Peri- and post-menopausal women have various options for the management of hot flashes, including hormone replacement therapy, SSRIs, and gabapentin. It looks as if hypnosis may also be helpful. In a recent study, researchers randomly assigned postmenopausal women to hypnotherapy or "structured attention," which was used as a control intervention.
Over the past decade, the clinical literature has published many studies documenting the psychosocial and health benefits of various mind-body interventions. Mindfulness-based interventions have been shown to reduce stress, to improve coping skills, and to promote feelings of well-being. Mindfulness-Based Cognitive Therapy (MBCT) is a new psychotherapeutic treatment which has been shown to reduce depressive symptoms and to reduce the risk of depressive relapse.
We have recently written about the link between vitamin D and depression. While several studies have indicated that low vitamin D levels may be associated with depression, we lack randomized, controlled trials assessing the benefits of vitamin D supplements for the treatment (or prevention) of depression. A recent report from the Women's Health Initiative Calcium and Vitamin D Trial included 36,282 women (50 to 80 years of age) who were randomized to receive 400 IU vitamin D (with 1000 mg calcium) or to placebo.
Recent reports suggest that people with lower folate levels are at higher risk of major depression or may experience more severe depressive symptoms. Other studies indicate that in folate deficient patients, antidepressants may be less effective or may take longer to take effect. In addition, some clinical trials have shown that folate may have a therapeutic effect on depression, either when taken alone or in combination with an antidepressant.
Soy-based products have long been touted as a treatment for menopausal symptoms. However, many of the clinical studies measuring the effectiveness of dietary sources of soy isoflavones (e.g., soy beverages, soy powder) for the treatment of menopausal vasomotor symptoms (i.e., hot flushes, night sweats) have been negative. Less is known about the effects of soy on cognition. A large clinical trial suggests that soy may not have any positive effects on cognition in postmenopausal women.
Most women undergoing infertility treatment experience increased anxiety. In a randomized clinical trial, researchers explored the effectiveness of acupuncture in diminishing anxiety in a group of women undergoing IVF. 43 patients undergoing IVF received either active acupuncture (n=22) or sham treatment (n=21). Women with a history of psychiatric illness and those using antidepressants and/or anxiolytic drugs were excluded from the study. Anxiety levels were assessed before and after treatment using the Hamilton Anxiety Rating Scale (HAS).
Many women with PMS and PMDD ask about herbal remedies for the treatment of their symptoms. WebMD recently reviewed this topic. The supplements most commonly mentioned for the treatment of PMS include chasteberry, evening primrose oil, Gingko biloba, St. John’s wort, and dandelion leaf. Some important things to remember:
While phytoestrogens have gained attention as possible alternatives to hormone therapy for the treatment of menopausal symptoms, placebo-controlled studies have yielded mixed results. Pomegranate seed oil is a very rich source of phytoestrogens. In this prospective randomized, placebo-controlled, double-blinded trial, 81 postmenopausal women received two daily doses of either 30 mg pomegranate seed oil (PGS) or placebo. The frequency of hot flashes decreased by 38.7% (P < 0.001) after 12 weeks of treatment with pomegranate seed oil and by 25.6% in the placebo group (P < 0.01). However, the difference between the two groups was not statistically significant (P = 0.17). The authors suggest that it may take a longer period of observation to demonstrate a difference between pomegranate seed oil and placebo.
Approximately seventy percent of all women experience hot flashes and/or night sweats (also called vasomotor symptoms) during the menopause transition (Stearns et al. 2002). Until recently, estrogen therapy was the treatment of choice for most women who sought treatment for hot flashes. Since the results of the Women's Health Initiative in 2002 noted risks of prolonged use of hormone therapy in older postmenopausal women (Roussouw et al. 2002), many women pursue other treatments for their hot flashes, including over-the-counter complementary and alternative medicines (CAMs), including soy isoflavones, black cohosh, and omega-3 fatty acids. However, there is limited evidence to support the use of these treatments for hot flashes to date.
