For the past year, Barbara Lash, a 49-year-old ex-nurse from Franklin, has been determined to fight her hot flashes with anything but the standard prescription drugs like Premarin.
On the advice of her nurse practitioner, Lash drinks a soy shake and eats tofu every day. She also nibbles cereal with flax seed, uses herbs like black cohosh and chaste tree berry, takes walks daily and lifts weights when she can.
“It’s amazing,” Lash says. Her hot flashes and mood swings are “just about gone” and she feels terrific.
Millions of women swear by prescription hormones to control both short-term menopausal symptoms like hot flashes and vaginal dryness, and to offset the longer-term risks of lowered estrogen levels like heart disease and osteoporosis.
But many others are leery, often because they fear that prescription estrogen drugs may raise breast cancer risk 30 to 40 percent (which is true) or because they feel that all alternative remedies, especially herbs, are “natural” and therefore automatically safe (which is hogwash).
For many herbal alternatives, in fact, there simply aren’t any data on long-term effects — good or bad — on breast cancer risk, says Dr. Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital.
Still, like Lash, many women are willing to try almost anything — as long as it’s not a prescription. But while some alternative remedies show promise, especially for short-term problems like hot flashes, others appear useless. The trick, of course, is to sort out which is which. So here goes:
– Soy. A 12-week Italian study of 104 postmenopausal women last month showed that women who took 76 milligrams of phytoestrogens (plant estrogens) from soy daily had a 45 percent reduction in hot flashes. (Those who took inactive placebo pills had a 30 percent reduction — proof that though hot flashes are real, so are expectations of relief.)
A just-published Australian study and an older American one show similar results, says Tufts University biochemist Margo Woods, who is running a study of women taking 45 mg a day.
There’s also animal data showing that soy can prevent breast cancer, as well as epidemiological data showing that in societies where soy consumption is high, like Japan, women have less breast cancer.
The magic of soy comes from substances called isoflavones (genistein and daidzein) that link up with cells much like estrogen does. Though some women take isoflavones themselves as supplements, it’s probably better to do as Japanese women do and eat the real thing — tofu, soy milk or soy yogurt, at least three to four servings a day.
Don’t use the low fat stuff — it’s too low in phytoestrogens. And if you buy powdered soy products, check the label to make sure each gram of powder has 1 milligram of phytoestrogens.
– Vitamin E. High doses (800 to 1,200 IUs a day) can reduce hot flashes, according to the North American Menopause Society, a nonprofit scientific organization.
– Black cohosh. Studies suggest only one herbal remedy that works for menopausal symptoms “and that’s black cohosh,” says Varro Tyler, emeritus professor of pharmacognosy (plant medicine) at Purdue University. But if you take a black cohosh product like Remifemin, don’t take more than 40 milligrams a day.
And don’t take it for more than three to six months. In fact, the menopause society recommends against taking it at all, arguing there’s not enough data on safety and efficacy of black cohosh, which comes from the cimicifuga plant. And if you still get periods, be wary because it can trigger heavy bleeding, adds Mary Pat Palmer, a Jamaica Plain mental health counsellor aka the “Urban Herbalist.”
– Dong quai. Though this is a favorite among herbalists who treat menopausal women, a study by the Kaiser Permanente Medical Care Program of Northern California in the journal Fertility and Sterility showed it’s no better than placebo.
– Chaste tree fruit. Another favorite of herbalists, this may ease “irregularities of the menstrual cycle,” according to the German Commission E, a world authority on herbal remedies. There are no known contradindications. If it does help, it may do so by increasing dopamine, a brain chemical, says Tyler of Purdue.
– Motherwort. Although there are no known side effects or contraindications, the German Commission E does not recommend it because the claims have not been proven.
– Raspberry leaf. Ditto, says Commission E. Tyler calls it “a popular folk remedy without scientific credentials.”
– Oil of evening primrose and borage seed oil. Mixed data put these “in the question mark category,” says Tyler.
– Ginseng. If you’re worried about breast cancer, don’t take it. Dr. Bruce Kessel, an endocrinologist at Beth Israel Deaconess Medical Center, has test tube data showing ginseng may act like estrogen to stimulate breast cancer cells.
– Progesterone creams, including those made from wild yams. These creams are heavily promoted, but “are so weak they are useless,” says the menopause society. The only reason to take progesterone, the society adds, is as a prescription drug to offset estrogen’s effect on the uterus.
– Acupuncture. Several studies suggest that acupuncture can reduce hot flashes 30 to 40 percent. A small Swedish study showed it cut hot flashes by more than 50 percent.
– Relaxation response. There’s solid data showing meditation and breathing exercises reduce hot flashes 30 to 40 percent.
– Exercise. Preliminary data suggests it reduces hot flashes (and it clearly reduces osteoporosis and heart disease risk.)
As for vaginal dryness, non-prescription options are few. Lubricants and moisturizers can help, as can staying sexually active.
There’s no question that educating yourself about alternatives takes work, says Lash, who works with a nurse practitioner at the Marino Center for Progressive Health in Cambridge. But the alternative approach, especially its emphasis on soy, can help.
“I think about Japanese women,” she says. “I feel if they can do it, I can do it.”