Evidence for managing menopause symptoms

What are the options for hot flashes, mood changes, or sleep problems? Here are facts about herbs, yoga, and more.

Since 2008, MsFLASH — a network of researchers funded by the National Institute on Aging — has been finding healthy ways to help women with symptoms of menopause. The following information and advice are based on findings from the group’s clinical trials. A summary of their results is in the journal Menopause.

The researchers from MsFLASH (which stands for “Menopause Strategies: Finding Lasting Answers for Symptoms and Health”) wish to thank the more than 1,300 people who have participated in their studies so far.

What is menopause?

Menopause is the time in life when the uterus stops menstruating. For those without a uterus but with ovaries, menopause is a change in the reproductive hormones produced by the ovaries. This usually occurs around age 51 or 52.

What is the most common experience?

Some do not have symptoms related to menopause. However, 80 to 90 percent do. Symptoms usually begin several years before menopause and include:

• Hot flashes — sweating and feelings of overheating sometimes followed by chills
• Problems sleeping
• Mood changes including anxiety or depression
• Other changes such as weight gain; loss of bone density, which increases risk of broken bones; and vaginal dryness, which can cause discomfort and make sex painful.

Researchers often measure the impact of menopausal symptoms by asking about overall quality of life.

What do we know about how to manage menopause-related symptoms?

“We know that hormone therapy can help most women with menopause symptoms,” says Susan Reed, MD, MPH, MS, director of the Women’s Reproductive Health Research Program and chief of service at the University of Washington Medical Center and an affiliate researcher at Kaiser Permanente Washington Health Research Institute.

Dr. Reed is a physician who studies women’s health. “More and more, women are wanting nonhormonal, alternative choices,” she says. “However, some of these work and some do not.” Based on her work and research by others, Dr. Reed offers these insights about nonhormonal treatments for managing menopause symptoms.

Nonhormonal therapies include the antidepressants called SSRIs, short for selective serotonin reuptake inhibitors. Examples are paroxetine or escitalopram. Other medications that might help are the antidepressant venlafaxine or the anticonvulsant gabapentin. Alternative therapies tested for relieving menopause symptoms include herbal and botanical nutritional supplements, exercise, and yoga.

Evidence from studies supports the following nonhormonal and alternative options for menopause symptoms:

• Low-dose SSRIs and gabapentin relieve about 50% of daily hot flashes.
• Low-dose SSRIs, yoga, and exercise might help with sleep and mood problems and improve quality of life.
• Cognitive behavioral therapy can improve quality of life and sleep.
• Vaginal gels and low-dose vaginal estrogen may help with vaginal discomfort. For some, vaginal estrogen may not be better than a vaginal gel that has no perfumes or additives or a natural, plant-based product such as coconut oil.

No strong evidence supports using botanicals or herbal supplements such as soy, black cohosh, dong quai, wild yam, or red clover for menopause symptoms.

“The good news for women approaching the age of menopause is that we have much better tools for managing symptoms than we had in the past,” says Dr. Reed. “I encourage women to talk with their health care providers about their symptoms, medical history, and personal preferences when deciding among these treatment options.”