If the fan on your female co-workers desk is running nearly all the timeeven in winter, its likely a sign shes going through the change" (translation: menopause). Menopause happens to every woman. According to the Centers for Disease Control and Prevention (CDC), about 37.5 million women are reaching or currently at menopause (ages 40 to 59) as of the 2000 census. Menopause, officially, is that time of transition when a womans body slowly makes less of the hormone estrogen and menstrual periods come to an end.

As a result in the change in estrogen levels, women may experience symptoms such as hot flashes, night sweats, low sex drive and irritability. Other health implications such as an increased risk for breast cancer, cardiovascular disease (CVD) and bone loss (osteoporosis) become a greater threat during this stage of life.

However, the management of symptoms associated with the change can be made much healthier with the use and/or inclusion of natural solutions. A range of ingredients are linked to helping women manage the symptoms. Some ingredients, such as soy isoflavones and black cohosh, have long standing in the scientific community, while newer research covers the health benefits of ingredients including long-chain omega-3 essential fatty acids (EFAs), hops extract and maca, an herb from the Andes.

Data from the Chicago-based market research firm Mintel reveals 94 percent of women think a healthy lifestyle is somewhat or very important to them. However, the report noted, exactly what healthy living means differs among women.

Although all women show significant levels of interest in supplements, the report noted, women aged 45 and older are the most likely to be interested in supplementation of some variety. Among those who report having experienced hot flashes or other symptoms of menopause, about one-third of women are currently treating, one-third are not currently treating (but have in the past), and one-third have never treated them," explained Molly Maier, Mintels Senior Health & Wellness analyst. When women do treat these symptoms, some 55 percent turn to products that dont require a prescription. The risks associated with menopausal hormone therapy have likely encouraged women to look to other sources for treatment."

In fact, according to SPINS, a market research and consulting firm for the natural products industry, the market for vitamins and supplements for menopause increased nearly 3 percent for the 52 weeks ending May 12, 2012, from the previous year to reach more than $6 million in the natural channel.¹ Sales declined 8.5 percent in the same period in the conventional channel.

Hot Flashes/Night Sweats

One of the most common climacteric symptoms with the bulk of research is hot flasheshence the need for a fan. That being the case, a great deal of research is focused on this category. Writing in the journal Menopause, a trio of Iranian researchers compared the efficacy of St. John's wort against a placebo in women with hot flashes.² During eight weeks, researchers studied the differences in frequency, duration and severity of hot flashes of the 100 female participants. Subjects had an average age of 50 occurrences in the two-month period. Both groups responded to the interventions, but there were three significant outcomes. First, the within-group differences in frequency, duration and severity of hot flashes were noticeable. Next, by week eight, the womens response to the herb had markedly improved from week four. Both groups responded to the interventions, and the within-group differences in frequency, duration and severity of hot flashes were statistically significant (P<0.05)," the researchers reported.

Two reports out of Canada found long-chain omega-3 EFAs improved both hot flashes and depression in middle-aged women. In the first study, conducted at Laval University, supplements of ethyl-eicosapentaenoic acid (E-EPA) were used in randomized clinical trials (RCTs) and found to reduce the frequency of hot flashes.³ In a second study, women classified as having mild to moderate depression (with some having experienced a major episode) were given either a placebo of sunflower oil or a dose of E-EPA and ethyl-docosahexaenoic acid (E-DHA) during eight weeks.⁴ By the end, both groups showed improvement; however, the women who did not experience a major depressive episode and received the E-EPA did improve slightly.

By now, soy isoflavones have earned a reputation as the de facto natural remedy for alleviating hot flashes. In fact, a recent meta-analysis released in May set out to determine the efficacy of extracted or synthesized soybean isoflavones in the alleviation of hot flashes in peri- and post-menopausal women.⁵ The review took into account nearly 300 double blind, randomized trials through Dec. 14, 2010. The review found nothing to dispute previous findings, concluding, Soy isoflavone supplements, derived by extraction or chemical synthesis, are significantly more effective than placebo in reducing the frequency and severity of hot flashes."

How effective are botanicals such as black cohosh and red clover in reducing night sweats? The results are mixed. The National Center for Complementary and Alternative Medicine (NCCAM) reported these botanicals are no more effective than a placebo. This conclusion comes from a study in Menopause where a team of researchers from Chicago spent a year testing these herbs on 89 women experiencing at least 35 episodes of hot flashes and night sweats per week.⁶ Whether used alone or in conjunction, black cohosh and red clover failed to perform, the study concluded in 2009.

Fast forward three years, and another study suggested black cohosh alone is effectiveafter some 300 post-menopausal women taking a black cohosh supplement reduced hot flashes.⁷ A randomized, double blind, placebo-controlled, multicenter clinical study utilizing an over-the-counter (OTC) supplement of black cohosh extract examined the efficacy and safety of the herb in reducing hot flashes.

Outside of the tried-and-true soy isoflavones (and less controversial than black cohosh), more innovations in the field of menopause relief have entered the market. A pair of studies found a patented extract of hops (as Lifenol®, from Naturex) could alleviate hot flashes. The phytoestrogenic properties of Lifenol were examined in 67 women for 12 weeks in an unpublished study. The women were given a daily dose of Lifenol and examined at six weeks and again at 12 weeks. Extracted from the female cones of European hops, the women found relief from hot flashes with daily dosing. The researchers later published similar findings in Maturitas, noting, Hop-derived prenylated flavonoids may provide an attractive addition to the alternative treatments available for relief of hot flushes and other menopausal discomforts."⁸

Another botanical formulation comes from the Ayurvedic tradition. Gencor Nutrients' Genopause is a non-estrogenic formulation for the support of women experiencing post-menopausal symptoms. Results of an unpublished study in 156 women show that in a six-month time frame, 54 percent had reductions in hot flashes, 98 percent realized reduced palpitations, and 95 percent had alleviation of insomnia.

Low Sex Drive

A non-traditional ingredient that supports a reduction in menopausal symptoms is French maritime pine bark (as Pycnogenol®, from Horphag Research). In one Italian study conducted for eight weeks, 70 women were divided into two groups, and given either the ingredient or a placebo.⁹ The 38 women taking Pycnogenol found relief and a better quality of life from the six most common symptoms associated with the change, including loss of libido, vaginal dryness, hot flashes, night sweats, mood swings and irregular periods.

Steeped in traditional medicine for improving sexual function and female hormone balance, the modern scientific community is now focused on maca for its potential to increase sexual desire for menopausal women. Preliminary findings show that Lepidium meyenii reduces psychological symptoms, including anxiety and depression, and lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity," wrote a panel of Australian researchers.¹⁰ As part of the Australian study, 14 postmenopausal women completed a randomized, double blind, placebo-controlled, crossover trial. They were each given 3.5 g/d of powered maca for six weeks, then placebo for another six, in either order, for 12 weeks. By the end of the trial, maca was shown to stimulate sexual desire.

Ginkgo biloba, commonly associated with improving memory, has been studied for its ability to improve mood and memory in menopausal women, as forgetfulness and depression are closely associated with the transition. In previous trials, improved memory was noted after just one week. Only this time, researchers wanted to see what would happen to mental agility during a longer periodone capsule per day for six weeks.¹¹ The results were just as positive, if not better. The women were divided into two groupsreceiving either ginkgo or a placebo.

At the end, the researchers wrote: The only significant effects of ginkgo were in the test of mental flexibility, in which there were significant menopausal-stage/ginkgo interactions. This was because subjects in stage +2 required fewer trials to complete the task and made fewer errors after ginkgo treatment, whereas those in stage +1 showed no benefits."

DHEA (dehydroepiandrosterone) is a natural sex hormone produced in our body by adrenal glands. As women age, levels decline. During menopause, women experience a double whammy of vaginal dryness/irritation and a low sex drive. These issues can be treated with pharmaceutical injections, which have been shown to work. However, a less invasive approach is the application of a DHEA cream intravaginally either once daily¹² or, even better, a few times a week.¹³

Present data show that local daily intravaginal DHEA administration at DHEA doses of 3.25 to 13 mg was able to rapidly and efficiently achieve correction of all the signs and symptoms of vaginal atrophy and improve sexual function, and caused no or minimal changes in serum sex steroid levels," concluded a team of Canadian researchers.

Another trial using the Lifeonol hop extract offered women relief from vaginal dryness and hot flashes. The women were given the extract or a placebo for 16 weeks. The treatments were switched at the halfway point. Midway, there appeared to be positive outcomes for both the placebo group and the hop group. But by the end of the trial, the outcome was described as superior" for the hop group.¹⁴

Bio-Botanicas Pueraria mirifica compound, Puresterol®, contains active constituents that have been tested in numerous studies yielding positive results in support of relieving menopausal symptoms such as hot flashes. A study on the efficacy and safety of Puresterol for the treatment of vasomotor symptoms¹⁵ concluded, Pueraria mirifica, containing phytoestrogens, relatively alleviated the climacteric symptoms in perimenopausal women. The transient negative profiles occurred in a small number of subjects that included anemia, and liver profiles. While there was a slight decrease in lipoproteins and an increase in hormonal profiles, Pueraria mirifica demonstrates great promise in the treatment of climacteric symptoms among perimenopausal women."

Bone Loss

Another study found that the phytoestrogens in Puresterol supported bone health in menopausal women.¹⁶ By the determination of the serum surrogate of bone turnover, it may be assumed that Pueraria mirifica has antiresorptive activity."

Following menopause, bones lose minerals including vitamin D, manganese and magnesium. Bone density decreases since calcium isn't as easily incorporated into bones as a result of decreased levels of estrogen. This loss of bone density results in fragile bones more likely to break, especially in the wrist, hip and spine.

The latest studies involving soy isoflavones center around bone loss; specifically, does supplementation with soy improve bone mineral density (BMD)? As referenced earlier, women going through menopause are at a greater risk for bone loss. A double blind, placebo-controlled study beginning in 2004 did not find significant differences in BMD in those women who supplemented with soy isoflavone tablets and those given a placebo.¹⁷

However, a team of Japanese researchers conducted a meta-analysis to clarify the effect of ingesting soy isoflavone extractsnot soy protein or foods containing isoflavoneson BMD in menopausal women.¹⁸ According to researchers, Meta-analysis including data from 1,240 menopausal women revealed that daily ingestion of an average of 82 (47 to150) mg/d soy isoflavones (aglycone equivalent) for six to 12 months significantly increased spine BMD by 22.25 mg/cm2 (95-percent CI: 7.62, 32.89; P=0.002) or by 2.38 percent (95-percent CI: 0.93, 3.83; P=0.001) compared with controls (random-effects model)." It appears the specific type of soy isoflavone given (i.e., extract versus full tablet), duration and region (Asian vs. Western) impacts its effectiveness in preventing loss of BMD during menopause, the Japanese reviewers concluded.

A number of studies have been undertaken to examine how calcium supplementation combined with vitamin D affects BMD. Along with calcium and vitamin D, manganese also supports BMD, among other healthy attributes. However, manganese, a trace mineral, is made in small quantities in the body. And similar to calcium and vitamin D, outside supplementation is neededespecially during the pre-menopausal yearsto reduce the risk of osteoporosis later, studies show.

One double blind, randomized, controlled trial tracked 120 peri- and post-menopausal women with an average age of 45 at the start during 30 days.¹⁹ By months end, the researchers proved a positive effect of calcium and vitamin D supplementation in women both peri- and post-menopausal status.

Further, another trial involved trace minerals, including calcium, vitamin D and manganese.²⁰ A group of healthy, older women in Californiaaverage age 66were evaluated for the effects of calcium supplementation (as calcium citrate malate, 1,000 mg/d elemental Ca) with and without the addition of zinc (15.0 mg/d), manganese (5.0 mg/d) and copper (2.5 mg/d) on spinal bone loss (L2-L4 vertebrae) in a two-year, double blind, placebo-controlled trial. By the time the trial wrapped, the researchers had once again shown intake of trace minerals can stunt the effects of osteoporosis.

Breast Cancer Prevention

It is believed menopause itself, that is the active change, does not cause an increased risk of developing breast cancer. The risk, according to the medical community, is associated with age.²¹ Given that premise, scientists of late have offered evidence of the benefits of omega-3 EFAs in reducing the risk of breast cancer in menopausal women. Long-chain omega-3s are considered essential building blocks for the cell membranes of the body and brain. The body does not produce it on its own; people must get it from their diet or supplementation.

Two years ago, the results from a large-scale study conducted in Washington state concluded the use of fish oil supplements may play a role in reducing the risk of breast cancer in menopausal women.²² In the study, 35,016 post-menopausal women who did not have a history of breast cancer completed a 24-page questionnaire detailing their use of non-vitamin, non-mineral specialty" supplements as part of the Vitamins and Lifestyle (VITAL) cohort study. After six years of follow-up, some 880 cases of breast cancer were identified. In the study, regular use of fish oil supplements was linked with a 32-percent reduced risk of breast cancer, specifically invasive ductal breast cancer, the most common type of the disease.

Cardiovascular Disease

On one of the final notes of supplementing during menopause, a lot of research continues to focus on managing vasomotor symptoms. However, studies show a woman's risk of heart disease intensifies drastically around the time of natural change.

In fact, research released in February 2010 suggested hot flashes and night sweats may, in fact, be a good thing. In the online edition of Menopause researchers reported that women who suffer from these vasomotor symptoms may be at lower risk for CVD, stroke and death.²³ The team reviewed medical information from 60,000 women who were enrolled in the Women's Health Initiative Observational Study and followed for 10 years, to determine the relationship between menopause symptoms and cardiovascular events. Subjects were grouped into four categorieswomen who experienced hot flashes and night sweats at the onset of menopause, later in menopause, during both time periods and not at all.

With scientific evidence mounting and declining sales in conventional retail stores, women are now likely seeing the better health implications of natural solutions for menopause relief.

Brenda Porter-Rockwell has been writing and editing for print and online publications for more than 10 years. She is also the community manager for the SupplySide Cosmetics Community.

References listed on the next page.

Find more information on menopause and other women's health issues in INSIDER's Content Library.

References:

1.            SPINSscan Natural, SPINSscan Conventional, powered by Nielsen

2.            Abdali, K. Khajehei, M., and Tabatabaee, H.R. Effect of St John's wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study." Menopause. 2010 Mar;17(2):326-31.

3.            Lucas, M., et al. Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial." Am J Clin Nutr February 2009 vol. 89 no. 2 641-651.

4.            Lucas, M., et al. Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial." Menopause. 2009 Mar-Apr;16(2):357-66.

5.            Taku, K., et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials." Menopause. 2012 Mar 19. [Epub ahead of print]

6.            Geller, S.E., et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial." Menopause. 2009; 16(6):11561166.

7.            Ross, S.M. Menopause: a standardized isopropanolic black cohosh extract (Remifemin) is found to be safe and effective for menopausal symptoms." Holist Nurs Pract. 2012 Jan-Feb;26(1):58-61.

8.            Heyerick, A., et al. A first prospective, randomized, double-blind, placebo-controlled study on the use of a standardized hop extract to alleviate menopausal discomforts." Maturitas 54. 2006 October. 164175.

9.            Errichi, S. et al. Supplementation with Pycnogenol® improves signs and symptoms of menopausal transition." Panminerva Med. 2011 Sep;53(3 Suppl 1):65-70.

10.          Brooks, N.A., et al. Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content." Menopause. 2008 Nov-Dec;15(6):1157-62.

11.          Elsabagh, S., Hartley. D.E., File, S.E. Limited cognitive benefits in Stage +2 postmenopausal women after 6 weeks of treatment with Ginkgo biloba." J Psychopharmacol. 2005 Mar;19(2):173-81.

12.          Labrie, F. et al. Serum steroid levels during 12-week intravaginal dehydroepiandrosterone administration." Menopause. 2009 Sep-Oct;16(5):897-906.

13.          Panjari, M., Davis, S.R. Vaginal DHEA to treat menopause related atrophy: a review of the evidence." Maturitas. 2011 Sep;70(1):22-5. Epub 2011 Jul 5.

14.          Erkkola, R. et al. A randomized, double-blind, placebo-controlled, cross-over pilot study on the use of a standardized hop extract to alleviate menopausal discomfort." Phytomedicine (2010), doi:10.1016/j.phymed.2010.01.007. 

15.          Lamlertkittikul, S., Chandeying V., Efficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatment of vasomotor symptoms in perimenopausal women: Phase II Study." J Med Assoc Thai. 2004 Jan;87(1):33-40.

16.          Manonai, J. et. al. Effects and safety of Pueraria mirifica on lipid profiles and biochemical markers of bone turnover rates in healthy postmenopausal women." Menopause: The Journal of the North American Menopause Society. Vol. 15, No. 3, 530-535.

17.          Levis, S. et al. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: a randomized, double-blind trial." Arch Intern Med. 2011 Aug 8;171(15):1363-9.

18.          Taku, K. et al. Effect of soy isoflavone extract supplements on bone mineral density in menopausal women: meta-analysis of randomized controlled trials." Asia Pac J Clin Nutr. 2010;19(1):33-42.

19.          Di Daniele, N. et al. Effect of supplementation of calcium and vitamin D on bone mineral density and bone mineral content in peri- and post-menopause women; a double-blind, randomized, controlled trial." Pharmacol Res. 2004 Dec;50(6):637-41.

20.          Strause, L. Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals." J Nutr. 1994 Jul;124(7):1060-4.

21.          Kath Moser, et al. Do women know that the risk of breast cancer increases with age?" Br J Gen Pract. 2007 May 1; 57(538): 404406.

22.          Brasky, T.M. et al. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) Cohort." Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1696-708.

23.          Szmuilowicz, E. D., Manson, J. E. and Seely, E. Menopausal vasomotor symptoms and cardiovascular disease." Menopause, 2011; : 1 DOI: 10.1097/gme.0b013e318209239a