Ask Barbie! Barbara Taylor MD's Q&A addressing your burning questions about Menopause

Ask Barbie: What are My Non-Hormonal Options for Menopause Management?

Do they do the same thing?

Welcome to ‘Ask Barbie’

Welcome to ‘Ask Barbie’, where I answer all your questions about menopause, and more.
Today’s question is a broad one. The question is: “What are my non-hormonal options for menopause management?”

Option Categories

Now this question breaks your options into just two categories:

Hormonal
Non-hormonal

But, within the non-hormonal category, there are many different options. They include:

Diet
Exercise
Lifestyle
Vitamins, minerals, and supplements
Herbs
Mechanical options
Hypnosis
Acupuncture
Non-hormonal medications

To think about your preferences for hormonal versus non-hormonal options, you have to first designate your goals.

Is it your goal to:

Merely alleviate your symptoms of menopause?
OR
Prevent the diseases of menopause?

And, no matter how you choose to manage your menopause, there will always be trade-offs!

Estradiol Deficiency

By definition, menopause is when you lose your female hormone estradiol (the estrogen that comes from your ovaries). Loss of estradiol causes a list of symptoms that are due to estradiol deficiency. But it also puts you at high risk for three diseases that are due to estrogen deficiency. They are:

Heart attack
Osteoporosis
Alzheimer’s disease

The reason you start assessment of your management preferences by designating your goals is because all options cannot accomplish the same goals. The key to success is to know what each of your options can do and what each of your options cannot do.

You don’t want to choose the wrong one for the long run.

There are always trade-offs. Everything has:

Some pros and cons.
Some advantages and disadvantages.
Some benefits and risks.

So you first designate your goals, and then you determine the pros and cons of each of your options for achieving your goals.

It is much easier to alleviate symptoms of estradiol deficiency than it is to prevent diseases of estradiol deficiency.

Estradiol

The only thing that can absolutely do everything for your menopause management is replacing your lost estradiol with the real thing, which is estradiol.

But that’s a hormonal option. And the question asks about your non-hormonal options.

All of your options in the non-hormonal category may be able to achieve some of your goals, but may also fall short of some of your goals.

And it really boils down to how many of the other options will you actually employ in order to achieve your goals? Estradiol can do it all all by itself; but none of the non-hormonal options can do it all all by themselves.

What this means is that if you choose a non-hormonal option, you will need to use several different options in order to even come close to what estradiol can do all by itself.

Always remember that a hormone is a hormone. And nothing else can do the hormone’s job.

So let’s talk about these non-hormonal categories of options.

Diet and Exercise

Starting with diet and exercise.

I’m discussing diet and exercise together because people use them together. Obviously, you can do just one or the other. And both have many, many great benefits for many aspects of your life. But, when it comes specifically to compensating for estradiol deficiency, they both fall short.

You can accomplish many things with just your diet and exercise, but not exactly the same things as you can with estradiol replacement. And knowing this in advance will help you make your decisions about how to manage your menopause.

Food is food. Exercise is exercise. And a hormone is a hormone. They will never do one another’s job.

Just remember that you will not achieve with food or exercise what you can achieve with estradiol.

Utilizing diet or exercise as an option for your menopause management requires one other thing that is unique to this particular option category: Honesty. You have to be honest with yourself about what you really will or will not do with your food or exercise.

You know yourself better than anyone else does. The only way any option is going to work for you is for you to utilize it to a degree that enables it to accomplish your goals.

But people fool themselves about these kinds of things all the time. Just look at all the people who make a New Year’s resolution to adhere to a diet or exercise regimen on a regular basis … but fail to keep that resolution. Don’t adopt a menopause management option that you will not pursue.

Diet and exercise can do a lot to help lessen the degree of some of your symptoms of estradiol deficiency. But they will never do as good a job as the real thing, which is estradiol.

Diet and exercise can do a lot to prevent a heart attack. The question is: Will you do enough of each to actually prevent the heart attack?

Diet and exercise alone cannot prevent bone loss. This is why I have loads of consultation clients who come to me in tears because they are health nuts with perfect diet and exercise, but who have lost bone like crazy.

Diet and exercise can definitely help decrease your risk of Alzheimer’s. However, since estradiol is a fuel for your brain, neither diet nor exercise can fully compensate for loss of estradiol.

Lifestyle

Next, we come to lifestyle. Lifestyle refers to things like:

Smoking
Recreational drug use
Alcohol intake
Sleep
Stress
Etc.

Lifestyle ends up being many different things that add up over time. Using lifestyle as a means of managing your menopause is difficult for most women.

Your lifestyle can definitely influence your symptoms of estradiol deficiency. And, depending on your lifestyle choices, it can either increase or decrease your symptoms of estradiol deficiency.

Some lifestyle measures decrease your risk for one disease, but increase your risk for another.

A good example of this is red wine.

One glass of red wine daily can decrease your risk for a heart attack. But that same one glass of red wine a day will definitely increase your risk for osteoporosis, Alzheimer’s, and even breast cancer.

Like diet and exercise, lifestyle options are difficult when it comes to true adherence. The kind of lifestyle options that can really make a difference are those that are absolutely routine and rigid. But most people don’t live their lives in a way that is strict enough to make lifestyle options feasible.

And once again, even the most perfect lifestyle in the world will not compensate for loss of your estradiol.

So you should adopt a healthy lifestyle regardless of how you choose to manage your menopause. It will benefit you in many ways in the long run.

Vitamins, Minerals, and Supplements

Now we come to the broad category of vitamins, minerals, and supplements.

Vitamins, minerals, and supplements are a fallacy in terms of what they can do for your menopause. This is because there is an entire industry devoted to production of vitamins, minerals, and supplements. The problem with the entire industry is that it is entirely unregulated. The absence of regulation makes it such that there is an absence of reliability. So, you cannot count on any vitamin, mineral, or supplement from the industry to be what it claims to be.

Vitamins, minerals, and supplements are always important. But we should all substitute the word “take” for the word “get.” Somehow, we live in a time when everybody tells everybody else which vitamins, minerals, and supplements they should “take.” The fact is that you should be getting your vitamins, minerals, and supplements from your food. And, of course, that means that you must be eating real food rather than fake food or processed food. But, will you actually do that?

If you do get all your vitamins, minerals, and supplements from real food, you will have no vitamin, mineral, or supplement deficiencies. But that will not compensate for a hormone deficiency. A hormone is a hormone is a hormone. And nothing else can function as the hormone.

If your body stopped producing insulin, would you take vitamins, minerals, and supplements instead of insulin replacement?

All of this is really just common sense. But fear is very powerful. Fear makes it impossible to think clearly or to ask questions that get to the truth. A real education gives you the whole story and the whole truth. And a real education doesn’t push a product on you. A real education also doesn’t make you think that you can accomplish something with an option when you really can’t.

Magical thinking is not a menopause management option.

Herbs

Well, what about herbs?

The management option of herbs for menopause is interesting.

Once again, by definition, menopause means loss of estradiol. So when it comes to herbs, we care about herbs that contain estradiol.

However, one of the most important things about menopause management is balancing estradiol with progesterone. This is because progesterone prevents uterine cancer. It has no other purpose. If you take any kind of estrogen, you need to also take progesterone.

So let’s address estrogen-containing herbs and progesterone-containing herbs separately.

There are only five herbs that contain any estrogen at all. They are:

Isoflavones
Red Clover
Licorice Root
Wild Yam
Hops

The herbs that contain estrogen are called “phytoestrogens.” Phytoestrogens are very weak forms of estrogen. They are only 1/100 to 1/1000 the strength of the estradiol produced by your body or a pharmaceutical company.

So phytoestrogens might help alleviate your symptoms of estradiol deficiency a little bit. But they probably will not be enough to alleviate them completely.

And don’t even think about using herbs to prevent the diseases of estradiol deficiency. There’s no way you’ll accomplish that goal.

There’s only one herb that contains progesterone. It’s Chasteberry.

The only purpose of progesterone at the time of menopause is to balance estradiol in order to prevent uterine cancer. So the trick becomes deciphering how much Chasteberry balances the estradiol in any given estrogen-containing herb. And that’s not something that you can measure or determine accurately.

Add to this the fact that all the issues of no regulation of the industry apply, too. And, since herbs are plants, the potency, purity, and predictability of each product, batch, leaf, powder, or root varies massively.

So using herbs to manage your menopause can be tricky, indeed. And this is true on several levels. The trade-off is that you manage only symptoms (possibly) and do not prevent any diseases.

Mechanical Options, Hypnosis, and Acupuncture

The categories of mechanical options, hypnosis, and acupuncture are all options that can help decrease the severity of some symptoms, and make you feel better. However, all are temporary. None of them can substitute as a hormone. So using them cannot hurt you at all. But it probably will not help you a lot, either.

Once again, the trade-off is that you manage only symptoms (possibly), and do not prevent any diseases.

Non-Hormonal Medications

The final management option consists of non-hormonal medications.

Now this category entails many different medications for many different symptoms and diseases.

This means that you would treat each symptom and each disease as a separate entity … rather than addressing them all as being due to estradiol deficiency.

So there are medications to alleviate your insomnia. And there are medications to alleviate your depression. And there are medications to alleviate your anxiety. But all of these symptoms are due to estradiol deficiency. And using a separate medication for each one has the risk of interactions between the individual medications.

Likewise, this category entails taking different medications to prevent the three fatal diseases of estradiol deficiency.

So there are statin drugs to prevent a heart attack. And there are bone-building drugs to reverse osteoporosis. But there are no drugs to prevent or reverse Alzheimer’s.

And again, there’s always the possibility of interactions between medications.

The issue of trade-offs comes up heavily for this management category. With every single medication you take, there will be both pros and cons. And the more medications you take, the more the cons outweigh the pros.

For example, statins decrease your risk of heart attack, but increase your risk of Alzheimer’s.

Of all of the non-hormonal management categories, this one is the most successful in terms of achieving your goals. However, it entails seeing a lot of different doctors for a lot of different medications, and then making sure that the sum of all the various medications is more beneficial than risky.

The Answer: Know Your Goals

As you can see, the smorgasbord of options for menopause management is vast. All the options do not accomplish the same goals. So first designate your goals, and then choose the options that can actually achieve your goals.

Always know that a hormone is a hormone is a hormone. And there’s nothing like the real thing. But if you choose to manage your menopause with something other than the real thing, be realistic about what the non-real thing can and cannot accomplish.

The goal is to know in advance what each management option can and cannot do. What you don’t want to do is adopt an option … only to discover many years later that it did not accomplish your goals. But by then, it will be too late.

My goal is to make sure that you know what you’re doing and that you get the results you want. I don’t like surprises. And I don’t want you to deal with the kind of surprises that you’ll have if you mistakenly try to use a menopause management option without realizing its limitations.

I want you to succeed with both:

Alleviating your symptoms of menopause

AND

Preventing the diseases of menopause

So be very careful when choosing management options for menopause. You don’t want to end up with the wrong one in the long run.

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