Menopause actually occurs at the end of a woman's last menstrual period. However, that fact is established only later, when a woman has had no periods for at least 12 months. The average age at which menopause occurs is about 50 years, but menopause may occur normally in women as young as 40. Regular menstrual cycles may continue up to menopause, but usually the last periods tend to vary in duration and amount of flow. With age, the ovaries become progressively less responsive to stimulation by lutienizing hormone and follicle-stimulating hormone, which are secreted by the pituitary gland. Consequently, the ovaries secrete smaller and smaller amounts of estrogen and progesterone, and egg release (ovulation) eventually stops.
   Fewer than one third of women 40 to 60 years old have heard about the landmark study that found the risks of hormone therapy for most menopausal women probably outweigh their benefits.

Lifestyle changes help deal with menopause
Women can fight menopause's heart-threatening consequences by losing weight, exercising more and eating better; and these lifestyle changes may be particularly helpful to those who stop taking hormone replacement therapy (HRT).

Nutritional treatment of menopause
Some Herbs and nutrients that may be helpful, but keep in mind that research on the role of herbs and menopause continues to be inconsistent and sometimes contradictory:

Black Cohosh root extract Black Cohosh is available at Physician Formulas
Chaste Berry extract may help some women, to buy Chaste-Berry at Physician Formulas.
Ginseng extract could help with energy level, but too much ginseng could lead to insomnia and be counterproductive.
Red Clover extract may help some women but more research is needed. For more Red-Clover extract information and supplement product information.
Phytoestrogens are getting a lot more attention and in the next few years we will find out if soy isoflavonoids could become routinely prescribed to women after menopause. See genistein for more info.
St. John's wort extract for mood enhancement could be helpful if women after menopause with low mood or mild depression
Calcium dosage is difficult to know ideally, but a range of 400 to 1000 mg seems reasonable.
Magnesium supplement could also be helpful in women after menopause.
Rheum rhaponticum has been studied.

Herbal Combo for Menopause - Finally some good news
The combination of black cohosh and St. John's wort reduces the physical and psychological symptoms of menopause. St. John's wort is used to treat mild to moderate depression, while women have taken black cohosh for menopausal complaints. To see if a fixed combination of the herbal medicines could benefit women with depression and menopausal symptoms, researchers studied 300 women. Of these women, half took the St. John's wort and black cohosh combination, while the other half took placebo pills. After four months, women who took the two-herb combination showed a 50 percent reduction in symptoms such as hot flashes and sweating, compared to 20 percent for those on placebo. The women who were on the herbs also had much better mood. There was no significant difference between the groups in the number of side effects. The improvement in menopausal symptoms was similar to that seen among women taking hormone therapy for three months. Source: Obstetrics & Gynecology, February 2006.
   Treating menopausal symptoms effectively with few side effects is not easy. Estrogen works but it has potential long term side effects. Only half of the women benefited from the herbal combination, but that's better than nothing. If women are interested in taking black cohosh and St. John's wort, they should discuss with their doctor first who may agree to this dosage. Two capsules of black cohosh in the morning along with one capsule of St. John's wort 300 mg. There may be women who respond to half this dosage while others may need more. You can experiment for yourself and take more or less depending on your symptoms. Be a little careful with St. John's wort since the effects can accumulate after several days and you may need to take less with time. If you get insomnia, you may be taking too much.

Menopause and Soy
Previous studies on the benefits of soy for relieving menopausal symptoms have produced mixed results. In a new study, a research group used a standardized soy product which contains 160 milligrams of total isoflavones, soy-derived antioxidants. Forty-three postmenopausal women were assigned to the soy product or placebo daily for three months. The average age of the women was 55 years and they had been off hormone replacement therapy for at least six months prior to entering the study. All of the women completed a menopause-specific quality-of-life questionnaire at the beginning of the study and again after 6 weeks and 3 months. Compared with placebo, soy therapy led to a 40-percent reduction in psychosocial complaints involving mood and depression, a 36-percent reduction in hot flashes and night sweats, as well as a 30-percent reduction in other physical symptoms, primarily low energy.
   Over the years numerous studies have been reported regarding the benefits or lack of effectiveness of isoflavones, such as genistein, for menopause symptom relief. Overall, the evidence is tilting towards some benefit. At the least, these isoflavones do not have the serious side effects that estrogen has when used for prolonged periods. If isolfavones are not enough to relieve menopausal symptoms, then a small amount of estrogen can be used for brief periods to relieve severe hot flashes and other symptoms.

Milk ingestion and bone health after menopause
Inhibition of bone turnover by milk intake in postmenopausal women.
Br J Nutr. 2008 Feb 26. Bonjour JP, Brandolini-Bunlon M, Boirie Y, Morel-Laporte F, Braesco V, Bertičre MC, Souberbielle JC. Service of Bone Diseases, University Hospital, Rue Micheli-Du-Crest, Geneva 1211, Switzerland.
We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that, in the long term, may be expected to reduce bone loss after menopause. Thirty healthy women post menopause with median age 59 years were enrolled in a prospective crossover trial of 16 weeks. After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk, participants were maintained during 6 weeks under the same 600 mg calcium diet and randomized to receive either 500 ml semi-skimmed milk, thus providing a total of 1200 mg calcium, or no milk supplement. In the next 6 weeks they were switched to the alternative regimen. The changes in blood variables between the periods of 6 weeks without and with milk supplementation were: for parathyroid hormone, - 3.2 pg/ml; for crosslinked telopeptide of type I collagen, - 624 pg/ml; for propeptide of type I procollagen, - 5.5 ng/ml; for osteocalcin, - 2.8 ng/ml. In conclusion, a 6-week period of milk supplementation induced a decrease in several biochemical variables compatible with diminished bone turnover mediated by reduction in parathyroid hormone secretion.

The Ongoing Hormone Confusion regarding menopause treatment
Breast cancer rates fell sharply in 2003, and then held steady at the lower rate in 2004. The most likely reason for the sharp fall in rates was that large numbers of women stopped taking hormone therapy for menopause. More doctors are now realizing that the recommendation for estrogen and progestin use after menopause (which has gone on for the past few decades) may not have been such good advice after all.
   We would suggest we all accept the fact that it is going to take a long time to find out the answers to the following questions: When is hormone replacement therapy appropriate for women who are going through menopause? Which hormones should be used for the treatment for menopause and for how long? What dosages are appropriate? These may seem like simple questions but after decades of research there still is no general agreement in the medical community regarding guidelines to appropriate hormone replacement in women after menopause.
   We are going to provide you with some of my general thoughts that you can use to guide your decisions. First, do not use hormones, whether synthetic or natural, unless you have a good reason to and there are no other good options (such as nutrients and herbs along with exercise, deep sleep, yoga, etc). Second, if you do need to take hormones, use the least amounts that work. Third, whenever possible use natural hormones rather than synthetic or horse-derived. Fourth, reevaluate your need for these hormones, and the dosages that you are using, on a regular basis. Perhaps your required dosage could be reduced over time, or even stopped altogether.
   The beneficial dosages may be a fraction of what doctors normally prescribe or are available over the counter. Perhaps women may do well at half the estrogen and progesterone amount normally prescribed. DHEA and pregnenolone are sold at up to 100 mg a capsule. Any dosage above 5 to 10 mg could be harmful and dangerous. In fact, those who actually benefit from DHEA or pregnenolone may do so at dosages less than 5 mg, perhaps even as low as 1 or 2 mg.
   Interestingly, A new study provides preliminary evidence that black cohosh herb may reduce breast cancer risk. Dr. Timothy R. Rebbeck of the University of Pennsylvania School of Medicine in Philadelphia compared 949 women with breast cancer to 1,524 healthy controls. Women who reported taking black cohosh were at a lower risk of breast cancer. Previous studies have shown that black cohosh can block cell growth. The herb is also an antioxidant, and has been shown to have anti-estrogen effects as well. International Journal of Cancer, April 1, 2007.
Comments: It is also possible that those who took black cohosh did not take estrogen or progesterone, and hence, had a lower rate of breast cancer when compared to women who took the hormones.

Menopause Symptoms
During the time before menopause (technically called the climacteric, but more recently called perimenopause), symptoms may be nonexistent, mild, moderate, or severe. Hot flashes affect 75 percent of women. During a hot flash, the skin, especially on the head and neck, becomes red and warm (flushed), and perspiration may be profuse. Most women have hot flashes for more than a year, and 25 to 50 percent have them for more than 5 years. A hot flash lasts from 30 seconds to 5 minutes and may be followed by chills.
   Psychological and emotional symptoms such as fatigue, irritability, insomnia, and nervousness may be caused by the decrease in estrogen levels. Night sweats may disturb sleep, making fatigue and irritability worse. A woman occasionally may feel dizzy, have tingling sensations (pins and needles), and be unusually aware of her heartbeat, which may seem to be pounding. Loss of bladder control, inflammation of the bladder or vagina, and pain during intercourse because of vaginal dryness may also occur. Sometimes muscles and joints ache.

Symptoms of menopause in brief include:
Missed period for at least 9 to 12 months, with no cause other than menopause. Abnormal or irregular periods, such as spotting, different cycles or a different flow. Changes in weight, difficulty sleeping, night sweats and hot flashes.
Difficulty concentrating, forgetfulness, depression and moodiness. Pain or burning during urination, or loss or weakened bladder control. Vaginal dryness. Thinning of bones.

Onset of menopause symptom
A shorter-than-normal time between menstrual periods may signal the onset of menopause for many women, while heavy bleeding may have other causes. Among women between the ages of 42 and 52, those in the early stage of menopause commonly have shortened intervals between periods -- fewer than 21 days. Often, these periods were "anovulatory," meaning the women had bleeding but did not ovulate.

Hormone replacement therapy and menopause
Recent studies indicate that long term replacement with Premarin (horse derived estrogens) and synthetic progesterone increases the risk for heart disease, cancer, blood clots and gallbladder disease. 

What is the opinion of the medical establishment?
The field of hormone or herbal therapy during or after menopause is very complicated and there is no consensus within the medical community regarding the best option for long term therapy. The medical community seems to be shifting its viewpoint on hormone replacement. It appears that most traditional doctors now prefer using low doses of hormones for a brief period of time to treat menopausal symptoms, but prefer not to continue hormone replacement therapy indefinitely as in the past.

Menopause Research update
Soy supplements that contain isoflavones do not seem to help lower cholesterol, boost bone density and keep the mind sharp after menopause, new research suggests. Isoflavones, compounds found in soybeans, chickpeas and other legumes, are similar to the female hormone estrogen. Because of this, researchers have been studying whether soy protein or supplements containing isoflavones might act as a sort of "natural" hormone replacement therapy, to counter the changes that often accompany the loss of estrogen in menopause.  However, the July 2004 Journal of the American Medical Association report suggests that this is not the case.

Hormone replacement therapy for menopause and diabetes
Hormone replacement therapy used to treat postmenopausal symptoms seems to accelerate the build-up of deposits in the coronary arteries of women who have abnormal glucose tolerance -- a sign of impending or full-blown diabetes.

Menopause, estrogen, and Alzheimer's disease
Estrogen pills appear to slightly increase the risk of Alzheimer’s disease and other forms of dementia in postmenopausal women, a study found, echoing recent findings involving estrogen-progestin supplements. The findings contradict the long-held belief that estrogen pills can help keep older women’s minds sharp. The results came from a government study called the Women’s Health Initiative and were published in The Journal of the American Medical Association. The research involved nearly 3,000 women, ages 65 to 79, who had had hysterectomies and had taken daily estrogen-only pills, sold by Wyeth Pharmaceuticals as Premarin, for an average of about five years.

They say there's a season for everything, and that may even be true for menopause. In a small survey from Hungary, women were most likely to stop having their period soon after the spring and fall equinoxes. There was a peak after the spring equinox and a smaller one after the autumn equinox, according to a team led by Dr. Janos Garai at the University of Pecs. The findings suggest that factors other than the dwindling of a woman's egg supply influence when she enters menopause, the researchers note in the journal Human Reproduction.

A review of randomized, controlled trials found black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Ann Intern Med 2002 Nov 19;137(10):805-13.

Four-week supplementation with soy isoflavone may have beneficial effects on bone metabolism and on serum lipids in perimenopausal women. These effects could have the potential to reduce risks of postmenopausal osteoporosis and of cardiovascular diseases in such women.

Twenty-three healthy perimenopausal women were assigned randomly to either isoflavone or placebo groups. The isoflavone group (n=12) received daily capsules of soy isoflavone extract (62 mg of isoflavones) and the placebo group (n=11) received daily placebo capsules for four weeks.

Urinary excretion of isoflavone was measured at baseline and at weeks two and four. Urinary excretion of pyridinoline and deoxypyridinoline, bone stiffness and levels of serum cholesterol, triglyceride and cholesterol fractions were measured at baseline and at week four.

Urinary isoflavone excretion -- primarily daidzein -- was increased in the isoflavone group compared to the placebo group. Excretion of bone resorption markers was reduced significantly in the isoflavone group, as was total serum cholesterol and low-density lipid cholesterol. Other serum biochemical parameters were not changed in either group.

Natural Alternatives to the Treatment of Menopause
The National Institutes of Health in the United States of America cut short its three-year study of hormone replacement therapies (HRTs) in July of 2003, citing an increased risk for stroke, heart attack and breast cancer among menopausal women taking HRTs. With recent news questioning the safety of prescription hormone therapy in treating symptoms of menopause, natural alternatives targeting menopausal health are seeing a lift in sales.

What is Menopause?
Menopause actually occurs at the end of a woman's last menstrual period. However, that fact is established only later, when a woman has had no periods for at least 12 months. The average age at which menopause occurs is about 50 years, but menopause may occur normally in women as young as 40 ore even earlier. Regular menstrual cycles may continue up to menopause, but usually the last periods tend to vary in duration and amount of flow.

With age, the ovaries become progressively less responsive to stimulation by luteinizing hormone and follicle-stimulating hormone, which are secreted by the pituitary gland. Consequently, the ovaries secrete smaller and smaller amounts of estrogen and progesterone, and egg release (ovulation) eventually stops.

Symptoms of Menopause
During the time before menopause (technically called the climacteric, but more recently called perimenopause), symptoms may be nonexistent, mild, moderate, or severe. Hot flashes affect 75 percent of women. During a hot flash, the skin, especially on the head and neck, becomes red and warm (flushed), and perspiration may be profuse. Most women have hot flashes for more than a year, and 25 to 50 percent have them for more than 5 years. A hot flash lasts from 30 seconds to 5 minutes and may be followed by chills.

Psychologic and emotional symptoms--fatigue, irritability, insomnia, and nervousness--may be caused by the decrease in estrogen levels. Night sweats may disturb sleep, making fatigue and irritability worse. A woman occasionally may feel dizzy, have tingling sensations (pins and needles), and be unusually aware of her heartbeat, which may seem to be pounding. Loss of bladder control, inflammation of the bladder or vagina, and pain during intercourse because of vaginal dryness may also occur. Sometimes muscles and joints ache.

Risk of Hormone Replacement Therapy
Recent studies indicate that long term replacement with Premarin (horse derived estrogens) and synthetic progesterone increases the risk for heart disease, cancer, blood clots and gallbladder disease. Therefore, what alternatives are available?

Natural Remedies to the Rescue
There are a number of natural nutrients and herbs that have been studied for the therapy of menopausal symtoms. They include calcium, magnesium, St. John's wort, soy isoflavanoids, ginseng, black cohosh, red clover leaf, and chaste berry extract. Let's evaluate each one of these supplements.

Calcium and Magnesium
About age 30, men and women begin to slowly lose bone mass. A diet rich in calcium helps build strong bones and is an essential part of prevention and treatment of osteoporosis. Women who have gone through menopause lose bone mass more rapidly. Too much bone loss causes osteoporosis, which can lead to broken bones and other serious health problems. Calcium is found in many foods, including dairy products such as milk or yogurt. If you do not get enough calcium from the foods you eat, you may choose to take calcium supplements.
Magnesium is a naturally occurring mineral. Magnesium is important for many systems in the body especially the muscles and nerves. Calcium and magnesium are required in a good balance to be most effectively used by the body.

St. John's Wort
One of the most common symptoms of menopause is mood changes, such as mood swings or depression. In a German study published in 1999, 111 women in a general medical practice were given St. John's wort daily for12 weeks. The patients, who were between 43 and 65 years old, had perimenopausal symptoms. The incidence and severity of typical psychological symptoms were recorded at baseline and after 5, 8, and 12 weeks of treatment. Substantial improvement in psychological symptoms was observed in the women treated with St. John's wort. Perimenopausal complaints diminished or disappeared completely in the majority of women. Of note, sexual well-being also improved after treatment with St. John's wort extract.

Soy Isoflavonoids
Isoflavones are types of flavonoids found in plants. The main sources for isoflavones are soy products, beans, peas, nuts, grain products, coffee, tea and certain herbs. Genistein is one of the best known and studied isoflavones and is found in high amounts in soy. Isoflavonoid ompounds in plants that have estrogen-like properties are called phytoestrogens. Isoflavones are proposed to have health benefits in a variety of human conditions, including coronary heart disease, menopause, osteoporosis, and endocrine-responsive cancers. Many isoflavones have estrogen-like properties and, because of a favorable side-effect profile, may be ideal alternatives to hormone replacement therapy with respect to cardiovascular benefits. Increased isoflavone intake affects estrogen metabolism by altering the steroid hormone concentrations and menstrual cycle length, thereby demonstrating a potential to reduce the risk for breast carcinoma.

Ginseng
The root of the ginseng plant has been used in China, Japan, and Korea for many centuries in the therapy of psychiatric and neurological disorders, and for enhancing vitality. Ginseng contains several saponins named ginsenosides that are believed to contribute to the adaptogenic properties. They are used in traditional Chinese medicine to improve stamina and combat fatigue and stress. Saponins are interesting natural compounds found in many plants, herbs, roots, and beans.
A randomized, double-blind, study was performed at the University of Bergen, in Norway to assess the effects of a standardized ginseng extract compared with those of a placebo on quality of life in symptomatic postmenopausal women. The study lasted 16 weeks and included 384 women.. The results showed the women who were on ginseng had improved their depression, and many of them reported a sense of well-being.

Black Cohosh
Black cohosh (cimicifuga racemosa), is native to eastern North America, and has historically been used by Native Americans for a variety of female conditions. Black cohosh contains a variety of phytoestrogens. The German Comminssion E has approved black cohosh for the treatment of menopausal symptoms, premenstrual syndrome, and dysmenorrhea. A survey of women done at the University of San Francisco published in 2002 indicated that women who used a combination of herbal remedies and estrogen were more satisfied in the outcome of their symptoms compared to women who used estrogen alone or herbs alone. The supplements mentioned in the study were black cohosh, ginkgo, and soy. Studies have demonstrated that this botanical medicine, when standardized properly to the terpene glycoside fraction, appears to be effective in alleviating menopausal symptoms. Adverse effects are extremely uncommon.

Red Clover Leaf
Red clover is a native plant of Europe, central Asia, and northern Africa. The flower head is the part of the plant used in herbal remedies. Scientists have identified estrogen-like substances called isoflavones and anticoagulant chemicals called coumarins in red clover.
To investigate the effectiveness and safety of a red clover isoflavone dietary supplement versus placebo on the change in hot flush frequency in postmenopausal women, a randomized, double blind, placebo-controlled trial was done at Vrije University Medical Center in Amsterdam, The Netherlands. Women with more than 12 months without periods and experiencing more than five flushes per day were enrolled. All received placebo tablets for 4 weeks and were subsequently randomized to either placebo or 80 mg isoflavones for a further 12 weeks. Improvement was measured by the decrease in number of hot flushes per day. During the first 4 weeks of placebo the frequency of hot flushes decreased by 16%. During the subsequent double blind phase, a further, statistically significant decrease of 44% was seen in the isoflavone group, whereas no further reduction occurred within the placebo group.

Chaste Berry Extract
Chaste Berry (Vitex agnus-castus) is a tree native to creek beds and river banks of the Mediterranean and Central Asia. Its pointy-leafed branches bear clusters of lavender flowers that are followed by reddish-black pepper-sized fruits. These fruits have long been used as traditional medicine for female conditions.
Chaste berry contains several different constituents, including flavonoids, iridoid glycosides, and terpenoids. Chaste berry does not contain hormones. Chaste Berry is thought to be able to help regulate hormones because of its effects on pituitary function. When Chaste Berry is taken as a dietary supplement, the pituitary produces lutenizing hormone which then produces more progesterone at the second phase (luteal phase) of the woman's cycle. Chaste Berry also is able to decrease high levels of prolactin, a hormone that is normally produced in the second phase of a women's cycle. When prolactin is present in large amounts it produces breast tenderness. Chaste Berry is commonly used in Europefor hot flashes associated with perimenopause (the transition years into menopause).

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