Menopause symptoms and the treatment options

Menopause is a physiologic process that affects all women, not a pathologic or disease-based one. The problem is that vasomotor symptoms, such as hot flashes, flushes and night sweats, can have an adverse effect on most women who are perimenopausal (around menopause) or postmenopausal. Approximately 80 percent of women report having these symptoms, with half experiencing moderate to severe symptoms.

Symptoms last, on average, between one and five years, though they may persist longer than a decade. Unfortunately, many women suffer through them without treatment.

According to a recent study, there are also increased cardiovascular risks in women who experience early menopause, occurring before the age of 46. Early menopause increases the risk of heart attacks and strokes twofold. The authors suggest the best way to lower risk may be to follow general preventive measures for reducing the risk of heart disease (Menopause. online June 11, 2012).

Are there viable treatment options to alleviate menopausal symptoms? The answer is yes, and we will look at some of these options including lifestyle modifications, hormone therapy and soy products.

Lifestyle modifications

In the Women’s Health Initiative Dietary Modification Trial, a large, randomized trial, the combination of weight loss and diet played a significant role in reducing or eliminating vasomotor symptoms in 90 percent of menopausal women (Menopause. online July 9, 2012).

When women lost more than 10 percent of their body weight, they were 56 percent more likely to eliminate vasomotor symptoms when compared to women who were in the control group and did not lose weight. This is impressive, but the results get even better. When dietary modifications were combined with greater than 10 percent weight loss, nearly nine out of 10 women saw an elimination of symptoms.

The design of the trial involved a low-fat diet with 20 percent of calories from fat, plus five servings of fruits and vegetables and an increase in fiber from whole grains to six servings daily.

This diet made it more than three times as likely that women would lose weight compared to the control group. The study involved over 17,000 women who were not on hormone therapy for menopausal symptoms. Thus, the results were purely due to weight loss and dietary changes.

Hormone therapy

Hormone therapy has been a hotly debated topic in recent years. The Women’s Health Initiative is one of the trials that prompted this debate, with unexpectedly negative results showing increased risk of stroke, heart attack, deep vein thrombosis and pulmonary embolism. However, there may be more to the story. This has to do with timing, personal history and dosage.

In a consensus statement by 15 medical organizations, short-term hormone therapy is thought to be safe for the treatment of vasomotor symptoms, depending on the woman’s health history, age and when menopause commenced (Menopause. online July 9, 2012).

Of note, the American College of Obstetricians and Gynecologists was not part of this consensus statement. Patients need to make an informed decision with their OB/GYN to determine if the benefits outweigh the risks on an individualized basis. For healthy women younger than 59 or within 10 years of the beginning of moderate-to-severe vasomotor symptoms, low-dose hormone therapy may be appropriate.

In March, the FDA approved a combination low-dose hormone therapy of 0.25 mg progestin and 0.50 mg estrogen called drospirenone/estradiol (www.fda.gov) for the treatment of hot flashes and night sweats. It reduced the frequency by two episodes a day at four weeks and by three episodes a day by 12 weeks. However, there are side effects, and it is contraindicated in several circumstances, the most severe being increased risk of stroke. Do not consider this medication without consulting your OB/GYN first.

Soy effect

Soy may have benefit in terms of brain functioning. In preliminary results, soy and soy isoflavones (nutrients from soy) have shown to potentially improve cognitive function in early menopause, something that hormone therapy is not approved for (Menopause. 2011; 18(7);732-753). This effect is lost on women who are older than 65 when soy is first given. In other words, there is an ideal window for treatment, much like there is with hormone therapy. For more about soy, see my March 8 article.

Soy products have had mixed results in treating vasomotor symptoms. In a recent meta-analysis (a group of 17 studies), soy supplements reduced hot flashes in menopausal women by a modest 21 percent (Menopause. online March 19, 2012). They are thought to have weakly estrogenic effects. When they did occur, hot flashes tended to be milder. The authors suggest that if no results are seen within four weeks, then it is unlikely that soy will affect hot flashes.

The choices are numerous. Lifestyle modifications appear to have the greatest beneficial impact, and the side effects are beneficial for the treatment and prevention of other diseases, as well. Soy may also be of benefit, especially with cognitive aspects. There is really no downside to adopting a nutrient-rich dietary approach.

Hormone therapy is an individual choice that should made in partnership with an OB/GYN. Women should not have to struggle through perimenopausal symptoms negatively impacting their quality of life because they were spooked by past treatment studies.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.