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Lifestyle Changes to Manage Menopause

The following lifestyle changes may help reduce bothersome symptoms and decrease health risks associated with menopause:

Increase Your Intake of Phytoestrogens

A substantially high intake of phytoestrogens (isoflavones and lignans) may help reduce your menopausal symptoms. They may also reduce your risk for diseases associated with estrogen loss. Phytoestrogens occur naturally in certain foods:

  • Isoflavones: soybeans, chickpeas, and legumes
  • Lignans: flaxseeds, whole grains, and some fruits and vegetables

Phytoestrogens can have an estrogenic effect. The classes of phytoestrogens, common compounds within the class, and food sources are listed in this table:

Phytoestrogen TypeCommon CompoundsFood Sources
IsoflavonesModified by intestinal bacteria to Genistein, DaidzeinSoybean (miso, tofu), garbanzo bean (chickpeas), bluegrass, clover
LignansConverted by intestinal bacteria to enterolactone, enterodiolFlaxseed (linseed), legumes, grains, seaweed, some fruits and vegetables
CoumestansRed clover, alfalfa, sunflower seeds, bean sprouts

There is no trace of phytoestrogens in green peas, fava beans, lentils, barley, or sesame.

From the journal Obstetrics and Gynecology , the following table lists the content of lignans by food type:

FoodLignans in milligrams (mg)
Flaxseed meal0.675
Flaxseed flour0.527
Lentils, seaweed0.01-0.02
Soybeans, kidney bean, sunflower seeds, wheat, garlic, asparagus, squash, carrot, sweet potato0.004-0.009

The content of isoflavones by food type is listed in the following table, which is also from the journal Obstetrics and Gynecology .

FoodIsoflavones (mg)
Roasted soybeans1.6 - 2.7
Textured vegetable protein2.3
Soy flour1.4-2.0
Tempeh0.9
Tofu0.3-0.6
Soymilk0.21
Tofu yogurt0.16-0.28

For more information, a soy and isoflavone database can be found at the US Department of Agriculture's website .

How much phytoestrogen is absorbed and who benefits the most

Because the body must convert or alter phytoestrogens through digestion, the actual amount of active compound that is absorbed varies. The relative potency is 0.1%-2.0% that of estradiol, a form of estrogen. In premenopausal women with high endogenous estrogens, phytoestrogen compounds compete for receptor sites with estrogens. Therefore, the net effect of phytoestrogens in premenopause may be anti-estrogenic (estrogen antagonist) because the activity on the receptor is much less.

In postmenopausal women who have high levels of endogenous estrogens, or who are taking exogenous estrogen therapy, again the net effect of phytoestrogens may be anti-estrogenic. In postmenopausal women with low levels of endogenous estrogen, occupation of the receptors by phytoestrogen compounds may increase the total estrogenic effect (estrogen agonist). This group of women (namely, postmenopausal, low endogenous estrogen, not on hormone replacement therapy) would be more likely to have vasomotor symptoms (eg, hot flashes and night sweats), have urogenital atrophy (eg, vaginal discomfort), and be at risk for osteoporosis. This is the group that could potentially benefit from phytoestrogen compounds in their diet.

This table shows the relative potency of phytoestrogens compared to estradiol, as cited in the journal Obstetrics and Gynecology .

CompoundRelative Value (mg)
Estradiol1
Genestein1200
Daidzein7700
Coumestrol500

Soy

The typical Asian diet contains 20-150 mg of isoflavones or 20-50 grams of soy protein per day. A typical diet supplementation would be a daily substitute of 50 grams of soy protein for the equivalent amount of animal protein. This is the equivalent of about 1 cup of soy flour. This amount would contain less than 350 mg of isoflavones, and an unknown amount of converted compounds would be biologically available. With certainty, the biologic effect of this amount of soy would be considerable less than 0.025 mg of transdermal estradiol, 0.5 mg of micronized estradiol, or 0.3 mg of conjugated equine estrogens (CEE).

A double-blind randomized controlled trial of 58 postmenopausal women comparing 45 grams of soy flour per day to 45 grams of wheat flour per day showed a 45% reduction in hot flashes with soy flour and a 25% reduction in hot flashes with wheat flour. An additional three studies support this finding. More information about soy can be found at the University of Illinois' StratSoy website .

Phytoestrogens and bone mineral density

There is insufficient data on the potential effect of dietary intake of phytoestrogens on bone mineral density in postmenopausal women.

Soy and lipids

A meta-analysis of the effects of soy consumption on lipids concluded that low density lipoprotein (LDL) could be modestly reduced by substituting daily servings of soy for animal protein. Some of the studies analyzed were poorly designed, and the analysis is subject to publication bias. Importantly, substituting soy means that the animal protein was removed from the diet. When we eat animal protein, we also eat animal fat. So it's difficult to separate the effect of removing animal protein and fat from the diet from a possible additional beneficial effect of adding soy. Any woman with elevated LDL needs to lower her daily fat content, especially saturated fats, which are found in animal-source food. Any method that accomplishes this goal will be helpful, and substituting soy products appears to be a safe and effective method.

Phytoestrogens and endometrium

There are no studies of the effect of phytoestrogens on endometrium.

Legumes

Studies on the safety of phytoestrogens are limited, but legumes appear to be safe as part of a balanced diet, and in cultures throughout the world, a dietary intake of phytoestrogen-containing foods has not been shown to be harmful. Rather, those cultures appear to be realizing health benefits from a diet that has lower fat and animal-source content then the standard American diet. Although it is unlikely that people could suffer an "overdose" effect from enriching their diet with phytoestrogen-containing foods, it would be possible to take excess amounts of neutraceutical concentrations of phytoestrogen derivatives, such as the isoflavones and ipriflavone. Isoflavones are not the only biologically active substances in soy beans; there are also protease inhibitors, omega-3 fatty acids, and phytosterols—all of which would be absent in a capsule containing concentrated isoflavones.

Soy and phytoestrogens cannot be considered a substitute for estrogen replacement therapy (ERT) and hormone replacement therapy (HRT). The effects of combining phytoestrogens with ERT/HRT are not completely understood.

Ipriflavone

Ipriflavone is a synthetic isoflavone derivative which is structurally very similar to daidzein and genistein. When ipriflavone is consumed by a human, it is metabolized; the major metabolite is daidzein.

Two placebo-controlled randomized trials involving postmenopausal women with osteopenia (most commonly caused by osteoporosis), treated with either calcium and placebo or calcium and ipriflavone (200 mg three times a day) for two years, reported that women who received calcium experienced a decrease in vertebral bone density. The women who received calcium and ipriflavone did not have a loss of bone density.

A placebo-controlled randomized trial involving postmenopausal women with osteoporosis, treated with either calcium and placebo or calcium and ipriflavone (200 mg three times a day) for two years, reported that women who received calcium experienced a decrease in vertebral bone density. Women who received calcium and ipriflavone had a gain in vertebral bone density. To date, there is only preliminary data regarding the use of ipriflavone and bone fractures.

The Ipriflavone Multicenter European Fracture Study of postmenopausal women with osteoporosis should be published soon. There have not been reports of significant side-effects from ipriflavone. The long-term safety has not been established. Further prospective studies are need to clarify the role of ipriflavone in management of postmenopausal women.

Phytoestrogens and other areas of study

At present, there is insufficient data on the potential effect of dietary intake of phytoestrogens on bone mineral density in postmenopausal women. Also, there are no studies of the effect of phytoestrogens on endometrium; this is possibly an area of future research.

Eat a Healthful Diet

A healthful diet during menopause can improve your sense of well-being. It may also reduce the risk of heart disease, osteoporosis, and certain cancers. Your diet should be low in saturated fat and high in fruits, vegetables, and grains. An adequate intake of calcium (1200-1500 mg per day) can help lower your risk of osteoporosis. You can increase the calcium in your diet by eating more calcium-rich dairy foods (low-fat or nonfat preferred), leafy green vegetables, and calcium-fortified foods and juices. Vitamin D, found in sunlight and certain foods (fortified milk, liver, and tuna), helps your body absorb calcium. Recent evidence supports dietary intake of omega-3 fatty acids (fish oil capsules, salmon, tuna)

Learn About the Research on Herbs and Botanicals

While some herbs and botanicals might be pharmacologically and clinically effective, they are not necessarily free of toxic effects or side-effects. Some of these products may interact with, augment, or oppose the effects of prescription medication. These products may be subject to contamination, alteration, and misidentification. In one study, 54 available ginseng products were analyzed; 25% of the products contained no ginseng at all.

There are no randomized placebo-controlled studies reported in the English literature to support any of the claims of herbal remedies for menopausal symptoms.

Black cohosh (Cimicifuga racemosa) : Black cohash (Cimicifuga racemosa) was shown in five small, uncontrolled trials to improve hot flash symptoms. All five studies were supported by the manufacturer of Remefemin, a Cimicifuga racemosa product. On the basis of these reports, black cohosh cannot be advocated as an effective intervention for hot flashes.

Blue cohosh (caulophyllum thalictroides) : There is no evidence to support the use of blue cohosh for any menopausal symptoms.

Chasteberry (vitex agnus castus) : There is no evidence to support the use of chasteberry for any menopausal symptoms.

Dong quai (angelica sinensis) : A double-blind, randomized controlled trial of 71 women found no benefit of Dong quai for relieving menopausal symptoms.

Ginseng (panax ginseng) : A placebo controlled trial found no benefit of Ginseng for relieving menopausal symptoms.

Evening primrose oil : A randomized double-blind, placebo-controlled trial found no benefit of evening primose oil for management of vasomotor symptoms.

Licorice or sage : There is no evidence to support the use of licorice or sage in the treatment of menopause.

Wild yams (dioscorea villosa) : Mexican wild yams do not contain any progesterone or progestogen. They do contain a substance (saponin) that can be chemically converted to progesterone, but the human body cannot perform this conversion. There are some wild yam cream products that contain a synthesized progesterone, which is added to the cream.

Progesterone creams : USP progesterone is the commercially prepared substance that is sold in bulk to compounding companies to make capsules, oils, tablets, nad gels. It may also be added to creams and sold over-the-counter. There is no evidence that use of these creams can be substituted for prescribed progestogens for the purpose of opposing estrogenic effects on the endometrium. There is little consistency or quality control; the detectable amount of progesterone in over-the-counter creams varies extremely from 0 to 500 mg/ml.

A randomized placebo-controlled trial of 20 mg of progesterone cream applied to the skin daily reported an improvement in vasomotor symptoms in 83% of treated women and 19% of placebo subjects. There is insufficient evidence to support the use of over-the-counter USP progesterone creams for the management of menopausal symptoms. These products should not be substituted for a prescribed progestogen as part of an estrogen and progestogen replacement therapy regimen.

Limit Caffeine and Alcohol

Cutting back on caffeine and alcohol may reduce symptoms of anxiety and insomnia. It may also reduce the loss of calcium from your body and reduce your risk of other health problems.

Quit Smoking

Smoking is the number one preventable cause of premature death. Giving up smoking can reduce your risk of early menopause, heart disease, osteoporosis, and many types of cancer, including lung and cervical cancer. Many women quit smoking successfully, often after several attempts. Your healthcare provider may offer medication that can help, such as the antidepressant Zyban (bupropion) and other smoking cessation aids, such as nicotine patches and gums. Support groups and smoking cessation classes can also help. The most successful smoking cessation programs involve a combination of behavior modification techniques and drug therapy.

Exercise Regularly

Regular exercise is a great remedy for many symptoms of menopause. It helps promote better sleep, stimulates brain chemicals that can reduce negative feelings and depression, and may reduce hot flashes. Weight-bearing exercises such as walking, climbing stairs, and resistance exercises, such as lifting weights, help to strengthen your bones and decrease your risk of osteoporosis.

Manage Stress

During menopause you may be facing many stressors, such as raising children or having children leave home, caring for elderly parents, and juggling a number of responsibilities. You can reduce stress by taking care of your whole self. This means eating a healthful diet, getting plenty of sleep, exercising regularly, and having enough time for rest and recreation. A variety of relaxation techniques can also help you to cope more effectively with stress. Examples include meditation, deep breathing, progressive relaxation, yoga, and biofeedback.

Stay Cool

If you are having hot flashes, try making a diary of when they happen and what seems to trigger them. This may help you find out what to avoid. Otherwise:

  • When a hot flash starts, go somewhere that is cool.
  • Sleeping in a cool room may keep hot flashes from waking you up during the night.
  • Dress in layers that you can take off if you get warm.
  • Use sheets and clothing that let your skin "breathe."
  • Carry a small, battery operated fan in your briefcase or purse.
  • Try having a cold drink (water or juice) at the beginning of a hot flash.
  • Avoid hot foods like soup or spicy foods.

References:

National Institute on Aging website. Available at: http://www.nia.nih.gov/ . Accessed February 14, 2006.

North American Menopause Society website. Available at: http://www.menopause.org/default.htm . Accessed February 14, 2006.

Seidl MM, Stewart DE. Alternative treatments for menopausal symptoms. Systematic review of scientific and lay literature. Can Fam Phys. 1998;44:1299-1308

Liske E. Therapeutic efficacy and safety of cimifuga raemosa for gynecologic disorders. Adv Therapy. 1998;15:43-51.

Israel D, Youngkin EQ. Herbal therapies for perimenopausal and menopausal complaints. Pharmacotherapy. 1997;17(5):970-984.

Hirata JD, Swiersz LM, Zell B, et al. Does Dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fert Steril. 1997;68(6):981-986.

Albertazzi P, Pansini F, Bonaccorsi G, et al. The effect of soy supplementation on hot flushes. Obstet Gynecol. 1998;91:6-11.

Blake J. Phytoestrogens: the food of the menopause? J Soc Obstet Genaecol Can. 1998;20(5):451-460.

Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med. 1995;333:276-282.

Gennari C, Agnusdei D, Crepaldi G, et al. Effect of ipriflavone—a synthetic derivative of natural isoflavones—on bone mass loss in the early years after menopause. Menopause. 1998;5:9-15.

Agnusdei D, Crepaldi G, Isaia G, et al. A double-blind, placebo-controlled trial of ipriflavone for prevention of postmenopausal spinal bone loss. Calcif Tissue Int. 1997;61:142-147.

Agnusdei D, Adami S, Cervetti R, et al. Effects of ipriflavone on bone mass and calcium metabolism in postmenopausal osteoporosis. Bone Miner. 1992;19(Suppl 1):S43-48.

Scheiber MD, Rebar RW. Isoflavones and postmenopausal bone health: a viable alternative to estrogen therapy. Menopause. 1999;6(3):233-241.

Leonetti HB, Longo S, Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol. 1999;94:225-228.

Rimm EB, Stampfer MJ. The role of antioxidants in preventive cardiology. Curr Opin Cardiol. 1997;12:188-194.

The Women's Health Initiative Study Group. Design of the Women's Health Initiative clinical trial observational study. Control Clin Trials. 1998;19(1):61-109.



Last reviewed February 2007 by Jeff Andrews, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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