Menopause over the counter

Menopause Drugs and Medications

There are a number of prescription and over-the-counter medications available to treat the symptoms of menopause. This article focuses on treatments for the 3 most common symptoms and complications: hot flashes, bone loss, and vaginal dryness.

Hot Flashes
Drugs and medications that treat hot flashes include:

  • Hormone therapy: Hormone therapy (also known as estrogen plus progestogen therapy) is widely considered the best treatment for moderate to severe hot flashes. Plus, it is the only FDA-approved medication for hot flashes. Another benefit of hormone therapy is that it will help prevent bone loss because estrogen supports your bone-building cells, called osteoblasts.
    In most cases, the lowest possible dose taken for the shortest amount of time is the best strategy to provide relief while limiting the risks associated with hormone therapy (which include an increased uterine cancer, breast cancer and stroke risk). Your doctor will work with you to determine your appropriate dose and length of treatment.
    Some women present certain risk factors that prevent them from taking hormone therapy. These risks include a history of breast cancer, blood clots, and abnormal uterine bleeding.

If you cannot take hormone therapy to manage your hot flashes, there are non-hormonal prescription medications available that may help. While they may relieve your discomfort, none of the below treatments are FDA-approved to treat hot flashes:

  • Anti-depressants: A low dose of venlafaxine (marketed as Effexor) may help relieve hot flashes. Venlafaxine belongs to a newer class of anti-depressants, known as selective serotonin reuptake inhibitors (SSRIs). Fluoxetine hydrochloride (Prozac) and sertraline hydrochloride (Zoloft) are other SSRIs that may reduce hot flashes.
    SSRIs boost your mood by allowing more serotonin to travel from neuron to neuron. More serotonin means less pain perception. In addition to reducing hot flashes, SSRIs may also help eliminate fatigue.
  • Clonidine: Marketed as Catapres in the US, clonidine is typically used to treat high blood pressure. But it has also reduced hot flashes in some women.
  • Gabapentin: Marketed as Neurontin, gabapentin is a common medication for seizures. But like SSRIs and clonidine, it may also help control hot flashes. It may be especially effective for women with nocturnal symptoms.

Bone Loss
Menopause puts women at risk for developing osteoporosis, so your doctor may prescribe a medication to help prevent bone loss. Medications that may reduce your risk for developing osteoporosis are:

  • Estrogen agonists/antagonists: Also known as selective estrogen receptor modulators (SERMs), estrogen agonists/antagonists offer the bone health benefits of hormone therapy but without the increased cancer risks. There is one approved estrogen agonist/antagonist used to treat osteoporosis-raloxifene, which is marketed as Evista.
  • Bisphosphonates: Bisphosphonates increase your bone mineral density by slowing down the work of osteoclasts (bone-absorbing cells). Alendronate (marketed as Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast) are FDA-approved bisphosphonates.

To learn more about preventing bone loss after menopause, read our article about osteoporosis prevention.

Vaginal Dryness
The treatments below relieve vaginal dryness:

  • Vaginal estrogen: Available by prescription in a cream, tablet, or ring, vaginal estrogen delivers a small amount of estrogen to the vaginal tissues. This helps maintain a healthy moisture balance. For women with certain risk factors that prevent them from taking estrogen pills, vaginal estrogen may still be a safe option.
  • Vaginal lubricants and moisturizers: If you’re looking for an over-the-counter option, there are a number of vaginal lubricants (Astroglide and K-Y) and moisturizers (Vagisil) available to relieve vaginal dryness.

Though the symptoms of menopause are a completely normal part of the transition, that doesn’t mean you have to endure them. Fortunately, there are a variety of prescription and over-the-counter medications available to help treat your symptoms. Talk with your doctor to explore the best treatment plan for you.

Updated on: 05/27/14 View Sources

Menopause Relief

Going through hormonal changes does not mean you have to suffer. Find relief from menopause symptoms with over the counter menopause medicine from CVS!

What Is Menopause?

Menopause is a milestone in a women’s life that marks the end of menstruation and her childbearing years. This is diagnosed after 12 months go by without getting your period. Typically, this occurs in women in their 40s or 50s. During and after menopause, a woman can no longer carry a child due to her ovaries’ inability to produce eggs.

What Are The Stages of Menopause?

There are three stages of menopause: perimenopause, menopause, and post menopause. The process of menopause occurs very slowly. Perimenopause is the first stage and is the point where your menstrual cycles become irregular. This happens years before menopause. During this stage, you may start feeling symptoms like hot flashes, but it is still possible for you to get pregnant since you are still ovulating.

Menopause marks the point when your period has ended. You’ll know your period is over for good once a year has gone by without getting it. At this point, your ovaries have stopped releasing eggs and producing as much estrogen.

Postmenopause is the last stage. This is the time after menopause occurs. During this stage, some menopause symptoms may subside but you will still have a lack of estrogen and may need to take menopause supplements to keep your hormone levels consistent to combat the resulting side effects.

What Are Some Menopause Symptoms?

Menopause is different for all women. But, some common menopause symptoms are hot flashes, moodiness, vaginal dryness, weight gain, frequent urination, and night sweats. Luckily, there is over the counter menopause medicine that can help you through this time in your life.

Menopause Symptom Relief & Treatment

There are plenty of products that may help relieve those uncomfortable menopause symptoms. When going through perimenopause and menopause, your body slows the production of hormones. Menopause medication supports in resupplying the body with the hormones it is lacking and may help relieve symptoms brought on by this. Some of these products include progesterone cream, menopause supplements, and vaginal moisturizer. For natural menopausal support, try Black Cohosh capsules. Black Cohosh is an herb that can be used to help relieve menopause symptoms like hot flashes and night sweats. Before taking this supplement, please consult your doctor or pharmacist to make sure it’s the best one for you.

At CVS, you will find a diverse array of products that may help to relieve hot flashes, night sweats, vaginal dryness, weight gain, and more symptoms of menopause. Feel like the younger version of yourself again and shop menopause products from trusted brands at CVS now!

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All About Over-the-Counter Menopause Symptom Remedies

The shelves at drugstores and health food stores are lined with products claiming to ease such common menopause symptoms as night sweats, hot flashes, and mood swings. But do they really work? And, more important, are they safe?

James A. Simon, MD, CCD, FACOG, clinical professor of obstetrics and gynecology at George Washington University, says the first step in wading through the huge array of over-the-counter (OTC) products that claim to treat menopause symptoms is having realistic expectations about what these products’ potential is for easing your particular menopause symptoms. “There are certainly over-the-counter products that may work for mild hot flashes, night sweats, or other menopause symptoms. But few will work on severe or persistent symptoms,” he says.

As a general rule, Dr. Simon suggests being wary of “miracle cures” when you go to select a product. “There is no one-size-fits-all approach to treating menopause symptoms. What works for one woman may not for another,” Dr. Simon explains. “And since these herbal and nutritional products are not regulated by the FDA , there is no way to know for certain that they contain the amount of an active ingredient that they claim to.”

It’s also important to realize that most OTC remedies for menopausal symptoms are herbal preparations and dietary supplements that fall under the umbrella of the Dietary Supplement Health and Education Act of 1994 and as such are not classified as medications or held to the same standard as prescription drugs. “These over-the-counter products are seldom tested, either for efficacy or for safety, the way that pharmaceuticals are tested,” Dr. Simon says.

Reading Between the Lines

Because over-the-counter treatments for menopause aren’t subjected to FDA scrutiny, Dr. Simon says you have to be a savvy shopper when looking for readily available OTC relief for menopausal symptoms. “You may not be getting what you think you are,” he says. “You will have no way to know whether the amount of active ingredients listed is incomplete or incorrect or the packaging touts benefits that are exaggerated, because there’s no testing required by the FDA on these products. And that means it’s hard to know exactly what you’re buying.”

Your best bet is often to go with a product produced by a well-known, high-quality manufacturer. It may cost a bit more, but your chances of getting what you’re paying for are also greater. With herbal products, you’ll want to look for those that are formulated with standardized extracts, which will help to ensure — although you have no guarantee — that a certain percentage of the key active ingredients is present.

Dr. Simon explains that many women perceive herbal supplements as a more natural menopause treatment because they come from plants. He points out that without FDA regulation of these products, you may be getting more or less of what it says on the bottle and that the claim “natural” does not equal safe. “That’s why it’s also important to talk to your health care provider before taking any unregulated OTC product,” says Dr. Simon. Another good choice is to consult a complementary or integrative physician who may be more familiar with the specifics of different herbal or dietary products. Dr. Simon suggests discussing the following issues:

  • Does this herb or dietary supplement have possible side effects?
  • Will this product interact with any of my other medications or affect an unrelated medical condition that I have?
  • What scientific evidence is there about how effective this particular remedy might be for my particular menopausal symptoms?

What Are the Risks of OTC Menopause Treatments?

While they may ease hot flashes, OTC herbal and dietary therapies may react poorly with some prescribed or OTC medications. Remedies such as OTC herbs, vitamins, or other supplements may also interfere with lab test results or healing after surgery or illness or may worsen some illnesses and health conditions. “Talk to your doctor or ask your pharmacist to help you choose a product for easing mild menopausal symptoms that’s right for you,” says Dr. Simon.

March 30, 2004 — More women experience menopause today than at any time in the nation’s history, and there are an increasing numbers of products aimed at helping relieve the symptoms, from clothing to herbal supplements.

Most women experience menopause, the absence of menstruation for one year, in their late 40s or early 50s, but some start having menopausal symptoms earlier. Peri-menopause is used to describe the time period prior to menopause, which is on average, four to seven years.

The Good Housekeeping Institute tested and evaluated a variety of products aimed at menopausal women.

Sleepwear for Menopausal Women

The Good Housekeeping Institute tested two brands of sleepwear to help women who have night sweats, in which their clothing becomes soaked during the night, leading to shivering and difficulty sleeping, since women must get up to change clothes. Sleepwear styles range from nightgowns to shortie sets for summer. The clothes are made from the same lightweight polyester fabrics used in active wear, which are known for their ability to wick away moisture from the body.

The tested products, which claim to wick away moisture, are:

Sleepwear from Hot Mama: Comes in assorted bright and pastel colors. Hot Mama uses the fabric “Coolmax.” Prices are $24 for separates, $50 for nightgown. (www.hotcoolwear.com)

The institute’s textiles department evaluated the wicking of the sleepwear before and after 20 washes and also evaluated pilling, shrinkage and appearance after 20 washes. An outside lab evaluated the drying time of the clothes and MVT (moisture vapor transmission), measuring the evaporative abilities of the fabric. Results: The sleepwear wicked away moisture faster and better than regular fabrics, especially cotton, though Wicking J performed better than Hot Mama. They also did well in the shrinkage and appearance-after-wash tests. Even after 20 washings, both brands dried twice as fast as cotton. Neither of the products did well in the pilling test (the test conditions simulated a year’s wear or 1,000 rubs), but this is true of any polyester-based fabric.

Consumer Tests: The textiles department had seven menopausal staffers and patients of Dr. Michelle Warren (director of Tte Center for Menopause and Hormonal Disorders and Women’s Health at Columbia Presbyterian Medical Center in New York) wear the clothes at night and rate them. Each tested one brand for one week.

Results: Five of the seven testers rated the sleepwear highly for their ability to keep them more comfortable during and after night sweats. All seven testers scored the sleepwear high for comfort and quality.

Menopause Supplements

Concerns about hormone replacement therapy, or HRT, have led many women in menopause to try over-the-counter menopause supplements. Most herbal remedies haven’t been tested for long-term safety and efficacy. Herbal remedies are not regulated by the U.S. Food and Drug Administration.

The Good Housekeeping Institute evaluated published literature on supplements such as black cohosh, soy isoflavones, evening primrose oil and kava and interviewed Dr. Laura Corio, attending physician in obstetrics and gynecology at Mount Sinai in New York City and at New York University, and author of The Change Before The Change. The supplements claim to offer relief from hot flashes, night sweats or mood swings. Conclusion: Research shows that two supplements can lessen the side effects of menopause: black cohosh and soy isoflavones (from soybean or red clover sources). Corio suggests taking 40 milligrams of black cohosh daily for no more than six months at a time.

Women who haven’t had a period for one year may find that taking soy isoflavones help reduce hot flashes. Corio suggests 50 milligrams a day. (Women who are at high risk for breast cancer or hormone-related cancers or have thyroid disease should use caution before taking soy isoflavones.)

The Good Housekeeping Institute does not recommend using kava supplements because of potential liver injury.

Here are some other findings:

1. Watch out for excessive dosages. The Good Housekeeping Institute found that one third of supplements in stores are sold in dosages exceeding Corio’s recommended levels. For instance, the institute found black cohosh being sold in 1,000 milligrams and soy isoflavones available in 125 milligrams.

2. Herbal supplements can interact with other drugs, so talk to your doctor before taking any supplements. Be careful about taking supplements with mixtures of herbals. Many supplement makers have products that mix herbals, but you may not need some of the herbals in them.

3. Be skeptical of claims that seem outrageous. The institute found wording such as “guaranteed menopausal comfort.” Manufacturers typically don’t say how long the supplements should be taken.

At-Home Test Kits

Some women wonder if they are entering menopause if they miss a period or two. Now, there are two FDA-approved at-home tests that say they can tell you if you’re entering menopause.

Menocheck ($19.97 for 2 tests) and Ru25 Plus ($24.95 plus $4.95 for shipping and handling) are urine tests that can detect an elevated FSH concentration (follicle-stimulating hormone).

FSH increases as a woman approaches menopause. FSH levels are normally under 12, but elevate during ovulation. In menopausal women, FHS levels are consistently high, 25 or higher. In peri-menopausal women, FHS levels fluctuate daily, sometimes hourly.

Menocheck is sold at Walgreens. A woman is supposed to take each of the tests in the kit one week apart. The woman checks her urine first thing in the morning to determine her FSH level.

Ru25 Plus is sold over the Internet. With this, a “positive” result is an FSH level over 25 and a “negative” result is a level lower than 25.

Good Housekeeping’s Advice

In the Good Housekeeping Institute’s opinion, a home test kit is not substitute for a full medical work-up, and doctors we consulted said that FSH levels could fluctuate, raising the possibility of an inaccurate test result. Although the kits may give you a correct reading, it you think you are in menopause or pre-menopause, the Good Housekeeping Institute advises you not to rely solely on a kit and see a doctor.

The makers of Ru25 Plus’ FSH Menopause Test Kit disagreed with with the institute’s opinion. It said the kits can detect elevated FSH levels, and that as with home pregnancy tests, the home FSH menopause tests are highly accurate (near 99.9 percent). “While it is true that follicle-stimulating hormone (FSH) levels fluctuate in normal reproductive women, it is also true that women who are menopausal will have FSH levels that are significantly higher and will remain elevated,” the statement said. “Each kit includes two tests. The first test is to check if one’s FSH levels are elevated, and the second test is to determine if the FSH levels remain elevated, as is explained in our product directions.”

Obstetrician/gynecologist Corio, who is a spokesperson for Menocheck, said the product, designed to detect menopause status early, has an accuracy rate of 99 percent and is approved by the FDA. Each package comes with two wand test devices, which are supposed to be used in a series.

“If both urine tests, taken a week apart, reveal positive results this woman is menopausal because there is no other time in a women’s life other than menopause when FSH levels surge and remain elevated over time,” Corio said in a letter to the Good Housekeeping Institute. She also said that Menocheck’s packaging encourages women to check with their doctors for a formal diagnosis and to begin treatment.

Nonhormonal treatments for menopause

Lifestyle changes, mind-body approaches, and nonhormonal prescription medications may help relieve menopause symptoms

Published: March, 2017

Menopause—medically defined as the absence of a menstrual period for a year—is due to a decline in estrogen and progesterone production by the ovaries. About 60% to 80% of women experience menopause symptoms, most commonly hot flashes and vaginal dryness. Studies indicate that menopause symptoms can last a decade or longer, affecting substantial numbers of women in their 60s.

Although randomized clinical trials indicate that hormone therapy can be safe and effective way to control most menopause symptoms, it’s not considered a first-line approach. Dr. JoAnn Manson, Michael and Lee Bell Professor of Women’s Health at Harvard Medical School, suggests trying lifestyle modifications for at least three months after symptoms begin before trying hormone therapy.

Nonhormonal treatments for hot flashes

The following have been found effective in reducing the discomfort from hot flashes—both those that interrupt daily life and those that disturb sleep:

  • Mind-body approaches. Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing hot flashes. There is also growing evidence that mindfulness-based stress reduction can reduce the severity of hot flashes.
  • Medication. Paroxetine (Paxil and others)—a selective serotonin reuptake inhibitor (SSRI) also used to treat depression—is the only nonhormonal medication approved by the Food and Drug Administration for managing hot flashes. However, other related antidepressants, including SSRIs like fluoxetine (Prozac) as well as norepinephrine reuptake inhibitors like venlafaxine (Effexor), have also shown to be defective in treating hot flashes. Two other prescription medications, gabapentin (Neurontin)—a drug for chronic nerve pain—and clonidine (Catapres)—a blood pressure drug—may also help hot flashes.
  • Weight loss. Women who are overweight or obese tend to report greater discomfort from hot flashes, compared with women of normal weights. A few studies have shown that losing weight helps lower the intensity of hot flashes.
  • Soy. There is quite a bit of evidence that soy products can alleviate hot flashes, but the degree of relief provided varies widely. In general, soy high in diadzein is most effective. Diadzein is a compound that can be converted in the intestines to equol, a chemical that attaches to estrogen receptors to duplicate some of estrogen’s effects in the body. However, because only about 50% of Asian and 25% Caucasian women carry the intestinal bacteria necessary to produce equol from daidzein, equol supplements may be more effective than soy. There is early evidence that a 10-milligram S-equol supplement taken twice a day may control hot flashes with no harmful side effects. However, more studies are needed to better determine its effectiveness.

Common treatments that may not relieve menopause symptoms

Although several nonhormonal treatments for menopause are often recommended, there is not enough evidence from clinical studies to recommend them. These include lifestyle changes like getting more exercise or practicing yoga, deep breathing, or relaxation techniques. Nor, despite scores of studies, is there convincing evidence that widely used herbal remedies like black cohosh, dong quai, ginseng, and wild yam are effective, either.

Nonhormonal treatments for vaginal dryness

Following menopause, vaginal tissues become thinner and drier, leading to itching and often making intercourse painful. According to Harvard Special Health Report Women’s Health: Fifty and Forward, two nonhormonal approaches—lubricants and moistures—have proven to be effective in relieving vaginal symptoms.

  • Vaginal lubricants. These water-based or silicone-based liquids or gels reduce friction during intercourse. Lubricants are not absorbed into the skin so don’t provide long-lasting relief. They should be applied right before having sex.
  • Vaginal moisturizers. These products adhere to or are absorbed by vaginal tissues, so they provide longer-lasting relief from itching and pain. Unlike lubricants they are designed to be applied regularly.

– By Beverly Merz
Executive Editor, Harvard Women’s Health Watch

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

New drug could reduce hot flashes ‘by 72 percent’

A trial of a new class of drug finds that it can reduce menopausal hot flashes by nearly three quarters within 4 weeks, and that this effect starts within 3 days of starting to take it.

Share on PinterestA new class of drug could reduce some of the symptoms of menopause.

The experimental compound, which was initially developed to treat schizophrenia, still needs to undergo further trials to fully evaluate its safety and effectiveness in relieving hot flashes in menopausal women.

However, the researchers are hopeful that the new class of drug will soon offer an effective alternative for women who should not or do not wish to undergo hormone replacement therapy (HRT).

The results of the trial were reported in 2017. But more recently, the researchers carried out a new analysis that looked in more detail at the time course of the drug’s effects.

The findings of the new analysis, which was led by Imperial College London in the United Kingdom, are published in the journal Menopause.

“We already knew,” says senior study author Waljit Dhillo, who is a professor in the Department of Medicine at Imperial College London, “this compound could be a game-changer for menopausal women and get rid of three quarters of their hot flashes in 4 weeks.”

“But this new analysis,” he continues, “confirms the beneficial effect is obtained very quickly — within just 3 days.”

The menopause, hot flashes, and HRT

The menopause is a stage in a woman’s life in which her periods stop and her level of the hormone estrogen — which is produced by the ovaries — begins to decline and she loses her ability to become pregnant naturally. This typically occurs between the ages of 45 and 55.

“Hot flashes” is a common term for the recurring, temporary episodes of “vasomotor symptoms,” in which women approaching and going through menopause experience flushing, hot sensations in the face and upper body.

In the United States, around three quarters of all menopausal women report experiencing hot flashes.

Some women will feel hot flashes as no more than annoyances or embarrassments, but for many others, the episodes can be very uncomfortable, causing clothes to become drenched in sweat.

Hot flashes can also occur at night, during sleep, and therefore result in night sweats. In some cases, the symptoms are severe enough to impact quality of life.

Each woman’s experience of hot flashes tends to follow a pattern that is unique to her. Typically, their frequency increases as she approaches the menopause, then reaches a peak for around 2 years after the menopause and gradually wanes thereafter.

The experience of hot flashes can last from 6 months to 5 years, although in some cases, they can linger for 10 years or longer.

HRT has helped to ease the symptoms of the menopause in many women. However, because it is based on estrogen, it is not without risk.

For example, in their paper, the study authors mention that HRT is not recommended for women with a history of breast cancer. Other research has also linked HRT to ovarian cancer risk.

Big reduction in hot flashes within 3 days

The new paper describes how an experimental compound — referred to as MLE4901 — was tested in a randomized, double-blind, and placebo-controlled trial. The participants were 37 menopausal women of age 40–62 who were having at least seven hot flashes per day.

The team randomly assigned the women to receive a 4-week course of either a daily 80-milligram dose of the drug or a placebo.

After the 4 weeks, the women then switched over, so that those on the drug then took the placebo and those on the placebo then took the drug, for another 4 weeks.

The results revealed that when they were taking the experimental drug, the women experienced, on average, fewer hot flashes over the 4 weeks, when compared with the average number experienced over the 4 weeks when they took the placebo.

But an equally important trial result — which became apparent when the researchers carried out the new time-course analysis — was that the compound began to show a “significant effect” within just 3 days.

For example, by day 3 of treatment with the drug, the frequency of the hot flashes reduced by 72 percent “compared with baseline” and showed a “51 percentage point reduction compared with placebo,” note the study authors.

The size of this effect “persisted throughout the 4-week period,” they add, further observing that the drug also reduced severity of hot flashes by 38 percent by day 3.

New drug could relieve many symptoms

Prof. Dhillo says that because MLE4901 has side effects that impact the liver, it will be other drugs with the same action that will be tested further in trials. One trial has already started in the U.S.

The researchers think that the compounds work by inhibiting neurokinin B (NKB), a substance in the brain that previous studies in animals and humans have suggested may trigger hot flashes.

The new analysis also found that the new drug relieved daytime hot flashes as well as night-time ones.

Also, the women reported that the number of hot flashes that disrupted their sleep at night fell by 82 percent and that they experienced 77 percent less impairment to concentration when on the drug.

However, the researchers could not say whether these further improvements were a result of fewer hot flashes or a direct result of the compound’s effect on the brain.

They are hopeful, nevertheless, that the drug may directly improve many menopausal symptoms — from hot flashes to sleeping disruption and impaired concentration, and even weight gain — because of the many parts of the brain affected by NKB.

Prof. Dhillo notes that the trial has enabled them to find a “new therapeutic use for the compound — which had previously been sitting on the shelf unused” — and that they expect that within 3 years, it will be making “a tangible difference to the lives of millions of women.”

“This class of new drugs may provide women with a much-needed alternative to HRT.”

Prof. Waljit Dhillo

PMC

Discussion

Our investigation revealed that Canadian pharmacy chains sold a variety of NHPs that claim they can provide relief from menopausal symptoms. Our study aimed to be as relevant as possible to the experience of women throughout Canada seeking over-the-counter assistance through the menopause transition. We explored the packaging information easily available to women making decisions in pharmacies about which menopause-related NHP to use. The descriptions of indications for use and contraindications are remarkably similar between the menopause treatments and therefore the cost of treatment becomes an important factor. According to our findings, the annual cost of purchasing OTC NHPs for menopausal symptoms can range from $29.20 to $872.35 (CAD$) for the average Canadian woman.

Natural health products available OTC for menopausal symptoms are assessed and licensed on the basis of safety and efficacy as per Health Canada’s regulation standards. However, while Health Canada requires evidence of the association of active ingredients with the health claim made by the product, the type and amount of evidence required depends directly on the health impact on consumers if the product does not work as expected. Menopause is considered a low-risk condition by Health Canada, in that symptoms are not life threatening and have the potential to resolve themselves over time , and Health Canada requires minimal efficacy evidence for natural health products in the low-risk category . The Health Canada regulations stipulate that the details provided on the labels of licensed NHPs must include information on risks and possible interactions with conventional treatments. Furthermore, Health Canada requires that all NHP manufacturers have a site license, signifying that the site is able to maintain proper production, labeling, handling, and distribution of the products made there . Health Canada rules on compliance with labeling ensure that the proper protocol for labeling is being followed and the necessary information is being provided to consumers. However, the volume of mandatory information means that the labels use very small font sizes in order to provide the details in two languages, making the warnings inaccessible to anyone with poor eyesight or lack of understanding of the terms used. Potential purchasers might find information about warnings of possible risks unsettling and seek additional information from pharmacists who must be prepared to answer detailed questions about the NHPs .

There have been many studies assessing NHP supplementation for relief of menopausal symptoms . However, the findings have been inconsistent, and the quality and heterogeneity of studies has reduced the number of trials that can be combined in systematic reviews or meta-analyses. An Australian systematic review carried out on OTC products for relief of hot flashes in menopausal women found contradictory research evidence of NHP supplementation’s effectiveness, concluding that the inconsistent data did not support the use of OTC products for menopausal symptoms .

Black cohosh has generated the most research interest as a treatment for menopause symptoms, of relevance to the results of our study which found that black cohosh was the most commonly available active ingredient, present in 70% of the products we identified. A 2012 Cochrane review of randomized controlled trials assessing black cohosh versus placebo or other treatments found that black cohosh did not significantly reduce hot flashes or menopausal symptom scores, whereas hormone treatment (compared to black cohosh) reduced symptom scores significantly . A 2015 extensive review of effects of herbal preparations on symptom clusters in menopause suggested that black cohosh had a significant effect on hot flashes , but this observation was based on qualitative review of the research, rather than the more rigorous quantitative methods used in the Cochrane review of randomized trials .

Black cohosh has been suspected of being linked to liver disorders, although cases are rare and can seldom be attributed directly to black cohosh . Evidence on safety of black cohosh from the Cochrane review was inconclusive because of inadequate reporting , and the more recent review suggested that the incidence of adverse effects associated with black cohosh did not differ from those associated with placebo .

A Cochrane review of the evidence supporting phytoestrogens (including soy and red clover isoflavones) for menopausal vasomotor symptoms produced no conclusive evidence that phytoestrogen supplementation effectively reduced the frequency or severity of hot flashes and night sweats . A sub-group of trials comparing Promensil (red clover isoflavones) to placebo did not find a significant reduction in hot flashes . A recent meta-analysis of the efficacy of phytoestrogens versus placebo indicated that hot flash frequency was reduced compared to placebo, but there was not a significant treatment effect of phytoestrogens on menopause symptoms more generally . In the few studies that reported side effects, there was no significant difference between phytoestrogen and placebo . A systematic review including chaste tree and black cohosh did not find either was more effective than the placebo in treating climacteric complaints . Despite the lack of supporting evidence for the effectiveness of black cohosh, chaste tree or isoflavones in the management of menopause symptoms, the recently published North American Menopause Society “recommendations for the clinical care of midlife women” acknowledges that women often seek out this type of treatment .

It is worth noting that several studies on the efficacy of NHP supplementation mention a strong placebo response ranging from 25% to 63% . Thus, it would seem that although the current literature does not show consistent efficacy evidence of the use of natural health products for menopause , women might still find relief of their symptoms from the placebo effect.

Our sample of OTC NHPs for menopause is a “snapshot” of products available in pharmacy chains across Canada. An apparent limitation to this study is that only nine Canadian pharmaceutical chains were investigated: between these chains, they are present in all provinces and territories in Canada and thus our sample represents a selection of the pharmacies where Canadian women would likely purchase an OTC supplement for menopausal symptoms. There are several other limitations of our study method. The stores we visited were in one city and we visited only one store per pharmacy chain. We cannot therefore comment on geographic or between-store variation. As well, availability does not necessarily reflect sales, although products that did not sell would be unlikely to remain for long on the store shelves. Our sample of NHPs represents the type and distribution of the 448 NHPs currently licensed by Health Canada for menopause, in terms of frequently found active ingredients and balance between single ingredient and multiple ingredient products . For example, the following active ingredients are commonly in Health Canada licensed menopause NHPs: black cohosh (51%), chaste tree (36%), soy or red clover isoflavones (20%); and 45% of the licensed NHPs include a single active ingredient .

The objective of our study is limited to the investigation of OTC NHPs in Canada-wide pharmacies only. Nevertheless, apart from the store own-brand products (for example black cohosh), the products identified in this research are not restricted to the selected pharmacy chains and are likely available at independent pharmacies, naturopaths and herbalists. It is of note that many NHPs advertised for menopausal symptoms (including those identified in our study) can be bought outside of pharmacies, for example by mail order or online.

While this study is specific to the NHPs available in Canada, the use of NHPs in treating menopausal symptoms is not limited to Canada alone. Other investigations into the use of natural health therapies (black cohosh, isoflavones, phytoestrogens, and others) to treat the symptoms of menopause have been published throughout the world, including in the United Kingdom, Australia, Italy, and Turkey . A brief informal search of pharmacy websites in Europe, Australia and USA found that Promensil® products and A.Vogel™ Sage, as well as many generic products of black cohosh, soy isoflavones, and chaste tree are widely available internationally. Therefore, our findings regarding the ingredients and doses of NHPs for menopause that are easily accessible to Canadian women have relevance beyond Canada.

Women are keen to make their own decisions about the use of NHPs in menopause , largely because of their concerns about perceived risks associated with hormone replacement therapy . Women must balance the potential for benefit with the possible harm when making NHP decisions however the quality and type of evidence available to support women is often limited as illustrated by our study. It is important that women are aware that the regulation of these products does not imply their effectiveness, as the evidence required by Health Canada for licensing NHPs treating “low therapeutic impact conditions”, including menopause, reflects “the low risk nature of these products” . Evidence-based decision aids designed to improve the quality of decision-making are fairly common to support menopausal women’s decisions about whether to use hormone replacement therapy . Unfortunately few studies of decision aids regarding the use of NHPs have been undertaken .

Over-the-counter NHPs are widely available for women who wish to self-manage their menopausal symptoms. Future directions for research in this area may include investigation into the high placebo response seen in controlled trials of NHP supplements for menopausal symptoms, as well as examining the efficacy and safety of combination NHP supplements; most published scientific trials have solely investigated single-ingredient supplements, though almost half of the products identified in this study available for purchase were combination products. Adequately designed decision aids would incorporate the evidence that is available to support the use of NHPs as well as discussing the information that is unknown .

  • Hot flushes & night sweats
  • he hot flush, generally coupled with sweat, is considered to be the most familiar symptom experienced. It is usually suffered by over 80 percent of women experiencing the menopause. The difficulty occurs as changes in hormone levels impair the temperature regulating area of the brain.
  • imply because hot flushes and sweats usually come up in sync, the two conditions are typically used interchangeably to express the same group of signs and symptoms. A night sweat is merely over sweating or a hot flush at nighttime. As night time sweats may cause sleep issues, they possess the potential to be troublesome to quality of life.
  • nexpected variations in room temperature, consuming hot and spicy foods as well as stress and anxiety may result in hot flushes and sweats
  • Changes in the Menstrual Cycle
  • enopause arises when menstrual cycles stop. However it is infrequent that the monthly menstrual bleed ends instantly. Most frequently, the menstrual cycle becomes improper with a propensity going towards heavy, extended or painful periods.
  • n some cases a woman may go a couple of months without a period, just simply for it to bring back with a vengeance.
  • busively heavy periods might be a sign of fibroids impacting the womb or some other gynaecological disorder, particularly if accompanied with serious pain. It usually is better to consult a health care professional if you have all these symptoms
  • Other Embarrassing Body Changes
  • hange in hormones in the course of the menopause not only impacts on the consistency of the menstrual cycle. They may also cause breast soreness or tenderness. This takes place simply because the female hormones get disposed of balance and is normally noticed at around the time of ovulation or menstruation.
  • urthermore, decreased oestrogen levels, combined with a reduction in testosterone in this particular period of life, may lead to a decline in libido or sexual drive. This can be made more serious resulting from vaginal dryness which happens due to a reduction in oestrogen, flow of blood and lubrication
  • Weight Gain
  • etting older usually implies a natural lowering of physical activity – therefore the menopause may not be the simple reason behind weight gain. Having said that, fluctuations in hormone levels do influence body weight, despite the fact that the method it does this may not be always consistent.
  • o in general, women are likely to put on weight throughout the menopause. Use this information to prepare yourself – exercise more and check out the food you eat
  • Low mood, Irritability and Anxiety
  • educing levels of hormones throughout the menopause can impact the way the brain performs and women may suffer from the symptom of mood swings or low mood throughout the menopause. These symptoms are very likely typical as compared to we realize, and pretty occasionally, variations in hormones may even give rise to depression.
  • oor mood throughout the menopause is not aided by the truth that this stage of life may be linked with children leaving home, forming ‘empty nests’ – not beneficial whenever you are already experiencing a little bit down anyway.
  • nxiety and irritability are additionally included in the menopause. Some women notice these symptoms identical in nature to pre-menstrual tension (PMT) and cope with them as such. Normally, anxiety or irritability can be accompanied by palpitations, or a consciousness of one’s heart rate
  • Muscle and Joint Pain

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