BY Oyetokunbo Ibidapo-Obe, FM/OB, MD, and Samuel Mathis, MD, UTMB
Roughly half of the population will eventually go through the symptoms of menopause. These hormonal changes affect almost all aspects of a woman’s life and health. During this time, patients may have hot flashes, changes in bone density, mood swings, changes in menstruation, slowed metabolism, and difficulty sleeping, to name a few. Several prescription drugs are available for these symptoms, but many patients desire more natural or integrative therapies to help with their symptoms.
The primary treatment for menopause in contemporary medicine is the use of hormones. Balancing the patient’s estrogen, progesterone, and other hormones can become a full-time job. Bio-identical hormones have become more popular lately as these are derived from plants or animals and are chemically identical to the estrogens produced by the body.
From an Integrative Medicine standpoint, the primary treatment for menopausal symptoms is to treat any underlying health issues that could worsen these symptoms. Working on lifestyle changes can significantly 
improve the severity of symptoms. Counseling should include recommendations for sleep, weight, and exercise. Exercise should be moderate intensity, and care should be taken to refrain from excessive exercise as that may worsen hormonal balance through cortisol release. Good quality sleep is challenging during this time but can help with symptoms if achieved. Melatonin, magnesium, or passionflower can promote good sleep quality.
One of the simplest ways to replete or supplement missing estrogens in the body is through healthy food choices. Studies have evaluated the effect of phytoestrogens in plants on menopausal symptoms. These small amounts of hormones can help decrease the severity of menopausal symptoms. These hormone-like compounds are high in soybeans, chickpeas, flaxseed, lentils, grains, fruits, vegetables, and red clover. One systematic review in 2012 found that soy helped decrease the severity of hot flashes by 26%. A Cochrane review did not confirm this finding but did note that symptomatic relief was found from supplements with genistein which is one of the main isoflavones in soy [1]. Overall, recommending a healthy plant-based diet should provide some benefit for patients’ overall health and may improve menopause symptoms.
There is limited evidence on supplement use for menopause causes, but these supplements can be helpful for the management of symptoms. One of the best-known supplements for menopause comes from the use of black cohosh. Many studies have looked at the underlying action of this supplement. It may work through the modulation of certain estrogen receptors or through serotonergic action similar to SSRIs [2]. This mechanism of action may also explain the supplement’s effect on mood. The recommended dose of black cohosh is 40-200mg of dried root daily in divided doses.
Another supplement that has gained popularity recently is red clover. It works through the previously mentioned phytoestrogen pathway. Due to its weak effects, red clover should be used as an addition to other treatments.
Acupuncture can be utilized for menopausal symptoms. While the studies have shown mixed results, the consensus among acupuncturists is that prolonged treatment of 6-8 weeks is needed to see significant results. Up to 6 months of treatment is needed for long-lasting effects. Acupuncture may be a viable treatment option for women with a history of breast cancer due to their inability to take estrogens.
Some studies have found that mind-body exercises such as yoga, tai chi, meditation, and progressive muscle relaxation may improve symptoms of menopause. There is some difficulty in performing good-quality studies on these forms of exercise. Most studies have found that there is some improvement in vasomotor symptoms after 2-3 months when these forms of self-care are utilized.
Finally, it is important to educate patients that menopause is a normal transition in life. With healthy lifestyle choices, supplements, and even some pharmacological intervention (if needed), this transition does not have to be a traumatic experience.
Citations:
- Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD001395. DOI: 10.1002/14651858.CD001395.pub4
- Warner, W. (2023) Perimenopause to Menopause. David Rakel (Ed.) Integrative Medicine 5th Elsevier.