About Menopause

A woman is said to have completed natural menopause when she has not had a period for 12 consecutive months. For American women, this typically happens at around age 51 or 52. Menopause occurs immediately if the uterus or both ovaries are surgically removed, or if the ovaries are damaged in cancer treatment with radiation therapy or certain drugs.

Common Symptoms During the Menopausal Transition

Some symptoms that women experience are related to menopause and decreased activity of the ovaries. Others may be related to aging in general.

Scientific evidence of a link to menopause is strongest for the following symptoms:

• Hot flashes and night sweats (also called vasomotor symptoms, because they involve the expansion of the blood vessels)
• Sleep difficulties
• Vaginal dryness, which can lead to painful intercourse and other sexual problems.

It is not certain whether the following symptoms are due to menopause, other factors that can come with aging, or a combination of menopause and these factors:

• Problems in thinking or in remembering things
• Urinary incontinence
• Physical complaints, such as tiredness and stiff or painful joints
• Changes in mood, such as depression, anxiety, and/or irritability.

The expert panel assembled for the NIH State-of-the-Science conference noted that menopause is a normal part of women's aging and advised that menopause should not be "medicalized" (or viewed as a disease).

Hormone Replacement for Menopausal Symptoms

For decades, hormone replacement therapy (HRT)—more recently known as menopausal hormone therapy (MHT)—was conventional medicine's main treatment for menopausal symptoms. In 2002, findings from a large study called the Women's Health Initiative raised serious concerns about the long-term safety of MHT. These concerns are one reason that many women are turning to alternative medicine (CAM)¹ therapies.

What the Science Says About CAM Therapies for Menopausal Symptoms

The NIH State-of-the-Science conference panel discussed the evidence on several CAM therapies:

• Six botanicals—black cohosh, dong quai root, ginseng, kava, red clover, and soy
• DHEA (dehydroepiandrosterone), a dietary supplement.

Very little well-designed research has been done on CAM therapies for menopausal symptoms. A small number of studies have been published, but they have had limitations (such as the way the research was done or treatment periods that may not have been long enough). As a result, the findings from these studies are not strong enough for scientists to draw any conclusions. Also, many studies of botanicals have not used a standardized product (i.e., one that is chemically consistent). The National Center for Complementary and Alternative Medicine (NCCAM) is sponsoring a number of studies on botanicals using products that are both well characterized (i.e., their ingredients have been carefully studied) and well standardized and on other CAM therapies that have shown possible promise for reducing menopausal symptoms.

² DHEA is a naturally occurring substance that is changed in the body to the hormones estrogen and testosterone. It is also manufactured and sold as a dietary supplement. A few small studies have suggested that DHEA might possibly have some benefit for hot flashes and decreased sexual arousal, although small randomized controlled trials have shown no benefit. Because levels of natural DHEA in the body decline with age, some people believe that taking a DHEA supplement can help treat or prevent conditions related to aging; however, there is no good scientific evidence to support this notion.

Concerns have been raised about whether DHEA is safe and effective. Its long-term effects, risks, and benefits have not been well studied, and scientists are not certain whether it might increase the risk for breast or prostate cancer. Before using DHEA for any purpose, people should talk to their health care provider about potential benefits and risks.

• More About CAM Therapies
  
• Menopausal Symptoms and CAM Publication (pdf)