Feel like you are always need to tear off layers of clothing? Have the thermostat turned way down? Finding yourself irritable, sleep deprived and perhaps truly not yourself. These can be typical symptoms of menopause. Many people ask us about the use of vitamins for menopause.
Once innocuously referred to as “the change”, this normal phase of life can be very dramatic. Or not. It in fact can be a very different experience from person to person.
Menopause is, by definition, the cessation of a woman’s normal monthly menstrual period. The average age of menopause is 50. However, sometimes the “perimenopausal” years can run for many years before or after this magic age. Thus, we see women from ages 40-60 dealing with some aspects of menopausal issues.
The hallmark of this natural process is the loss of the body’s production of estrogen and progesterone. Once vital to a woman’s fertility and monthly hormonal cycle, their production drops off significiantly as the ovaries start to peter out. This leads not only to less of these circulating hormones, but also to less testosterone which the body had previously converted from estrogen (women of course tend to have far lower testosterone levels than men at all times). The good news is monthly bleeding comes to a halt (of course this is often after several months to years of erratic, sometimes heavier and unpredictable periods).
The effects of losing these hormones (namely estrogen) can be profound. Hot flashes happen for many. They can range from occasional and mild to severe, frequent and debilitating. They tend to occur more commonly at night. We hear stories of women who were cold all their lives suddenly shedding the covers at night and wrestling with their spouses to turn down the thermostat. Other than the obvious benefit of saving on your heating bill, hot flashes can be highly disruptive and a source of great distress for many women.
The effects of these flushing sensations are sometimes even more wide reaching than meets the eye. They can happen at night on a more minor level, where you are not even consciously aware that they are happening. The result can be severely disrupted sleep (again this may not be obvious when it is happening) and profound fatigue or irritability the next day. Hot flashes (whether you are aware of them or not) are often the cause for some of the common complaints associated with menopause: feeling tired, moody and irritable, weight gain. The weight gain can be multifactorial but disrupted sleep does influence weight by disrupting some hormones that are key to weight and metabolism.
What to do? Menopause is a complicated issue that can affect different women in different ways. So as with most issues, there is no one size fits all answer. Until the late 90s it was common practice to give women Hormone Replacement Therapy once they came close to menopause. Makes sense. Replace whats missing and you can just pretend “the change” never happened. While this is so when it comes to hot flashes ( they tend to improve), there are some downsides to hormone replacement which prohibit it serving as an ideal solution for every woman.
Hormone replacement typically consists of replacing estrogen and progesterone at low doses. The estrogen is what is most helpful in reducing menopausal symptoms, but in women who have uterus (i.e. those who have not had a hysterectomy) it is important that they receive progesterone with the estrogen to prevent cancer of the lining of the uterus which comes from estrogen by itself (called “unopposed estrogen” since the progesterone controls the growth of the lining of the uterus that estrogen causes).
Estrogen and progesterone together or combined therapy have some pros and some cons. Hot flash and symptom relief are a big plus. Other benefits include improvement in bone density, improved vaginal health (less dryness and atrophy of tissues) which can help with some aspects of urinary incontinence as well.
As with any medication, there are always potential side effects. Even this replacement of hormones the body naturally produces, when given therapeutically turns out not to be the fountain of youth upon which many had hung their hopes. The Women’s Health Initiative, a large series of studies examining these very issues (i.e. does Hormone Replacement in menopause hurt or help and in which ways?) came up with some conclusions re downside. The group of women taking the estrogen and progesterone combo did end up with higher rates of heart attacks, strokes, blood clots and breast and colon cancer. The estrogen only group (no progesterone used because of no uterus) had increased risk of stroke and blood clot but no change in risk of heart disease, or colon cancer. The effect of estrogen only on breast cancer is yet unclear, with some data suggesting a slight protective effect as combined to the harmful effect of combined therapy.
So what is the take away? This data suggests that hormone replacement should certainly not be used across the board in all menopausal women. And while it is useful in treating bone density and hot flashes the increased risk of cardiovascular and malignancies suggest very judicious use. It is our practice to recommend HRT only to women who have intolerable menopausal symptoms which are not amenable to other therapies (more on what those might be later). They should use the lowest dose possible and for the least amount of time possible. The use of topical estrogens for vaginal dryness is of less concern since they are considered to act locally and not be systemically absorbed.
A very popular practice since the mid 2000s has been the use of “Bioidentical Hormones”. This refers to the practice of compounding hormones in varying doses on an individual basis, either in the form of pills, patchs or gels. Often it includes the use of estrogen, progesterone, testosterone and DHEA in varying amounts.
In theory we love the idea that we are not all the same and each have different individual needs. This has in fact been one of our founding missions at Vous Vitamin®, to address peoples individual needs in regards to vitamins. Thus we are certainly fans of the idea. However, we do not believe the science currently supports these methods of hormone replacement.
There are no significant studies that show any benefit to these over traditional hormones and especially given the varied methods, absorption and general lack of standardization in these practices it is very hard to safely recommend them. The use of Testosterone and DHEA are actually not FDA approved for use in women at all. Also, there is no standardization to the methods by which individuals are measured and applied to therapy. In fact, studies have shown that there is little correlation between hormone levels and actual menopausal symptoms. Using these levels to target therapies then does not make logical sense. Therefore we advise extreme caution in the use of “bioidenticals”. We understand that many women , including a number of celebrities swear by the wonderful effects on their hot flashes, sex drive and more. However, we believe many of these issues can be remedied with more proven, potentially safer means, both prescription and not.
So what to do about menopausal symptoms? There are both some prescription and natural remedies with decent evidence in their favor. Also, recognize that the natural course of menopausal symptoms is to resolve on their own in the vast majority of people. Most women’s symptoms have abated within 2-5 years of onset. However, a small percentage, less than 10% will continue to have hot flashes 10 years into menopause and beyond.
If the symptoms are troublesome some prescription options (other than hormones) can be considered, namely a variety of antidepressants. The key here is to recognize that they can be used in menopause beyond their use for depression. Some of the SSRIS and SNRIs (common classes of antianxiety/antidepressants) are very helpful in reducing hot flashes. We prefer the SNRIs as they tend to have fewer side effects (weight gain and loss of libido are more common with the SSRIs). Venlafaxine and the other drugs in this class can be helpful in reducing hot flashes and in addition, some of the mood symptoms often associated with menopause.
Some herbal remedies are also commonly used for hot flashes. Perhaps the most popular is Black Cohosh. This root from a plant native to North America, is touted as a natural reducer of hot flashes and vaginal dryness. While studies are mixed as to whether or not this is helpful, we have found that in practice it is hit or miss. That is, some women find it very helpful in reducing symptoms while others do not. As for downside, it is generally considered safe. However, rare reports of liver problems have been reported. It is our belief that finding a pure reputable brand is essential as with all herbal and supplement products. Some authorities also caution using Black Cohosh if you have history of breast cancer due to concerns that it may stimulate estrogen receptors. Data on this is lacking but we do advise finding another solution in women with a history of breast cancer.
Among other vitamins for menopause Vitamin E has been suggested to play a role in reducing hot flashes. Some studies have combined it with black cohosh to show some modest relief, even at lower doses. It is our belief that low doses of Vitamin E (under 100 IUs) are generally safe and possibly useful. Higher doses can increase risk of bleeding and have not been shown to be more effective.
Soy products or phytoestrogens have been shown to reduce some symptoms of menopause. Since many can be found in natural food sources (soy products abound) we suggest obtaining soy in moderation through these products (not to exceed two servings daily) and avoid supplementation. Because soy and the phytoestrogens can have an effect on estrogen receptors, caution should be used especially among those with a breast cancer history.
Both primrose oil and flaxseed have been suggested for hot flashes. Little evidence supports their use . We believe you can do better with some of the other treatments mentioned.
Last but certainly not least talked about is DHEA. Many tout this supplement for it’s role in stopping aging or improving sex drive. If you think it sounds to good to be true, you are probably right.
DHEA is a hormone made by the body in the adrenal gland, a small gland that rests on top of the kidney. DHEA is hormone building block used by your body to make other sex hormones like testosterone and estrogen. DHEA gradually declines with age after reaching a peak in your 20s. While DHEA supplementation has been shown to improve bone density, its effect on hot flashes and other libido issues has not been proven. What does seem likely is an association between high DHEA levels and breast cancer. Therefore we do not find it’s use warranted. Too bad, so sad. DHEA is not the fountain of youth. It sounds way better than it actually performs.
Menopause is a natural phase of life, but nonetheless it is a disruption of a woman’s previous hormonal balance that can cause many negative symptoms. However, most women can weather the storm and find a new and pleasant normal once hot flashes subside. There are many prescription and vitamin or supplement options for helping ease through this period of flux. Hormone replacement is a complicated consideration and each woman’s risks and benefits should be assessed individually. Vitamins for menopause can be of great help. Each woman’s individual vitamin needs should be assessed based on her diet, lifestyle and health history (take our brief survey to get a Personalized Multivitamin). While menopause is a universal process, each woman’s experience with it is unique and should be treated that way.
Romy Block specializes in Endocrinology and Metabolism and is mother to three active adolescent boys. Arielle Levitan is a Doctor of Internal Medicine with a special interest in Preventive Medicine and Women’s Health. She is a mother of three teen agers. As professional women with active family lives, they recognize that people often neglect their own health needs and are uncertain about what vitamins to take. Each person is different in her diet, exercise and health history, and will benefit from different nutrients. After years of advising their patients about the proper vitamins to take, Drs. Block and Levitan created Vous Vitamin® to provide people everywhere with quality vitamins that are suited to their individual needs. They are authors of the award winning The Vitamin Solution: Two Doctors Clear Confusion About Vitamins and Your Health (She Writes Press, 2015). Take your vitamin survey now to get exactly the right vitamins for your needs.
The statements made in this article have not been evaluated by the Food and Drug Administration. The products offered by Vous Vitamin® are not intended to diagnose, treat, cure, or prevent any disease.
Nothing contained herein is intended to be a diagnosis or constitute medical advice. The symptoms described in this Blog may be a result of a serious medical condition which requires medical treatment. You should consult with your doctor if you are experiencing any of the symptoms mentioned in this Blog and before beginning any vitamin or supplement regimen.