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Complementary and Alternative Medicine - Cam

Search Health Information    Menopause (Holistic)

Menopause (Holistic)

About This Condition

Menopause is not a disease —it’s a natural part of life. According to research or other evidence, the following self-care steps may be helpful.
  • Eat soy and flaxseed

    Make foods high in phytoestrogens, such as flaxseed, tofu, soy milk, tempeh, and roasted soy nuts, a regular part of your diet

  • Control symptoms with isoflavones

    Supplements containing at least 80 to 100 mg a day of isoflavones from soy or red clover may help control symptoms

  • Cool down with black cohosh

    Some people have found 20 mg of a concentrated herbal extract twice a day relieves hot flashes

  • Find relief with exercise

    Even light aerobic activities can help reduce menopausal symptoms

  • Quit smoking

    Smokers are more likely to experience hot flashes and other menopausal symptoms

About

About This Condition

Menopause is the cessation of the monthly female menstrual cycle. Women who have not had a menstrual period for a year are considered postmenopausal.

Most commonly, menopause takes place when a woman is in her late forties or early fifties. Women who have gone through menopause are no longer fertile. Menopause is not a disease and cannot be prevented. Many hormonal changes occur during menopause. Postmenopausal women are at higher risk of heart disease and osteoporosis , presumably because of a decrease in the production of estrogen or other hormones.

Symptoms

Several unpleasant symptoms may accompany menopause. Some, such as vaginal dryness, result from the lack of estrogen. Others, such as hot flashes and decreased sex drive, are caused by more complex hormonal changes. Some women experience depression , anxiety , or insomnia during menopause.

Healthy Lifestyle Tips

Sedentary women are more likely to have moderate or severe hot flashes compared with women who exercise.1 , 2 In one trial, menopausal symptoms were reduced immediately after aerobic exercise.3

Cigarette smoking may be related to hot flashes in menopausal women. Preliminary data have shown that women who experience hot flashes are more likely to be smokers.4 Another preliminary study found that new users of hormone replacement therapy for the relief of menopausal symptoms were more likely to be current cigarette smokers than were those who had never smoked.5

Holistic Options

Acupuncture may be helpful in the treatment of menopausal symptoms. Animal research suggests that acupuncture may help normalize some biochemical changes that are associated with menopausal disturbances of memory, mood, and other functions.6 One preliminary trial in humans demonstrated a significant reduction (more than 50%) in hot flashes in menopausal women receiving either electroacupuncture (acupuncture with electrical stimulation) or superficial acupuncture (shallow needle insertion).7 Other preliminary trials support these results8 , 9 and suggest additional menopausal symptoms may also respond to acupuncture.10 However, no placebo-controlled trials have been done to conclusively prove the effectiveness of acupuncture for menopausal symptoms.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Eat soy and flaxseed
Make foods high in phytoestrogens, such as flaxseed, tofu, soy milk, tempeh, and roasted soy nuts, a regular part of your diet.

Soybeans contain compounds called phytoestrogens that are related in structure to estrogen, though some reports show soy’s estrogenic activity to be quite weak.11 Soy is known to affect the menstrual cycle in premenopausal women.12 Societies with high consumption of soy products have a low incidence of hot flashes during menopause.13

In one double-blind trial, supplementation with 60 grams of soy protein caused a 33% decrease in the number of hot flashes after four weeks and a 45% reduction after 12 weeks.14 However, in further analysis of the data in this trial, researchers credit constituents in soybeans other than phytoestrogens for the therapeutic effect.15 In one controlled clinical trial, high intake of phytoestrogens from soy and flaxseed reduced both hot flashes and vaginal dryness; however, much (though not all) of the benefit was also seen in the control group.16 In another double-blind study, 100 mg per day of isoflavones extracted from soy was effective in relieving hot flashes,17 and another double-blind trial found that 120 mg of soy isoflavones per day was as effective as estrogen therapy for relieving menopausal symptoms.18 Eating 25 grams of soy nuts per day has also been shown to relieve menopausal symptoms in a double-blind trial.19 In other double-blind research, supplementation with 60 mg per day of isoflavones from soy significantly improved mental function and mood in postmenopausal women.20

As a result of these studies, doctors often recommend that women experiencing menopausal symptoms eat tofu, soy milk, tempeh, roasted soy nuts, and other soy-based sources of phytoestrogens. Soy sauce contains very little phytoestrogen content, and many processed foods made from soybean concentrates have insignificant levels of phytoestrogens. Supplements containing isoflavones extracted from soy are commercially available, and flaxseed (as opposed to flaxseed oil) is also a good source of phytoestrogens.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
2 Stars
Asian Ginseng
200 mg per day of standardized extract
Learn More

A double-blind trial found that Asian ginseng (200 mg per day of standardized extract) helped alleviate psychological symptoms of menopause, such as depression and anxiety , but did not decrease physical symptoms, such as hot flashes or sexual dysfunction, in postmenopausal women who had not been treated with hormones.21 In another double-blind trial, supplementation with 3 grams per day of red ginseng (heated Asian ginseng) for 12 weeks significantly improved menopausal hot flashes, compared with a placebo.22

2 Stars
Black Cohosh
20 mg of a highly concentrated herbal extract taken twice per day
Learn More

Some, but not all, double-blind trials support the usefulness of black cohosh for women with hot flashes associated with menopause.23 In a three-month study of postmenopausal women, 40 mg per day of an extract of black cohosh was as effective as estrogen therapy in the treatment of hot flashes.24 A review of eight trials concluded black cohosh to be both safe and effective.25 However, one double-blind trial found that black cohosh is ineffective as a treatment for menopausal symptoms.26 Many doctors recommend 20 mg of a highly concentrated extract taken twice per day; 2 to 4 ml of tincture three times per day may also be used.

In a double-blind study of postmenopausal women who were experiencing psychological symptoms, a combination of black cohosh and St. John's wort was significantly more effective than a placebo in improving both menopausal symptoms and depression . The product used in this study contained (per tablet) black cohosh standardized to 1 mg of triterpene glycosides and St. John's wort standardized to 0.25 mg of hypericin. The amount taken was two tablets twice a day for eight weeks, followed by one tablet twice a day for eight weeks.27

2 Stars
Black Cohosh and St. John's Wort (Depression)
Two tablets twice a day for 8 weeks, then one tablet twice a day for 8 weeks, each tablet supplying 1 mg of triterpene glycosides from black cohosh and 0.25 mg of hypericin from St. John's wort
Learn More
In a double-blind study of postmenopausal women who were experiencing psychological symptoms, a combination of black cohosh and St. John's wort was significantly more effective than a placebo in improving both menopausal symptoms and depression . The product used in this study contained (per tablet) black cohosh standardized to 1 mg of triterpene glycosides and St. John's wort standardized to 0.25 mg of hypericin. The amount taken was two tablets twice a day for eight weeks, followed by one tablet twice a day for eight weeks.28
2 Stars
Maca
2.5 to 3 grams per day for 6 to 12 weeks
Learn More
Maca (Lepidium meyenii) has been used traditionally for balancing female hormones. A review of randomized controlled trials concluded that maca appeared to be beneficial in the treatment of menopausal symptoms. The amount used in these studies was 2.5 to 3 grams per day for 6 to 12 weeks.29
2 Stars
Magnesium
250 to 500 mg per day 
Learn More
In a preliminary trial, supplementation with magnesium (250 to 500 mg per day for 4 weeks) significantly decreased the frequency of hot flashes by 47% in women who were experiencing menopausal symptoms after treatment for breast cancer.30
2 Stars
Progesterone
Apply enough topical cream to provide 20 mg of the supplement to the skin daily
Learn More

Natural progesterone supplementation has been anecdotally linked to reduction in symptoms of menopause.31 , 32 , 33 In one trial, natural progesterone was found to have no independent effect on symptoms, and synthetic progestins were found to increase breast tenderness.34 However, a double-blind trial found that topical administration of natural progesterone cream led to a reduction in hot flashes in 83% of women, compared with improvement in only 19% of those given placebo.35 Preliminary research has found that oral, micronized progesterone therapy is associated with improved quality of life among postmenopausal women. However, oral micronized progesterone is available only by prescription in the United States.36 Hot flashes, anxiety , depression , sleep problems, and sexual functioning were among the symptoms improved in a majority of women surveyed. Synthetic progestins, also available only by prescription, have reduced symptoms of menopause.37 , 38 , 39

Progesterone is a hormone and, as such, concerns about its inappropriate use (i.e., as an over-the-counter supplement) have been raised. The amount of progesterone in commercially available creams varies widely, and the progesterone content is not listed on the label because the creams are legally regulated as cosmetics, not dietary supplements. Therefore, a physician should be consulted before using these hormone-containing creams as supplements. Although few side effects have been associated with topical progesterone creams, skin reactions may occur in some users. Effects of natural progesterone on breast cancer risk remain unclear; research has suggested both increased and reduced risk.

2 Stars
Pycnogenol
60 to 200 mg per day
Learn More
In a double-blind trial, perimenopausal women who took 200 mg per day of Pycnogenol experienced reduction of menopausal symptoms as measured by a women’s health questionnaire.40 Improvement in menopausal symptoms was also reported in another double-blind trial, in which women took 30 mg of pycnogenol twice a day for three months.41
2 Stars
Red Clover
80 mg of isoflavones daily
Learn More

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.42 These herbs include licorice , alfalfa , and red clover . In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.43 No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.44 A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.45 An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.46 In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.47 An extract of red clover also decreased symptoms of anxiety and depression in postmenopausal women in a double-blind study. The extract provided 80 mg of isoflavones per day and was taken for 90 days.48

2 Stars
Sage and Alfalfa
4 to 6 grams daily of dried herb or equivalent
Learn More
Sage may reduce excessive perspiration due to menopausal hot flashes during the day or at night.49 It is believed this is because sage directly decreases production of sweat. In a preliminary study, supplementation with a product containing extracts of the leaves of sage and alfalfa resulted in complete elimination of hot flushes and night sweats in 20 of 30 women, with varying degrees of improvement in the other ten cases.50
2 Stars
Vitamin E
Refer to label instructions
Learn More

Many years ago, researchers studied the effects of vitamin E supplementation in reducing symptoms of menopause. Most,51 , 52 , 53 , 54 , 55 but not all,56 studies found vitamin E to be helpful, and the benefit of vitamin E was confirmed more recently in a double-blind trial.57 Many doctors suggest that women going through menopause take 400 to 800 IU per day of vitamin E for a trial period of at least three months to see if symptoms are reduced. If helpful, this amount may be continued or a lower amount may be tried for maintenance.

1 Star
Alfalfa
Refer to label instructions
Learn More

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.58 These herbs include licorice , alfalfa , and red clover . In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.59 No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.60 A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.61 An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.62 In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.63

1 Star
Blue Vervain
Refer to label instructions
Learn More

Blue vervain (Verbene hastata) is a traditional herb for menopause; however, there is no research to validate this use. Tincture has been recommended at an amount of 5–10 ml three times per day.

Preliminary evidence suggests that supplementation with St. John’s wort extract (300 mg three times daily for 12 weeks) may improve psychological symptoms, including sexual well-being, in menopausal women.64

1 Star
Burdock
Refer to label instructions
Learn More

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.65 These herbs include licorice , alfalfa , and red clover . In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.66 No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.67 A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.68 An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.69 In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.70

1 Star
DHEA
Refer to label instructions
Learn More

Aging in women is characterized by a progressive decline in blood DHEA (dehydroepiandrosterone) and DHEA-sulfate (DHEAS) levels. These levels can be restored with DHEA supplementation. This process also improves the response of some brain chemicals, called endorphins, to certain drugs.71 These endorphins are involved in sensations of pleasure and pain ; improving their response may explain why DHEA has an effect on mood symptoms associated with menopause. In one double-blind trial, however, menopausal women who took 50 mg of DHEA per day for three months had no improvement in symptoms compared with women taking placebo.72 Further study is needed to validate a role for DHEA in the management of menopausal symptoms.

1 Star
Dong Quai
Refer to label instructions
Learn More

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.73 These herbs include licorice , alfalfa , and red clover . In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.74 No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.75 A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.76 An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.77 In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.78

1 Star
Flavonoids
Refer to label instructions
Learn More

In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the flavonoid hesperidin taken over the course of the day helped relieve hot flashes.79 Although placebo effects are strong in women with hot flashes, other treatments used in that trial failed to act as effectively as the flavonoid/vitamin C combination. Since then, researchers have not explored the effects of flavonoids or vitamin C in women with menopausal symptoms.

1 Star
Flaxseed
2 tablespoons of flaxseeds twice per day
Learn More
In a preliminary trial, supplementation with crushed flaxseeds for six weeks improved the average hot flash score (a measure of the frequency and severity of hot flashes) by 57% in postmenopausal women who were not receiving estrogen therapy. The treatment consisted of 2 tablespoons of flaxseeds (along with at least 10 ounces of liquid) twice a day. About one-fifth of the women discontinued treatment because of abdominal symptoms or other side effects.80 In a double-blind trial, daily consumption of 25 g of partially defatted ground flaxseed significantly decreased the number of hot flashes and improved overall menopausal symptoms. However, the improvements were not greater than those in women given a placebo (wheat bran).81 Because of these conflicting results, the effectiveness of flaxseed as a treatment for menopause remains uncertain.
1 Star
Licorice
Refer to label instructions
Learn More

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.82 These herbs include licorice , alfalfa , and red clover . In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.83 No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.84 A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.85 An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.86 In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.87

1 Star
Motherwort
Refer to label instructions
Learn More

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.88 These herbs include licorice , alfalfa , and red clover . In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.89 No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.90 A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.91 An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.92 In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.93

1 Star
Sage
Refer to label instructions
Learn More

Sage may reduce excessive perspiration due to menopausal hot flashes during the day or at night.94 It is believed this is because sage directly decreases production of sweat. In a preliminary study, supplementation with a product containing extracts of the leaves of sage and alfalfa resulted in complete elimination of hot flushes and night sweats in 20 of 30 women, with varying degrees of improvement in the other ten cases.95

1 Star
St. John’s Wort
Refer to label instructions
Learn More

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market.98 Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort.

In a double-blind study of postmenopausal women who were experiencing psychological symptoms, a combination of black cohosh and St. John's wort was significantly more effective than a placebo in improving both menopausal symptoms and depression . The product used in this study contained (per tablet) black cohosh standardized to 1 mg of triterpene glycosides and St. John's wort standardized to 0.25 mg of hypericin. The amount taken was two tablets twice a day for eight weeks, followed by one tablet twice a day for eight weeks.99

Preliminary evidence suggests that supplementation with St. John’s wort extract (300 mg three times daily for 12 weeks) may improve psychological symptoms, including sexual well-being, in menopausal women.100 101

1 Star
Vitamin C
Refer to label instructions
Learn More

In 1964, a preliminary trial reported that 1,200 mg each of vitamin C and the flavonoid hesperidin taken over the course of the day helped relieve hot flashes.102 Although placebo effects are strong in women with hot flashes, other treatments used in that trial failed to act as effectively as the flavonoid/vitamin C combination. Since then, researchers have not explored the effects of flavonoids or vitamin C in women with menopausal symptoms.

1 Star
Wild Yam
Refer to label instructions
Learn More

A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.103 These herbs include licorice , alfalfa , and red clover . In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort (30 drops three times daily) was found to reduce symptoms of menopause.104 No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai (4.5 grams three times daily in capsules) had no effect on menopausal symptoms or hormone levels.105 A double-blind trial using a standardized extract of subterranean clover (Trifolium subterraneum), a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.106 An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a 12-week double-blind study.107 In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women. The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks.108

References

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2. Hammar M, Berg G, Lindgren R. Does physical exercise influence the frequency of postmenopausal hot flushes? Acta Obstet Gynecol Scand 1990;69:409–12.

3. Slaven L, Lee C. Mood and symptom reporting among middle-aged women: the relationship between menopausal status, hormone replacement therapy, and exercise participation. Health Psychol 1997;16:203–8.

4. Staropoli CA, Flaws JA, Bush TL, Moulton AW. Predictors of menopausal hot flashes. J Womens Health 1998;7:1149–55.

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6. Toriizuka K, Okumura M, Iijima K, et al. Acupuncture inhibits the decrease in brain catecholamine contents and the impairment of passive avoidance task in ovariectomized mice. Acupunct Electrother Res 1999;24:45–57.

7. Wyon Y, Lindgren R, Hammar M, Lundeberg T. Acupuncture against climacteric disorders? Lower number of symptoms after menopause. Lakartidningen 1994;91:2318–22 [in Swedish].

8. Popivanov P. Menopausal indices as criteria for the effectiveness of acupuncture treatment of the climacteric syndrome. Vutr Boles 1983;22:110–3 [in Bulgarian].

9. Kraft K, Coulon S. Effect of a standardized acupuncture treatment on complaints, blood pressure and serum lipids of hypertensive, postmenopausal women. A randomized, controlled clinical study. Forsch Komplementarmed 1999;6:74–9 [in German].

10. Lianzhong W, Xin Z. 300 cases of menopausal syndrome treated by acupuncture. J Trad Chin Med 1998;18:259–62.

11. Baird DD, Umbach DM, Landsedell L, et al. Dietary intervention study to assess estrogenicity of dietary soy among postmenopausal women. J Clin Endocrinol Metab 1995;80:1685–90.

12. Cassidy A, Bingham S, Setchell KD. Biological effects of a diet of soy protein rich in isoflavones on the menstrual cycle of premenopausal women. Am J Clin Nutr 1994;60:333–40.

13. Knight DC, Eden JA. A review of the clinical effects of phytoestrogens. Obstet Gynecol 1996;87:897–904 [review].

14. Albertazzi P, Pansini F, Bonaccorsi G, et al. The effect of dietary soy supplementation on hot flushes. Obstet Gynecol 1998;91:6–11.

15. Albertazzi P, Pansini F, Bottazzi M, et al. Dietary soy supplementation and phytoestrogen levels. Obstet Gynecol 1999;94:229–31.

16. Brezinski A, Adlercreutz H, Shaoul R, et al. Short-term effects of phytoestrogen-rich diet on postmenopausal women. Menopause 1997;4:89–94.

17. Han KK, Soares JM Jr, Haidar MA, et al. Benefits of soy isoflavone therapeutic regimen on menopausal symptoms. Obstet Gynecol 2002;99:389–94.

18. Kaari C, Haidar MA, Junior JMS, et al. Randomized clinical trial comparing conjugated equine estrogens and isoflavones in postmenopausal women: a pilot study. Maturitas2006;53:49–58.

19. Welty FK, Lee KS, Lew NS, et al. The association between soy nut consumption and decreased menopausal symptoms. J Womens Health 2007;16:361–9.

20. Casini ML, Marelli G, Papaleo E, et al. Psychological assessment of the effects of treatment with phytoestrogens on postmenopausal women: a randomized, double-blind, crossover, placebo-controlled study. Fertil Steril2006;85:972–8.

21. Wiklund IK, Mattson LA, Lindgren R, et al. Effects of a standardized ginseng extract on quality of life and psychological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Int J Clin Pharm Res 1999;19:89–99.

22. Kim SY, Seo SK, Choi YM, et al. Effects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women: a double-blind randomized controlled trial. Menopause 2012;19:461–6.

23. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecological disorders. Advances Therapy 1998;15:45–53.

24. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 2005;20:30–5.

25. Lieberman S. A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Womens Health 1998;7:525–9.

26. Newton KM, Reed SD, LaCroix AZ, et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 2006;145:869–79.

27. Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006;107:247–55.

28. Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006;107:247–55.

29. Lee MS, Shin BC, Yang EJ, et al. Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas 2011;70:227–33.

30. REF:Park H, Parker GL, Boardman CH, et al. A pilot phase II trial of magnesium supplements to reduce menopausal hot flashes in breast cancer patients. Support Care Cancer 2011;19:859–63.

31. Lee JR. Natural Progesterone. The multiple roles of a remarkable hormone. Sebastipol, CA: BLL Publishing, 1993, 31–7.

32. Gaby AR. Commentary. Nutr Healing 1996;June:1,10–1.

33. Wright JV. Hormones for menopause. Nutr Healing 1996;June:1–2,9.

34. Greendale GA, Reboussin BA, Hogan P, et al. Symptom relief and side effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin Interventions Trial. Obstet Gynecol 1998;92:982–8.

35. Leonetti HB, Long S, Anasti JM. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol 1999;94:225–8.

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105. Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril 1997;68:981–6.

106. Nestel PJ, Pomeroy S, Kay S, et al. Isoflavones from red clover improve systemic arterial compliance but not plasma lipids in menopausal women. J Clin Endocrinol Metab 1999;84:895–8.

107. Tice JA, Ettinger B, Ensrud K, et al. Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study: a randomized controlled trial. JAMA 2003;290:207–14.

108. van de Weijer PHM, Barentsen R. Isoflavones from red clover (Promensil®) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas 2002;42:187–93.

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