tag:theconversation.com,2011:/us/topics/postmenopause-5971/articlesPostmenopause – The Conversation2023-11-10T00:38:34Ztag:theconversation.com,2011:article/2158062023-11-10T00:38:34Z2023-11-10T00:38:34ZPerimenopause usually begins in your 40s. How do you know if it has started?<figure><img src="https://images.theconversation.com/files/555977/original/file-20231026-17-bz53zk.jpg?ixlib=rb-1.1.0&rect=198%2C54%2C5808%2C3953&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-wearing-red-and-black-checkered-blouse-using-flat-screen-computer-RMweULmCYxM">Unsplash/Christina @wocintechchat.com</a></span></figcaption></figure><p>More than <a href="https://www.abs.gov.au/statistics/people/population/population-census/2021">half our population</a> (50.7%) are born with ovaries and will experience perimenopause in midlife. This occurs as hormone levels decrease and ovaries slow their release of eggs. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580996/">Perimenopause</a> usually <a href="https://www.mountsinai.org/health-library/report/menopause#:%7E:text=Early%20Stage.,be%20sudden%20surges%20in%20estrogen.">begins</a> in the early to mid-40s. Some people even begin perimenopause earlier, due to premature ovarian insufficiency or medical treatments such as chemotherapy or surgical oophorectomy (ovary removal). </p>
<p>Menopause is technically the single day 12 months after your last period. It usually <a href="https://www.menopause.org.au/health-info/infographics/menopause-what-are-the-symptoms">occurs</a> five to ten years after perimenopause begins, between ages 45 and 55.</p>
<p>Up to 80% of people in perimenopause <a href="https://pubmed.ncbi.nlm.nih.gov/26115590">experience symptoms</a>. But it’s not just hot flushes – symptoms can be incredibly varied and range in severity.</p>
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Read more:
<a href="https://theconversation.com/what-is-perimenopause-and-how-does-it-affect-womens-health-in-midlife-122186">What is perimenopause and how does it affect women's health in midlife?</a>
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<h2>What are the symptoms?</h2>
<p>Oestrogen affects every system in the body and so too can perimenopause <a href="https://doi.org/10.3109/13697137.2013.865721">symptoms</a>. These <a href="https://www.menopause.org.au/health-info/infographics/menopause-what-are-the-symptoms">include</a>:</p>
<ul>
<li><a href="https://www.maprc.org.au/about_depression">depression</a> and anxiety</li>
<li>body aches</li>
<li>“brain fog” and forgetfulness</li>
<li>irregular periods or periods of unusual heaviness or lightness</li>
<li>insomnia </li>
<li>night sweats</li>
<li>hot flushes</li>
<li>vaginal dryness</li>
<li>no interest in sex</li>
<li>urinary urgency. </li>
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<p>It’s impossible to anticipate which, if any, <a href="https://app.datadissect.com.au/f/vital-menopause">symptoms</a> you’ll experience, or in what <a href="https://www.menopause.org.au/images/stories/infosheets/docs/ams_symptom_score_card.pdf">order</a> they will begin. </p>
<h2>What impact does perimenopause have on work and life?</h2>
<p>Around 30% of symptomatic Australians find their perimenopause symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/27013286/">significantly interfere</a> with daily activities, including their ability to work. </p>
<p>The Australian Women’s Health Survey <a href="https://www.jeanhailes.org.au/uploads/Research/Menopause-and-Australian-Women-FINAL_PUBLISHED.pdf">reported</a> 46% of participants have taken an extended break from work, study or exercise due to menopause symptoms.</p>
<p>Thanks to the personal nature of many symptoms, and the stigma surrounding them, these statistics may still <a href="https://www.menopause.org.au/images/stories/education/docs/women-work-and-the-menopause-final-report.pdf">under-report</a> the impact of perimenopause on both individuals and society. </p>
<p>The Australian Institute of Superannuation Trustees <a href="https://treasury.gov.au/sites/default/files/2023-03/c2023-379612-australian_institute_of_superannuation_trustees.pdf">estimated</a> the retirement of women due to menopausal symptoms would equate to lost earnings and super of more than A$15.2 billion for every year of early retirement. </p>
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Read more:
<a href="https://theconversation.com/how-to-design-menopause-leave-policies-that-really-support-women-in-the-workplace-209282">How to design menopause leave policies that really support women in the workplace</a>
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<p>Some women experience significant deterioration in their mental health in the lead up to menopause. Perimenopausal depression (PMD) is a serious illness and is categorised as a subset of <a href="https://pubmed.ncbi.nlm.nih.gov/23995026/">major depression</a>. It certainly shouldn’t be dismissed as female “hysteria” or a bad mood when someone is seeking care or support. In fact, <a href="https://www.suicidepreventionaust.org/news/statsandfacts#1690952813832-1e5deecd-69f3">female suicide</a> rates <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603326/">increase from ages 40–60</a>.</p>
<h2>Know when to seek help</h2>
<p>Each woman’s experience will be different, and not all symptoms are related to menopause, but with early recognition and seeking help when needed, this life transition can be a smoother journey. </p>
<p>There are various <a href="https://www.menopause.org.au/hp/management/treatment-options">treatment</a> options for perimenopausal symptom relief. The gold standard is <a href="https://www.menopause.org.au/images/factsheets/What_is_MHT_and_is_it_safe_V7.pdf">menopausal hormone treatment</a>, which used to be called hormone replacement therapy. This works by counterbalancing the hormone losses of perimenopause and comes in a range of doses and formulations, including gels, patches, pessaries, creams and tablets. </p>
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<img alt="Two women laugh in the sun" src="https://images.theconversation.com/files/555980/original/file-20231026-21-a905ny.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555980/original/file-20231026-21-a905ny.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555980/original/file-20231026-21-a905ny.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555980/original/file-20231026-21-a905ny.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555980/original/file-20231026-21-a905ny.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555980/original/file-20231026-21-a905ny.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555980/original/file-20231026-21-a905ny.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Symptoms of perimenopause vary greatly between individuals.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/two-woman-taking-a-sideview-selfie-jFyavA0669c">Priscilla du Preez/Unsplash</a></span>
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<p>The period after menopause is <a href="https://www1.racgp.org.au/ajgp/2019/july/making-choices-at-menopause">associated with</a> higher risks for heart disease, diabetes, osteoporosis and dementia. If menopausal hormone treatment is started within ten years of menopause, it may also <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2023.1260427/full">reduce these risks</a>. </p>
<p>Some women find it helpful to go through a <a href="https://menopause.org.au/hp/information-sheets/ams-symptom-score-card">symptom checklist</a> before seeing their GP (or going through it with their GP) if they want an official diagnosis of perimenopause or treatment for symptoms. </p>
<p>There are also <a href="https://wellfemme.com.au/">national specialist telehealth menopause services</a> available if you’re not getting the care you need locally (currently <a href="https://wellfemme.com.au/wellfemme-services/">A$295 or $165 concession</a>, before the Medicare rebate, for a long appointment with a doctor and a detailed report to send to your GP). </p>
<p>And it’s important to know you can seek a second opinion if you’re not being listened to.</p>
<p>Perimenopause doesn’t just impact those personally going through perimenopause, it also affects their partners, families, businesses, workforce participation and gender equity. We all need to be educated about perimenopause and consider how to increase flexibility and support in our workplaces and other environments. </p>
<p>The federal parliament has <a href="https://www.youtube.com/watch?v=1cw68MdWb2A">just commenced</a> a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Menopause">Senate inquiry into issues related to menopause and perimenopause</a>. This will include the economic cost, physical impacts, government policies and programs, and cultural and societal factors. So we can expect to see more discussion of these issues until the final report is delivered in September 2024. </p>
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Read more:
<a href="https://theconversation.com/all-the-reasons-you-might-be-having-night-sweats-and-when-to-see-a-doctor-211436">All the reasons you might be having night sweats – and when to see a doctor</a>
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<p class="fine-print"><em><span>Erin Morton is a member of the Australasian Menopause Society. </span></em></p>Menopause is technically the single day 12 months after your last period. But perimenopause can last years. Here’s what to look for.Erin Morton, Associate Professor, Health Data & Clinical Trials, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172182023-11-08T17:36:49Z2023-11-08T17:36:49ZBreast cancer prevention drug approved for post-menopausal women in the UK – here’s how it works<figure><img src="https://images.theconversation.com/files/558434/original/file-20231108-21-8cqks7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5577%2C3706&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anastrozole may stop breast cancer before it starts.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/just-awaken-senior-lady-holding-morning-1950650434">fizkes/ Shutterstock</a></span></figcaption></figure><p>A drug that can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961114/">halve the risk</a> of developing breast cancer in post-menopausal women has been approved for use in the UK. This drug, called anastrozole, could benefit an estimated 289,000 women in the UK who are at <a href="https://www.nice.org.uk/guidance/cg164/ifp/chapter/how-breast-cancer-risk-is-described">increased risk of breast cancer</a>. </p>
<p>Anastrozole was already approved for use in the UK as a breast cancer treatment. It belongs to a group of drugs called <a href="https://www.ncbi.nlm.nih.gov/books/NBK557856/">aromatase inhibitors</a> that were first developed to treat breast cancer in women who had undergone menopause.</p>
<p>The key to anaztrozole’s success both in treating and preventing breast cancer, is due to its effects on the body’s oestrogen levels.</p>
<p><a href="https://www.cancerresearchuk.org/about-cancer/breast-cancer/getting-diagnosed/tests-breast-cancer-cells">Up to 80%</a> of all breast cancers produce a protein called the oestrogen receptor, which binds to the hormone oestrogen. When it binds, this protein tells breast cancer cells to divide. This overrides the normal controls that prevent cells from dividing too much – causing a tumour to grow. The more oestrogen circulating around the body, the more likely it is that tumour growth will be stimulated.</p>
<p>But anastrozole reduces oestrogen levels, preventing breast cancer cells from dividing. It does this by targeting a specific enzyme in the body.</p>
<p>Before the menopause, most of the body’s oestrogen is produced in the ovaries. But after the menopause, oestrogen is instead produced by an enzyme called <a href="https://academic.oup.com/edrv/article/30/4/343/2355213">aromatase</a>. This oestrogen is typically made in our fat tissue. Aromatase produces oestrogen by converting other hormones – such as testosterone and androstenedione.</p>
<p>Anastrozole and similar drugs – such as letrozole and exemestane – stop aromatase from working and drastically reduce the amount of oestrogen in the body. This means that in post-menopausal breast cancer patients, the drug is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564654/">very effective</a> at stopping cancers which produce the oestrogen receptor from recurring after surgery or chemotherapy.</p>
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<img alt="A nurse looks at a breast cancer scan on a computer screen." src="https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558436/original/file-20231108-19-ipcdma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The majority of breast cancers produce a protein which bind to the hormone oestrogen.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-patient-undergoes-screening-procedure-mammogram-1951533499">ORION PRODUCTION/ Shutterstock</a></span>
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<p>The reason anastrozole also works to prevent breast cancer is because often the earliest stages of normal breast tissue becoming cancerous depend on oestrogen. Indeed, many of the <a href="https://breastcancernow.org/about-breast-cancer/awareness/breast-cancer-causes">known risk factors</a> for developing breast cancer – such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488186/">late menopause</a> and <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet">obesity</a> – are associated with increased oestrogen levels. But using anastrozole to reduce oestrogen levels can stop breast cancer before it even starts in at-risk post-menopausal women.</p>
<h2>Preventative drug</h2>
<p>Thanks to the new licence, post-menopausal women in the UK who are at moderate to high risk of developing breast cancer will now be offered the chance to take anastrozole to protect themselves. Women who have a <a href="https://www.nice.org.uk/guidance/cg164/ifp/chapter/First-steps-finding-out-about-your-family-history">family history of the disease</a> should talk to their doctor about their risk and whether they could benefit from taking anastrozole.</p>
<p>It’s worth noting, however, that the drastic reductions in oestrogen levels caused by an aromatase inhibitor such as anastrozole are not without their drawbacks. Not only may it <a href="https://www.breastcancer.org/treatment-side-effects/menopause/types/hormonal-therapy">worsen menopause symptoms</a>, it may also cause other <a href="https://www.frontiersin.org/articles/10.3389/fendo.2021.713700/full">side-effects</a> – such as a decrease in bone density and increased risk of fractures. These side-effects <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2104162">can become more serious</a> the longer the drug is taken. This is why it’s currently recommended that anastrozole is only taken for prevention for five years.</p>
<p>Women who are at increased risk of breast cancer and are considering using anastrozole need to be supported in making an informed decision that’s right for them. Women with osteoporosis or serious kidney or liver disease are <a href="https://www.nhs.uk/medicines/anastrozole/">particularly advised</a> to discuss this decision with their doctor first.</p>
<p>In the UK, there are <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer">almost 56,000 new diagnoses of breast cancer</a> annually. The NHS estimates that if just 25% of eligible patients opt to take anastrozole, then <a href="https://www.england.nhs.uk/2023/11/tens-of-thousands-of-women-set-to-benefit-from-repurposed-nhs-drug-to-prevent-breast-cancer">2,000 breast cancer cases</a> could be prevented each year in the UK. </p>
<p>Breast cancer is the <a href="https://www.who.int/news-room/fact-sheets/detail/breast-cancer">most common cancer in the world</a>. An estimated 2.3 million people – mainly women – will develop the disease each year. Preventing even a fraction of these cancers has the potential to save many lives and reduce suffering. Although anastrozole is prescribed off-label to prevent breast cancer in <a href="https://www.cancer.org/cancer/types/breast-cancer/risk-and-prevention/aromatase-inhibitors-for-lowering-breast-cancer-risk.html">other countries</a>, the UK is the first to license it for this specific use. Given the burden of breast cancer, it’s hoped that other countries will follow suit.</p><img src="https://counter.theconversation.com/content/217218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Allinson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anastrozole was already approved for use in the UK to treat breast cancer.Sarah Allinson, Professor, Department of Biomedical and Life Sciences, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2090042023-08-18T10:06:20Z2023-08-18T10:06:20ZHow tracking menopause symptoms can give women more control over their health<figure><img src="https://images.theconversation.com/files/540127/original/file-20230731-234595-td2ntl.jpg?ixlib=rb-1.1.0&rect=32%2C5%2C3566%2C2343&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can track your menopause symptoms by using an app, a dedicated website or a diary. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ny-usa-2-may2022young-fitness-woman-2157077103">Krotnakro/Shutterstock</a></span></figcaption></figure><p>Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them.</p>
<p>People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. </p>
<p>The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important.</p>
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<img alt="A word cloud displaying the symptoms of menopause." src="https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/menopause-symptoms-tags-cloud-estrogen-level-1017507085">Double Brain/Shutterstock</a></span>
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<p><a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. </p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
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<p>The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry.</p>
<p>There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. </p>
<p>The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. </p>
<p>As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. </p>
<p>One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” </p>
<h2>Why does monitoring symptoms help?</h2>
<p>One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. </p>
<p>Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms.</p>
<p>Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. </p>
<p>Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. </p>
<p>Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.</p><img src="https://counter.theconversation.com/content/209004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lancastle consults to Gedeon Richter, Theramex, Merck Serono and Health and Her. The links with Theramex and Merck Serono are prior to 2020.
She has received honoraria and expenses from Gedeon Richter, Theramex, and Merck Serono for presentations and CPD events. The menopausal symptom monitoring research was funded by a KESS studentship for my PhD student (Robin Andrews), which included company partner funding from Health and Her, and I have provided web-support articles for Health and Her. The studies discussed in this article did not involve Health and Her clients and was not administered via the Health and Her organisation. Health and Her were not involved in the analysis or write up of the studies discussed in this article. </span></em></p>Tracking the many physical and emotional symptoms of menopause with a website, app or diary can help women better monitor their health.Deborah Lancastle, Associate Professor of Psychology, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/597872016-12-06T02:22:26Z2016-12-06T02:22:26ZWhat women with breast cancer should know about estrogens<figure><img src="https://images.theconversation.com/files/146450/original/image-20161117-18113-kc2bjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors and patients should appreciate the many roles estrogens play in the body.</span> <span class="attribution"><span class="source">Doctor and patient image via www.shutterstock.com.</span></span></figcaption></figure><p>One of every eight women in the United States <a href="http://www.breastcancer.org/symptoms/understand_bc/statistics">will develop invasive breast cancer</a> over her lifetime. <a href="http://www.breastcancer.org/symptoms/diagnosis/hormone_status/read_results">Eighty percent of those cancers</a> are fueled in part by estrogens.</p>
<p>One treatment for women whose breast cancer is fueled by estrogen – or what is often called estrogen receptor (ER)-positive breast cancer – is for them to take drugs that block estrogens. But estrogens have benefits that should be considered.</p>
<p>This particularly affects postmenopausal women who have gone through the trauma of surgery for invasive breast cancer. They are typically faced with a very difficult decision. Should they take estrogen blockers or not? Is the treatment worth it, balancing the risk of recurrence of the cancer with potential quality-of-life issues?</p>
<p>When prescribing a particular drug for postmenopausal, ER-positive, breast cancer survivors, physicians often consider the effects of estrogen blockers on <a href="http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-hormone-therapy">bone and the uterus</a>.</p>
<p>However, they also need to consider the effects on other aspects of women’s health. Estrogens also have many positive effects on mental health, cognitive function, libido and protection of the brain, possibly even slowing the onset of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728624/">Alzheimer’s disease</a>.</p>
<p>I am a neuroendocrinologist, and I have studied the effects of hormones, including estrogens, on the brain, behavior and mental health for over 40 years. Not only is the fact that “estrogen” is actually a class of hormones <a href="http://press.endocrine.org/doi/pdf/10.1210/en.2008-0396">not well understood</a>, but so are the many positive functions of estrogens. As with any health treatment, the potential negative effects should be weighed against the potential positive effects. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/146451/original/image-20161117-18128-5citjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146451/original/image-20161117-18128-5citjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146451/original/image-20161117-18128-5citjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146451/original/image-20161117-18128-5citjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146451/original/image-20161117-18128-5citjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146451/original/image-20161117-18128-5citjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146451/original/image-20161117-18128-5citjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s estrogens, not estrogen.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-263085500/stock-photo-papers-with-hormones-list-and-tablet-with-words-estrogens-.html?src=a3HUbVzTGdtnmxelDI09Bw-1-44">Estrogens image via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>There is no hormone called estrogen</h2>
<p>First, a primer on what exactly “estrogen” is. There is actually <a href="http://press.endocrine.org/doi/pdf/10.1210/en.2008-0396">no hormone called</a> “estrogen.” Estrogens are a class of hormones. There are three different forms of estrogens in the body: estradiol, estriol and estrone. Although they are all pretty similar in function, they vary in potency. Estrogens found in plants, like soy, are also sometimes simply called “estrogen,” although their effects may differ from those of the estrogens produced in the body.</p>
<p>Estradiol is the dominant estrogen circulating prior to menopause. It is produced mainly in the ovaries. In most cases, this is the most potent form of estrogen. During pregnancy, the dominant form is estriol, produced by the placenta. And during menopause, when the levels of estradiol decrease, the dominant estrogen is estrone, produced in fat tissue. </p>
<p>The ovaries stop producing estrogens during menopause, resulting in lower levels of estrogens in the body. Yet other organs, including fat and the brain, continue to produce them. There are still estrogens doing whatever they were doing before, but because their levels are lower, they are not doing their work as effectively.</p>
<p>One class of estrogen blockers that is often prescribed for women with estrogen receptor-positive breast cancer does its job by blocking estrogens from getting to the receptors of the cells in the body, including cancer cells. The body still produces estrogens, but their effects are blocked in some cells. </p>
<p>A second class, called aromatase inhibitors, blocks the production of estrogens. Both types of estrogen blocker act in the brain as well as the breast, ovaries, vagina and many other parts of the body. </p>
<p>Since these drugs block the effects of estrogens, we should expect that, besides blocking the negative effects of estrogens on the breast cancer, they will block the positive effects on the brain and on mental health.</p>
<p>Unfortunately, many experiments directly assessing the effects of these drugs in breast cancer survivors are missing essential controls. It would not be ethical to give one group of women with a high risk of recurrence of breast cancer a placebo. </p>
<p>However, although much more research on the effects of anti-estrogens in postmenopausal women with breast cancer is needed, by considering what we know about the effects of estrogens <a href="http://www.sinauer.com/an-introduction-to-behavioral-endocrinology-864.html">from animal studies</a>, all that we know about the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27680875">effects of estrogens in women without breast cancer</a> and what we know from some studies about the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26786934">effects of anti-estrogens</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/25906766">in breast cancer survivors</a>, we can conclude that anti-estrogens are likely to compromise quality of life in some women.</p>
<h2>What are the positive effects of estrogens?</h2>
<p>The many positive functions of estrogens and their effects on health are often underestimated. </p>
<p>Estrogens are responsible for the development of reproductive tissues and female secondary sexual characteristics (like breasts) at puberty. They also maintain bone density and decrease the risk of osteoporosis, which can result in brittle bones that break easily. But the role estrogens play in women’s health goes far beyond reproductive health and bone density.</p>
<p>Some of the most profound effects of estrogens are in the brain. For instance, hot flashes, which many women experience while going through menopause, are due to the loss of estrogens acting on brain areas involved in temperature regulation. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/146452/original/image-20161117-18138-5axe5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/146452/original/image-20161117-18138-5axe5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=691&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146452/original/image-20161117-18138-5axe5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=691&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146452/original/image-20161117-18138-5axe5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=691&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146452/original/image-20161117-18138-5axe5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=868&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146452/original/image-20161117-18138-5axe5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=868&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146452/original/image-20161117-18138-5axe5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=868&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Estrogen may have a protective role in the brain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-100336682.html">Brain image via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<p>They can also influence <a href="http://press.endocrine.org/doi/10.1210/er.2001-0016">cognitive function</a> – <a href="https://www.ncbi.nlm.nih.gov/pubmed/25205317">how we think</a>, particularly
verbal memory and fluency, which is the memory of words and how we express ourselves in language. And around the time of menopause in many women, they are believed to have an <a href="https://womensmentalhealth.org/posts/proving-the-estrogen-withdrawal-hypothesis-of-perimenopausal-depression/?doing_wp_cron=1478622920.9318621158599853515625">anti-depressive effect</a>. </p>
<p>Sleep disturbances during menopause are believed to be caused by absence of the estrogens acting on sleep centers in the brain. The decreased actions of estrogens on the brain during menopause may also <a href="http://www.sciencedirect.com/science/article/pii/S0018506X15301677">influence sexual desire</a>.</p>
<p>And finally, estrogens may be protective in the brain. This has been demonstrated in nonhuman primates. In women, estrogens may decrease the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27327261">incidence of Alzheimer’s disease</a> if <a href="http://jama.jamanetwork.com/article.aspx?articleid=195464">hormone replacement begins soon after menopause</a>. </p>
<p>After menopause, the level of estrogens drops to low amounts. Appreciable amounts are still produced in fat tissue. We now believe that the brain also produces some estrogens as well, a topic that is being studied right now.</p>
<h2>Weighing the pros and cons of estrogen blockers</h2>
<p>Should women with estrogen receptor-positive breast cancer take inhibitors of estrogens? The decision of whether or not to use estrogen blockers is a complex one that each woman must make in consultation with her oncologist. </p>
<p>The potential negative effects of these blockers on the brain and quality of life should be weighed against the potential positive effects on recurrence of the cancer. The answer to this will depend on the absolute risk of recurrence of the cancer. </p>
<p>In making a decision about a treatment that could impact quality of life, it would be most helpful to speak with an oncologist who is fully aware of the potential negative, as well as positive, effects of these drugs.</p><img src="https://counter.theconversation.com/content/59787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeffrey D. Blaustein does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Estrogens also have many positive effects on mental health, cognitive function, libido and protection of the brain, possibly even slowing the onset of Alzheimer’s disease.Jeffrey D. Blaustein, Professor of Psychological and Brain Sciences, UMass AmherstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/180072014-02-13T03:32:12Z2014-02-13T03:32:12ZTrick or treat? Alternative therapies for menopause<figure><img src="https://images.theconversation.com/files/40961/original/s4m5ggcs-1391731842.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What really works to alleviate hot flushes and other symptoms of menopause?</span> <span class="attribution"><span class="source">splityarn/Flickr</span></span></figcaption></figure><p>During menopause, estrogen levels drop, leading to a number of unpleasant symptoms.</p>
<p>The transition to menopause can significantly affect women’s quality of life, with many willing to try anything to alleviate the hot flushes, night sweats, decline in libido, backaches and other symptoms that result from their drop in oestrogen levels. </p>
<p>Hormone replacement therapy (HRT) is the most effective treatment for the relief of menopause symptoms and works by topping up declining oestrogen levels with synthetic version of the hormone. It’s <a href="https://theconversation.com/hormone-replacement-therapy-and-cancer-lets-get-the-facts-straight-4975">effective</a> around 80% to 90% of the time. </p>
<p>HRT comes with a <a href="https://theconversation.com/hormone-replacement-therapy-and-cancer-lets-get-the-facts-straight-4975">small increase</a> in the risk of breast cancer and blood clots. But due to the severity of the menopausal symptoms, many women believe the benefits of HRT outweigh the relatively small risks associated with the treatment. Being overweight, for instance, carries a far higher risk of developing breast cancer compared with the risks associated with taking HRT for less than five years. </p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/12117397">large clinical trial</a> published a decade ago sparked widespread fears that HRT could cause cancer, stroke and heart disease. While the risks are now considered to have been <a href="https://theconversation.com/hormone-replacement-therapy-and-cancer-lets-get-the-facts-straight-4975">overstated</a>, they led to a dramatic decline in the use of hormone therapy. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/40974/original/fhb3dh5d-1391734021.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/40974/original/fhb3dh5d-1391734021.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40974/original/fhb3dh5d-1391734021.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40974/original/fhb3dh5d-1391734021.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40974/original/fhb3dh5d-1391734021.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40974/original/fhb3dh5d-1391734021.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40974/original/fhb3dh5d-1391734021.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Just because products are natural, doesn’t mean they’re risk-free.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/sanzibar/2611481094/sizes/l/">sanzibar/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>As many as 60% of women between the age 50 to 60 now <a href="http://www.ncbi.nlm.nih.gov/pubmed/21631851">use complementary and alternative</a> treatments. </p>
<p>But while manufacturers are quick to claim to provide a wide array of benefits to menopausal women, in many instances, there’s <a href="http://benthamscience.com/ebooks/Sample/9781608054534-sample.pdf">little scientific evidence</a> to show they work. Let’s look at what the science has to say about the safety and efficacy of these products.</p>
<h2>Phytoestrogens</h2>
<p>Phytoestrogens are plant-derived compounds with a similar structure to human oestrogen, but are not as potent as the synthetic hormones used in HRT. </p>
<p><strong>Isoflavones</strong></p>
<p>Isoflavones are a class of phytoestrogens widely consumed by women to treat menopausal symptoms, especially hot flushes. They’re found in soy beans, soy-based foods such as tofu, lentils, alfalfa sprouts and chickpeas. </p>
<p>Studies have shown isoflavones in soy <a href="http://www.ncbi.nlm.nih.gov/pubmed/17593379">may be beneficial</a> for reducing cardiovascular disease and <a href="http://www.ncbi.nlm.nih.gov/pubmed/20452475">improving</a> bone strength. But there is conflicting evidence on their effectiveness for treating menopausal symptoms. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16675169">One study</a>, for instance, suggested that isoflavone treatment may be effective only when the number of flushes experienced daily is relatively high. </p>
<p>Overall, it seems that soy in the diet of menopausal women may be beneficial and is unlikely to do harm. </p>
<p><strong>Red clover</strong></p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/40968/original/jq8zmybv-1391733100.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/40968/original/jq8zmybv-1391733100.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=878&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40968/original/jq8zmybv-1391733100.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=878&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40968/original/jq8zmybv-1391733100.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=878&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40968/original/jq8zmybv-1391733100.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1103&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40968/original/jq8zmybv-1391733100.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1103&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40968/original/jq8zmybv-1391733100.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1103&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Red clover.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/randihausken/2590899732/sizes/l/">randihausken/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Red clover is a plant compound that contains four different isoflavones (formononetin, biochanin A, daidzein, and genistein). It is available as a tablet, tea, or in liquid form and is widely used by menopausal women.</p>
<p>The data is mixed on the effectiveness of red clover to reduce menopausal symptoms. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11910671">Some studies</a> suggest it delivers no improvement over placebo while <a href="http://www.ncbi.nlm.nih.gov/pubmed/12851275">others report</a> decreased frequency of hot flushes. </p>
<p>There have been no reported safety issues with taking red clover.</p>
<h2>Herbal remedies</h2>
<p>Herbal remedies have been used throughout the world as a traditional medicine for centuries, either in tea, tablet or powder forms. </p>
<p><strong>Black cohosh</strong></p>
<p>Black cohosh is an American perennial plant which has been used for hundreds of years to alleviate menopausal symptoms. It is the most studied herbal supplement, however, no researchers have identified its active constituent nor its mode of action. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/40967/original/dvx5k63b-1391732754.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/40967/original/dvx5k63b-1391732754.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40967/original/dvx5k63b-1391732754.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40967/original/dvx5k63b-1391732754.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40967/original/dvx5k63b-1391732754.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40967/original/dvx5k63b-1391732754.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40967/original/dvx5k63b-1391732754.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Black cohosh.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/8583446@N05/2694055172/sizes/l/">milesizz/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
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<p>Studies have demonstrated that black cohosh is mildly effective for alleviating <a href="http://www.ncbi.nlm.nih.gov/pubmed/17179056">hot flushes</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/15863547">mood swings</a>.</p>
<p>It’s safe to use for up to six months, although there have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Lontos+S%2C+Jones+RM%2C+Angus+PW%2C+Gow+PJ.+Acute+liver+failure+associated+with+use+of+herbal+preparations+containing+black+cohosh.+Med+J+Aust+2003%3B+179%3A+390-91">case reports</a> of liver failure in women using black cohosh for longer periods. </p>
<p>Further studies are required to clarify whether black cohosh may work to alleviate symptoms by mimicking estrogen.</p>
<p><strong>Maca</strong></p>
<p>Maca, a biennial herbaceous plant native to Peru has been used historically used for its putative fertility-enhancing and aphrodisiac properties. </p>
<p>Maca is marketed based on reported benefits in relieving menopause symptoms, though there is scant published scientific data show it is effective and exerts any estrogenic activity.</p>
<p><strong>Evening primrose oil</strong></p>
<p>Evening primrose oil is obtained from the seeds of a biennial plant native to the United States. It contains high levels of omega-6 essential fatty acids and is widely used for skin disorders, rheumatoid arthritis, multiple sclerosis, chronic fatigue, asthma and gastrointestinal disorders.</p>
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<img alt="" src="https://images.theconversation.com/files/40966/original/qzfvzmwd-1391732603.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/40966/original/qzfvzmwd-1391732603.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=489&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40966/original/qzfvzmwd-1391732603.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=489&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40966/original/qzfvzmwd-1391732603.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=489&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40966/original/qzfvzmwd-1391732603.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=614&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40966/original/qzfvzmwd-1391732603.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=614&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40966/original/qzfvzmwd-1391732603.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=614&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Evening primrose plant.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/wanderingnome/8111318834/sizes/l/">wanderingnome/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p>Women have also been using primrose oil for decades for alleviating breast pain, endometriosis, and symptoms of menopause such as hot flushes. </p>
<p>As with other herbal supplements, the precise mechanism of action is not fully clear and the <a href="http://www.healthline.com/natstandardcontent/evening-primrose-oil">efficacy</a> of evening primrose oil for relieving symptoms in menopausal women is not conclusive.</p>
<p><strong>Dong quai</strong></p>
<p>Dong quai is also prepared from the root of a perennial aromatic herb, this one native to China and Japan. Dong quai has long been used in traditional Chinese medicine to regulate menstrual cycle and alleviate menopausal symptoms. </p>
<p>Scientific <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Hirata+JD%2C+Swierz+LM%2C+Zell+B%2C+et+al.+Does+dong+quai+have+estrogenic+effects+in+postmenopausal+women%3F+A+double-blind%2C+placebo+controlled+trial.+Fertility+and+Sterility+1997%3B+68%3A+981-6">evidence</a> suggests it is ineffective for relieving menopausal symptoms. But when used in combination with other herbs (such as black cohosh, chasteberry, milk thistle, chamomilla and Siberian ginseng) <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Wong+VC%2C+Lim+CE%2C+Luo+X%2C+Wong+WS.+Current+alternative+and+complementary+therapies+used+in+menopause.+Gynecological+Endocrinology+2009%3B+25%3A166%E2%80%9374">appears to be useful</a> in controlling hot flushes and other menopausal symptoms.</p>
<p><strong>Ginseng</strong></p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/40965/original/dyypjq8z-1391732419.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/40965/original/dyypjq8z-1391732419.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40965/original/dyypjq8z-1391732419.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40965/original/dyypjq8z-1391732419.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40965/original/dyypjq8z-1391732419.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40965/original/dyypjq8z-1391732419.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40965/original/dyypjq8z-1391732419.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Ginseng.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/centralasian/3259345993/sizes/o/">Cea./Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p><a href="http://www.herbs-for-menopause.com/ginseng/ginseng-benefits.htm">Gingeng</a>, a root native to Chinese medicine has been used for centuries for a number of ailments. However, few studies have examined the effects of ginseng on menopausal symptoms. </p>
<p>Ginseng does not have estrogenic effects, suggesting it does not exert any hormone replacement-like effects. But it has <a href="http://www.ncbi.nlm.nih.gov/pubmed/17593379">been reported</a> to alleviate some menopausal symptoms. </p>
<h2>Other complementary therapies</h2>
<p>Homeopathy is a system of alternative medicine, where substances that cause symptoms of disease in healthy subjects would cure such symptoms in sick subjects. Active ingredients are used and repeatedly diluted in alcohol or distilled water until no molecules of the original substance remains. </p>
<p>Studies <a>show</a> homoeopathy is no more effective as a menopause treatment than a placebo, and since the ingredients are extensively diluted, it is unlikely to have any side effects. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/40971/original/c2x8qpxn-1391733413.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/40971/original/c2x8qpxn-1391733413.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40971/original/c2x8qpxn-1391733413.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40971/original/c2x8qpxn-1391733413.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40971/original/c2x8qpxn-1391733413.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40971/original/c2x8qpxn-1391733413.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40971/original/c2x8qpxn-1391733413.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The evidence for accupuncture is mixed.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/rocketlass/4716251954/sizes/l/">rocketlass/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>Complementary methods such as acupuncture, moxibustion (a traditional Chinese medicine treatment that involves burning a herb called <a href="http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/mugwort">Mugwort</a>) and reflexology are popular methods used to treat symptoms of various disease, including menopausal symptoms. </p>
<p>Again, there are contradictory studies, which <a href="http://www.ncbi.nlm.nih.gov/pubmed/10853874">some indicate</a> that such complementary methods alleviate menopausal symptoms to some extent, while <a href="http://www.ncbi.nlm.nih.gov/pubmed/20207087">other studies demonstrate</a> no benefit.</p>
<h2>So, what’s the verdict?</h2>
<p>Although some complementary and alternative therapies may have been used for many years with reports of great success, there is little scientific data to prove their efficacy. </p>
<p>And when studies have been undertaken, they’re of varying quality. Differences in findings across studies of the same product may be due to less-than-optimal trial design, variation in products and composition of products used, inadequate dosing, the length of treatment and small population size.</p>
<p>There’s no doubt that more clinical trials are required to ascertain the effectiveness of such methods in treating menopausal symptoms. In the meantime, exercise caution when taking complementary therapies and talk to your doctor about how they’ll interact with other medications you’re taking. </p>
<p>Just because they’re natural, doesn’t mean they’re risk-free.</p><img src="https://counter.theconversation.com/content/18007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>During menopause, estrogen levels drop, leading to a number of unpleasant symptoms. The transition to menopause can significantly affect women’s quality of life, with many willing to try anything to alleviate…Lily Stojanovska, Professor and Acting Director Centre for Chronic Disease Prevention and Management, Victoria UniversityVasso Apostolopoulos, Adjunct Professor and Sessional Academic, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.