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Becausemenopause isn’t a disease but rather a normal part of every woman’s life as she ages, it makes sense to consider a natural approach to handling symptoms. For some women, this may be enough to ease them through the years when symptoms are most annoying.

Lifestyle changes are one of the most straightforward ways to combat symptoms and should be a first step. These include:

✔ EATING A BALANCED DIET

✔ AVOIDING ALCOHOL AND CAFFEINE

✔ STAYING WELL HYDRATED

✔ REDUCING STRESS

✔ SLEEPING SEVEN TO EIGHT HOURS PER NIGHT

✔ TAKING VITAMINS B, C, D AND E

✔ EXERCISING REGULARLY

Brittle nails

Weight

Bloatinggain

Incontinence

Changes in odor

Joint pain

Headaches

Bone loss/ brittle bones

You’ve heard about the importance of diet your whole life, and it’s especially helpful at this stage. Incorporating foods that promote natural estrogen levels in the body (think soy, alfalfa, apples, cherries,

Incorporating foods like alfalfa promotes

✔ Smoke

✔ Have a family history of early menopause

✔ Have undergone cancer treatment (chemotherapy and/or radiation)

✔ Have had a hysterectomy potatoes, yams and rice) can help, sometimes significantly. You also want to be sure you’re getting enough calcium and vitamin D to protect your bones.

✔ Have an autoimmune disease (Crohn’s disease, etc.)

Herbal supplements are one of the most common ways women manage menopausal symptoms. These supplements fall into two basic categories: phytoestrogenic and hormoneregulating.

Phytoestrogenic supplements contain plantproduced components with estrogen-like actions. These can include such herbs as black cohosh, red clover, soy, dandelion, dong quay and others.

Hormone-regulating supplements contain no estrogen but nourish the pituitary and endocrine glands to stimulate the body’s own production of natural hormones.

Alternative medicine, including acupuncture, Chinese herbal medicine and massage, is increasing in popularity as a treatment for relief of menopausal symptoms. Personally, I’m a fan of acupuncture and Chinese herbal medicine and have had success with both. I like the holistic approach that treats the entire person—physical, mental, emotional—not just her symptoms.

A multi-pronged approach may bring about the most satisfying results. For some women, however, symptoms aren’t alleviated with these measures, and, for them, hormone replacement therapy (HRT) may be useful.

“Themosteffective treatment for hot flashes, night sweats and urogenital changes is estrogen therapy,” notes Montgomery, who is certified as a specialist in menopausal practice. “This is a medical fact, but it doesn’t mean every woman needs or wants to use hormone therapy.”

A few decades ago, the vast majority of menopausal women were prescribed hormone replacement therapy (HRT). Then, in the early 1990s, the Women’s Health Initiative (WHI) was launched to address the pros and cons of HRT. After the study results were published in 2002 in The Journal of the American Medical Association, many women understandably shied away from hormone therapy for fear of increased risk of some cancers, heart disease and blood clots.

Montgomery finds there is still a great deal of fear and misinformation about HRT. Education is required in order for each woman to find what’s best for her.

A 2013 update to the WHI study carries some hopeful news for women struggling with menopausal symptoms but who are fearful of HRT. It concluded that the risk level depends on the individual and includes her age, overall health history and years since menopause began. This update reveals that younger women (those under age 60) are at low risk with estrogen therapy and that short-term hormone therapy is still considered beneficial for those with troubling hot flashes.

“If you’re between the ages of 50 and 60, it’s perfectly reasonable to be taking HRT, but if you are, you should have this discussion with your health care provider every year. At age 70, you’d have to make a very strong case for being on HRT. By that time, the symptoms are usually gone and the risks are greater,” says Montgomery.

For women whose primary symptom is vaginal dryness and discomfort with intercourse, low-dose estrogen therapy in the form of a vaginal ring, topical cream or tablet inserted vaginally may be the answer. This type of therapy is typically considered lower risk than systemic HRT because only a minimal amount of estrogen is absorbed into the bloodstream.

“Quality of life is important. Even some women who’ve had breast cancer are now being allowed to use low-dose estrogen vaginal preparations for vaginal menopausal changes,” observes Montgomery.

“There’s a lot of new research recently, which is exciting, and there are some new therapies for menopause,” he adds.

These include the non-hormonal medications ospemifene (brand name Osphena®) to treat painful sex due to menopause; paroxetine (brand name Brisdelle®), which is FDA-approved to treat hot flashes; and the combination of conjugated estrogens and bazedoxifene (brand name Duavee®) to treat hot flashes and prevent menopausal bone loss.

With any type of HRT, the general concept is to use the lowest dose that meets your personal health goals as discussed with your health care provider, including a realistic assessment of risks and benefits.

Montgomery points out that if you start taking medicine to relieve symptoms, once those symptoms are better, or gone, you should talk with your health care provider about stopping the medication or going to a lower dose to have the same quality of life. He emphasizes the importance of having an annual well woman visit and addressing the continued use (or not) of

“Fear—particularly of breast cancer—is a potent factor driving women in their health care choices, so you need to discuss HRT with your health care provider,”

“What I suggest is that patients try herbal therapies first. They don’t have a lot of scientific evidence supporting broad usage, but if they help, that’s all that matters. If they don’t work, then we can try hormones, but this should always be done on an individual basis.”