Menopause is a natural biological process that all women experience, typically in their 40s or 50s. It marks the end of menstruation and fertility and is characterized by a decline in estrogen production. This hormonal shift can lead to various symptoms, including hot flashes, night sweats, mood changes, sleep disturbances, brain fog, and vaginal dryness.
For some women, these symptoms are mild and manageable. However, for others, they can significantly disrupt their daily lives, impacting their work, relationships, and overall quality of life. As a result, many women seek treatments to alleviate these symptoms.
Treatments for Menopause Symptoms
Hormone Therapy
Hormone therapy (HT), particularly estrogen therapy, is considered the primary and most effective treatment for moderate to severe menopause symptoms. Dr. Anna Barbieri, Assistant Clinical Professor in the Department of Obstetrics and Gynecology at Mount Sinai School of Medicine, emphasizes that "there is just nothing as effective and nothing that has as wide-ranging effects and benefits as hormone therapy."
Dr. Lauren Streicher, Medical Director of the Northwestern Medicine Center for Sexual Medicine and Menopause, adds that effectively managing hot flashes with hormone therapy can have long-term health benefits. Hot flashes, which can last for an average of seven years (and often longer for Black women), are associated with cardiovascular disease, brain fog during perimenopause, potential declines in cognitive function, and other medical problems.
However, hormone therapy is not suitable for everyone. It is generally not recommended for women with a history of hormone receptor-positive cancers (such as breast and endometrial cancers), stroke, blood clots, or cardiovascular disease.
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Non-Hormonal Options
For women who cannot or prefer not to take hormone therapy, several non-hormonal options are available. These include:
- Antidepressant medications: Certain antidepressants can be used off-label to help manage hot flashes and mood changes.
- Fezolinetant: This is a recently approved drug specifically designed to reduce the frequency and severity of hot flashes.
- Lifestyle and behavioral techniques: These include avoiding triggers like alcohol, practicing cognitive behavioral therapy, maintaining a healthy diet and exercise routine, and even using hypnosis. Dr. Monica Christmas, Associate Professor and Director of the Center for Women’s Integrated Health at The University of Chicago Medicine, recommends these techniques to promote general health and well-being during menopause.
The Appeal of Menopause Supplements
Given the potential risks and limitations of hormone therapy and the need for lifestyle adjustments, many women turn to over-the-counter menopause supplements as a seemingly natural and convenient way to manage their symptoms. Companies often market these supplements as solutions for a wide range of menopause-related issues. The rising popularity of menopause supplements also highlights a lack of access to evidence-based options, rampant misinformation about hormone therapy, and gaps in our knowledge about menopause.
However, experts caution that not all menopause supplements are effective or safe. Many have not been thoroughly studied, and some may even be harmful.
The Menopause Society's Position
In its 2023 position statement on non-hormone therapies, The Menopause Society (formerly known as the North American Menopause Society) did not recommend any dietary supplement for managing menopause symptoms. Their conclusions were based on flawed studies, mixed results, or an overall lack of evidence for most supplements they examined.
A Nuanced Approach
While generally agreeing with The Menopause Society's stance, the experts consulted by TODAY.com advocate for a more nuanced approach. They suggest that supplements may have a place in managing menopause symptoms, depending on the individual's symptoms, comfort level with other treatments, and the specific supplements being used.
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Dr. Streicher suggests considering supplements for women with mild symptoms or those who are already taking prescription medications and want to add something extra. Dr. Barbieri might recommend supplements like magnesium, L-theanine, or inositol for patients with breast cancer and sleep issues who cannot take hormone therapy. Research suggests these supplements are safe for such patients.
Ultimately, the decision to take menopause supplements should be based on a well-informed conversation between the patient and a healthcare provider, taking into account the patient's preferences and what might realistically work for them.
Common Ingredients in Menopause Supplements
The market offers a vast array of menopause supplements, many containing proprietary blends of ingredients. It is important to note that supplements are not regulated by the FDA in the same way as pharmaceutical drugs. The responsibility for ensuring the safety and accurate labeling of products lies with the supplement manufacturers and distributors.
Third-Party Verification
Experts recommend choosing supplements with a third-party verification label, such as USP or GMP certifications. This indicates that the product has been tested and verified to contain the ingredients listed on the label.
The Placebo Effect
It's also important to be aware of the placebo effect. Taking a new supplement may initially lead to a feeling of improvement, but this effect is often temporary.
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Here are some common ingredients found in menopause supplements:
- Vitamins and Minerals: Supplements may be beneficial if a woman is deficient in certain vitamins and minerals during menopause. For example, low levels of vitamin D are linked to poor bone health and depression. Similarly, deficiencies in vitamin B12 and ferritin (iron) can also impact health and well-being. It is recommended to consult with a doctor to test for deficiencies before taking supplements.
- Isoflavones, Phytoestrogens, and "Plant-Based Hormones": Phytoestrogens are plant compounds that mimic estrogen in the body. Isoflavones, a type of phytoestrogen, are derived from soybean products. These supplements are not recommended for women avoiding hormone therapy due to health concerns, particularly those with a history of estrogen-derived cancers. While phytoestrogen supplements are generally not advised for these patients, consuming phytoestrogens naturally found in foods like soy is usually considered safe. General "plant-based hormone" creams often contain a lab-produced version of progesterone derived from yams. Experts emphasize that plants do not contain human hormones.
- Black Cohosh: This herb is often used to alleviate hot flashes and night sweats, although its effectiveness has not been definitively proven. Black cohosh can also increase liver enzymes, making it unsuitable for individuals with underlying liver conditions. If taken, regular monitoring of liver function is essential.
- St. John's Wort: Marketed for hot flashes and depression, St. John's Wort can interact with various medications, potentially affecting a person's health.
- Combinations of Herbs: Some products contain complex blends of botanical ingredients, and the actual ingredients may not always be clearly listed.
Before Taking Menopause Supplements
Experts strongly advise against trying new supplements without consulting a doctor. Schedule a dedicated appointment to discuss menopause symptoms, treatment options, and preferences. Avoid simply adding a menopause conversation to the end of another appointment, as this may not allow for a thorough discussion.
Unfortunately, many doctors, even OB-GYN specialists, lack extensive training in menopause management. If your doctor is not knowledgeable about menopause treatments, seek out a specialist. The Menopause Society offers a tool to find menopause experts in your area. Telehealth consultation services like Midi and Gennev may be helpful if finding a local specialist is difficult.
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