting or seizures.  It may affect clotting factors.  The dose may need to be altered if you use insulin. 

 

 

Vaginal Changes

 

Changes occur in the vagina.  The size becomes narrow and shorter.  You may notice a loss of lubrication.  The lining becomes thinner, drier, and more fragile.  A decrease in secretions may cause itching and pain.  Sexual activity may cause pain.  Adding lubrication can help.  You could notice some bleeding after sex.  The outer area is also more sensitive to contact. 

 

The pH of the vagina changes.  This can upset the normal bacterial balance.  You may have fewer problems with yeast but more bacterial infections.  Treatments for yeast will not help these types of infections.  See your health care team if you have drainage, odor, burning, and itching. 

 

Tips to help relieve vaginal symptoms are listed below.

 

Hygiene

 

Wash the vaginal area with mild soap and water.  Avoid douches, perfumed oils, soaps, and sanitary pads and tampons which cause irritation.  Ointments such as Bag Balm^® may help relieve external irritation.

 

Moisturizers

 

Gels and creams may be used two or three times a week at night to restore moisture to the lining.  They are longer lasting than lubricants.  It may take two months or more before you notice an effect.  Common brands are Replens^® and Gynemoistrin^®. 

 

Lubricants

 

You may choose creams, gels, liquids, or suppositories.  Using a good amount of these products should help reduce pain from dryness.  Frequent sex can often be helpful to maintain vaginal health.  Common brands of lubricants are K-Y^® jelly, Surgilube^®, Astroglide^®, Vagisil^®, and Liquid Silk^®.

 

Vitamin E

 

Vitamin E capsules may be broken and the contents smeared onto the vaginal lining and outer area for added moisture.

 

Phytoestrogens

 

These may also help to relieve vaginal changes.  (See above)

 

 

Bladder Changes

 

With age, bladder problems may occur due to lower hormone levels.  The muscles of the pelvic floor can become relaxed.  If you have had a child or have gained weight, this could also add to your risk for bladder problems.  Leakage of urine is a common complaint.  You may notice that you leak urine when you cough, sneeze, laugh, lift heavy objects, or exercise. 

 

You may notice the feeling that you need to “go now” and may not be able to make it to the bathroom.  You may also notice the need to pass urine more often.  These symptoms along with pain can be signs of a bladder infection.

 

If you are having symptoms, talk to your health care team.

 

Tips to reduce bladder problems are listed below.

 

Hygiene

 

Keep the genital area clean and dry.  Wash with mild soap and water.  Empty your bladder and wash after intercourse.  Always wipe from front to back after using the toilet.  Wear cotton underwear.  Avoid perfumed products which may irritate the genital area.

 

Drink liquids

 

Drinking plenty of liquids flushes your bladder and dilutes your urine.  Try to drink most of your daily liquids before supper to avoid nightly trips to the bathroom.  Avoid drinking large amounts of caffeine and diet sodas. 

 

Schedule

 

Schedule your bathroom breaks.  If urgency is a problem, plan to go every hour and slowly increase the time to two hours, then three hours.  Empty your bladder before exercising. 

 

Kegel exercises

 

Use to strengthen the muscles of the pelvic floor.  Working these muscles may help prevent incontinence and improve sexual function.

 

The muscle is easy to locate when you void.  Just squeeze it to stop urine flow and release it to restart.  Pull up and inwards.  You may do these at any time of the day.  Once you have located the muscle, do not perform this exercise while voiding.   Below are other techniques to strengthen this muscle.

 

1. Contract the muscle for 3 seconds, then release for 3 seconds.  Repeat six times, three times a day.

 

2. Butterfly flutter – contract strongly for 1 second.  Release for 1 second, repeating quickly 20 times.

 

3.  Extended contraction – contract for 10 seconds.  Release.  Then repeat.  Do five repetitions three times a day.

 

Bladder Infections

 

Cranberry

Uses:  It may prevent bladder infections.

Dosage:  For prevention, drink 3 ounces of cranberry juice cocktail daily. 

As a treatment, drink 12 to 32 ounces a day. 

If you use capsules of dried powder, take 1- 6 capsules which is equal to 3 ounces of juice.

Side effects are that large amounts of juice (more than 3 – 4 liters a day) often results in diarrhea and other GI symptoms.

 

Echinacea (use these forms:  E. angustifolia, and Echinacea purpurea)

Uses:  It may be helpful to prevent or treat infections that recur.

Dosage:  Use the dried root 1 – 2gm three times a day.

    Use the freeze-dried plant 325 – 650mg three times a day.

    Use the tincture form (1:5) 3 – 4ml three times a day

    Use the fluid extract (1:1) 1 – 2ml three times a day

Use for 8 weeks and then stop for at least 2 weeks before you restart. 

 

Yeast Infections

 

Florajen Acidophilus

Uses:  It prevents yeast infections.

Dosage:  Take 1 capsule daily on an empty stomach with water, juice, or milk.  Take a Florajen capsule 1 – 2 hrs after taking an antibiotic.  One capsule = 6 cups of fresh yogurt.  Keep refrigerated at all times.  If you travel it is ok to leave at room temperature for two weeks.  You may also insert capsules into the vagina.

 

Sexuality

 

Sexuality includes all of the feelings we have about ourselves.  It includes those feelings about ourselves as sexual beings and the way we express those feelings to others.  It is the expression of the whole person emotionally, mentally, and physically.  Midlife does not have to mean a decline in sexuality.  It may improve as you become more comfortable with yourself, have fewer things to distract you, and a loving partner.  The mind plays the most involved role in sexuality.  Much of your sexual response is related to your thought process.  If you remain interested in sex, this process will not create a sudden end to your sex appeal. 

 

 

Tips to reduce issues related to sexuality are listed below.

• Have open communication between partners about sexual feelings.
• Take a hot bath or shower before sex for muscle relaxation.
• Provide time for foreplay.
• Use erotic literature or films if desired.
• Engage in regular exercise and rest.
• Use the morning time for sexual activity.
• Eat a well balanced diet.
• Use relaxation techniques such as yoga, massage, meditation, visualization exercises, and aromatherapy.
• Reduce or stop the use of tobacco, alcohol, salt, caffeine, and refined sugar.

 

Summary

 

Don’t forget, menopause is not a disease, but rather a normal passage which you will likely go through with little or no trouble.

 

Knowing about menopause, what to expect, and what to do to stay healthy in future years will help guide you through this time with success.  Choose a health care team member who will listen to you and understands your changing health needs.  A key to self development is to maintain a healthy mind and body.

 

For further details on how to prevent chronic illness and maintain life long health ask for the Health Facts for You listed below.

 

Health Facts for You:   #5668 A Health Guide for Women ages 50 or older

 

Internet Sites

 

http://www.niddk.nih.gov/health/urolog/pubs/uniwomen

 

http://www.menopause-online.com/herbther.htm

 

http://www.menopause.org

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 04/22/2011

Copyright © 04/22/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5351

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