Diet  The first form of self-help is to look at your diet.  Try to increase the amount of foods containing phytoestrogens and reduce your intake of animal products.   Foods high in phytoestrogens include soy, beans, flaxseed and flaxseed oil, pulses, berries, vegetables, nuts, seeds, wholegrains, rye, and vegetables.  Consult one of the many menopause diet books freely available from libraries and bookstores.
	Overweight being overweight can contribute to menopausal symptoms because estrogen is stored in fatty tissue - this can lead to an imbalance with other 'female' hormones, and exaggerate other risks such as thrombosis and heart disease.
	Underweight being very underweight increases the risk of osteoporosis after the menopause because there are not enough fat cells to store the necessary estrogen to prevent bone loss.  Being underweight also decreases weight bearing movement which again is essential to prevent bone thinning in later life.
	Essential Oils an Aromatherapist will select essential oils appropriate to the accompanying symptoms of your peri or menopause period.  While evidence for the phytoestrogenic and other hormonal action of herbs is quite significant, as yet, the evidence for the topical application or inhalation of essential oils having similar effects is scarce.  Use Aromatherapy to complement your existing care whether it is conventional or through herbs and supplements.  Essential oils can help with skin and hair care, anxiety, mood, insomnia, relaxation, psychological symptoms and general well-being.  A good therapist will also be able to advise and support you through what can be a difficult period.  Your therapist should also be able to advise you on lifestyle, nutrition, and refer you on to an appropriately qualified practitioner in order to take advantage of the many complementary treatments available.

Below is a list of herbs and supplements reported to be useful for the various symptoms of the peri menopause period and the menopause.  This list is for information only but can act as a basis for further enquiry with your GP, Herbalist or supplement supplier.

	Estrogens  While many symptoms of the menopause can be a result of not enough estrogen, other symptoms can be a result of an imbalance between estrogen and other 'female' hormones such as progesterone.  Estrogen can have both positive and negative effects, hence the cautions associated with HRT.  For example, while estrogens can relieve the symptoms of hot flushes, moods and depression, and the later development of osteoporosis, too much estrogen enlarges breast tissue which can in some cases lead to cancer.  Estrogens can also thicken the blood, leading to clots in those who may be susceptible.
	Soy  Soy has been hailed the miracle food for relief from the menopause.  Not only does it contain phytoestrogens, but it also contains genistein and daidzein which have been shown to be similar to the drug Tamoxifen, which is used to help prevent breast cancer.  However, soya product taken with Tamoxifen can reduce its effectiveness due to the soya taking up estrogen receptors needed by the more powerful tamoxifen to do its work effectively. In far eastern countries with high soy diets such as Japan, incidents of breast cancer are considerably lower than the west.  Significantly, when the Japanese come to live in the West, their chance of breast cancer increases.
	Anti-estrogens While some menopausal symptoms are positively helped by estrogens, the same estrogens can have negative effects elsewhere - these are called anti-estrogens.  For example, Tamoxifen (similar to the phytoestrogens)  herbs and supplements act in the same way, for example, while red clover may help with hot flushes, it can also stimulate breast tissue, a precursor to cancer.
	Psychological symptoms such as forgetfulness, irritability and mood swings: Dong quai, Ginkgo Biloba, Vitamin E, the essential fatty acids (EFAs) such as Evening primrose or Star flower.  Aromatherapy and massage for anxiety, motivation and insomnia.
	Exercise the importance of exercise cannot be stressed enough.  Regular exercise can help prevent bone thinning, hot flushes, increase general fitness and help with the psychological symptoms of the menopause.  It also helps to increase cardiovascular fitness to help prevent 'old age' diseases such as heart attacks and strokes.
	Supplements and herbs
	Herbs offer a safer alternative to conventional medication in that they act to balance estrogen levels rather than raise levels. Being a natural alternative, their actions is considerably much gentler than conventional HRT.  If natural estrogen levels are low, herbal supplements containing phytoestrogens and phytoestrogens obtained from the diet will bind to the 'spare' estrogenic receptors so raising the level of estrogen in our body.  If estrogen levels are too high in ratio to other hormones, the phytoestrogens will bind with the spare receptors to prevent the much more powerful estrogens produced by our own body from binding, so lowering the ratio of estrogen to other hormones.  An abnormal ratio of estrogen with progesterone, the ovulation stimulating hormones LH (lutinising Hormone) and FST (Follicle Stimulating Hormone).  The latter 2 produced by the pituitory gland.
	Vitex agnus castus is thought to act on the pituitary to help balance the LH and FSH secretion hormones during the menopause and pre menopause period.
	Black cohosh binds to the serotonin receptors in the brain to help depression.  It also has a balancing effect on hormones to help with mood swings for both pre and menopausal women.
	Yam  hot flushes, irritability and depression associated with the menopause.
	Dosage it is important to obtain the recommended therapeutic dose for each herb or supplement.  For example, the most effective trials use Black cohosh with a 27-deoxyacteine content.  Some supplements contain much less so would have no therapeutic value.  Many recommended doses on popular brand labels are less than those used in clinical trials so CONSULT YOUR HERBALIST
	Hot flushes  Red clover, Yam, Agnus cactus, Black cohosh, Dong quai or Vitamins C and E.
	Vaginal dryness  Evening primrose or other similar EFA supplement, Vitamin C and E, or Black cohosh.
	Skin and hair  Essential oils, Essential Fatty Acid supplements.
	Oesteoporosis Calcium supplements, Vitamin D, sunlight to process Vitamin D, Potassium and Magnesium for bone growth and density. Weight bearing exercise, attention to body weight. EARLY MENOPAUSE IS A HIGH RISK FACTOR FOR OSTEOPOROSIS - CONSULT YOUR GP.

Try the questionnaire Are you at risk from osteoporosis? to get an indication of the lifestyle changes you may need to make to minimise the risk

The HRT cake

Sources of information

Arena S, Rappa C, Del Frate E, Cenci S, Villani C (2002) A natural alternative to menopausal hormone replacement therapy. Phytoestrogens. Minerva Endocrinology Feb 54(1):53-7

Blair R (2001) The interactive effects of tamoxifen and phytoestrogens

Soya isoflavones interrupt breast cancer medication. Leatherhead Food RA Editorial

The Natural Health Website for Women Natural alternatives to HRT

Foodlineweb Newsletter Soy story

MCW Health link New Studies Question the Use of Herbs for Menopause Relief

National Osteoporosis Society What are phytoestrogens?

Nagata C, Shimizu H, Takami R, Hayashi M, Takeda N, Yasuda K (1999) Hot flushes and other menopausal symptoms in relation to soy product intake in Japanese women. Climeracteric: Journal of the International Menopause Society. March 2(1):6-12

Pinkerton JV, Santen R (2002) Use of alternatives to estrogen for treatment of menopause. Minerva Endocrinology March 27(1):21-41

© Jane Ellwood June 2002