The American College of Obstetricians and Gynecologists (ACOG) issued these guidelines on the most popular herbal products for menopause:

Soy and isoflavones (plant estrogens found in beans, particularly soybeans). High isoflavone intake (about 50 grams of soy protein per day) may be helpful in the short-term (2 years or less) to relieve hot flashes and night sweats. However, results from one recent study released in July 2003 found that isoflavone supplements (pills) made from red clover did not help women with hot flashes or other menopause symptoms. Another study of breast cancer survivors found that taking soy products did not help their hot flashes. But, taken over a long time, soy and isoflavones may have good effects on cholesterol and bones. Results from other recent studies show that, while eating foods with soy can be safe, taking very large amounts of soy and isoflavone supplements may be harmful to women who have had a type of breast cancer called estrogen-dependent breast cancer, and may be harmful to other women as well. These results leave open the question of whether soy products may protect women against breast cancer or add to its cause.

St. John's wort. May be helpful in the short-term (2 years or less) to treat mild to moderate depression in women (when given in doses of less than 1.2 milligrams a day). A recent study showed it does not help severe depression. It also can increase skin sensitivity to the sun and may interfere with prescription antidepressants.

Black cohosh. May be helpful in the short-term (6 months or less) to treat hot flashes and night sweats. It seems to be safe, but studies have been small and brief, with none longer than six months.

Chasteberry (also known as monk's pepper, Indian spice, sage tree hemp, and tree wild pepper). There are very few studies on the use of this in menopausal women. A study of women with premenstrual syndrome (PMS) who used it found it helped them with symptoms such as anger, headache, and breast fullness, but not bloating and other symptoms.

Evening primrose. Although some women take evening primrose for breast pain, bladder symptoms, and menopausal symptoms, there is little or no proof that it works. One study on hot flashes found that taking evening primrose was no better than taking placebo (a sugar pill).

Dong quai. A study that looked at dong quai's effect on hot flashes found that it was no better than placebo (sugar pill) -although the 4.5-gram dose used in the study was lower than that typically given in Chinese medicine. This herb can be toxic because it contains compounds that can thin the blood, causing excessive bleeding. It also can make the skin more sensitive to sun and increase your risk of skin cancer.

Valerian root. This has traditionally been used as a sleeping aid. But the U.S. Pharmacopoeia, which sets manufacturing standards for medicines, does not support its use. There also have been reports of heart problems and delirium (severe confusion) linked to suddenly stopping its use.

Ginseng. Most of the labels on ginseng products (including Siberian, Korean, and American, white and red) say they relieve stress and boost immunity (the body's response to fight illness). A study of menopausal women by the leading maker of ginseng found the product did not relieve hot flashes, but did improve women's sense of well-being. But, there have been many reports of problems with ginseng products. For instance, some ginseng products had little or no ginseng in them. Others contained large amounts of caffeine. Some products even contained pesticides or lead.

Wild and Mexican yam. There are no published reports that show wild and Mexican yam cream helps menopausal symptoms.

What are some practical things I can do to help deal with the symptoms of menopause?

There are things you can do to help relieve some menopausal symptoms.

Hot Flashes. Specific things can bring on hot flashes: a hot environment; eating or drinking hot or spicy foods, alcohol, or caffeine; and stress. You can try to decrease hot flashes by avoiding these triggers. Dress in layers and keep a fan in your home or workplace. Some women find that regular exercise brings relief from hot flashes and other symptoms.

******* Dryness. You can help ******* dryness and irritation by using an over-the-counter ******* lubricant. There are also prescription estrogen replacement creams that your HCP may recommend to help relieve ******* dryness and painful sex. If you have spotting or bleeding while using estrogen creams, you should see your HCP.

Difficulty Sleeping. One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week. But, avoid vigorous exercise too close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. Many women find they sleep better after drinking something warm, such as herb tea or warm milk. Try to keep your bedroom at a comfortable temperature. Also avoid napping during the day and try to go to bed and get up at the same times every day.

I know that I am at risk for getting other diseases as I age and reach menopause. What can I do to stay healthy during this time of my life?

A lack of estrogen during menopause causes your bones to lose calcium and become weaker, putting you at risk for severe bone loss or osteoporosis. A lack of estrogen also increases your risk of heart disease. You can help prevent osteoporosis and heart disease by taking these steps:

Get enough calcium to keep your bones strong. Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,500 mg per day. You also can talk with your HCP about taking medicine to help preserve bone and slow down bone loss. Get at least 30 minutes of physical activity on most days of the week. Try weight-bearing exercises, like walking, running, or dancing.

Eat healthy by including plenty of whole grain products, vegetables, and fruits in your diet. Choose a diet low in total fat, saturated fat, and cholesterol.

Maintain a healthy weight. Ask your HCP what a healthy weight is for you.

Control your blood pressure. Ask your HCP what a healthy number is for you and how often you need it checked.

If you have diabetes, control and monitor your blood sugar levels.

Lower your cholesterol to the right level. Ask your HCP what a healthy level is for you.

If you smoke, try to quit. Ask your HCP for help or visit this special section of the NWHIC web site: www.4woman.gov/QuitSmoking

If you drink alcohol, limit it to no more than one drink per day.

September 2003

Publications
La menopausia y las hormonas - El paquete incluye una hoja de datos con información sencilla y útil para las mujeres que piensan comenzar una terapia con hormonas para la menopausia. Explica cómo las hormonas pueden ayudar con la menopausia, y cuáles mujeres no las deben tomar por razones de sus factores de riesgo médico. También incluye una tarjeta del tamaño de cartera con preguntas acerca de la salud en la tercera edad que todas pacientes deberían hacerle a su proveedor de cuidado médico.


Menopause & Hormones Fact Sheet - This information packet includes a fact sheet with simple and clear guidance for women who are considering hormone therapy for menopause. It explains how hormones can help with menopause, and which patients should not take hormones. It also includes a convenient "purse card" with important questions to ask your doctor or healthcare provider about options for staying healthy through menopause and beyond.


Age Page: Menopause - This fact sheet explains what menopause is, and the different symptoms and health concerns that accompany its different stages. It gives recommendations for what women can do to stay healthy throughout menopause and answers common questions about hormone therapy, phytoestrogens and other important issues for menopausal women.


Alternative Therapies for Managing Menopause Symptoms - There are many alternative therapies for managing menopause symptoms available to women today, such as botanical products, acupuncture, so-called plant estrogens (phytoestrogens) and others. Interest in these therapies has risen since the cancellation of the estrogen plus progestin (hormone therapy) portion of the Women's Health Initiative (WHI) clinical study. This brochure explains the current scientific evidence about their safety and effectiveness and lists other sources of information.


Frequently Asked Questions - Menopause - This fact sheet discusses menopause symptoms, treatments, including postmenopausal hormone therapy (HT), practical steps women can take to alleviate symptoms and prevent diseases like osteoporosis and heart disease.


Menopause and Bladder Control - This brochure discusses the effect of menopause on bladder control, the different types of incontinence and how they can be treated.


Menopause Tutorial from the National Library of Medicine - This interactive tutorial guides the user through an audio-visual presentation explaining menopause, how and why it occurs, the signs and symptoms associated with menopause, and how to cope. It also explains the health concerns facing women in postmenopause and discusses recent evidence on the risks and benefits of hormone therapy. Each portion of the module has a quiz to help review key points.


Menopause Years - ACOG Publication #AP047 (Copyright © ACOG) - This brochure describes the physical changes that may occur around menopause and what can be done to stay healthy during this time.


Menopause: An Update, 2003 - In the 2 years since printing Menopause: One Woman’s Story, Every Woman’s Story—A Resource for Making Healthy Choices, research studies have yielded more information for women to consider. This addendum explains the most important updates. We’ve tagged some of these with page numbers from the full Menopause booklet where more detailed information is available. Information about ordering the full booklet is at the end.


Menopause: One Woman's Story, Every Woman's Story - A Resource for Making Healthy Choices - This publication is written to provide women with information so they can make choices about their health care before, during, and after menopause. It explains menopause, lists symptoms to look for, and the impact menopause can have on women's' health. This discusses treatment for menopause symptoms and ways to reduce the health risks associated with aging, including discussions on hormone replacement therapy or HRT, plant estrogens, diet, exercise and smoking cessation.


Questions and Answers About Black Cohosh and the Symptoms of Menopause - This fact sheet provides an overview of the use of black cohosh for menopausal symptoms.