Isoflavones. Icecreams? No, for Menopause. What?

Icecreams

The Tor and sheep’s poo

The stone of the Glastonbury Tor holds the sun’s warmth and shares it with my back.  I duck out of the wind, soak in the fabulous views of the Salisbury plains and reflect on the last year and half since diagnosis with Myeloma.  Deep breaths of fresh air (fused with sheep poo aroma) fill my lungs. I’m sure the menopause (Meno) conundrum has been one of the most challenging and inspiring learning elements of this cancer journey.  Are you ready for part three (and final for now) of the Menopause blogs? Let’s talk ‘alternative’ (read non-medical) Meno symptom management solutions and finally, my decision about what, if anything, to take.  It’s probably apt that I am writing this in a place full of people living ‘alternative’ lifestyles or certainly appearing to be very happily in their own world…

 

The Tor at Glastonbury

The Tor, Glastonbury

Sheep

Sheep

Previous posts about Menopause

If you are happening upon this blog and interested in Menopause and Menopause and Cancer please see my previous posts on Menopause (part 1 and 2, links under Recent posts on the righthand side of this page).  Now, let’s crack on with the next instalment, part 3, the alternatives to HRT. A rhyme? Unintentional!  Any poets out there? Maybe it’s time for Meno poetry.  I hear Menopause, The Musical and the comedians (Victoria Wood (rest in peace), Sandra TsingKathy BurkeAngela Verges, and Jeff Allen have and are doing a fine job); room for another genre? Hey, if it gets all of us talking Meno, I’m keen. All poetic contributions welcome!!!

 

Menopause, The Musical

Menopause, The Musical

 

Menopause (Meno) part three (my final Menopause focussed post for now)

Wee recap; my MMmM project (Multiple Myeloma and managing Menopause symptoms) began by exploring the traditional medical models, asking my oncology team and gynaecologists for advice.  I then turned to a wide range of menopause experts by experience and occupation for complementary, natural and alternatives to Hormone Replacement Therapy (HRT).  I found myself falling into the world of Isoflavones, phytoestrogens, red clover black cohosh and more.  Here is what I discovered…

 

Alternatives to HRT

Actually before we get it into alternatives, let’s be clear, one completely valid option is to take nothing and embrace the menopause process as a natural part of aging; to cope with whatever symptoms are experienced.  However, for many of us, in the same way that managing difficult periods, pre-menstrual syndrome (PMS) or tension (PMT), difficult pregnancy, endometriosis, polycystic ovaries, fibroids and other gynaecological processes and concerns, it is either unnecessary to put up with unwanted symptoms or they are simply intolerable.  Additional support is needed.

Below are some of the alternatives to HRT and practical solutions I encountered and many of which I have tried.  Please note most complementary and alternative treatment options do not yet have robust evidence of effectiveness; though some women will experience benefit from some of these treatments.1

 

Isoflavones and Phytoestrogen

 

The definitions and characteristics (interesting nutrition and hormone stuff);

Isoflavones are crystalline compounds whose derivatives occur in many plants (especially pulses), often as glycosides.  Phytoestrogens refer to a substance found in certain plants which can produce effects like that of the hormone oestrogen when ingested into the body.2

Isoflavones are oestrogenically potent phytoestrogens.  The main dietary isoflavones, called genistein and daidzein, are mostly found in legumes such as soy, chick peas, lentils and beans.  Lignans and prenylated flavonoids (also phytoestrogens) have potent oestrogenic activity but there are few studies about them. 2

 

Evidence is mixed about Soy

A recent study found a reduction in hot flushes when women used soy germ extract with 100mg of isoflavone glycosides.3  It is not clear from studies to date, whether frequent soy consumption explains the lower rate of hot flushes among different ethnic groups.

 

Red clover and Promensil

Red clover, another source of isoflavones, contains compounds that are metabolised to genistein and daidzein after consumption. The most studied red clover product is Promensil. 4

 

Promensil double strength

Promensil

 

  • A ‘natural’, non-medical, easily accessible, alternative to HRT
  • Growing evidence base that it works in improving unwanted Menopause symptoms
  • A three-month dosage duration is recommended initially
  • Not enough evidence yet looking at long term effects
  • Just like HRT, it is unlikely to work for everyone

 

Promensil and hot flushes

Managing women with phytoestrogens

Managing women with phytoestrogens

The evidence

There are few studies exploring Promensil and Isoflavones for the management of Menopause symptoms and other health benefits though fortunately the evidence base is slowly growing.

A recent review highlighted evidence supporting use of Promensil at 80 mg/day for treating hot flushes in menopausal women.  This finding was consistent across 3 studies included in the meta-analysis. Promensil was found to be safe over the short-term duration of the studies (3 months).5

A more comprehensive review with a rather unfortunate name ‘Managing women with phytoestrogens’ also reviewed the studies mentioned above. (It makes me angry when its implied or explicitly stated women need managing!!)  Setting this name issue aside, the researchers proposed that one of the most widely researched food supplements has been the phytoestrogenic preparation containing red clover isoflavones. Six randomised trials exploring the impact on vasomotor symptoms (night sweats, hot flashes, and flushes) were included, three of which displayed a significant benefit compared to placebo.6

Data from small randomised and observational trials showed benefits of using red clover isoflavones for osteoporosis and cardiovascular disease. Red clover isoflavones may also derive psychological benefits. Safety data is positive so far.  The reviewers conclude with further studies would be welcome, particularly in women with significant medical risks.6

A 2018 paper describes a study of 50 patients where a combination of 40mg dose of Isoflavone along with calcium, vitamin D and inulin improved vasomotor disturbances as well as quality of life and sexual function in menopausal women.  This was a small trial with a number of limitations so the results while promising, need further investigation.7

 

From the makers of Promensil (Check out their website and research claims)

Here are two sheets summarising clinical support for red clover Isoflavones relating to a range of health domains.

Clinical Support for Red Clover Isoflavones

Clinical Support for Red Clover Part1

Clinical Support for Red Clover Isoflavones Part2

Clinical Support for Red Clover Part2

They also explain the difference between Promensil and other red clover products including soy isofalvones.  Check it out here.

 

The controversy

There had to be some debate, right?  This is Menopause we’re talking about after all!  Studies involving Promensil were reviewed, analysed and reported in a 2014 Cochrane review paper. 4  Only five trials met the search criteria and the authors argue that,

No conclusive evidence shows that phytoestrogen supplements effectively reduce the frequency or severity of hot flushes and night sweats in perimenopausal or postmenopausal women.

On a positive note the same review highlights the possibility of a positive outcome from genistein and concludes

…benefits derived from concentrates of genistein should be further investigated.

Read the full paper here.

 

Other ‘Alternatives’, Complimentary Medicine and Lifestyle choices for managing Meno symptoms

Beyond the better known isoflavones, I came across a number of other recommendations for using supplements, making lifestyle changes and employing complimentary medicine for reducing unwanted Menopause symptoms and side effects.  I then went hunting for scientific evidence of each product’s effectiveness and began trying a few things out.  Here is a list of the alternatives I looked into:

  • Probiotics
  • Vitamins (A, C, D, E, K, Zinc)
  • Omega 3
  • Black Cohosh
  • Acupuncture
  • Chill Pillows (a new take on chill pill!).
  • Exercise
  • Chinese Medicine
  • Cognitive Behavioural Therapy
  • Non-hormonal pharmaceutical treatments

Some women have found benefits from natural remedies BUT the research is mixed and caution is advised.  Check out these summaries; 1,8,9

Complimentary alternative therapies.

Natural remedies for hot flushes  

A paper Mallhi et al with a long list of alternatives, dosage and known side effects.

Here are my discoveries in more detail; I hope they prove useful…

 

 

Udos Super8 Probiotic
Probiotics and Vitamins

Now for a confession, I can’t remember exactly who told me to take probiotics and a full range of vitamin B’s, Calcium and Vitamin A, C,  D and Zinc to help with menopausal symptoms (blame it on Chemo and Menopause memory impact!).  I am 99% sure, I first heard this from my Nutrition therapist, then from the amazing lady who runs our local health shop and then finally I’m sure it came up in the interviews facilitated by Katie Phillips with Menopause experts that I have mentioned in my previous posts (See links below for some of the interviews and more about Katie).  I take VitD, VitB and Calcium daily as part of my Cancer treatment as advised by my medical team so it has not been a hardship to add the probiotic.

Muhleisen’s paper highlights probiotics for reinstating vaginal equilibrium in menopause 10 and Britton’s paper advocates probiotics to prevent vaginal dryness and atrophy.11 Count me in!

 

Omega 3

According to a recent review, Omega-3 supplements may alleviate night sweats but not hot flushes.12

 

Vitamin C, D, E – more mixed results

A 2013 paper highlighted that Vitamin C and E reduce the intensity and number of hot flashes via promotion of adrenal function though it is very important that the correct dosage is used and no large doses are taken.13

In contrast, LeBlanc’s 2015 paper and 2010 studies (by Dennehy et al and Lerchbaum et al ) show there is no evidence that vitamin D or E helps vasomotor symptoms but do recommend vitamin C, D, K and calcium for maintaining bone health.14,15,16

 

Zinc and Vitamin K

Zinc and Vitamin K are positively associated with bone mass however I couldn’t find any evidence for either reducing unwanted menopause symptoms.17,18, 19

 

For healthy hair during menopause – vitamin Bs, C, Proteins and Fats

Sugar craving during Menopause – check your Vitamin C levels

Consider going VEGAN or simply eat more plants! 

One study showed that vegans reported less bothersome vasomotor symptoms than omnivores.20

 

Vitamin A

I couldn’t find any relevant studies regarding Vitamin A and menopause and menopause symptoms.  Please let me know if you can!

 

Black Cohosh

While an older 2010 study found black cohosh reduced hot flushes21 a recent, more comprehensive Cochrane review concluded there is insufficient evidence to either support or oppose the use of black cohosh for menopausal symptoms.22

 

Chinese Medicine, Dong Quai, Ginseng 

Another 2016 Cochrane review found insufficient evidence that Chinese herbal medicines were any more or less effective than placebo or HRT for the relief of night sweats and hot flushes.23

 

Non-hormonal pharmaceutical treatments (e.g. SSRIs often referred to as anti-depressants)

A 2010 review of studies found Clonidine, SSRIs and SNRIs, gabapentin and relaxation therapy showed a mild to moderate effect on reducing hot flushes in women with a history of breast cancer.24

 

fullsizeoutput 1490 225x300 - Isoflavones. Icecreams? No, for Menopause. What?

Chillmax pillow

Chillmax pillow

A Chillmax Pillow

This is a wonderful, wonderful recommendation (thank you Sis-in-law and Mum-in-law!!)  Slip it under your pillow case or lie it vertically down your pillow to provide your head and neck with a cool sensation.  Ahhh, bliss.

 

Acupuncture

Acupuncture may be beneficial in comparison to not taking anything though the evidence is weak at the moment.25

 

Regular exercise

Ha. We can never escape this one it seems.   While exercise isn’t directly linked to vasomotor symptoms of menopause including hot flushes it is recommended to support the related impact of Menopause changes and symptoms.  Check out these articles – A good time to exercise and Meno and constipation.26

 

Cognitive Behavioural Therapy (CBT)

There is growing evidence that CBT can help reduce the impact of Menopause symptoms.27  The British Menopause Society have released a helpful leaflet that has been endorsed by the UK National Institute of Clinical Excellence (NICE).28

 

Alternatives to HRT and Cancer

A 2013 systematic review of soy and red clover as used by breast cancer patients or those at risk of breast cancer, found a lack of evidence showing harm from use of soy with respect to risk of breast cancer or recurrence. Soy intake in line with a traditional Japanese diet (2-3 servings daily, containing 25-50mg isoflavones) may be protective against breast cancer and recurrence. Soy does not increase circulating estradiol or affect estrogen-responsive target tissues. Prospective data of soy use in women taking tamoxifen does not indicate increased risk of breast cancer recurrence. Evidence on red clover is limited though existing studies propose that it may not possess breast cancer-promoting effects.29

A 2015 study proposed a combination of Soy and probiotics may have potential for reducing the risk of breast cancer.30

Another three-year study concluded that when compared to HRT, Promensil was safer as there was no effect on known breast cancer risk factor.31

New shoot amongst the dryness

New shoot amongst the dryness

 

Menopause, Sex and Vaginal Dryness

Let’s talk about sex baby, let’s talk about….sex.  Remember that track by Salt n Pepa? Except I’m talking about sex during Menopause.  Many women find sex painful due to vaginal dryness or don’t fancy sex at all as Meno creeps up on them.  Women – you do not have to put up with this state of affairs.  For dryness, there are medical issued and organic/natural products that can make a real difference.  Consider trying out Yes (mostly organic) or Sylk products. Here is a link to an article 32 which includes a comparison between multiple product options.  How Important is vaginal lubricant and moisturiser composition? If you are concerned that your vaginal dryness might be severe and not easily solved by a moisturising lubricant you may be interested in this presentation on Vulvovaginal Atrophy (VVA).  It has some great info on the moisturising lubricants too.33

 

Twice Two cups

Twice

Will I go through Meno twice?

One thing the gynaecologist did say is that I am very unlikely to have to go through Menopause twice; that is, it shouldn’t reverse once my chemo stops and start again at a later stage.  That seems like a kind gift from the Universe.  I’ll hang on to that.

Of course, I will still be part way through my own Meno journey, living with the uncertainty of not knowing whether mine will finish after 3 years, 7 years or be considerably longer lasting.  Hey, so long as the symptoms are managed and I continue to feel myself, I am happy and willing to embrace this new, wondrous, challenging and clever process, my body goes through.  Hopefully too, in a few months’ time, after being on my chosen treatment and monitoring symptoms, I will be much clearer about what is a Chemo or Cancer induced symptom versus a Menopause symptom.  Meno and hormones may no longer be a fall-back excuse for my ‘well aren’t I moody today’ moments!

So now to my decision:

For me, taking nothing is not an option at this stage as maintaining an even mood, improved libido and reducing hot flushes are a must.  Do I try Promensil and or trust in the gynaecologist who was adamant HRT was the way to go? I wonder what is holding me back.  I think it is my oncologist with the anti-HRT opinion that is still bothering me; I need to have another talk with him.

 

My Decision(s) and a U-turn

Talking and researching must stop at some stage and a decision be made.  Continued talking and researching can make decisions much harder to make; there will always be contrasting views and experiences.  A stake in the ground, a baseline, is needed.  I must make the decision that is right for me with the information I have today.  After all, I know any decision is not set in stone, I can change it later, if new information comes my way, or my body doesn’t like the solution I try or the decision stops feeling right to me.

So, what’s it to be?

I’m going to start natural plant based bioidentical HRT gel and progesterone tablets.

Except I’m not.  Deep Breath.

Just when I had decided to start natural plant based bioidentical HRT (I had even submitted the prescription) my Mum, my very precious, kind Mum, was diagnosed with breast cancer.  Deep breath.  I won’t talk about this now, other than to say, the all important public health system has once again appeared to have caught the little nasty early; thank you health teams, thank you Universe.

Now, with breast cancer in my family, my chances of getting secondary cancer (and breast cancer) seemed to have leapt from a statistic to a reality.  Another deep breath.  Talk to self; be sensible.  I let my med team know and asked for a mammogram and a chat with the breast cancer team.  My oncologist referred me immediately.

I had based my ‘go with HRT’ decision on two factors in the end: a) The delivery mechanism for the estrogen component is via gel and does not go directly through my liver and, b) the research investigating HRT side effects and long term effects is present and more robust than Promensil, at this stage.  Although now…

 

Out with HRT and in with Promensil

The HRT rational above was discarded considering the increased risk of secondary cancer and my recent family diagnosis.  Promensil now seemed much more appealing.  Despite the lack of larger and longitudinal studies, I decided Promensil was work the risk.  I needed help and I was being monitored extensively each week; if a negative impact occurred, I figured it would be picked up quickly and I could stop Promensil immediately.

Two other things helped me embrace this decision; it felt right as soon as I had made it (a better feeling than I ever had with HRT) and it fitted with the additional chat I had with my oncologist.  He knows me best, is a clinical lead and has spent most time with me over the last 15 months.  He has my best interests at heart and has always coped with my endless queries and requests for repeated explanations.  While I do trust the others in the haemo-oncology team, I gave weight to his opinion and his caution over adding this long-term medication into the mix. He said he felt HRT would add extra risk, risk that wasn’t able to have a statistic put on it due to my individual circumstances and the few studies exploring HRT and Myeloma relapse.

Finally, I am reminded that while I usually place my store in scientific evidence, just because something hasn’t been rigorously studied yet, doesn’t mean it won’t later be discovered to be beneficial.  Cannabis oil for chronic illness/pain and ketamine for some mental health disorders spring to mind, as substances we might have first thought of as harmful yet in certain doses and conditions, have been found to have positive outcomes.  Mindfulness didn’t start out with an evidence base, yet now, it is well established as having beneficial outcomes in many circumstances.

Therefore, I have taken the risk (whatever that is) of introducing yet another supplement/medication into my life.

 

Promensil 80mg Red Clover Isoflavones

Promensil 80mg Red Clover Isoflavones

Promensil = Improvement (my case study so far)

I started Promensil while conducting this research and then stopped when I thought I’d better gather the evidence first and make a more informed decision.  I was a bit reluctant to stop as I hadn’t noticed any adverse effects and there had seemed to be an improvement in Meno symptoms.  When I stopped, the night-sweats returned with a vengeance.

Promensil is shaping up to be a wonder product for me.  Although I am open to the possibility it is a placebo effect.  Now back on it, I have taken one pill, once per day, for six weeks (the double strength version).  Much to my delight the full body night-sweats with drenched bed linen and night clothes are no longer!!  I don’t remember having one in the last fortnight at all!  Plus, a lovely UK heat wave have meant nights have been hot (in the mid-20s Celsius/77 Fahrenheit at times).  The improvement timing couldn’t have been better, otherwise I think I would set the bed and house on fire or internally combusted!

 

Hot flashes

My daily hot flashes now tend to occur in the afternoon, rather than all through the afternoon and evening, are less severe and less frequent; down to 2 per day though I haven’t monitored closely. I do know I’m not stripping off clothes and putting them back on minutes later any near as often, not even every night.

For the last ten days, I have switched to taking Promensil around lunch time or a little later, as most hot flushes appeared in the afternoons or evenings, when they did occur.  I have discovered this has had a positive benefit too; flushes have reduced again and while I have not been taking a log, it seems I am only getting one flush a day now.

 

Other symptoms

The jury is out on other symptoms.  I seem to sleep slightly better, deeper while asleep though I still wake often.  I need to monitor the Meno symptoms closely at the end of each week and during my non-chemo week, to determine any changes; the chemo and steroids at the beginning of the week are likely to interfere with sleep (negatively) and energy (positively).  In the middle two weeks of the six on Promensil, I thought my mood had been slightly more even, though I need to check with Hubby on this; suspect he may disagree!

Over the last two weeks with so much going on, health, family and otherwise, I have exercised and meditated less, my mind has been very occupied and I think my mood has fluctuated a lot.  Feels like the Promensil was unlikely to have any positive impact on that symptom!  Though, who knows maybe my mood would have been worse, if I hadn’t taken it.  No science here, no objectivity, remember these are just observations, interpretations and surmising.  Though, I am the expert in my own body and mind so I’m rolling with a ‘Promensil is working’ concept for now.

On a couple of occasions, I’ve noticed if I drink a hot drink quickly or have a moment of frustration or stress, a hot flush followed very quickly.  I’ll keep an eye on this and try to notice if it always happens or appears random rather than linked to hot drinks and stress.  Though I believe this is not uncommon.  Check out these known triggers for hot flushes.

 

Menopause was hard to write about

I have found Menopause hard to write about. Maybe I hesitated because I wasn’t sure whether I was going through it or not: the symptoms are so like those that accompany cancer and chemo.  No, that wasn’t it really, I was embarrassed, at first.  Outside of my very close friends and eventually, close clinicians, I have found it one of the hardest subjects to raise.  I’m not sure why.  Especially when, I am a psychologist who believes in taking the unhelpful stigma out of, well, EVERYTHING.

Menopause has been more difficult to disclose than cancer: WEIRD. Talking about menopause with and due to cancer and chemo: DOUBLE WEIRD.  This combo takes Meno, ‘to another level’ (the catch phrase of 2017-18, I’m sure).    Talking about some aspects of Menopause have been harder than others; vaginal dryness for instance.  For some reason, I found this really hard to write/talk about.  Worried I’d be judged maybe?  Worried people would assume I was experiencing vaginal dryness and for some reason not wanting people to assume that everything I write about, happens to me?  Strange, given mostly it does, and the blog is of a personal nature.  But that’s the point isn’t it.  Get talking.  Reduce stigma.  There is nothing to be embarrassed or awkward about.  These processes are natural, they do not need to be hidden, talked about in secret or god forbid, suffered in silence.

I think underneath it all, I believe my and many European societies or so called developed countries with an individualistic tendency, associate women, during and post menopausal as old, unsexy, and past it.  I know that simply isn’t true.  Sophia Loren, Helen Mirren, my Mum, spring to mind – all sexy, awesome women, regardless of age.  Yet I worried and continue to worry about feeling and being: old, unsexy and past it, particularly when my skin gets thin and wrinkly from steroids and chemo, my grey hair becomes more abundant and my energy or libido feel low.  I worry when I stop feeling like myself.

All is not lost; applying psychology skills, and finding psychological flexibility, I constantly and consistently challenge these thoughts and feelings.  Though some days it is hard to do. I remind myself of a new more helpful perspective.  I take time to reflect, recognise and acknowledge that I haven’t felt old or unsexy every day or every moment of the day.  In fact, I have and do feel mighty fine, a lot of the time (another rhyme?).  Not bad for a woman fast approaching 50.

 

Menopause communities…have you found yours?

Thank goodness for the new wave of open discussion about Menopause and growing social communities like the Menopause Café movement.  It’s about time.  Here are two Meno stories and an episode of Loose Women about Meno.  You may also want to check out the magazine Menopause Matters.  I’m very grateful for Katie Phillips, her wonderful interviewees, the menopause café team, the celebs who have shared their stories (Kim Cattrall, Zoe Ball, Meg Matthews, Lorraine Kelly to name a few (see their and others’ stories here)  and the ordinary (spectacular) women in my life who have disclosed their menopause journeys to me.  Thanks for helping me get over my embarrassment by reminding me; I am not alone and that my Meno related decisions will be the right ones for me.

I have a lot of time for the author Christine Northrup with her interest and application of both her  medical and holistic complimentary health expertise.  Here is one of her books that you might find particularly useful.

Christine Northrup The Wisdom of Menopause

The Wisdom of Menopause

 

Your feedback

Please do share the link to this blog, ask any questions you may have and do let me know:

  • What has been the hardest part of your menopause or menopause with cancer journey?
  • What has been the hardest part of caring for someone going through menopause or menopause and cancer?
  • What have you discovered?
  • Your Meno poem
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Resources, References, Study papers and more:

Menopause, The Musical

https://www.ents24.com/uk/tour-dates/menopause-the-musical-touring

Communities: The Menopause Cafe

https://www.menopausecafe.net/

English Oxford Living Dictionary (August, 2018). 

Definition of isoflavones. https://en.oxforddictionaries.com/definition/isoflavone

Definition of phytoestrogen.  https://en.oxforddictionaries.com/definition/phytoestrogen

Alternatives to HRT

Complimentary alternative therapies

https://www.womens-health-concern.org/help-and-advice/factsheets/complementaryalternative-therapies-menopausal-women/

Natural remedies for hot flashes – black cohosh, ginseng and more

https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/natural-remedies-for-hot-flashes

Mallhi, T. H., Khan, Y. H., Khan, A. H., Mahmood, Q., Khalid, S. H., & Saleem, M. (2018). Managing Hot Flushes in Menopausal Women: A Review. Journal of the College of Physicians and Surgeons–Pakistan: JCPSP28(6), 460-465.

https://www.jcpsp.pk/archive/2018/Jun2018/jcpsp-vol28-no6.pdf#page=48

Soy germ and isoflavones

Imhof, M., Gocan, A., Imhof, M., & Schmidt, M. (2018). Soy germ extract alleviates menopausal hot flushes: placebo-controlled double-blind trial. European journal of clinical nutrition, 1.

https://www.nature.com/articles/s41430-018-0173-3

 

Support for Promensil

Promensil website

https://promensil.co.uk/

Myers, S. P., & Vigar, V. (2017). Effects of a standardised extract of Trifolium pratense (Promensil) at a dosage of 80 mg in the treatment of menopausal hot flushes: A systematic review and meta-analysis. Phytomedicine24, 141-147.

Panay, N. (2011). Taking an integrated approach: managing women with phytoestrogens. Climacteric14(sup2), 2-7.

Controversy & Genistein

Lethaby  A, Marjoribanks  J, Kronenberg  F, Roberts  H, Eden  J, Brown  J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD001395. DOI: 10.1002/14651858.CD001395.pub4.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full

Vitamins, Black Cohosh and more

Vitamins in combination with Isoflavones –

Vitale, S. G., Caruso, S., Rapisarda, A. M. C., Cianci, S., & Cianci, A. (2018). Isoflavones, calcium, vitamin D and inulin improve quality of life, sexual function, body composition and metabolic parameters in menopausal women: result from a prospective, randomized, placebo-controlled, parallel-group study. Przeglad menopauzalny= Menopause review17(1), 32.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925192/

Probiotics

10 Muhleisen, A. L., & Herbst-Kralovetz, M. M. (2016). Menopause and the vaginal microbiome. Maturitas91, 42-50.

https://www.sciencedirect.com/science/article/pii/S0378512216301244

11 Britton, R. A., Irwin, R., Quach, D., Schaefer, L., Zhang, J., Lee, T., … & McCabe, L. R. (2014). Probiotic L. reuteri treatment prevents bone loss in a menopausal ovariectomized mouse model. Journal of cellular physiology229(11), 1822-1830.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994184/

Omega 3

12 Mohammady, M., Janani, L., Jahanfar, S., & Mousavi, M. S. (2018). Effect of omega-3 supplements on vasomotor symptoms in menopausal women: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology.

https://www.sciencedirect.com/science/article/pii/S030121151830335X

Vitamin C & E

Support for Vitamin C & E

13 Doshi, S. B., & Agarwal, A. (2013). The role of oxidative stress in menopause. Journal of mid-life health4(3), 140.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952404/

No support for Vitamin E (Note – an older paper and findings may be outdated)

15 Dennehy, C., & Tsourounis, C. (2010). A review of select vitamins and minerals used by postmenopausal women. Maturitas, 66(4), 370-380.

https://www.ncbi.nlm.nih.gov/pubmed/20580500

Vitamin D

14 LeBlanc, E. S., Hedlin, H., Qin, F., Desai, M., Wactawski-Wende, J., Perrin, N., … & Stefanick, M. L. (2015). Calcium and vitamin D supplementation do not influence menopause-related symptoms: Results of the Women’s Health Initiative Trial. Maturitas81(3), 377-383.

https://www.sciencedirect.com/science/article/pii/S0378512215006477

16 Lerchbaum, E. (2014). Vitamin D and menopause—A narrative review. Maturitas79(1), 3-7.

https://www.sciencedirect.com/science/article/pii/S0378512214001996

Zinc

18 Kim, D. E., Cho, S. H., Park, H. M., & Chang, Y. K. (2016). Relationship between bone mineral density and dietary intake of β-carotene, vitamin C, zinc and vegetables in postmenopausal Korean women: a cross-sectional study. Journal of International Medical Research44(5), 1103-1114.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536545/

Vitamin K

19 Jaghsi, S., Hammoud, T., & Haddad, S. (2018). Relation Between Circulating Vitamin K1 and Osteoporosis in the Lumbar Spine in Syrian Post-Menopausal Women. The open rheumatology journal12, 1.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842378/

17 Kim, M. S., Kim, E. S., & Sohn, C. M. (2015). Dietary intake of vitamin K in relation to bone mineral density in Korea adults: The Korea National Health and Nutrition Examination Survey (2010–2011). Journal of clinical biochemistry and nutrition57(3), 223-227.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639586/

 

Black Cohosh

21 N.B. Old study – Borrelli, F., & Ernst, E. (2010). Alternative and complementary therapies for the menopause. Maturitas66(4), 333-343.

https://www.sciencedirect.com/science/article/pii/S0378512210002197

22 Leach  MJ, Moore  V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007244. DOI: 10.1002/14651858.CD007244.pub2.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007244.pub2/full?highlightAbstract=menopause&highlightAbstract=menopaus

 

Acupuncture

25 Dodin  S, Blanchet  C, Marc  I, Ernst  E, Wu  T, Vaillancourt  C, Paquette  J, Maunsell  E. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD007410. DOI: 10.1002/14651858.CD007410.pub2.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007410.pub2/full?highlightAbstract=menopause&highlightAbstract=menopaus

Chinese Medicine

23 Zhu  X, Liew  Y, Liu  ZL. Chinese herbal medicine for menopausal symptoms. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD009023. DOI:10.1002/14651858.CD009023.pub2.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009023.pub2/full?highlightAbstract=menopause&highlightAbstract=menopaus

Non hormonal interventions e.g. SSRIs

24 Rada  G, Capurro  D, Pantoja  T, Corbalán  J, Moreno  G, Letelier  LM, Vera  C. Non‐hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD004923. DOI: 10.1002/14651858.CD004923.pub2.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004923.pub2/full?highlightAbstract=menopause&highlightAbstract=menopaus

Cognitive Behavioural Therapy (CBT)

28 British Menopause Society – CBT for Menopause Fact Sheet

https://thebms.org.uk/_wprs/wp-content/uploads/2017/02/BMSfactsheet-CBT-for-HCPs-FINAL.pdf

27 Stefanopoulou, E., & Grunfeld, E. A. (2017). Mind–body interventions for vasomotor symptoms in healthy menopausal women and breast cancer survivors. A systematic review. Journal of Psychosomatic Obstetrics & Gynecology38(3), 210-225.

https://www.ncbi.nlm.nih.gov/pubmed/27832718

Vegan-Plant based diet

20 Beezhold, B., Radnitz, C., McGrath, R. E., & Feldman, A. (2018). Vegans report less bothersome vasomotor and physical menopausal symptoms than omnivores. Maturitas112, 12-17.

https://www.sciencedirect.com/science/article/pii/S0378512218300100

Exercise

26 Move Over Menopause – 5 reasons why this is the best time to exercise.

https://www.healthline.com/health/move-over-menopause-5-reasons-why-this-is-the-best-time-to-exercise#1

Alternatives to HRT and Cancer

29 Fritz H, Seely D, Flower G, Skidmore B, Fernandes R, Vadeboncoeur S, et al. (2013) Soy, Red Clover, and Isoflavones and Breast Cancer: A Systematic Review. PLoS ONE 8(11): e81968. https://doi.org/10.1371/journal.pone.0081968

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842968/

30 Toi, M., Hirota, S., Tomotaki, A., Sato, N., Hozumi, Y., Anan, K., … & Ohno, S. (2013). Probiotic beverage with soy isoflavone consumption for breast cancer prevention: a case-control study. Current Nutrition & Food Science9(3), 194-200.

https://www.ingentaconnect.com/content/ben/cnf/2013/00000009/00000003/art00004

 

Use of Promensil in women with a family history of Breast Cancer

31 Atkinson, C., Warren, R. M., Sala, E., Dowsett, M., Dunning, A. M., Healey, C. S., … & Bingham, S. A. (2004). Red clover-derived isoflavones and mammographic breast density: a double-blind, randomized, placebo-controlled trial [ISRCTN42940165]. Breast Cancer Research6(3), R170.

http://www.evaluategroup.com/Universal/View.aspx?type=Story&id=151835

Some of the interviews

https://www.youtube.com/results?search_query=katie+Phillips+menopause+week+of+interviews

Katie Phillips (facilitator of week of My Menopause – interviews with menopause experts)

https://theschoolofself.love/

Celebrity Meno Stories

https://rejuvage.com/9-celebrities-speak-out-menopause/

Menopause Magazine

https://menopausematters.co.uk/magazine/

Vaginal Dryness

Importance of vaginal lubricant and vaginal moisturiser (with helpful product comparison)

32 Edwards, D., & Panay, N. (2016). Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?. Climacteric19(2), 151-161.  https://www.tandfonline.com/doi/abs/10.3109/13697137.2015.1124259#aHR0cHM6Ly93d3cudGFuZGZvbmxpbmUuY29tL2RvaS9wZGYvMTAuMzEwOS8xMzY5NzEzNy4yMDE1LjExMjQyNTk/bmVlZEFjY2Vzcz10cnVlQEBAMA==

Vulvovaginal Atrophy (VVA)

33 Treating vulvovaginal atrophy/genitourinary syndrome of menopause: Lubricants, Moiturizers and Vaginal DHEA.  Slides by Nick Panay, Imperial College London.

https://www.menopause.org/docs/default-source/agm/panay-n-2017-slides.pdf

 

Acknowledgements

Images: 

Unsplash:

Ice-creams – Mark Cruz -334535

Sheep – Sam Carter -191161

The Tor in Glastonbury – Hello I’m Nic -710394

New shoot amongst the dry – Stas Ovsky -632497

Two cups – Tom Crew -661269

Boy and microphone – Jason Rosewell -60014

 

Other images:

Four women – Menopause Musical – https://www.ents24.com/uk/tour-dates/menopause-the-musical-touring

Promensil picture 1 – me

Promensil picture 2 – https://promensil.co.uk/

Probiotics – me

Chillmax pillow – me

Article related pictures – me

Book – https://www.drnorthrup.com/

 

 

© 2018 Janine Hayward www.psychingoutcancer.com.  All rights reserved.

 

August 13th, 2018 by