There are two major, feminine concerns that face adult women through their lifetime. The first is problems that occur around the menstrual cycle, which when severe are termed Premenstrual Syndrome or PMS. The second is the cessation of menstruation in the mature female or menopause. A major milestone in a mature female’s life is menopause when periods cease.
For the past 50 year or more, hormone replacement therapy has been used to manage unpleasant symptoms that commonly occur around the menopause. This hormone replacement therapy has been in the form of estrogen medications or estrogen medications combined with synthetic preparations of progesterone, which are called progestins. Unfortunately, the disadvantages and limitations of hormone replacement therapy (HRT) have become apparent in recent research, where it is now known that HRT can be potentially dangerous.
In general terms, modern scientific literature shows that the use of hormone replacement therapy by conventional means may have many more risks than benefits for the woman who is going through the transition of menopause or perimenopause. While the menopause can precipitate unpleasant symptoms such as hot flashes, lack of psychological well being and urinary problems, the real significance for the post-menopausal years is the onslaught of age-related disease, such as breast cancer, cardiovascular disease, thin bones (osteoporosis) and age-related declines in brain function.
There is no doubt that major hormonal changes occur around the menopause, but the idea that menopause is merely a deficiency of the female hormone estrogen is a misleading, naïve concept. This concept has been accepted, perhaps inappropriately, by many women. The recent scientific information on the safety and effectiveness of certain kinds of conventional hormone replacement therapy is “spine-chilling.” It appears that certain combinations of conventional hormone replacement therapy may actually cause breast cancer.
While this type of conventional therapy may help reduce symptoms in the menopause, it does not fulfill its promise of protecting mature females against heart disease or mental decline with age. In fact, some studies show that quality of life is not enhanced by taking conventional hormone replacement therapy. For these reasons, many mature women are seeking natural and viable alternatives to hormone replacement therapy, at least in the context of attempts to control unpleasant symptoms around the menopause, by simple and gentle means.
In my book entitled “The Menoplan”, I point out that there are many ways whereby problems in the menopause can be managed using natural pathways. I have pointed to the importance of positive lifestyle and the use of natural substances for improving a mature woman’s experience during the menopause. My book, “The Menoplan,” points out several mechanisms for achieving comfort and health in the menopause, without resorting to potentially dangerous hormone replacement therapy by using estrogen replacement therapy (ERT) alone or hormone therapy using a combination of estrogens with progestins.
Many natural substances have been proposed for the relief of symptoms around the menopause or for the nutritional support of PMS. In recent medical literature, scholarly physicians have examined the evidence behind the use of many dietary supplements for the management problems surrounding the menopause or altered menstrual function. A conservative body of medical opinion continues to argue that the use of many herbs, botanicals and nutrients for menopause symptom relief or health may not have been demonstrated adequately in scientific studies. However, the science of nutritional support for menopause and PMS using dietary supplements is emerging with much strength and there are many evidence-based studies now showing variable benefits of a number of natural agents in the management of menopause.
These natural substances for menopause or PMS have a long precedent of safety of use in many cases and they do not present the potential risks that conventional hormone replacement therapy with estrogen or progestins or a combination thereof. There are hundreds of thousands of women who have achieved help with their menopausal transition with natural substances including soy isoflavones, black cohosh, chasteberry, L-theanine, red clover extracts and selected vitamins, especially those that function as anti-stress support. I have written extensively about the benefits of soy inclusion in the diet in the menopausal female in my two books “The Soy Revolution” (Dell Publishing, Random House 2000) and “Soya for Health” (Mary Ann Liebert Publishers Inc., 1994).
Given the awful news about conventional hormone replacement therapy and its side effects, anything that can reduce the need for drug medications or contribute to the simple and gentle management of the menopause or PMS must be perceived as valuable. Dietary supplements are best applied with positive lifestyle changes, but several scientists have indicated that some natural substances do present viable alternatives to hormone replacement therapy and they may improve troublesome symptoms in the menopausal such as hot flashes. Again, I add the word of caution that our legal system does not permit the sale of dietary supplements with disease prevention or treatment claims. That said, many physicians, including a growing number of conventional gynecologists, are using dietary supplements in patients with the intent of disease prevention and/or treatment; and most specifically they are using them in the management of the menopause. I stress that menopause or PMS may not be a distinct disease and, in fact, I must emphasis that menopause cannot be considered a disease per se.
In my approaches in the natural pathways to healthy menopause and menstrual function, I have proposed several natural agents which I believe have good scientific agreement to support their use as valuable nutritional support for these common experiences among adult women. Considering the management of the menopause transition, most scientific support lies with the use of soy isoflavones and black cohosh which form major ingredients and constituents of the product Menoplan™. There is good scientific agreement that red clover contains isoflavones, similar to those found in soy, may help with hot flashes and other symptoms in the menopause that may compromise well being. Red clover is found in Menoplan™.
Promising information exists on the benefits of certain vitamins and the use of evening primrose oil and/or dong quai for menopause and PMS. Though much of the support for the use these natural substances is anecdotal, in comparison to the studies with soy, red clover and black cohosh, I believe these constituents to be valuable in PMS and menopause as nutritional support.
I have stressed consistently that it is incorrect to see any dietary supplement as a “magic bullet” for menopause, PMS or any other condition or diseases. Certainly, dietary supplements must not be used as a substitute for a healthy diet. In several of my writings, I have focused on the major public health initiative presented by Syndrome X, sometimes called the Metabolic Syndrome. Syndrome X is the combination of being overweight, having high blood cholesterol and/or high blood pressure, all linked by the underlining insulin resistance. This entity of Syndrome X has emerged as an important issue now that it may cause irregular menstruation and polycystic ovary syndrome, especially in young females.
In my book “Combat Syndrome X, Y and Z”, I present a concept that Syndrome X has far-reaching health implications beyond its obvious role in the causation of cardiovascular disease. I have indicated that menopause may “load the gun” in terms of health problems for some women and I fear that Syndrome X may “pull the trigger” in many females.
The natural way to a healthy menopause involves the change of adverse to positive lifestyles together with the appropriate use of simple, gentle, natural substances. For this approach I recommend dietary supplements and if such things are not effective then women may consider the options of hormone replacement therapy. These issues are best discussed in a doctor-patient relationship because there is no doubt that some women will benefit primarily from hormone replacement therapy in a conventional manner, but it is apparent that such benefits are often outweighed by the documented risks of this form of conventional medical management.
Deciding to take hormone replacement therapy with drugs is one of the most important decisions in a woman’s lifetime, especially in relationship to menopause and sometimes in relationship to PMS. There is growing evidence that natural substances can provide benefits for the nutritional support of the menopause and many doctors consider these dietary supplements to be quite valuable in these circumstances.
Menoplan™ is an evidence-based dietary supplement that was designed to provide nutritional support for the perimenopause and menopause and it may have value as nutritional support for PMS. Menoplan™ contains those natural substances that have been associated with benefits in menopausal women in the scientific literature; and it has a unique proprietary formulation that is generally more complete and not found in any other dietary supplement product.
The ingredients of Menoplan include black cohosh in its well-documented and research standardized extract form of 2%, together with soy isoflavones providing the “power of soy.” Contained within Menoplan™ is an extract of green tea called L-theanine, which assists with the normal body function of a relaxation response. Added to the formula are evening primrose oil, which provides nutritional support for reproductive organ function and breast health, dong quai, a traditional female specific herb, and chasteberry for which there is a long precedent and history of use for female health. Finally, Menoplan contains the benefits of ginkgo biloba, which support central nervous system functions and blood flow to the brain. In comparison with other popular menopause supplements such as Estroven® and Remifemin®, Menoplan™ has a more versatile formula. Constituents of Menoplan™ have antioxidant function which can assist in nutritional support for anti-aging. Overall, Menoplan™ with recommendations for lifestyle change presents a useful first line option for individuals experiencing uncomplicated transitions in the menopause and problems surrounding menstrual cycles.
By Stephen Holt, MD, MRCP (UK), FRCP (C), FACP, FACG, FACN, FACAM