All change

Published on 22/09/2002 01:00

THE interim results of the Menopause Survey 2002 won’t come as a surprise to women who are actually going through it: the most common symptoms were hot flushes (74%), night sweats (70%), disturbed sleep (73%), poor concentration and memory (72%), reduced libido (65%), aches and pains (64%) and depression (53%).

More and more women are looking for a more natural way to cope with the menopause, especially since July, when a long-term HRT study was abandoned. The US study found that those taking combined oestrogen and progestogen HRT were slightly more likely to develop breast cancer, heart disease, stroke and blood clots, a risk which outweighed the benefits of fewer hip fractures or cases of bowel cancer. However, experts here and in the US were quick to point out that the study only confirmed what they had long suspected: it’s OK to take HRT for four to five years when menopause symptoms are most severe, but not beyond that.

So what are a woman’s non-drug options? Some basic lifestyle changes can help with hot flushes: wearing light clothes and avoiding those things which cause sweating, such as coffee, alcohol, curries and hot baths or showers. Relaxation techniques help, too: deep abdominal breathing at least twice a day can reduce hot flushes by about 40%.

Dietary changes and supplements are popular, but the evidence is often inconclusive. Trials of soya for reducing hot flushes, for example, have had conflicting results. It’s often cited that Japanese women, who eat a lot of soya, don’t get hot flushes. But experts point out that they also eat a lot of oily fish, and this may have something to do with the lack of menopausal symptoms.

However, soya might be useful in other areas. A recent Dutch study suggests that it can protect post-menopausal women from heart disease and stroke. Soya is rich in phyto-oestrogens (natural plant oestrogens), which are similar in structure to the female hormone oestrogen, and may mimic the beneficial effects of oestrogen on the heart.

The most commonly used and best-researched herbal remedy is black cohosh (Cimicifuga racemosa). Studies have shown that standardised extracts are as effective as HRT at relieving hot flushes, night sweats and vaginal dryness, and that it reduces anxiety and irritability. It’s believed that black cohosh works on two fronts: it balances the body’s oestrogen-progesterone levels and it affects the dilation of blood vessels, thereby reducing hot flushes and sweating. Side effects are rare, and the general recommendation is to use black cohosh - as a tablet, tincture or tea - for up to six months continuously. (Black cohosh is not related to blue cohosh, which can be toxic.)

Other herbs often used for the menopause include red clover (Trifolium pratense), because it contains phyto-oestrogens. Studies have not confirmed that it helps common symptoms, but it may increase the blood flow in arteries, something which diminishes with menopause. (Care should be taken with red clover as it may stimulate breast cancer cells.) Dong quai (Angelica sinesis) is often taken for hot flushes but, again, studies have been inconclusive.

St John’s wort can help with the depression and anxiety that often accompany the menopause, and has been shown in clinical trials to greatly reduce other symptoms, too, such as disturbed sleep and low sex drive. For the best results, a standardised extract of the active ingredient hypericin needs to be taken for six weeks. (St John’s wort should never be taken with other anti-depressants, and can clash with many prescribed drugs, including HRT, so tell your GP if you’re taking it.)

Vitamin E supplements were taken with some success by women in the WNAS survey. In trials, it reduced the number of hot flushes for some, and there is evidence that it can help protect against osteoporosis.

Creams containing wild yam extracts are becoming popular. Wild yam (Dioscorea villosa) contains diosgenin, a progesterone precursor, a natural substance that can only be turned into progesterone in the laboratory. So any progesterone in a cream has been synthesised, making it a hormone replacement therapy in itself. There is some evidence that such creams can help reduce hot flushes, but the amount of progesterone can vary greatly between products. Creams which contain only extract of wild yam have been shown to lower LH hormones - high levels of which have been linked to hot flushes. Other helpful treatments include acupuncture and yoga. Exercise is very effective too since, as well as increasing aerobic capacity and maintaining bone mass density, it’s a great way to lift the spirits.

It should be noted, however, that women should not stop taking HRT without letting their GP know.

LIFE BEGINS AT 50?

Far from being dreaded, most women questioned for a recent survey said that the menopause signalled an improvement in their lives. The Social Issues Research Centre in Oxford questioned women aged 50-64, and found that 65% said they were happier than before the menopause. Although 19% said their sex life was less satisfactory, 29% said it got better.

A century ago, the average age of the menopause was 47, but the life expectancy of British women was only 49. Now women become menopausal at just over 50 and life expectancy is nearer 80.

CONTACTS

Natural Menopause Advice Service (www.nmas.org.uk) Women’s Nutritional Advisory Service (01273 487366; www.wnas.org.uk) Menopause Online (www.menopause-online.com)

To find a complementary practitioner, contact the Complementary Medical Association (www.the-cma.org.uk)