Menopausal Symptoms (Other Than Osteoporosis)
The hormonal changes of menopause can produce a wide variety of symptoms, ranging from hot flashes and vaginal dryness to anxiety, depression, and insomnia. Many of these symptoms are undoubtedly caused by the natural decrease in estrogen production that occurs at menopause; however, the human body is so complex that other hormonal factors undoubtedly also play a role.
Menopause is not a disease. It is clearly a natural process, but one that many women prefer not to experience. No longer do women accept as merely part of life the decrease in libido, pain during intercourse, years of hot flashes, and other uncomfortable problems that may accompany menopause. This raises an important point: How close to nature do we want to live? One of the most valued ideals of alternative medicine is the desire to trust nature, but sometimes we may want to draw a line. For example, in a state of nature, infant and maternal mortality is high. This process of survival of the fittest helps humanity as a species to be stronger, but it is not something that a compassionate society can tolerate. Thus, no matter what our ideals, we frequently find ourselves tampering with nature. The treatment of menopause is simply one example among many.
Estrogen-replacement therapy can alleviate many of the problems associated with menopause. However, it creates counterbalancing risks. The most frightening issue is the increased risk of breast cancer that appears to be associated with replacement estrogen. In addition, estrogen therapy can cause blood clots in the legs, and it appears to raise the risk of heart disease rather than prevent it (as previously thought). The decision whether to use estrogen-replacement therapy for menopausal symptoms should involve a careful examination of the risks and benefits in consultation with a physician.
Principal Proposed Natural Treatments
Several natural treatments may reduce menopausal symptoms, as compared to placebo. (The latter comparison is essential, as placebo itself is dramatically effective for menopause, generally reducing the rate of hot flashes by 50%!)28
We do not know for sure whether any of these reduce the risk of osteoporosis. See the full article on Osteoporosis for more detailed information on natural ways to prevent bone loss.
Soy and Soy (or Other Source) Isoflavones
Both soy and red clover contain phytoestrogens (naturally occurring substances with estrogen-like actions) called isoflavones. It is thought that the isoflavones in these herbs may offer some benefits of estrogen with less risk. However, the current evidence base for this hypothesis is conflicting.
Improvements in hot flashes as well as other symptoms, such as vaginal dryness and mood, have been seen in many studies of soy, mixed soy isoflavones, aglycone isoflavones, and the isoflavone genistein alone.23-24,69-72,91-93,146,153,163 However, about as many studies have failed to find significant benefit as compared to placebo with soy or concentrated isoflavones.5,43,44,67,73,79,80,94,107,108,113,133-134,153,179 A review of 13 randomized trials with 1,996 women showed a reduced frequency of hot flashes with soy isoflavones compared to placebo, with more than 12 weeks of treatment showing the greatest effect. Hot flash severity improved in 9 randomized trials involving 988 women with soy isoflavones compared to placebo.173
For example, a double-blind study of 247 women suffering from menopausal hot flashes compared the effects of placebo and genistein over a period of one year.133 Genistein was taken at a dose of 54 mg per day. The results indicated that use of genistein significantly reduced hot flashes as compared to placebo.
In addition, isoflavones from red clover have shown inconsistent results in studies, with the best and largest study finding no benefit.68,95,109,110, 114
What can one make of this mixed evidence? One problem here is that placebo treatment has a strong effect on menopausal symptoms. In such circumstances, statistical noise can easily drown out the real benefits of a treatment under study. Unlike estrogen, which has such a powerful effect on hot flashes and other menopausal symptoms that its benefits are almost always clear in studies, soy or concentrated isoflavones likely have a more modest effect, one that does not always show itself above the background noise of statistical variation. It has also been suggested that the placebo used in many of these studies, polyunsaturated fatty acids, may have efficacy of its own; this would tend to hide actual benefits.115
Another explanation may be that certain women benefit from soy isoflavones more than others. In about one-third of people, isoflavones are converted by intestinal bacteria into a substance called equol. At least two studies suggest that these equol producers may experience greater reduction in their menopausal symptoms than non-equol producers.155,156
Evidence regarding whether soy or soy isoflavones are helpful for osteoporosis remains conflicting.7-15,73-75,96-102,159 On balance, it is probably fair to summarize current evidence as indicating that isoflavones (either as soy, genistein, mixed isoflavones, or tofu extract) have a modestly beneficial effect on bone density.
Interestingly, one small but long-term study suggests that progesterone cream (another treatment proposed for use in preventing or treating osteoporosis) may decrease the bone-sparing effect of soy isoflavones.96
Soy isoflavones (60 mg-160 mg daily for 6 weeks to 30 months) were associated with significantly improved cognitive function and visual memory in a review of 10 randomized trials with 1,024 postmenopausal women. The isoflavones were compared to placebo in all trials. However several factors, such as age at the start of treatment, location of treatment, and treatment duration may affect the overall success of the supplement.177
For more information, including dosage and safety issues, see the full Isoflavone article.
The herb black cohosh is widely used for treatment of menopause, but the evidence that it works remains incomplete and inconsistent.160,161
The best study was a 12-week, double-blind, placebo-controlled trial of 304 women with menopausal symptoms.111 This study appeared to find that black cohosh was more effective than placebo. The best evidence was for a reduction in hot flashes. However, the statistical procedures used in the study were somewhat unusual and open to question.
Promising results were also seen in a 3-month, double-blind study of 120 menopausal women.141 Participants were given either black cohosh or fluoxetine (Prozac). Over the course of the trial, black cohosh proved more effective than fluoxetine for hot flashes, but fluoxetine was more effective than black cohosh for menopause-related mood changes.
Previous smaller studies have found improvements not only in hot flashes but also in other symptoms of menopause. For example, in a double-blind, placebo-controlled study, 97 menopausal women received black cohosh, estrogen, or placebo for 3 months.81 The results indicated that the herb reduced overall menopausal symptoms (including hot flashes) to the same extent as the drug. In addition, microscopic analysis showed that black cohosh had an estrogen-like effect on the cells of the vagina. This is a positive result because it suggests that black cohosh might reduce vaginal thinning. However, black cohosh did not affect the cells of the uterus in an estrogen-like manner; this too is a positive result, as estrogen’s effects on the uterus are potentially harmful. Finally, the study found hints that black cohosh might help protect bone. However, a great many of the study participants dropped out, making the results less than reliable.
One study, too small to have reliable results from a statistical point of view, found black cohosh equally effective as 0.6 mg daily of conjugated estrogens.125
A study reported in 2006 found that black cohosh has weak estrogen-like effects on vaginal cells and possible positive effects on bone (specifically, stimulating new bone formation).116
A substantial (244-participant) double-blind study published in 2007 compared black cohosh against the synthetic hormone tibolone and found them equally effective for treating menopausal symptoms.142 Though not approved as a drug in the US, tibolone does appear to be effective for menopausal symptoms, and therefore these results are somewhat promising.143 However, this study lacked a placebo group, and since the placebo effect is powerful for this condition, this omission significantly reduces the meaningfulness of the results.
One interesting double-blind study evaluated a combination therapy containing black cohosh and St. John's wort in 301 women with general menopausal symptoms as well as depression.117 The results showed that use of the combination treatment was significantly more effective than placebo for both problems. A smaller study using a combination of the same two herbs found improvements in overall menopausal symptoms as well as cholesterol profile.138
In contrast, there have been several studies that failed to find benefit. For example, in a 12-month double-blind, placebo-controlled study of 350 women, participants were given either black cohosh, a supplement containing 10 herbs, the multibotanical plus soy, standard hormone replacement therapy, or placebo.118,154 The results showed significant benefits as compared to placebo for hormone replacement therapy, but only slight, nonsignificant benefits with the other treatments. In addition, a double-blind study of 122 women failed to find statistically significant benefits with black cohosh as compared to placebo,119 as did another study enrolling 132 women,123 as well as one double-blind, placebo-controlled study that involved 124 women given a black cohosh/soy isoflavone combination.120 These negative outcomes were quite possibly due to the relatively small sizes of the black cohosh groups. In a condition such as menopausal symptoms, where the placebo effect is strong and treatment is relatively weak, large numbers of participants are necessary to show benefit above and beyond the placebo effect. Nonetheless, this is an impressive number of negative studies, and some question must remain about the efficacy of this herb.
The bottom line: Black cohosh may be modestly effective for reducing hot flashes and other symptoms of menopause, but doubts remain.
Some interesting information has developed regarding how black cohosh might work. In the past, the herb was described as a phytoestrogen. However, subsequent evidence indicates that black cohosh is not a general phytoestrogen, but may act like estrogen in only a few parts of the body: the brain (reducing hot flashes), bone (potentially helping to prevent or treat osteoporosis), and possibly the vagina (alleviating dryness and thinning). It does not appear to act like estrogen in the breast or the uterus, which is good news, as estrogen is carcinogenic in those tissues.20,21,30-32,81,83-87,103,121 If this theory is true, black cohosh is a selective-estrogen receptor modifier (SERM), somewhat like the drug raloxifen (Evista). However, more evidence is needed.
For more information, including dosage and safety issues, see the full Black Cohosh article.
Other Proposed Natural Treatments TOP
Rhubarb contains the phytoestrogenic substance lindleyin. On this basis, extracts of rhubarb have been tried for control of menopausal symptoms. In a 12-week, double-blind, placebo-controlled trial of 109 women with menopause-related problems, use of a special rhubarb extract (ERr 731) significantly improved symptoms as compared to placebo.124 Note: Raw rhubarb is toxic when taken in excessive quantities. The special standardized extract used in these trials was processed so as to remove toxic components.
Grass pollen extracts have shown promise for treatment of benign prostate enlargement. Their benefits in that condition may result from a hormonal effect. On this basis, grass pollens have been proposed for treatment of menopausal symptoms. One double-blind, placebo-controlled study followed 54 women with menopausal symptoms and found benefits with a supplement containing grass pollen extract.122
The herb Pueraria mirifica, which contains numerous phytoestrogens, has recently been promoted as an effective treatment for menopausal symptoms. In one double-blind study, the herb showed promise for improving vaginal dryness.136 In another trial comparing Pueraria mirifica to standard estrogen treatment (0.625 mg conjugated equine estrogen), researchers found the herb to be equally effective at relieving a range of menopausal symptoms.152
In addition, another double-blind study found benefit with a combination product containing standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, and chasteberry.137
For many years, the hormone progesterone (so-called “natural progesterone,” as distinguished from the synthetic progestins used in birth control pills and hormone replacement therapy) was aggressively promoted by some alternative medicine practitioners as the true cure for osteoporosis. However, at that time there was no meaningful evidence that progesterone helps prevent osteoporosis—these claims were based largely on anecdotes, plausible reasoning, and “studies” that did not come close to modern scientific standards. When the subject was finally studied properly, the first results indicated that progesterone does not work for osteoporosis after all. However, it may work for other menopausal symptoms. A 1-year, double-blind, placebo-controlled study of 102 women found that cream containing 20 mg of the hormone progesterone may be effective against hot flashes,39 though it did not appear to protect bone from breakdown. However, another double-blind trial failed to find 32 mg daily effective for osteoporosis or any other menopause-related symptoms.88 See the Progesterone article for more information.
The hormone dehydroepiandrosterone (DHEA) has been tested as a treatment for menopausal symptoms, with some promising results in a small, preliminary trial.104 Because it is a naturally-occuring hormone, there has been some concern regarding the safety of supplemental DHEA. (See DHEA article for more information on its safety.) However, a placebo-controlled trial with 93 postmenopausal women found DHEA supplementation for 1 year was not associated with increased adverse endometrial effects or changes in blood lipids or insulin sensitivity.165
A small double-blind study conducted in Iran reported that vitamin E (400 IU daily) was more effective than placebo for treating menopausal hot flashes.145 However, a larger US study failed to find vitamin E significantly helpful for hot flashes associated with breast cancer treatment.42
An extract made from human placenta (HPE) is used in South Korea and other areas of East Asia as a treatment for numerous conditions. One study compared HPE against normal saline solution for treatment of menopause.151 In this 8-week trial, participants were given either normal saline or HPE as a subcutaneous injection through the skin of the abdomen. The results appear to indicate that HPE might improve some symptoms of menopause.151
Evidence far too weak to be relied upon at all has been quoted in support of flaxseed,147-149gamma oryzanol,76multivitamin/multimineral combinations,130 and St. John's wort.41 Other proposed treatments that lack meaningful supporting evidence include bioflavonoids,41chasteberry, licorice,105suma, and vitamin C. In one trial, a combination of St. John’s wort and chasteberry for 16 weeks failed to produce any significant benefit compared to placebo in 100 women suffering from hot flashes due to menopause.162
Evidence regarding whether acupuncture might improve menopausal symptoms remains unconvincing.89,106,126-128, 132,135,166,167,170,180 For example, one study that appears on the surface to be well-designed found no benefit at all in the placebo group.135 This is so unusual as to cast significant doubt on the results. Another pilot study found no significant difference between the sham (fake) acupuncture and real acupuncture for hot flashes.159 A small, placebo-controlled study among breast cancer patients with hot flashes due to their treatments did suggest some benefit for acupuncture, though the results were inconclusive.164 Two studies involving 462 post-menopausal women each concluded that acupuncture, when added to usual self-care, effectively reduces the frequency of hot flashes for at least 2 months. This effect may only be short-term, however. In one of these studies, researches re-evaluating participants at 6 and 12 months found the acupuncture group was no better that the group who received only self-care.166,167 Results were unpromising in a small single-blind randomized trial of 54 women. Acupuncture was compared to sham acupuncture for hot flashes in peri-menopausal and post-menopausal women. There was no difference between the groups in a combined measure of hot flash frequency and severity 8 weeks after treatment ended.171
Acupuncture in combination with dietary principals used in the Traditional Chinese herbal medicine and self-massage was significantly better than diet and self-massage alone in a randomized trial with 100 menopausal women. The addition of acupuncture was associated with a decrease in the frequency of hot flushes, sudden sweating, sleep disorders, irritability, and headache. Acupuntcure was also associated with decreased intensity of memory loss, vaginal dryness, skin changes, urinary tract problems, and genital itching.178
It has been suggested that royal jelly is beneficial for menopausal symptoms, but there is no evidence to support this claim. The same is true regarding Traditional Chinese herbal medicine for menopause. One study has been widely reported as proving the effectiveness of a particular Chinese herbal formula, but because it lacked a placebo group, it actually does not do so.90 Another study failed to find the Chinese herb Pueraria lobata helpful for menopausal symptoms.144
However, a single-blind randomized trial of 120 women found that a combination of evening primrose oil, damiana, ginseng, and royal jelly taken for 4 weeks significantly reduced menopausal symptoms compared to placebo.172
The herb alfalfa contains strong phytoestrogens.45-47 This might make it helpful for menopause, but no studies have been reported.
One double-blind, placebo-controlled study failed to find melatonin more helpful than placebo for menopausal symptoms. (Actually, placebo did a little better than melatonin.) Another study failed to find that ginkgo improved mood, general energy level, or mental function in menopausal women.112
Heavy exercise causes increased calcium loss through sweat, and the the body does not compensate for this by reducing calcium loss in the urine.150 The result can be a net calcium loss great enough so that it presents health concerns for menopausal women. One study found that use of an inexpensive calcium supplement (calcium carbonate), taken at a dose of 400 mg twice daily, is sufficient to offset this loss.150
In a randomized, controlled trial, 8 weeks of daily supervised yoga was modestly more effective than a similar amount of supervised physical exercise in relieving menopausal symptoms (eg, hot flashes), decreasing psychological stress, and improving cognitive abilities among 120 women.157,158 Another study failed to find exercise helpful for reducing menopausal symptoms.129
Aerobic exercise however, may be beneficial for sedentary women. In a randomized trial of 176 women who had their last menstrual period within 3-36 months, aerobic exercise was associated with a decrease in menopausal symptoms, including night sweats, irritability, depression, mood swings, headache, and urinary problems. The trial compared unsupervised aerobic exercise for 50 minutes, 4 times per week to twice monthly health lectures.175
Relaxation therapies were not effective in reducing the frequency or severity hot flashes in peri- and postmenopausal women. Four randomized trials with 281 women compared relaxation therapies to acupuncture, superficial needle insertion, paced respiration, placebo, or no treatment.176
There is inconsistent evidence to support the use of wild yam to reduce menopausal symptoms. For example, in a double-blind, placebo-controlled study of 23 women with symptoms of menopause, use of wild yam did not reduce hot flashes nor raise levels of progesterone or estrogen in the body.168 However, a study involving 50 menopausal women found that the yam species Diascorea alata (12 mg sachet twice daily for 12 months) was more effective at relieving menopausal symptoms than placebo.169
A randomized trial of 64 pre-, peri-, and postmenopausal women showed improvement of menopausal symptoms with a combination of Cynanchum wilfordii, Phlomis umbrosa and Angelica gigas compared to placebo.174
In a randomized trial of 88 women with moderate to severe postmenopausal symptoms, fenugreek seed husk extract was associated with a reduction in hot flashes when compared to placebo. Fenugreek also improved physical and mental fatigue, and overall well-being.181
Estriol: A Safer Form of Estrogen? TOP
For over a decade, some alternative medicine practitioners have popularized the use of a special form of estrogen called estriol, claiming that, unlike standard estrogen, it does not increase the risk of cancer. However, this claim is unfounded.
There is no real doubt that estriol is effective. Controlled and double-blind trials have found oral or vaginal estriol effective for reducing hot flashes, night sweats, insomnia, vaginal dryness, recurrent urinary tract infections, and osteoporosis.49-57
Estriol might cause less vaginal bleeding as a side effect than other forms of estrogen, but this has not been proven.58,59
However, like other forms of estrogen, oral estriol stimulates the growth of uterine tissue. This leads to a risk of uterine cancer.
In a placebo-controlled study of 1,110 women, uterine tissue stimulation was seen among women given estriol orally (1 mg to 2 mg daily) as compared to those given placebo.60 Another large study found that oral estriol increased the risk of uterine cancer.61 In another study of 48 women given estriol 1 mg twice daily, uterine tissue stimulation was seen in the majority of cases.62
In contrast, a 12-month, double-blind trial of oral estriol (2 mg daily) in 68 Japanese women found no effect on the uterus.63 It may be that the high levels of soy in the Japanese diet altered the results.
Additionally, test tube studies suggest that estriol is just as likely to cause breast cancer as any other form of estrogen.64
The bottom line: If you are considering using estriol, think of it as equivalent to any other form of estrogen.
References[ + ]
1. Albertazzi P, Pansini F, Bonaccorsi G, et al. The effect of dietary soy supplementation on hot flushes. Obstet Gynecol. 1998;91:6-11.
2. Brzezinski A, Adlercreutz H, Shaoul R, et al. Short-term effects of phytoestrogen-rich diet on postmenopausal women. Menopause. 1997;4:89-94.
3. Scambia G, Mango D, Signorile PG, et al. Clinical effects of a standardized soy extract in postmenopausal women: a pilot study. Menopause. 2000;7:105-111.
4. Washburn S, Burke GL, Morgan T, et al. Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women. Menopause. 1999;6:7-13.
5. St. Germain A, Peterson CT, Robinson JG, et al. Isoflavone-rich or isoflavone-poor soy protein does not reduce menopausal symptoms during 24 weeks of treatment. Menopause. 2001;8:17-26.
6. Potter SM, Baum JA, Teng H, et al. Soy protein and isoflavones: their effects on blood lipids and bone density in postmenopausal women. Am J Clin Nutr. 1998;68(suppl):1375S-1379S.
7. Alekel DL, St. Germain A, Peterson CT, et al. Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women. Am J Clin Nutr. 2000;72:844-852.
8. Harrison E, Adjei A, Ameho C, et al. The effect of soybean protein on bone loss in a rat model of postmenopausal osteoporosis. J Nutr Sci Vitaminol (Tokyo). 1998;44:257-268.
9. Fanti O, Faugere MC, Gang Z, et al. Systematic administration of genistein partially prevents bone loss in ovariectomized rats in a nonestrogen-like mechanism [abstract]. Am J Clin Nutr. 1998;68(suppl):1517S-1518S.
10. Arjmandi BH, Alekel L, Hollis BW, et al. Dietary soybean protein prevents bone loss in an ovariectomized rat model of osteoporosis. J Nutr. 1996;126:161-167.
11. Arjmandi BH, Birnbaum R, Goyal NV, et al. Bone-sparing effect of soy protein in ovarian hormone-deficient rats is related to its isoflavone content. Am J Clin Nutr. 1998;68(suppl):1364S- 1368S.
12. Fanti P, Monier-Faugere MC, Geng Z, et al. The phytoestrogen genistein reduces bone loss in short-term ovariectomized rats. Osteoporos Int. 1998;8:274-281.
13. Anderson JJ, Ambrose WW, Garner SC. Biphasic effects of genistein on bone tissue in the ovariectomized, lactating rat model. Proc Soc Exp Biol Med. 1998;217:345-350.
14. Malochet S, Picherit C, Horcajada-Molteni MN, et al. Do endurance training and soy isoflavones exhibit additive effects on ovariectomy-induced osteopenia in the rat? [abstract]. J Bone Miner Res. 1999;14(suppl 1):S536.
15. Gallagher JC, Rafferty K, Haynatzka V, et al. The effect of soy protein on bone metabolism [abstract]. J Nutr. 2000;130:666S-669S.
19. Stoll W. A phythotherapeutic agent affects atrophic vaginal epithelium. Double-blind study: Cimicifuga vs. an estrogen preparation [translated from German]. Therapeutikon. 1987;1:23-31.
20. Liske E, Hanggi W, Henneicke-Von Zepelin HH, et al. Physiological investigation of a unique extract of black chosh ( Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. 2002;11:163-174.
21. Einer-Jensen N, Zhao J, Andersen KP, et al. Cimicifuga and melbrosia lack oestrogenic effects in mice and rats. Maturitas. 1996;25:149-153.
22. Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol. 2001;19:2739-2745.
23. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine 3rd ed. Berlin, Germany: Springer-Verlag; 1998: 246.
24. Warnecke G. Influencing menopausal symptoms with a phytotherapeutic agent [in German]. Med Welt. 1985;36:871-874.
25. Stolze H. An alternative to treat menopausal complaints [translated from German]. Gyne. 1982;1:14-16.
26. Lehmann-Willenbrock VE, Riedel H-H. Clinical and endocrinologic examinations about therapy of climacteric symptoms following hysterectomy with remaining ovaries [in German; English abstract]. Zentralbl Gynakol. 1988;110:611-618.
27. Liske E, Hanggi W, Henneicke-Von Zepelin HH, et al. Physiological investigation of a unique extract of black cohosh ( Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med. 2002;11:163-174.
28. MacLennan A, Lester S, Moore V. Oral estrogen replacement therapy versus placebo for hot flushes: a systematic review. Climacteric. 2001;4:58-74.
29. Einer-Jensen N, Zhao J, Andersen KP, et al. Cimicifuga and Melbrosia lack oestrogenic effects in mice and rats. Maturitas. 1996;25:149-153.
30. Seidlova-Wuttke D, Wuttke W. Selective estrogen receptor modulator activity of Cimicifuga racemosa extract: clinical data [abstract]. Phytomedicine. 2000;7(suppl 2):11.
31. Seidlova-Wuttke D, Jarry H, Heiden I, et al. Effects of Cimicifuga racemosa on estrogen-dependent tissues [abstract]. Phytomedicine. 2000;7(suppl 2):11-12.
32. Wuttke W, Jarry H, Heiden I, et al. Selective estrogen receptor modulator (SERM) activity of the Cimicifuga racemosa extract.
BNO 1055: pharmacology and mechanisms of action [abstract]. Phytomedicine. 2000;7(suppl 2):12.
39. Leonetti HB, Longo S, Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol. 1999;94:225-228.
40. Adlercreutz H, Mazur W. Phyto-estrogens and Western diseases. Ann Med. 1997;29:95-120.
41. Grube B, Walper A, Wheatley D. St. John's Wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther. 1999;16:177-186.
42. Barton DL, Loprinzi CL, Quella SK, et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol. 1998;16:495-500.
43. Baber RJ, Templeman C, Morton T, et al. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women. Climacteric. 1999;2:85-92.
44. Knight DC, Howes JB, Eden JA. The effect of Promensil™, an isoflavone extract, on menopausal symptoms. Climacteric. 1999;2:79-84.
45. Kurzer MS, Xu X. Dietary phytoestrogens. Annu Rev Nutr. 1997;17:353-381.
46. Shemesh M, Lindrer HR, Ayalon N. Affinity of rabbit uterine oestradiol receptor for phyto-oestrogens and its use in a competitive protein-binding radioassay for plasma coumestrol. J Reprod Fertil. 1972;29:1-9.
47. De Leo V, Lanzetta D, Cazzavacca R, et al. Treatment of neurovegetative menopausal symptoms with a phytotherapeutic agent [in Italian; English abstract]. Minerva Ginecol. 1998;50:207-211.
48. 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;68:981-986.
49. Takahashi K, Manabe A, Okada M, et al. Efficacy and safety of oral estriol for managing postmenopausal symptoms. Maturitas. 2000;34:169-177.
50. Minaguchi H, Uemura T, Shirasu K, et al. Effect of estriol on bone loss in postmenopausal Japanese women: a multicenter prospective open study. J Obstet Gynaecol Res. 1996;22:259-265.
51. Itoi H, Minakami H, Sato I. Comparison of the long-term effects of oral estriol with the effects of conjugated estrogen, 1-alpha-hydroxyvitamin D3 and calcium lactate on vertebral bone loss in early menopausal women. Maturitas. 1997;28:11-17.
52. Hayashi T, Ito I, Kano H, et al. Estriol (E3) replacement improves endothelial function and bone mineral density in very elderly women. J Gerontol A Biol Sci Med Sci. 2000;55:B183-B190.
53. Dugal R, Hesla K, Sordal T, et al. Comparison of usefulness of estradiol vaginal tablets and estriol vagitories for treatment of vaginal atrophy. Acta Obstet Gynecol Scand. 2000;79:293-297.
54. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329:753-756.
55. van der Linden MC, Gerretsen G, Brandhorst MS, et al. The effect of estriol on the cytology of urethra and vagina in postmenopausal women with genito-urinary symptoms. Eur J Obstet Gynecol Reprod Biol. 1993;51:29-33.
56. Holland EF, Leather AT, Studd JW. Increase in bone mass of older postmenopausal women with low mineral bone density after one year of percutaneous oestradiol implants. Br J Obstet Gynaecol. 1995;102:238-242.
57. Nozaki M, Hashimoto K, Inoue Y, et al. Usefulness of estriol for the treatment of bone loss in postmenopausal women [in Japanese; English abstract]. Nippon Sanka Fujinka Gakkai Zasshi. 1996;48:83-88.
58. Minaguchi H, Uemura T, Shirasu K, et al. Effect of estriol on bone loss in postmenopausal Japanese women: a multicenter prospective open study. J Obstet Gynaecol Res. 1996;22:259-265.
59. Takahashi K, Manabe A, Okada M, et al. Efficacy and safety of oral estriol for managing postmenopausal symptoms. Maturitas. 2000;34:169-177.
60. Granberg S, Ylostalo P, Wikland M, et al. Endometrial sonographic and histologic findings in women with and without hormonal replacement therapy suffering from postmenopausal bleeding. Maturitas. 1997;27:35-40.
61. Weiderpass E, Baron JA, Adami HO, et al. Low-potency oestrogen and risk of endometrial cancer: a case-control study. Lancet. 1999;353:1824-1828.
62. Montoneri C, Zarbo G, Garofalo A, et al. Effects of estriol administration on human postmenopausal endometrium. Clin Exp Obstet Gynecol. 1987;14:178-181.
63. Takahashi K, Manabe A, Okada M, et al. Efficacy and safety of oral estriol for managing postmenopausal symptoms. Maturitas. 2000;34:169-177.
64. Lippman M, Monaco ME, Bolan G. Effects of estrone, estradiol and estriol on hormone-responsive human breast cancer in long-term tissue culture. Cancer Res. 1977;37:1901-1907.
65. Komesaroff PA, Black CV, Cable V, et al. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric. 2001;4:144-150.
66. Wuttke W. Paper presented at: 84th Annual Meeting of The Endocrine Society; June 21, 2002. Abstracts P3-333, P3-317.
67. Kotsopoulos D, Dalais FS, Liang YL, et al. The effects of soy protein containing phytoestrogens on menopausal symptoms in postmenopausal women. Climacteric. 2000;3:161-167.
68. van de Weijer P, Barentsen R. Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas. 2002;42:187.
69. Murkies AL, Lombard C, Strauss BJ, et al. Dietary flour supplementation decreases post-menopausal hot flashes: effect of soy and wheat. Maturitas. 1995;21:189-195.
70. Han KK, Soares JM, Haidar MA et al. Benefits of soy isoflavone therapeutic regimen on menopausal symptoms. Obstet Gynecol. 2002;99:389-394.
71. Faure ED, Chantre P, Mares P. Effects of a standardized soy extract on hot flushes: a multicenter, double-blind, randomized, placebo-controlled study. Menopause. 2002;9:329-334.
72. Upmalis DH, Lobo R, Bradley L, et al. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause. 2000;7:236-242.
73. Messina M, Gardner C, Barnes S. Gaining insight into the health effects of soy but a long way still to go: commentary on the fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease. J Nutr. 2002;132:547S-551S.
74. Lees CJ, Ginn TA. Soy protein isolate diet does not prevent increased cortical bone turnover in ovariectomized macaques. Calcif Tissue Int. 1998;62:557-558.
75. Jayo MJ. Dietary soy isoflavones and bone loss: a study in ovariectomized monkeys [abstract]. J Bone Miner Res. 1996;11(suppl 1):S228.
76. Cicero AF, Gaddi A. Rice bran oil and gamma-oryzanol in the treatment of hyperlipoproteinaemias and other conditions. Phytother Res. 2001;15:277-289.
77. Chenoy R, Hussain S, Tayob Y, et al. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. BMJ. 1994;308:501-503.
78. Wiklund IK, Mattsson LA, Lindgren R, et al. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Int J Clin Pharmacol Res. 1999;19:89-99.
79. Penotti M, Fabio E, Modena AB, et al. Effect of soy-derived isoflavones on hot flushes, endometrial thickness, and the pulsatility index of the uterine and cerebral arteries. Fertil Steril. 2003;79:1112-1117.
80. Burke GL, Legault C, Anthony M, et al. Soy protein and isoflavone effects on vasomotor symptoms in peri- and postmenopausal women: the Soy Estrogen Alternative Study. Menopause. 2003;10:147-153.
81. Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas. 2003;44(suppl 1):S67-S77.
82. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. AdvTher. 1998;15:45-53.
83. Nesselhut T, Schellhase C, Dietrich R, et al. Investigation into the growth-inhibitive efficacy of phytopharmacopia with estrogen-like influences on mammary gland carcinoma cells [translated from German]. Arch Gynecol Obstet. 1993;254:817-818.
84. Freudenstein J, Dasenbrock C, Nisslein T. Lack of promotion of estrogen dependent mammary gland tumors in vivo by an isopropanolic black cohosh extract [abstract]. Phytomedicine. 2000;7(suppl 2):13.
85. Nesselhut T, Liske E. Pharmacological measures in postmenopausal women with an isopropanolic aqueous extract of Cimicifugae racemosae rhizoma.Menopause. 1999;6:1072-3714.
86. Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med. 1998;217:369-378.
87. Jarry H, Harnischfeger G. Endocrine effects of constituents of Cimicifuga racemosa 1. The effect on serum levels of pituitary hormones in ovariectomized rats. Planta Med. 1985;1:46-49.
88. Wren BG, Champion SM, Willetts K, et al. Transdermal progesterone and its effect on vasomotor symptoms, blood lipid levels, bone metabolic markers, moods, and quality of life for postmenopausal women. Menopause. 2003;10:13-18.
89. 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;6:74-79.
90. Chen LC, Tsao YT, Yen KY, et al. A pilot study comparing the clinical effects of Jia-Wey Shiau-Yau San, a traditional Chinese herbal prescription, and a continuous combined hormone replacement therapy in postmenopausal women with climacteric symptoms. Maturitas. 2003;44:55-62.
91. Crisafulli A, Marini H, Bitto A, et al. Effects of genistein on hot flushes in early postmenopausal women: a randomized, double-blind EPT- and placebo-controlled study. Menopause. 2004;11:400-404.
92. Chiechi LM, Putignano G, Guerra V, et al. The effect of a soy rich diet on the vaginal epithelium in postmenopause: a randomized double blind trial. Maturitas. 2003;45:241-246.
93. Messina M, Hughes C. Efficacy of soyfoods and soybean isoflavone supplements for alleviating menopausal symptoms is positively related to initial hot flush frequency. J Med Food. 2003;6:1-11.
94. Secreto G, Chiechi LM, Amadori A, et al. Soy isoflavones and melatonin for the relief of climacteric symptoms: a multicenter, double-blind, randomized study. Maturitas. 2004;47:11-20.
95. Tice JA, Ettinger B, Ensrud K, et al. Phytoestrogen supplements for the treatment of hot flashes: The Isoflavone Clover Extract (ICE) Study. JAMA. 2003;290:207-214.
96. Lydeking-Olsen E, Beck-Jensen JE, Setchell KD, et al. Soymilk or progesterone for prevention of bone loss. A 2 year randomized, placebo-controlled trial. Eur J Nutr. 2004 Apr 14. [Epub ahead of print]
97. Dalais FS, Ebeling PR, Kotsopoulos D, et al. The effects of soy protein containing isoflavones on lipids and indices of bone resorption in postmenopausal women. Clin Endocrinol (Oxf). 2003;58:704-709.
98. Kreijkamp-Kaspers S, Kok L, Grobbee DE, et al. Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women. JAMA. 2004;292:65-74.
99. Yoles I, Yogev Y, Frenkel Y, et al. Tofupill/Femarelle (DT56a): a new phyto-selective estrogen receptor modulator-like substance for the treatment of postmenopausal bone loss. Menopause. 2003;10:522-525.
100. Chen YM, Ho SC, Lam SS, et al. Soy isoflavones have a favorable effect on bone loss in Chinese postmenopausal women with lower bone mass: a double-blind, randomized, controlled trial. J Clin Endocrinol Metab. 2003;88:4740-4747.
101. Cotter A, Cashman KD. Genistein appears to prevent early postmenopausal bone loss as effectively as hormone replacement therapy. Nutr Rev. 2003;61:346-351.
102. Atkinson C, Compston JE, Day NE, et al. The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2004;79:326-333.
103. Burdette JE, Liu J, Chen SN, et al. Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. J Agric Food Chem. 2003;51:5661-5670.
104. Genazzani AD, Stomati M, Bernardi F, et al. Long-term low-dose dehydroepiandrosterone oral supplementation in early and late postmenopausal women modulates endocrine parameters and synthesis of neuroactive steroids. Fertil Steril. 2003;80:1495-501.
105. Somjen D, Knoll E, Vaya J, et al. Estrogen-like activity of licorice root constituents: glabridin and glabrene, in vascular tissues in vitro and in vivo. J Steroid Biochem Mol Biol. 2004;91:147-155.
106. Cohen SM, Rousseau ME, Carey BL. Can acupuncture ease the symptoms of menopause? Holist Nurs Pract. 2003;17:295-299.
107. Macgregor CA, Canney PA, Patterson G, et al. A randomised double-blind controlled trial of oral soy supplements versus placebo for treatment of menopausal symptoms in patients with early breast cancer. Eur J Cancer. 2005;41:708-714.
108. Kok L, Kreijkamp-Kaspers S, Grobbee DE, et al. A randomized, placebo-controlled trial on the effects of soy protein containing isoflavones on quality of life in postmenopausal women. Menopause. 2005;12:56-62.
109. Baber RJ, Templeman C, Morton T, et al. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women. Climacteric. 1999;2:85-92.
110. Knight DC, Howes JB, Eden JA. The effect of Promensil™, an isoflavone extract, on menopausal symptoms. Climacteric. 1999;2:79-84.
111. Osmers R, Friede M, Liske E, et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005;105:1074-1083.
112. Hartley DE, Elsabagh S, File SE, et al. Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and cognition of 6 and 12 weeks' treatment in post-menopausal women. Nutr Neurosci. 2005;7:325-333.
113. Manonai J, Songchitsomboon S, Chanda K, et al. The effect of a soy-rich diet on urogenital atrophy: A randomized, cross-over trial. Maturitas. 2005 Nov 15. [Epub ahead of print].
114. Hidalgo LA, Chedraui PA, Morocho N, et al. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: A randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005;21:257-264.
115. Campagnoli C, Abba C, Ambroggio S, et al. Polyunsaturated fatty acids (PUFAs) might reduce hot flushes: an indication from two controlled trials on soy isoflavones alone and with a PUFA supplement. Maturitas. 2005;51:127-134.
116. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006;13:185-196.
117. Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol. 2006;107:247-255.
118. Newton K, Reed S, Grothaus L, et al. The herbal alternatives for menopause (HALT) study: background and study design. Maturitas. 2005;16:134-146.
119. Frei-Kleiner S, Schaffner W, Rahlfs VW, et al. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas. 2005;51:397-404.
120. Verhoeven MO, van der Mooren MJ, van de Weijer PH, et al. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause. 2005;12:412-420.
121. Nappi RE, Malavasi B, Brundu B, et al. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol. 2005;20:30-35.
122. Winther K, Rein E, Hedman C, et al. Femal, a herbal remedy made from pollen extracts, reduces hot flushes and improves quality of life in menopausal women: a randomized, placebo-controlled, parallel study. Climacteric. 2005;8:162-170.
123. Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III Double-Blind, Randomized, Placebo-Controlled Crossover Trial of Black Cohosh in the Management of Hot Flashes: NCCTG Trial N01CC1. J Clin Oncol. 2006;24:2836-2841.
124. Heger M, Ventskovskiy BM, Borzenko I, et al. Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial. Menopause. 2006 Aug 4. [Epub ahead of print]
125. Wuttke W, Raus K, Gorkow C. Efficacy and tolerability of the black cohosh (actaea racemosa) ethanolic extract BNO 1055 on climacteric complaints: A double-blind, placebo- and conjugated estrogens-controlled study. Maturitas. 2006 Aug 21. [Epub ahead of print]
126. Huang MI, Nir Y, Chen B, et al. A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertil Steril. 2006;86:700-710.
127. Vincent A, Barton DL, Mandrekar JN, et al. Acupuncture for hot flashes: a randomized, sham-controlled clinical study. Menopause 2006 Oct 2. [Epub ahead of print]
128. Sandberg M, Wijma K, Wyon Y, et al. Effects of electro-acupuncture on psychological distress in postmenopausal women. Complement Ther Med. 2002;10:161-169.
129. Wilbur J, Miller AM, McDevitt J, et al. Menopausal status, moderate-intensity walking, and symptoms in midlife women. Res Theory Nurs Pract. 2005;19:163-180.
130. Kirby RS. Menopacenutrient therapy: an alternative approach to pharmaceutical treatments for menopause. Int J Fertil Womens Med. 2006;51:125-129.
131. Sammartino A, Tommaselli GA, Gargano V, et al. Short-term effects of a combination of isoflavones, lignans, and cimicifuga racemosa on climacteric-related symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Gynecol Endocrinol. 2006;22:646-650.
132. Nir Y, Huang MI, Schnyer R, et al. Acupuncture for postmenopausal hot flashes. Maturitas. 2006 Dec 18. [Epub ahead of print].
133. D'Anna R, Cannata ML, Atteritano M, et al. Effects of the phytoestrogen genistein on hot flushes, endometrium, and vaginal epithelium in postmenopausal women: a 1-year randomized, double-blind, placebo-controlled study. Menopause. 2007 Jan 23. [Epub ahead of print]
134. Cancellieri F, De Leo V, Genazzani AD, et al. Efficacy on menopausal neurovegetative symptoms and some plasma lipids blood levels of an herbal product containing isoflavones and other plant extracts. Maturitas. 2007 Jan 30. [Epub ahead of print].
135. Zaborowska E, Brynhildsen J, Damberg S, et al. Effects of acupuncture, applied relaxation, estrogens, and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies. Climacteric. 2007;10:38-45.
136. Manonai J, Chittacharoen A, Theppisai U, et al. Effect of Pueraria mirifica on vaginal health. Menopause. 2007 Mar 30. [Epub ahead of print]
137. Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats, and quality of sleep: Randomized, controlled, double-blind pilot study. Gynecol Endocrinol. 2007;23:117-122.
138. Chung DJ, Kim HY, Park KH, et al. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J. 2007;48:289-294.
139. Elavsky S, McAuley E. Physical activity and mental health outcomes during menopause: a randomized controlled trial. Ann Behav Med. 2007;33:132-142.
140. Wilbur J, Miller AM, McDevitt J, et al. Menopausal status, moderate-intensity walking, and symptoms in midlife women. Res Theory Nurs Pract. 2005;19:163-180.
141. Oktem M, Eroglu D, Karahan HB, et al. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther. 2007;24:448-461.
142. Bai W, Henneicke-von Zepelin HH, Wang S, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibolone. Maturitas. 2007 Jun 21. [Epub ahead of print]
143. Yang HM, Liao MF, Zhu SY, et al. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol® on the climacteric syndrome in peri-menopausal women. Acta Obstet Gynecol Scand. 2007;86:978-985.
144. Woo J, Lau E, Ho SC, et al. Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause. Menopause. 2003;10:352-361.
145. Ziaei S, Kazemnejad A, Zareai M. The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet Invest. 2007 Jul 30. [Epub ahead of print]
146. Khaodhiar L, Ricciotti HA, Li L, et al. Daidzein-rich isoflavone aglycones are potentially effective in reducing hot flashes in menopausal women. Menopause. 2007 Jul 18. [Epub ahead of print]
147. Pruthi S, Thompson SL, Novotny PJ, et al. Pilot evaluation of flaxseed for the management of hot flashes. J Soc Integr Oncol. 2007;5:106-112.
148. Lemay A, Dodin S, Kadri N, et al. Flaxseed dietary supplement versus hormone replacement therapy in hypercholesterolemic menopausal women. Obstet Gynecol. 2002;100:495-504.
149. Dodin S, Lemay A, Jacques H, et al. The effects of flaxseed dietary supplement on lipid profile, bone mineral density and symptoms in menopausal women: a randomized double-blind wheat germ placebo-controlled clinical trial. J Clin Endocrinol Metab. 2004 Dec 21. [Epub ahead of print]
150. Martin BR, Davis S, Campbell WW, et al. Exercise and calcium supplementation: effects on calcium homeostasis in sportswomen. Med Sci Sports Exerc. 2007;39:1481-1486.
151. Kong MH, Lee EJ, Lee SY, et al. Effect of human placental extract on menopausal symptoms, fatigue, and risk factors for cardiovascular disease in middle-aged Korean women. Menopause. 2007 Oct 10. [Epub ahead of print]
152. Chandeying V, Sangthawan M. Efficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: phase III study. J Med Assoc Thai. 2007;90:1720-1726.
153. Khaodhiar L, Ricciotti HA, Li L, et al. Daidzein-rich isoflavone aglycones are potentially effective in reducing hot flashes in menopausal women. Menopause. 2008;15:125-132.
154. Reed SD, Newton KM, LaCroix AZ, et al. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. 2008;15:51-58.
155. Uesugi S, Watanabe S, Ishiwata N, et al. Effects of isoflavone supplements on bone metabolic markers and climacteric symptoms in Japanese women. Biofactors. 2005;22:221-228.
156. Jou HJ, Wu SC, Chang FW, et al. Effect of intestinal production of equol on menopausal symptoms in women treated with soy isoflavones. Int J Gynaecol Obstet. 2008 Apr 4.
157. Chattha R, Raghuram N, Venkatram P, et al. Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study. Menopause. 2008 May 6.
158. Chattha R, Nagarathna R, Padmalatha V, et al. Effect of yoga on cognitive functions in climacteric syndrome: a randomised control study. BJOG. 2008 May 22.
159. Avis NE, Legault C, Coeytaux RR, et al. A randomized, controlled pilot study of acupuncture treatment for menopausal hot flashes. Menopause. 2008 Jun 2.
160. Kanadys WM, Bozena LG, Jan O. Efficacy and safety of black cohosh ( Actaea/Cimicifuga racemosa) in the treatment of vasomotor symptoms--review of clinical trials] Ginekol Pol. 2008;79:287-96.
161. Borrelli F, Ernst E. Black cohosh ( Cimicifuga racemosa) for menopausal symptoms: A systematic review of its efficacy. Pharmacol Res. 2008 Jun 8.
162. van Die MD, Burger HG, Bone KM, et al. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2008 Sep 10.
163. Kurzer MS. Soy consumption for reduction of menopausal symptoms. Inflammopharmacology. 2008 Sep 26.
164. Hervik J, Mjaland O. Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial. Breast Cancer Res Treat. 2008 Oct 7.
165. Panjari M, Bell RJ, Jane F, et al. The safety of 52 weeks of oral DHEA therapy for postmenopausal women. Maturitas. 2009;63:240.
166. Kim KH, Kang KW, Kim DI, et al. Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women--a multicenter randomized clinical trial. Menopause. 2010;17:269.
167. Borud EK, Alraek T, White A, et al. The acupuncture on hot flashes among menopausal women study: observational follow-up results at 6 and 12 months. Menopause. 2010;17(2):262.
168. Komesaroff PA, Black CV, Cable V, et al. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric. 2001;4:144-150.
169. Hsu CC, Kuo HC, Chang SY, Wu TC, Huang KE. The assessment of efficacy of Diascorea alata for menopausal symptom treatment in Taiwanese women. Climacteric. 2011;14(1):132-139.
170. de Luca AC, da Fonseca AM, Lopes CM, Bagnoli VR, Soares JM, Baracat EC. Acupuncture-ameliorated menopausal symptoms: single-blind, placebo-controlled, randomized trial. Climacteric. 2011;14(1):140-145.
171. Kim DI, Jeong JC, Kim KH, et al. Acupuncture for hot flushes in perimenopausal and postmenopausal women: a randomised, sham-controlled trial. Acupunct Med. 2100;29(4):249-256.
172. Yakoot M, Salem A, Omar AM. Effectiveness of a herbal formula in women with menopausal syndrome. Forsch Komplementmed. 2011;18(5):264-268.
173. Taku K, Melby MK, Kronenberg F, et al. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. 2012;19(7):776-790.
174. Chang A, Kwak BY, Yi K, et al. The effect of herbal extract (EstroG-100) on pre-, peri- and post-menopausal women: a randomized double-blind, placebo-controlled study. Phytother Res. 2012;26(4):510-516.
175. Moilanen JM, Mikkola TS, et al. Effect of aerobic training on menopausal symptoms--a randomized controlled trial. Menopause. 2012;19(6):691-696.
176. Saensak S, Vutyavanich T, et al. Relaxation for perimenopausal and postmenopausal symptoms. Cochrane Database Syst Rev. 2014;7:CD008582.
177. Cheng PF, Chen JJ, et al. Do soy isoflavones improve cognitive function in postmenopausal women? A meta-analysis. Menopause. 2014 Jul 7 [Epub ahead of print].
178. Baccetti S, Da Fre M, Becorpi A, et al. Acupuncture and traditional Chinese medicine for hot flushes in menopause: a randomized trial. J Altern Complement Med. 2014;20(7):550-557.
179. Chen MN, Lin CC, Liu CF. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015;18(2):260-269.
180. Ee C, Chondrose P, Myers SP, et al. Acupuncture for menopausal hot flashes: a randomized trial. Ann Intern Med. 2016;164(3):146-154
181. Shamshad Begum S, Jayalakshmi HK, Vidyavathi HG, et al. A novel extract of fenugreek husk (FenuSMART™) alleviates postmenopausal symptoms and helps to establish the hormone balance: a randomized, double-blind, placebo-controlled study. Phytother Res. 2016;30(11):1775-1784.
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