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Flaxseed: Easing Night Sweats

Talk with your doctor before taking any herbal or dietary supplements for menopausal symptoms. The FDA does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.

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Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis Signs and symptoms of menopause are usually enough to tell most women that they've started the menopausal transition. More Information Hormone therapy Hormone therapy and your heart Bioidentical hormones: Are they safer?

Hormone therapy and vaginal bleeding Menopause hormone therapy: Follow-up appointments? Menopause hormone therapy: Who shouldn't take it? Testosterone therapy in women Show more related information. Request an Appointment at Mayo Clinic. More Information Acupuncture. Share on: Facebook Twitter. Show references Menopause. National Institute on Aging. Accessed April 24, Casper RF, et al.


  • Practice Essentials!
  • Winter of the White Wolf (Noble Heart Book 4).
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Clinical manifestations and diagnosis of menopause. Longo DL, et al. Menopause and postmenopausal hormone therapy. In: Harrison's Principles of Internal Medicine.

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Menopause - Diagnosis and treatment - Mayo Clinic

New York, N. Nelson LM, et al. Clinical manifestation and evaluation of spontaneous primary ovarian insufficiency premature ovarian failure. Menopausal symptoms and complementary health practices. National Center for Complementary and Alternative Medicine. Heart disease facts. Centers for Disease Control and Prevention. Santen RJ, et al.

Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet].

Menopausal hot flashes. Martin KA, et al. Both nonhormone prescription medications and nonprescription agents including complementary and alternative medicine CAM therapies have been studied in comparison with menopausal hormone therapy or placebo. These studies focus primarily on the relief of vasomotor symptoms. Postulated mechanisms for SSRIs and SNRIs include central effects on serotonin, dopamine, or norepinephrine, 26 while the potential benefit of isoflavones is thought to be mediated through their affinity for estrogen receptors.

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The principal uncertainty for nonhormone therapies is effectiveness, whereas for hormone therapies it is the balance of benefits and harms. In May , the U. This updated systematic review included research published through November , but the report did not consider treatment of menopausal symptoms. The benefit-risk ratio for menopausal [hormone therapy] is favorable for women who initiate [hormone therapy] close to menopause but decreases in older women and with [greater] time-since-menopause in previously untreated women.

Women younger than 60 years old should not be concerned about the safety profile of [menopausal hormone therapy]. The Endocrine Society recently performed an extensive review of evidence surrounding postmenopausal hormone therapy, published as a scientific statement.

Position statements on compounded therapies have also been issued. The NAMS does not generally recommend compounded combined hormone therapy and suggests that compounded hormone products include a patient package insert identical to that required for products that have government approval. ACOG states that in addition to having the same safety issues as those associated with FDA-approved menopausal hormone therapy, compounded hormones may have additional risks intrinsic to compounding.

From the perspectives of systematic review and evidence synthesis, there are a number of challenges in comparing different hormone therapies and comparing those therapies to alternatives:. Two large-hormone replacement therapy trials exemplify the complexities described above when collecting evidence for a systematic review on this topic.

The WHI, which is a primary evidence base for harms from hormone replacement therapy, had a treatment population that overlaps but differs from the target population in this review. The WHI hormone trials excluded women with severe menopausal symptoms and enrolled primarily women older than those recently menopausal. These population characteristics of the WHI trials are relevant when attempting to interpret the results.

A more recent report from the WHI observational trial 34 found women experiencing early vasomotor symptoms were at the lowest risk of cardiovascular disease and cardiovascular events. For an individual menopausal woman considering hormonal or nonhormonal therapies, the questions of interest are: Given the presence of menopausal symptoms, what is the balance of benefits and harms of these therapies?

Does the timing and duration of these therapies affect the balance? Accordingly, the objectives of this review include: systematically reviewing and synthesizing evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, potential benefits other than symptom relief, and potential harms. Women experiencing symptoms accompanying natural menopause during perimenopausal or postmenopausal periods or surgically induced menopause during the postmenopausal period.

Three categories of interventions are included in the report: hormone therapies, nonhormone prescription therapies, and nonprescription therapies:. For KQ1 and KQ4, at least 12 weeks of followup for adequate assessment of hormone and nonprescription treatment effects is required for inclusion. This is based on evidence that efficacy in treating vasomotor symptoms with these agents is demonstrable by 4 to 8 weeks—and translates into similar efficacy at 12 weeks. Longitudinal studies on coronary heart disease, stroke, venous thromboembolism, endometrial cancer, gallbladder disease, and osteoporotic fractures require a followup of one year or greater for inclusion.

Key Question 1. What is the comparative effectiveness of different treatments for reducing symptoms of menopause vasomotor symptoms, sleep disturbance, psychological symptoms, urogenital atrophy, and sexual function and for improving quality of life? Individual agents will be compared to the extent permitted by the evidence.


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Evidence evaluating hormone therapies will be considered separately for women with and without a uterus. Women with breast cancer will be excluded. Key Question 2. What are the effects of menopausal hormone therapy preparations on coronary heart disease, stroke, or venous thromboembolism; gallbladder disease; osteoporotic fractures; or endometrial, breast, colorectal, or ovarian cancers? Exposure will be examined according to duration of use and initiation relative to age and onset of menopause. For women desiring contraception, combined estrogen-progestogen and progesterone-only contraceptives are included.

Key Question 3. What are the effects of nonhormone therapy preparations on coronary heart disease, stroke, or venous thromboembolism; gallbladder disease; osteoporotic fractures; or endometrial, breast, colorectal, or ovarian cancer? Key Question 4. Does effectiveness and adverse effects vary among subgroups of participants defined by demographics, symptom severity, other medications, and comorbidities or according to agent, preparation, or dose? When less estrogen is made after menopause, women lose much of this protection.

Midlife also is the time when risk factors for heart disease, such as high cholesterol levels, high blood pressure, and being physically inactive, are more common. All of these combined factors increase the risk of heart attack and stroke in menopausal women. Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus , a hormone called progestin.

A Natural Approach to Menopause

If you do not have a uterus, estrogen is given without progestin. Estrogen can be given in several forms. Systemic forms include pills, skin patches, and gels and sprays that are applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or in a patch. With systemic therapy, estrogen is released into the bloodstream and travels to the organs and tissues where it is needed.

These forms release small doses of estrogen into the vaginal tissue. Systemic estrogen therapy with or without progestin has been shown to be the best treatment for the relief of hot flashes and night sweats. Both systemic and local types of estrogen therapy relieve vaginal dryness. Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures.

Combined estrogen and progestin therapy may reduce the risk of colon cancer. Several antidepressants are available for the treatment of hot flashes. Gabapentin, an antiseizure medication, and clonidine, a blood pressure medication, are prescription drugs that can be prescribed to reduce hot flashes and ease sleep problems associated with menopause. Selective estrogen receptor modulators SERMs are drugs that act on tissues that respond to estrogen. SERMs are available for the relief of hot flashes and pain during intercourse caused by vaginal dryness.

Plants and herbs that have been used for relief of menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness. Also, the way that these products are made is not regulated.