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Clinical Hub,Patient Education,Health and Nutrition Facts For You,OB, GYN, Womens Health, Infertility

Menopausal Health - A Nonhormonal Approach (5351)

Menopausal Health - A Nonhormonal Approach (5351) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, OB, GYN, Womens Health, Infertility

5351










Menopausal Health
A Nonhormonal Approach



1
Table of Contents


What is Menopause? ....................................................................................................................... 2

What You Should Know About Medical Alternatives ................................................................... 3

Taking Care of Menopausal Symptoms .......................................................................................... 4
Menstrual Changes .............................................................................................................. 4
Hot Flashes or Night Sweats ............................................................................................... 4
Sleeplessness ....................................................................................................................... 7
Fatigue and Depression ....................................................................................................... 8
Vaginal Changes ............................................................................................................... 10
Bladder Changes ............................................................................................................... 11
Bladder Infections ............................................................................................................. 12
Yeast Infections ................................................................................................................. 12

Summary ....................................................................................................................................... 13

Internet Sites ................................................................................................................................. 13


2

What is Menopause?

Menopause refers to the end of menstrual periods. The average age at which this occurs is 51.
Your genes and family history often play a role in the age you reach menopause. Other factors
are listed below
ξ Smoking.
ξ Prior removal of the ovaries.
ξ Treatments such as chemotherapy (chemo) and radiation.

Symptoms

Symptoms of menopause can vary with each woman. They may occur slowly over time while
hormone levels change. For some women the onset of symptoms can be sudden and severe.
Lifestyle, coping methods, and stress may also play a role in how you can manage these
symptoms. The symptoms are listed below.

ξ Hot flashes
ξ Night sweats
ξ Irregular menstrual bleeding
ξ Muscle aches and pains
ξ Sleeplessness
ξ Mood swings

Other common symptoms
ξ Vaginal dryness and itching
ξ Pain with intercourse
ξ Loss of urine with coughing, sneezing, or laughing
ξ Frequent vaginal and urinary tract infections

You may prefer to try to manage your symptoms and promote health through diet and lifestyle
changes. Or, you may choose the use of alternative medicine. If your symptoms are a problem
for you, talk to your health care team. They will help you decide if hormone therapy is an option
for you.

In this booklet, we will discuss lifestyle changes you can make to promote long-term health. We
will also suggest things you can do to relieve symptoms.






3
What You Should Know About Medical Alternatives

Alternative therapy can be used to relieve symptoms. Some of these are listed below.
ξ Megavitamins
ξ Massage therapy
ξ Acupuncture
ξ Biofeedback and relaxation techniques
ξ Healing touch
ξ Herbal medicine.

The value of these is not yet known. Using large amounts of herbal products or using them
together may be harmful.

How herbal products work in the body is not known. These products are not produced to comply
with a standard. We do not know how herbs may work with or against each other or other
medicines.

Women using herbal products should be under the care of their health care team and should be
aware of the guidelines listed below.

ξ Do not take while pregnant or breast feeding.
ξ Do not take a large quantity of any one herbal product.
ξ Buy only products when the plants and their amounts are listed on the packet (not a
guarantee of safety).
ξ Use the advice and knowledge of qualified herbalists or your health care team when
choosing these products.
ξ Be sure to inform your health care team if you are using both prescription and herbal
products.









4

Taking Care of Menopausal Symptoms

Menstrual Changes

You may have noticed a change in your normal menses over the past few months or years. Very
few women have an abrupt end of menses without symptoms. Your menses may be light, or
heavy, or occur more often. You may miss a cycle for a few months and then start your menses
again. If you have received chemotherapy, you may have stopped having a menses or your
menses occur unevenly. The younger the age you receive chemotherapy, the more severe the
symptoms or menstrual changes.

Hot Flashes or Night Sweats

The hot flash or night sweat is a sudden onset of warmth in the face or neck. You may notice a
short period of rapid heart rate. Your skin may appear flushed and you may begin to perspire.
You may feel dizzy or have headaches. Causes of hot flashes are listed.
ξ Stress
ξ Anxiety
ξ Spicy foods
ξ Hot drinks
ξ Alcohol
ξ Caffeine
ξ Warm environment
ξ Synthetic clothing

Tips to reduce hot flashes are listed.
ξ Exercise regularly (daily if possible) 30 - 40 minutes to help reduce stress.
ξ Try daily relaxation and meditation.
ξ Avoid alcohol, caffeine, and spicy foods.
ξ Use only cotton clothing or clothing that “breathes” and wear in layers.
ξ Avoid a warm environment.

Vitamins

ξ Vitamin E - 400 - 800 IU a day. It may take 6-8 weeks for relief.

Good food sources: wheat germ oil, corn oil, soybean oil, soybeans, sunflower seeds,
sweet potatoes, asparagus, peanuts, almonds. Vitamin C will help how much vitamin. E
you absorb. If symptoms are not relieved add:

ξ Vitamin B6 - 200 mg daily - can be taken along with Vitamin E. It may take 6-8 weeks
before you notice any changes.

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Prescription medicines

Clonidine – Use a 0.1 mg patch and change it once a week. It must be prescribed by your
doctor.
Side effects are dry mouth, constipation, drowsiness, hypotension, or severe rebound
hypertension.
Bellergal -S® – It must be prescribed by your doctor. Take 1 tablet at bedtime. This is for
short term use only.
Paxil® – It must be prescribed by your doctor. Take 10mg. It is a SSRI (Selective Serotonin
Reuptake InhibiIttor) antidepressant.
Zoloft® – It must be prescribed by your doctor. Take 25 – 50mg. It is a SSRI antidepressant.
Effexor® – It must be prescribed by your doctor. Take 37.5 mg or cut the tablet in half. It is
an antidepressant.

Herbs

Ginseng
Uses: To reduce vaginal dryness and hot flashes and may increase energy and improve
concentration.
Dosage: Take two 100mg capsules with 4% active ingredient; or one cup of tea made by
steeping one teaspoon of dried herb 10-15minutes.
Side effects are increased blood pressure, headache, vomiting, insomnia, nose bleed,
endometrial growth and bleeding. If you notice unusual bleeding, see your health care team.
Avoid ginseng if you are taking aspirin, ibuprofen, or drugs to prevent blood clotting such as
warfarin.
Warning: Do not use ginseng if you have been told not to use estrogen or are taking an
antidepressant.

Black Cohosh
Dosage: Take 40mg a day. It may take 3 - 4 weeks before a response is seen, but do not use
it longer than 6 months at any time. Allow 2-3 weeks between uses. The best brand has
been found to be Remifemin®.
Warning: Do not use Black Cohosh if you have been told not to use estrogen, have high
blood pressure, or have heart problems.

Chasteberry
Uses: It may help reduce hot flashes, night sweats, headaches, heart palpitations, and vaginal
drying and thinning, or treat PMS.
Dosage – Take 20mg a day
Side effects are that it may reduce sex drive or cause a rash.





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Oil of evening primrose
Uses: It may help to relieve hot flashes.
Dosage: Take 80 – 100mg a day. Take one 40mg tablet twice per day.

Phytoestrogens, (isoflavones)
Uses: These are substances found in plants – such as legumes. They have a structure close to
estrogen. It may help to relieve hot flashes.
Dosage: Take 30 – 50mg a day not to exceed 100mg. Include foods in your diet that add
isoflavones at least 3 times a week to help reduce symptoms.
Warning: Do not use Phytoestrogens in excess of normal dietary intake if you have been told
not to use estrogen products.

Food sources are soybeans and soy-based foods. Isoflavones may not be found in soy products that
are processed such as soy burger, soy hot dogs, soy sauce, etc.


Food

Serving

Isoflavones (mg)

Calories

Fat (g)

low fat tofu

½ cup

35

45-75

1.5-2.5

tempeh

½ cup

35

165

6

soy milk (regular)

1 cup

30

130-150

4

soy mild (low-fat)

1 cup

20

90-120

2

roasted soy nuts

¼ cup

60

195

9.5

roasted soy butter

2 tbsp.

17

170

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Other foods that contain isoflavones are Mexican yams, alfalfa, garlic, celery, sprouted green
peas, black and green beans, cashews, peanuts, almonds, flax seeds, and whole grains such as
wheat, oats, corn, brown rice, and citrus fruits. One cup of soybeans = 300mg isoflavones.

There are many new products on the market that contain isoflavones in tablet form. These
include Promensil® and Estroven® to name two. They are best used by the body when taken
along with at least 20mg of soy protein, i.e. soy milk. There is some concern that taking them in
a concentrated form may have adverse affects on tissues in the body. If you wish to increase your
soy intake, you should try to use foods that contain soy such as those listed in the above table.

Acupuncture may reduce or eliminate hot flashes, muscle aches and joint pain.

Massage & Relaxation Therapy may reduce hot flashes

7

Sleeplessness

Exercise

Exercise may help you to sleep better if done daily for 20 – 40 minutes. The exercise you do
needs to be aerobic such as those listed below.
ξ brisk walking
ξ hiking
ξ jogging
ξ aerobic dance
ξ biking
ξ swimming
ξ racket sports
ξ cross-country skiing.

As a basic rule, you should take a brisk walk of 2-3 miles, 3-4x a week. Your goal should
be to walk about one mile in 15 minutes. Avoid exercise within two hours before
bedtime.

Nutrients

Calcium
Uses: This can provide a calming effect.
Dosage: Use 1500mg daily, split into at least two doses, after meals and at bedtime.

Melatonin
Uses: It controls the sleep-wake schedule (jet lag). It may help shorten the time it takes to
fall asleep.
Side effects are decreased fertility, hypothermia, and eye damage. High doses may cause
excess sleepiness, confusion, and headache the next morning. Long term effects are
unknown. Use as directed.

Vitamin B Complex
Uses: It helps promote a restful state.
Dosage: Take as directed on label.

Herbs

Valerian root (Passion flower)
Uses: It is known to have a calming effect. It may ease tension and reduce irritability.
Doses: Use capsules (1-1.5% valtrate or 0.8% valeric acid); 450 – 900mg a daily at bedtime.
Long term effects are unknown.
Side effects are headache, uneasiness, insomnia, and heart palpitations


8
Kava Kava
Uses: It may reduce anxiety, insomnia, and pain.
Dosage: Take 50 - 240mg a day.
Drug interactions: Kava interacts with alcohol and psychoactive medicines. Also, it may
cause slowed motor reflexes and skin disorders.

Hops
Uses: It is a sleep aid.
Dosage: Take as directed.
Side effects have not been reported.

Chamomile or Catnip
Uses: It has a calming effect and can be used as a sleeping aid.
Dosage: It can be purchased as a tea.
Side effects are abdominal cramps, tongue thickness, swelling of lips, hives, blockage of
airway, mild allergic reaction in those persons allergic to ragweed.

Other Recommendations

Take time to relax before bedtime. Drink a cup of warm milk, listen to soft music or read a
book. Do activities that help calm your body and allow it to get ready for rest. Avoid
caffeine, alcohol, chocolate, tobacco, or other stimulants before bedtime.

Create a set of habits and follow them on a routine basis.
ξ Go to bed only when you are sleepy.
ξ Do not stay in bed if you are not sleepy. Get up and move to another room and read,
watch TV, or some other quiet activity.
ξ Use the bedroom only for sleeping and sex. Don’t work, eat, or watch TV in the
bedroom.
ξ Keep the bedroom comfortable and quiet.
ξ Do not nap during the day if this is not a normal thing that you do.
ξ Take a hot bath (not a shower) an hour or two before bedtime.

Fatigue and Depression

Fatigue and depression are frequent symptoms. A lack of REM (rapid eye movement) sleep will
often cause fatigue. This may lead to increased irritability, tension, trouble with coping in daily
routines, and the “blues”.

Exercise

Exercise will help to form better sleep habits. It will also raise serotonin and dopamine levels
to help treat mild depression. See above.


9
DHEA
Uses: It improves mood, energy, and sex drive, lowers the effects of stress hormones, boosts
fat loss, preserves muscle mass and strengthens the immune system.
Dosage: Take 5 – 50mg a day.
Side effects are acne, hair growth, low energy, irritability, trouble sleeping, headache,
menstrual irregularity, increased eye pressure, adverse lipid changes, and rapid heart rate.

Testosterone
Uses: It maintains muscle mass, lowers total cholesterol, and boosts energy and sex drive.
Side effects are that, in high doses, it may cause harmful cholesterol levels, psychological
problems, infertility, and acne. It may cause an increased risk for stroke. It must be
prescribed by your doctor.

Herbs

Ginseng
Uses: It boosts energy and relieves slight depression. It promotes feelings of well being.
Dosage: Take two 100mg capsules daily that contain a 4% active ingredient. It may be
purchased in capsules, drops, teabags, or dried herbs. A tea may be made using one teaspoon
of dried herb and steeped for 10-15 minutes once per day. The type of ginseng most studied
is Panax Ginseng.
Warning: If you have been told not to use estrogen, you should not use this herb.

Chasteberry
Uses: It may reduce symptoms of PMS and depression.
Dosage: Use it in capsule form once a day or steep a pinch of powder 10-15 minutes to
make one cup of tea.

St John’s Wort
Uses: It may ease slight or moderate depression, anxiety or nervous excitement.
Dosage: Take 2 – 4g. per day.
Side effects are that it may cause stomach upset and sensitivity to light in high doses. Do not
use with other antidepressants. It may act as an MAO inhibitor, so avoid foods high in
tyramine or tryptophan.

Ginkgo biloba
Uses: It may help with resistant depression, mild memory loss, dizziness.
Dosage: Take 120 – 160mg a day split into a few doses. It may take 4-6 weeks before you
notice effects.
Side effects are mild GI upset (1% of cases), or headache.
Do not take with aspirin, ibuprofen, or drugs to prevent blood clotting or seizures. It may
affect clotting factors. The dose may need to be altered if you use insulin.


10


Vaginal Changes

Changes occur in the vagina. The size becomes narrow and shorter. You may notice a loss of
lubrication. The lining becomes thinner, drier, and more fragile. A decrease in secretions may
cause itching and pain. Sexual activity may cause pain. Adding lubrication can help. You could
notice some bleeding after sex. The outer area is also more sensitive to contact.

The pH of the vagina changes. This can upset the normal bacterial balance. You may have
fewer problems with yeast but more bacterial infections. Treatments for yeast will not help these
types of infections. See your health care team if you have drainage, odor, burning, and itching.

Tips to help relieve vaginal symptoms are listed below.

Hygiene

Wash the vaginal area with mild soap and water. Avoid douches, perfumed oils, soaps, and
sanitary pads and tampons which cause irritation. Ointments such as Bag Balm® may help
relieve external irritation.

Moisturizers

Gels and creams may be used two or three times a week at night to restore moisture to the
lining. They are longer lasting than lubricants. It may take two months or more before you
notice an effect. Common brands are Replens® and Gynemoistrin®.

Lubricants

You may choose creams, gels, liquids, or suppositories. Using a good amount of these
products should help reduce pain from dryness. Frequent sex can often be helpful to
maintain vaginal health. Common brands of lubricants are K-Y® jelly, Surgilube®,
Astroglide®, Vagisil®, and Liquid Silk®.

Vitamin E

Vitamin E capsules may be broken and the contents smeared onto the vaginal lining and outer
area for added moisture.

Phytoestrogens

These may also help to relieve vaginal changes. (See above)

11

Bladder Changes

With age, bladder problems may occur due to lower hormone levels. The muscles of the pelvic
floor can become relaxed. If you have had a child or have gained weight, this could also add to
your risk for bladder problems. Leakage of urine is a common complaint. You may notice that
you leak urine when you cough, sneeze, laugh, lift heavy objects, or exercise.

You may notice the feeling that you need to “go now” and may not be able to make it to the
bathroom. You may also notice the need to pass urine more often. These symptoms along with
pain can be signs of a bladder infection.

If you are having symptoms, talk to your health care team.

Tips to reduce bladder problems are listed below.

Hygiene

Keep the genital area clean and dry. Wash with mild soap and water. Empty your bladder
and wash after intercourse. Always wipe from front to back after using the toilet. Wear
cotton underwear. Avoid perfumed products which may irritate the genital area.

Drink liquids

Drinking plenty of liquids flushes your bladder and dilutes your urine. Try to drink most of
your daily liquids before supper to avoid nightly trips to the bathroom. Avoid drinking large
amounts of caffeine and diet sodas.

Schedule

Schedule your bathroom breaks. If urgency is a problem, plan to go every hour and slowly
increase the time to two hours, then three hours. Empty your bladder before exercising.

Kegel exercises

Use to strengthen the muscles of the pelvic floor. Working these muscles may help prevent
incontinence and improve sexual function.

The muscle is easy to locate when you void. Just squeeze it to stop urine flow and release it
to restart. Pull up and inwards. You may do these at any time of the day. Once you have
located the muscle, do not perform this exercise while voiding. Below are other techniques
to strengthen this muscle.

1. Contract the muscle for 3 seconds, then release for 3 seconds. Repeat six times, three times a
day.

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2. Butterfly flutter – contract strongly for 1 second. Release for 1 second, repeating quickly 20
times.

3. Extended contraction – contract for 10 seconds. Release. Then repeat. Do five repetitions
three times a day.

Bladder Infections

Cranberry
Uses: It may prevent bladder infections.
Dosage: For prevention, drink 3 ounces of cranberry juice cocktail daily.
As a treatment, drink 12 to 32 ounces a day.
If you use capsules of dried powder, take 1- 6 capsules which is equal to 3 ounces of juice.
Side effects are that large amounts of juice (more than 3 – 4 liters a day) often results in diarrhea
and other GI symptoms.

Echinacea (use these forms: E. angustifolia, and Echinacea purpurea)
Uses: It may be helpful to prevent or treat infections that recur.
Dosage: Use the dried root 1 – 2gm three times a day.
Use the freeze-dried plant 325 – 650mg three times a day.
Use the tincture form (1:5) 3 – 4ml three times a day
Use the fluid extract (1:1) 1 – 2ml three times a day
Use for 8 weeks and then stop for at least 2 weeks before you restart.

Yeast Infections

Florajen Acidophilus
Uses: It prevents yeast infections.
Dosage: Take 1 capsule daily on an empty stomach with water, juice, or milk. Take a Florajen
capsule 1 – 2 hrs after taking an antibiotic. One capsule = 6 cups of fresh yogurt. Keep
refrigerated at all times. If you travel it is ok to leave at room temperature for two weeks. You
may also insert capsules into the vagina.

Sexuality

Sexuality includes all of the feelings we have about ourselves. It includes those feelings about
ourselves as sexual beings and the way we express those feelings to others. It is the expression
of the whole person emotionally, mentally, and physically. Midlife does not have to mean a
decline in sexuality. It may improve as you become more comfortable with yourself, have fewer
things to distract you, and a loving partner. The mind plays the most involved role in sexuality.
Much of your sexual response is related to your thought process. If you remain interested in sex,
this process will not create a sudden end to your sex appeal.

13

Tips to reduce issues related to sexuality are listed below.
ξ Have open communication between partners about sexual feelings.
ξ Take a hot bath or shower before sex for muscle relaxation.
ξ Provide time for foreplay.
ξ Use erotic literature or films if desired.
ξ Engage in regular exercise and rest.
ξ Use the morning time for sexual activity.
ξ Eat a well balanced diet.
ξ Use relaxation techniques such as yoga, massage, meditation, visualization exercises, and
aromatherapy.
ξ Reduce or stop the use of tobacco, alcohol, salt, caffeine, and refined sugar.

Summary

Don’t forget, menopause is not a disease, but rather a normal passage which you will likely go
through with little or no trouble.

Knowing about menopause, what to expect, and what to do to stay healthy in future years will
help guide you through this time with success. Choose a health care team member who will
listen to you and understands your changing health needs. A key to self development is to
maintain a healthy mind and body.

For further details on how to prevent chronic illness and maintain life long health ask for the
Health Facts for You listed below.

Health Facts for You: #5668 A Health Guide for Women ages 50 or older

Internet Sites

http://www.niddk.nih.gov/health/urolog/pubs/uniwomen

http://www.menopause-online.com/herbther.htm

http://www.menopause.org


Spanish Version of this HFFY is #7063


Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©1/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5351.