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Women's health



Related Terms
  • Abnormal menstrual bleeding, Alzheimer's disease, amenorrhea, anti-androgen, anti-estrogen, atrophic vaginitis, bacterial vaginosis, breast cancer-related hot flashes, calcium, Candida, cervicitis, cervix, chronic pelvic pain, contraceptive, corpus luteum deficiency, cramps, cytokines, dysmenorrheal, ectopic pregnancy, emmenagogue, endometriosis, estrogen, fibrocystic breast disease, follicle-stimulating hormone, FSH, GABA, gardnerella, gonorrhea, gynecologist, hirsutism, hormonal disorders, hormone replacement therapy, hormone-related vaginitis, hot flashes, HRT, hypermenorrhea, hypothalamus, hypothyroidism, hysterectomy, hysteroscopy, incontinence, interleukins, irregular menstrual cycles, irritant vaginitis, laparoscopy, leukorrhea, LH, luteal phase deficiency, luteinizing hormone, menopausal disorders, menopausal hot flashes, menopausal symptoms, menopause, menorrhagia, menses, menstrual, menstrual pain, menstruation, neurochemicals, oophrectomy, osteoporosis, ovaries, ovariotomy, ovulation, PCOS, peri-menopause, pituitary gland, PMDD, PMS, polycystic ovary syndrome, postmenopause, premenstrual dysphoric disorder, premenstrual syndrome, premenstrual tension, progesterone, progestin, serotonin, uterine fibroids, uterus, vaginal dryness, vaginal inflammation, vaginal yeast infection, vaginitis, vitamin D, vulvovaginitis, xenoestrogens, yeast infection, yeast vaginitis.

Background
  • Healthcare for women includes the entire spectrum of a woman'slife, not just pregnancy and childbirth. Besides developing conditions such as diabetes, heart disease, and cancer, women have special health issues that revolve around hormonal changes in their bodies and their reproductive organs. Also, medical problems canaffect women and men differently.
  • Women's health issues include breast conditions, menstruation, infections, menopause, heart conditions, mental health, osteoporosis, and sexual health.
  • This monograph focuses on hormonal changes in the female body and the relationship these hormonal changes have on the overall health of a woman. Other women's health issues, such as osteoporosis, heart disease, breast cancer, and ovarian cancer, are covered in separate condition monographs.
  • Hormonal changes in women can cause health imbalances to arise, including menopause, pre-menstrual syndrome (PMS) and related conditions (such as dysmenorrhea, menorrhagia, amenorrhea, and polycystic ovary syndrome), and infections of the vagina.
  • For women, hormone imbalance is the term that describes the incorrect relationship between the two primary hormones, progesterone and estrogen, in the body.
  • For a woman to have regular menstrual cycles, the reproductive organs, including the ovaries and uterus, should all be functioning normally. The hypothalamus stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The hypothalamus is a part of the brain that links the nervous system with hormone release. FSH and LH cause the ovaries to produce the hormones estrogen and progesterone. Estrogen and progesterone are responsible for the cyclical changes in the endometrium (uterine lining), including menstruation. In addition, a woman's genital tract should be free of any abnormalities to allow the passage of menstrual blood.
  • Normally, in the first 10-12 days of the menstrual cycle, only estrogen is produced in the female body. If ovulation occurs, then progesterone is produced by the ovaries. On or about day 28, levels of both hormones drop, resulting in menstruation. However, if ovulation does not occur, women can still have the menstrual period, but the estrogen is never "balanced" by progesterone, which needed ovulation to trigger its production. This results in symptoms of hormone imbalance;- estrogen is present but progesterone production drops to very low levels.
  • Variations in the estrogen/progesterone balance can have a dramatic effect on health. Hormonal imbalances are also thought to play a major role in PMS, or premenstrual syndrome.
  • Hormonal imbalances in women may be a result of aging, stress levels, a lack of exercise, poor nutrition, alcohol intake, poor sleep, synthetic hormone replacement therapy (HRT), and environmental toxins, called xenoestrogens, such as the pesticides DDT and dioxin.
  • Symptoms of hormone imbalance in women tend to increase as a woman ages and continue until menopause. Hormone imbalance symptoms can include: allergy symptoms, such as sneezing and runny nose; depression, fatigue and anxiety; endometriosis, a condition in which the tissue that lines the uterus is found to be growing outside the uterus, on or in other areas of the body; fibrocystic breasts or lumps in the breasts; hirsutism or hair loss and facial hair growth; headaches, dizziness and foggy thinking; low sex drive; osteoporosis or the gradual loss of bone; PMS or premenstrual syndrome; urinary tract infections and incontinence; uterine fibroids; weight gain, water retention and bloating; and wrinkly skin.

Complications
  • Menopause:
  • Several chronic medical conditions tend to appear after menopause. By becoming aware of the following conditions, women can take steps to help reduce their risk.
  • Cardiovascular disease: When estrogen levels decline, the risk of cardiovascular disease increases. Heart disease is the leading cause of death in women and men. Heart disease risk-reduction steps include stopping smoking, reducing high blood pressure, getting regular aerobic exercise, and eating a diet low in saturated fats and plentiful in whole grains, fruits, and vegetables.
  • Osteoporosis: During the first few years after menopause, women may lose bone density at a rapid rate, increasing their risk of osteoporosis. Osteoporosis is a condition that causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist, and spine. It is important during this time for women to get adequate calcium and vitamin D. It is recommended by healthcare professionals for postmenopausal women to have about 1,200-1,500 milligrams of calcium and 800 I.U. (international units) of vitamin D daily. It's also important to exercise regularly. Strength training and weight-bearing activities such as walking and jogging are especially beneficial in keeping the bones strong and healthy.
  • Urinary incontinence: Urinary incontinence is the loss of bladder control. As the tissues of the vagina and urethra lose their elasticity, postmenopausal women may experience a frequent, sudden, strong urge to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing, or lifting (stress incontinence).
  • Weight gain: Many women gain weight during the menopausal transition. Individuals may need to eat less, perhaps as many as 200-400 fewer calories a day, and exercise more just to maintain their current weight.
  • PMS:
  • PMS symptoms may become severe enough to hinder women from maintaining normal function. The incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle.
  • Premenstrual dysphoric disorder (PMDD): PMDD is a condition where women suffer from many of the physical symptoms of PMS, often more severely than other women. In addition, they experience debilitating emotional symptoms such as feelings of hopelessness, isolation, and extreme mood swings. Researchers estimate that PMDD affects between 3-8% of women in their reproductive years. Major depression is common in women with PMDD, although PMDD can occur in women who do not have a history of major depression.
  • The complications of secondary dysmenorrhea depend on the underlying cause. For instance, pelvic inflammatory disease can scar fallopian tubes and compromise reproductive health. The scarring can lead to an ectopic pregnancy, in which the fertilized egg stays in the fallopian tube rather than traveling through the tube to implant in the uterus, or it implants somewhere else outside the uterus. Endometriosis, another possible cause of secondary dysmenorrhea, can lead to impaired fertility.

Integrative therapies
  • Strong scientific evidence:
  • Calcium: Calcium is the nutrient consistently found to be the most important for attaining peak bone mass and preventing osteoporosis. Adequate vitamin D intake is required for optimal calcium absorption. Adequate calcium and vitamin D are deemed essential for the prevention of osteoporosis in general, including postmenopausal osteoporosis. Multiple studies of calcium supplementation in the elderly and postmenopausal women have found that high calcium intakes can help reduce the loss of bone density. Studies indicated that bone loss prevention could be achieved in many areas, including ankles, hips, and spine. Although calcium and vitamin D alone are not recommended as the sole treatment of osteoporosis, they are necessary additions to pharmaceutical treatments. Treatment of postmenopausal osteoporosis should only be done under supervision of a qualified healthcare professional.
  • Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria or irregular heartbeat. Talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
  • Vitamin D: Adults with severe vitamin D deficiency lose bone mineral content ("hypomineralization") and experience bone pain, muscle weakness, and osteomalacia (soft bones). Treatment for osteomalacia depends on the underlying cause of the disease and often includes pain control and orthopedic surgical intervention, as well as vitamin D and phosphate binding agents.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Good scientific evidence:
  • Calcium: There is a link between lower dietary intake of calcium and symptoms of premenstrual syndrome (PMS). Calcium supplementation has been suggested in various clinical trials to decrease overall symptoms associated with PMS, such as depressed mood, water retention, and pain.
  • Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria or irregular heartbeat. Calcium appears to be safe in pregnant or breastfeeding women. Talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
  • Lactobacillus acidophilus: Multiple human studies report that Lactobacillus acidophilus vaginal suppositories are effective in the treatment of bacterial vaginosis. Additional research is necessary before a firm conclusion can be reached. Patients with persistent vaginal discomfort are advised to seek medical attention.
  • Lactobacillus acidophilus may be difficult to tolerate if allergic to dairy products containing Lactobacillus acidophilus. Avoid with history of an injury or illness of the intestinal wall, immune disease or heart valve surgery. Avoid with prescription drugs, like corticosteroids. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy Lactobacillus acidophilus.Therefore, it is recommended that Lactobacillus acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids (like famotidine (Pepcid®), esomeprazole (Nexium®)) to decrease the amount of acid in the stomach one hour before taking Lactobacillus acidophilus.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. Estimates of the number of women who experience menstrual cramps with dysmenorrhea range from 50-93%. In 10-26% of women, this pain may be severe. Herbalists have recommended aromatherapy, the therapeutic use of essential oils from plants, as a treatment for menstrual cramps. The oils are absorbed into the body via the olfactory system and the skin. Lavender, clary sage, and rose are three of the oils traditionally used to treat dysmenorrhea.
  • Avoid in individuals with a known allergy/hypersensitivity to Rosa spp., rose hip dust, its constituents, or members of the Rosaceae family.
  • Sage: Sage (Salvia officinalis) may contain compounds with mild estrogenic activity. In theory, estrogenic compounds may decrease menopausal symptoms. Sage has been tested against menopausal symptoms with promising results.
  • Avoid if allergic or hypersensitive to sage species, their constituents, or to members of the Lamiaceae family. Use cautiously with hypertension (high blood pressure). Use the essential oil or tinctures cautiously in patients with epilepsy. Avoid with previous anaphylactic reactions to sage species, their constituents, or to members of the Lamiaceae family. Avoid if pregnant or breastfeeding.
  • Soy: Soy (Glycine max) products containing isoflavones have been studied for the reduction of menopausal symptoms such as hot flashes. The scientific evidence is mixed in this area, with several human trials suggesting reduced number of hot flashes and other menopausal symptoms, but more recent research reporting no benefits. Overall, the scientific evidence does suggest benefits, although better quality studies are needed in this area in order to make a conclusion.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.
  • Vitamin D: Without sufficient vitamin D, inadequate calcium is absorbed and the resulting elevated parathyroid (PTH) secretion causes increased bone resorption. This may weaken bones and increase the risk of fracture. Vitamin D supplementation has been shown to slow osteoporosis and reduce fracture, particularly when taken with calcium.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Unclear or conflicting scientific evidence:
  • Acupressure, Shiatsu: Based on initial research, acupressure may reduce symptoms of dysmenorrhea, pain medication use, and anxiety associated with menstruation. Further research is needed before a conclusion can be made.
  • With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
  • Acupuncture: Although some studies report beneficial results, currently there is not adequate available evidence to recommend for or against the use of acupuncture in the treatment of symptoms of menopause such as hot flashes or in the treatment of dysmenorrhea. High quality clinical research is needed to make a conclusion.
  • There is preliminary evidence suggesting that electroacupuncture may increase ovulation in some women with polycystic ovarian syndrome (PCOS). However, available study is inadequate to recommend for or against electroacupuncture for this indication.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.
  • Aromatherapy: Abdominal aromatherapy massage with a combination of essential oils may reduce the intensity of menstrual cramps in women with dysmenorrhea. More research is needed in this area to identify the most effective essential oils.
  • Avoid with history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Belladonna: Bellergal® (a combination of phenobarbital, ergot, and belladonna) has been used to treat premenstrual syndrome (PMS) symptoms as well as menopausal symptoms like hot flashes. However, in human studies belladonna supplements have not shown effectiveness. More studies are needed.
  • Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (bell peppers, potatoes, eggplants). Avoid with history of heart disease, high blood pressure, heart attack, abnormal heartbeat (arrhythmia), congestive heart failure, stomach ulcer, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren's syndrome, dry mouth (xerostomia or salivary gland disorders), neuromuscular disorders such as myasthenia gravis, or Down's syndrome. Avoid if pregnant or breastfeeding.
  • Bilberry: Preliminary evidence suggests that bilberry may be helpful for the relief of dysmenorrhea, although more research is necessary before a firm conclusion can be drawn.
  • Avoid if allergic to plants in the Ericaceae family or to anthocyanosides (a component of bilberry). Avoid with a history of low blood pressure, heart disease, bleeding, diabetes, blood clots, or stroke. Avoid if pregnant or breastfeeding. Stop use before surgeries or dental or diagnostic procedures involving blood tests.
  • Black cohosh: Black cohosh (Actaea racemosa, formerly known as Cimicifuga racemosa) is popular as an alternative to hormonal therapy in the treatment of menopausal symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness. Several studies have reported black cohosh to improve symptoms for up to six months, although the current evidence is mixed. The mechanism of action of black cohosh remains unclear and the effects on estrogen receptors or hormonal levels (if any) are not definitively known. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy. Safety and efficacy beyond six months have not been proven, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated. Nonetheless, caution is advisable until better-quality safety data are available.
  • Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional. Use cautiously if allergic to members of the Ranunculaceaefamily such as buttercups or crowfoot. Avoid if allergic to aspirin products, non-steriodal anti-inflammatories (NSAIDs, Motrin®, ibuprofen, etc.), blood-thinners (like warfarin) or if history of blood clots, stroke, seizures, or liver disease. Stop use before surgery/dental/diagnostic procedures with bleeding risk and avoid immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Black tea: Preliminary research suggests that chronic use of black tea may improve bone mineral density (BMD) in older women. Better research is needed to more clearly determine the effects of black tea for osteoporosis prevention.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use caution if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances and insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism and irritability.
  • Boron: Animal and preliminary human studies report that boron may play a role in mineral metabolism, with effects on calcium, phosphorus, and vitamin D. However, research of bone mineral density in women taking boron supplements does not clearly demonstrate benefits in osteoporosis. Additional study is needed before a firm conclusion can be drawn.
  • Inorganic boron (boric acid, borax) has been used as an antiseptic based on proposed antibacterial and antifungal properties. It is proposed that boric acid may have effects against candidal and non-candidal vulvovaginitis. A limited amount of poor-quality research reports that boric acid capsules used in the vagina may be effective for vaginitis. Further evidence is needed before a recommendation can be made.
  • Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate or glycinate. Avoid with history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions like breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.
  • Calcium: Calcium supplementation above the normal daily dietary intake has not been shown to reduce stress fractures. Further studies are needed to better determine the role of calcium in bone stress injury prevention.
  • Rickets and osteomalacia (bone softening) are commonly thought of as diseases due to vitamin D deficiency; however, calcium deficiency may also be another cause in sunny areas of the world where vitamin D deficiency would not be expected. Calcium gluconate is used as an adjuvant in the treatment of rickets and osteomalacia, as well as a single therapeutic agent in non-vitamin D deficient rickets. Research continues into to the importance of calcium alone in the treatment and prevention of this condition. Treatment of rickets and osteomalacia should only be done under the supervision of a qualified healthcare professional.
  • Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria or irregular heartbeat. Talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
  • Chamomile: Chamomile douche may improve symptoms of vaginitis with few side effects. Because infection (including sexually transmitted diseases), poor hygiene, or nutritional deficiencies can cause vaginitis, medical attention should be sought by people with this condition. Better research is needed before a conclusion can be drawn regarding the role of chamomile in the management of vaginitis.
  • Avoid if allergic to chamomile or any related plants such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Chasteberry: It remains unclear if chasteberry is an effective therapy in the management of irregular menstrual cycles. The use of chasteberry for corpus luteum deficiency also remains controversial. Additionally, most studies evaluating chasteberry for premenstrual syndrome (PMS) have been of poor study design, although one recent trial demonstrating benefit is of high quality. Further evidence is necessary before a firm conclusion can be drawn.
  • Avoid if allergic or hypersensitive to members of the Vitex (Verbenaceae) family or any chasteberry components. When taken in recommended doses, chasteberry appears to be well tolerated with few side effects. Use cautiously in patients taking oral contraceptives or hormone replacement therapy Use cautiously with dopamine agonists or antagonists. Avoid with hormone sensitive cancers or conditions (like ovarian cancer or breast cancer). Avoid if pregnant, breastfeeding or if undergoing in vitro fertilization.
  • Chiropractic: There is currently not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of dysmenorrhea or premenstrual syndrome.
  • Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, and migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid if taking drugs that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
  • Chromium: There is currently a lack of evidence for or against the use of chromium for the treatment of bone resorption and bone loss in postmenopausal women.
  • Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
  • Copper: Supplementation with copper may be helpful in the treatment and/or prevention of osteoporosis, although early human evidence is conflicting. Further research is needed before clear conclusions can be drawn.
  • Avoid if allergic to copper. Avoid copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia. Avoid with genetic disorders affecting copper metabolism (e.g. Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis). Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6 milligrams/liter. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking birth control pills. Use cautiously if at risk for selenium deficiency. Doses that do not exceed the recommended dietary allowance appear to be safe during pregnancy and breastfeeding.
  • Creatine: Creatine is an amino acid that is found in the muscles. Early studies examining the effect of creatine in aging suggest that creatine may increase bone density when combined with resistance training. Further studies in which creatine alone is compared with placebo are needed.
  • Avoid if allergic or hypersensitive to creatine. Early research suggests that creatine may reduce muscle cramps that are often associated with hemodialysis. However, further studies are needed to confirm this claim. Avoid if taking diuretics (e.g. hydrochlorothiazide or furosemide). Use cautiously with asthma, diabetes, gout, kidney disease, liver disease, muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone made in the human body and secreted by the adrenal gland. DHEA serves as precursor to male and female sex hormones (androgens and estrogens). Many different aspects of menopausal disorders have been studied using DHEA as a treatment, such as vaginal pain, hot flashes or emotional disturbances such as fatigue, irritability, anxiety, depression, insomnia, difficulties with concentration, memory, or decreased sex drive (which may occur near the time of menopause). Additionally, the ability of DHEA to increase bone density is under investigation. Effects are not clear at this time.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or with anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Dong quai: There is limited poor-quality study of Dong quai as a part of herbal combinations used for amenorrhea. There are also unclear results of preliminary, poor-quality human research of Dong quai in combination with other herbs for dysmenorrhea.
  • Dong quai supplements may increase the risk of bleeding in sensitive individuals, such as those taking medications to reduce blood clotting, including aspirin and warfarin (Coumadin®). Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae / Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with diabetes, glucose intolerance or hormone sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.
  • Echinacea: When echinacea is used at the same time as the prescription cream econazole nitrate (Spectazole®), vaginal yeast infections (Candida) may occur less frequently. However, further research is needed to confirm this.
  • Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea(no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid using echinacea in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.
  • Evening primrose oil: Primrose oil has been suggested as a possible treatment for osteoporosis. Well-designed human trials are needed before primrose oil can be recommended for osteoporosis therapy.
  • Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.
  • Fennel: Fennel has been used to treat dysmenorrhea. Although preliminary study is promising, there is currently insufficient evidence to recommend for or against this use of fennel.
  • Avoid if allergic or hypersensitive to fennel or other members of the Apiaceae family. Fennel is generally well-tolerated. However, serious allergic reactions may occur. Use cautiously with diabetes. Avoid with epilepsy. Avoid in infants and toddlers. Avoid if pregnant or breastfeeding.
  • Flaxseed: Flaxseed (Linum usitatissimum) and its derivative flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid, which is a biologic precursor to omega-3 fatty acids such as eicosapentaenoic acid. There is preliminary evidence from randomized controlled trials that flaxseed oil may help decrease mild menopausal symptoms. Additional research is necessary before a clear conclusion can be drawn.
  • Flaxseed has been well-tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil or other plants of the Linaceae family. Avoid large amounts of flaxseed by mouth and mix with plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that cause bleeding risk (like anticoagulants and non-steroidal anti-inflammatories (like aspirin, warfarin, Advil®)), high triglyceride levels, diabetes, mania, seizures or asthma. Avoid if pregnant or breastfeeding. Avoid with breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods.
  • Gamma linolenic acid (GLA): Gamma linolenic acid (GLA) is a dietary omega-6 fatty acid found in many plant oil extracts. Limited available study has examined the effect of GLA on menopausal hot flashes. No improvement in the number of hot flashed was noted as compared with placebo. More clinical studies are required to better determine effectiveness.
  • A study using Efamol (containing GLA) suggests there may be benefit for premenstrual syndrome symptoms. More information is needed in this area before a firm recommendation can be made.
  • Some clinical evidence suggests that GLA and eicosapentaenoic acid (EPA) enhance the effects of calcium supplementation for osteoporosis. More clinical studies are required.
  • Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
  • Gamma oryzanol: Gamma oryzanol is a mixture of ferulic acid esters of sterol and triterpene alcohols, and it occurs in rice bran oil at a level of 1-2%, although it has been extracted from corn and barley oils as well. It is theorized that some of the health benefits from rice bran oil, namely its cholesterol-lowering effects, may be due to its gamma oryzanol content. Gamma oryzanol may reduce menopausal symptoms. However, these results must be viewed cautiously as a high placebo effect is associated with the treatment of menopausal symptoms. Additional study is needed in this area to better determine gamma oryzanol's effect on menopausal symptoms.
  • Avoid if allergic/hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants (blood thinners), central nervous system (CNS) suppressants, growth hormone, drugs or herbs that alter blood sugar levels, immunomodulators, luteinizing hormone or luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering or thyroid drugs, or herbs or supplements with similar effects. Use cautiously with diabetes, hypothyroidism, hypoglycemia, hyperglycemia and high cholesterol. Avoid if pregnant or breastfeeding.
  • Ginkgo: Initial study in women with premenstrual syndrome (PMS) or breast discomfort suggests that ginkgo may relieve symptoms including emotional upset. Further well-designed research is needed before a recommendation can be made.
  • Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.
  • Ginseng: Although ginseng (Panax ginseng) has been used for menopausal symptoms, evidence from a small amount of research is unclear in this area. Some studies report improvements in depression and sense of well-being, without changes in hormone levels.
  • Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Grape seed: Little information is available for the use of grape seed extract in the treatment of premenstrual syndrome. Early study shows positive results but further research is necessary before a recommendation can be made.
  • There are reports of people with allergy to grapes or other grape compounds, including anaphylaxis. Individuals allergic to grapes should not take grape seed and related products. Use cautiously if taking anticoagulants. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Grape seed may interfere with the way the body processes certain drugs that use the liver's "cytochrome P450" enzyme system. Avoid if pregnant or breastfeeding.
  • Green tea: Green tea supplements are made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant. A study conducted in healthy postmenopausal women showed that a morning/evening menopausal formula containing green tea was effective in relieving menopausal symptoms including hot flashes and sleep disturbances. Further studies are needed to confirm these results.
  • Green tea supplements may increase the risk of bleeding in sensitive individuals, such as those taking medications to reduce blood clotting, including aspirin and warfarin (Coumadin®). Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease. Caffeine-free green tea supplements are available.
  • Hops: When used in combination with other products, hops may help alleviate menopausal symptoms, such as hot flashes and difficulty sleeping, because it has estrogen-like activity. However, until more well-designed studies are performed, a strong recommendation cannot be made.
  • Hops may cause drowsiness, therefore, caution is advised when operating an automobile or heavy machinery. Hops supplements are not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.
  • Horsetail: Silicon may be beneficial for bone strengthening. Because horsetail (Equisetum arvense) contains silicon, it has been suggested as a possible natural treatment for osteoporosis. Preliminary human study reports benefits, but more detailed research is needed before a firm recommendation can be made. People with osteoporosis should speak with a qualified healthcare provider about possible treatment with more proven therapies.
  • Avoid if allergic or hypersensitive to horsetail or nicotine. Avoid with a history of chronic alcohol abuse, malnutrition, and kidney disorders. Use cautiously with abnormal heart rhythms, diabetes, gout, neurological disorders, and osteoporosis. Avoid in children. Avoid if pregnant or breastfeeding.
  • Hypnotherapy: Early evidence shows that hypnotherapy may be beneficial in the treatment of hot flashes and may improve quality of life in women with menopausal disorders. Further research is needed.
  • Use cautiously with mental illnesses (e.g. psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
  • Kudzu: Kudzu (Pueraria lobata) originated in China and was brought to the United States from Japan in the late 1800s. It is distributed throughout much of the eastern United States and is most common in the southern part of the continent. Kudzu contains chemicals called isoflavones, which are reported to have estrogenic activity. There is conflicting evidence regarding the effects of kudzu on menopausal symptoms. Additional study is needed to clarify these results.
  • Avoid if allergic or hypersensitive to Pueraria lobata or members of the Fabaceae/Leguminosae family. Use cautiously if taking anticoagulants/anti-platelet and blood pressure lowering agents, hormones, antiarrhythmics, benzodiazepines, bisphosphonates, diabetes medications, drugs that are metabolized by the liver's cytochrome P450 enzymes, mecamylamine, neurologic agents, or methotrexate. Well-designed studies on the long-term effects of kudzu are currently unavailable. Avoid if pregnant or breastfeeding.
  • Lactobacillus acidophilus: Lactobacillus acidophilus taken by mouth or as a vaginal suppository has not been adequately assessed for the prevention or treatment of vaginal candidiasis. More research is needed in this area a before a conclusion can be drawn.
  • Lactobacillus acidophilus may be difficult to tolerate if allergic to dairy products containing Lactobacillus acidophilus. Avoid with history of an injury or illness of the intestinal wall, immune disease, or heart valve surgery. Avoid with prescription drugs, like corticosteroids. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy Lactobacillus acidophilus.Therefore, it is recommended that Lactobacillus acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids (like famotidine (Pepcid®), esomeprazole (Nexium®)) to decrease the amount of acid in the stomach one hour before taking Lactobacillus acidophilus.
  • Licorice: Spironolactone is a synthetic steroid that is commonly used as a diuretic in women with polycystic ovary syndrome. Licorice has been used in combination with spironolactone to reduce side effects related to the diuretic activity of spironolactone.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid licorice with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Massage: Initial research of the effects of massage on mood in women with premenstrual dysphoric disorder (PMDD) is inconclusive. A recent study investigating abdominal meridian massage (Kyongrak) found positive effects for menstrual cramps and dysmenorrhea. Further study is needed before a recommendation can be made for premenstrual syndrome.
  • Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Milk thistle: An herbal preparation containing milk thistle may be effective in decreasing menopausal symptoms. However, milk thistle alone has not been researched.
  • Use cautiously if allergic to plants in the aster family (Compositea or Asteraceae), daisies, artichoke, common thistle, or kiwi. Use cautiously with diabetes. Avoid if pregnant or breastfeeding.
  • Omega-3 fatty acids, fish oil, alpha-linolenic acid: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). There is preliminary evidence suggesting possible benefits of fish oil/omega-3 fatty acids in patients with dysmenorrhea. Additional research is necessary before a firm conclusion can be reached.
  • Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid, or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. Pregnant and breastfeeding women should not consume doses that exceed the recommended dietary allowance (RDA).
  • Peony: Traditionally, peony was used to treat menstrual problems and lack of a menstrual period. Preliminary research suggests that peony may have hormonal effects. More research is needed to support the use of peony for menstrual irregularities.
  • Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.
  • Phosphates, phosphorus: Early research shows that high amounts of phosphorus may have negative effects on bone density. This is because phosphorus decreases bone formation and increases bone resorption. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to any ingredients in phosphorus/phosphate preparations. Use phosphorus/phosphate salts cautiously with kidney or liver disease, heart failure, unstable angina (chest pain), recent heart surgery, hyperphosphatemia (high phosphate blood level), hypocalcemia (low calcium blood level), hypokalemia (low potassium blood level), hypernatremia (high sodium blood level), Addison's disease, intestinal obstruction or ileus, bowel perforation, severe chronic constipation, acute colitis, toxic megacolon, hypomotility syndrome, hypothyroidism, scleroderma, or gastric retention. Avoid sodium phosphate enemas with congenital or abnormalities of the intestine. Too much phosphorus may cause serious or life-threatening toxicity.
  • Physical therapy: Supervised or home-based physical therapy has been used in combination with resistance and endurance training in physically frail elderly women taking hormone replacement therapy to improve bone density. Although early study is promising, more studies are needed in this area.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Pomegranate: There is currently not enough evidence to support the use of pomegranate in the reduction of menopausal symptoms.
  • Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root/stem bark should only be used under supervision of a qualified healthcare professional. Use cautiously with liver damage or disease. Pomegranate supplementation can be unsafe during pregnancy when taken by mouth. The bark, root, and fruit rind can cause menstruation or uterine contractions. Avoid if breastfeeding due to a lack of scientific data.
  • Probiotics: Vaginal suppositories containing probiotics may be effective in the treatment or prevention of bacterial vaginosis. However, not all applications of probiotics show benefit. Probiotics have also not been adequately studied for the prevention or treatment of vaginal candidiasis. More research is needed in this area before a conclusion can be drawn.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Propolis: Propolis may be an effective treatment for vaginitis. However, more research is needed.
  • Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
  • Pycnogenol®: Preliminary human data shows that Pycnogenol® may have a potential analgesic (pain relieving) effect on dysmenorrhea. Further research is needed to confirm these results.
  • Avoid if allergic/hypersensitive to pycnogenol, its components, or members of the Pinaceae family. Use cautiously with diabetes, hypoglycemia, or bleeding disorders. Use cautiously if taking hypolipidemics, medications that may increase the risk of bleeding, hypertensive medications, or immune stimulating or inhibiting drugs. Avoid if pregnant or breastfeeding.
  • Qi gong: It has been suggested that regular Qi gong therapy may help to reduce symptoms of premenstrual syndrome (PMS). High quality human study is still needed in this area.
  • Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Red clover: Red clover (Trifolium pratense) is a legume, which like soy, contains "phytoestrogens" (plant-based chemicals that are similar to estrogen, and may act in the body like estrogen or may actually block the effects of estrogen). Laboratory research suggests that red clover isoflavones have estrogen-like activity. However, there is no clear evidence that isoflavones share the possible benefits of estrogens (such as effects on bone density). Red clover isoflavones are proposed to reduce menopausal symptoms (such as hot flashes) and to serve as a possible alternative to hormone replacement therapy (HRT). However, most of the available human studies are poorly designed and short in duration. As results of published studies conflict with each other, more research is needed before a clear conclusion can be drawn.
  • It is not clear if red clover isoflavones have beneficial effects on bone density. Most studies of isoflavones in this area have looked at soy, which contains different amounts of isoflavones, as well as other non-isoflavone ingredients. More research is needed to better understand the effects of red clover on osteoporosis.
  • Avoid if allergic to red clover or other isoflavones. Use caution with hormone replacement therapy (HRT) or birth control pills. Use caution with history of a bleeding disorder, breast cancer, or endometrial cancer. Use caution with drugs that thin the blood. Avoid if pregnant or breastfeeding.
  • Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet that are believed to correspond to other parts of the body. Currently, there is not enough evidence to support the use of reflexology for treating hot flashes and other menopausal symptoms, dysmenorrhea, or premenstrual syndrome. Further research is necessary.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus. There is promising early evidence from human trials supporting the use of relaxation techniques to reduce menopausal symptoms,although effects appear to be short-lived. There is also early evidence that progressive muscle relaxation (PMR) training may improve physical and emotional symptoms associated with premenstrual syndrome (PMS). Further research is necessary before a conclusion can be drawn.
  • Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven techniques.
  • Soy: It has been theorized that phytoestrogens in soy (such as isoflavones) may prevent post-menopausal bone loss and reduce the risk of osteoporosis. However, more research is needed before a conclusion can be made.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.
  • St. John's wort: Extracts of St. John's wort (Hypericum perforatum) have been recommended traditionally for a wide range of medical conditions. The most common modern-day use of St. John's wort is the treatment of depression. Although St. John's wort supplements have been used with effectiveness in treating depression associated with menopause, there is a lack of high quality human studies supporting the use of St. John's wort for peri-menopausal symptoms or premenstrual syndrome (PMS).
  • St. John's wort interferes with the way the body processes many drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood in the short-term (causing increased effects or potentially serious adverse reactions) and/or decreased in the blood in the long-term (which can reduce the intended effects). Examples of medications that may be affected by St. John's wort in this manner include carbamazepine, cyclosporin, irinotecan, midazolam, nifedipine, birth control pills, simvastatin, theophylline, tricyclic antidepressants, warfarin, or HIV drugs such as non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs). The U.S. Food & Drug Administration (FDA) suggests that patients with HIV/AIDS on protease inhibitors or non-nucleoside reverse transcriptase inhibitors avoid taking St. John's wort. Avoid if allergic or hypersensitive to plants in the Hypericaceae family. Rare allergic skin reactions like itchy rash have been reported. Avoid with organ transplants, suicidal symptoms, or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with diabetes or with history of mania, hypomania (as in Bipolar Disorder), or affective illness. Avoid if pregnant or breastfeeding.
  • Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Preliminary research suggests that tai chi may be beneficial in delaying early bone loss in postmenopausal women and preventing osteoporosis. Additional evidence and long-term follow-up is needed to confirm these results.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
  • Tea tree oil: In laboratory studies, tea tree oil has been shown to kill yeast and certain bacteria. However, at this time there is not enough information available from human studies to make recommendations for or against the use of tea tree oil for vaginal infections.
  • Avoid allergic or hypersensitive to tea tree oil (Melaleuca alternifolia), any of its constituents, balsam of Peru, benzoin, colophony (rosin) tinctures, eucalyptol, or other members of the Myrtle (Myrtaceae) family. Avoid taking tea tree oil by mouth. Avoid if taking antineoplastic agents. Use tea tree oil applied to the skin cautiously in patients with previous tea tree oil use. Avoid if pregnant or breastfeeding.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) has been examined for the treatment of dysmenorrhea in several small studies. Research in this area suggests that the use of TENS may reduce short-term discomfort and need for pain medications.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) herbs are commonly used for menopausal symptoms such as hot flushes. TCM herbs have also been reported to increase pregnancy rates in women with polycystic ovary syndrome. More studies are needed to explore the possible contributions of TCM herbs for these indications.
  • Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ephedra (ma huang). Avoid ginseng if pregnant or breastfeeding.
  • Valerian: Valerian root (Valerian officinalis) has been used as a sedative and anti-anxiety treatment for more than 2,000 years. There is currently not enough available scientific evidence on the use of valerian for menopausal symptoms.
  • Caution is advised when taking valerian supplements, as numerous adverse effects including drowsiness and drug interactions are possible. Caution is also advised when operating heavy machinery or an automobile if taking valerian supplements. Valerian is not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.
  • Vitamin B6: There is some evidence that taking vitamin B6 orally may improve symptoms of premenstrual syndrome (PMS) such as breast pain or tenderness (mastalgia) and PMS-related depression or anxiety in some patients. Further research is needed before a recommendation can be made.
  • Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA).
  • Vitamin C (ascorbic acid): Preliminary human study shows that vitamin C vaginal tablets given once a day may help patients suffering from non-specific vaginitis. Further research is needed to confirm these findings.
  • Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods, as well as in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding.
  • Vitamin E: Vitamin E is a fat-soluble vitamin with antioxidant properties. A study of oral vitamin E reports a very small reduction in frequency of breast cancer-related hot flashes (approximately one less hot flash per day), but no preference among patients for vitamin E over placebo.
  • There is preliminary evidence of possible benefits of vitamin E supplementation to reduce dysmenorrhea and premenstrual syndrome, although additional research is necessary before a firm conclusion can be reached.
  • Vitamin E supplements may increase the risk of bleeding in sensitive individuals, such as those taking medications to reduce blood clotting, including aspirin and warfarin (Coumadin®). Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe if taken at doses lower than the recommended dietary allowance (RDA). Avoid with retinitis pigmentosa (loss of peripheral vision).
  • Vitamin K: Vitamin K appears to prevent bone resorption, and adequate dietary intake is likely necessary to prevent excess bone loss and for osteoporosis prevention. Elderly or institutionalized patients may be at particular risk and adequate intake of vitamin K-rich foods should be maintained. Unless patients have demonstrated vitamin K deficiency, there is no evidence that additional vitamin K supplementation is helpful.
  • Avoid if allergic or hypersensitive to vitamin K. Injection into the muscle or vein should only be done by a healthcare professional; many serious side effects have occurred after injection. Menadiol (type of vitamin K that is not available in the United States) should be avoided with glucose-6-phosphate dehydrogenase deficiency. Conditions that interfere with absorption of ingested vitamin K may lead to deficiency, including short gut, cystic fibrosis, malabsorption (various causes), pancreas or gall bladder disease, persistent diarrhea, sprue, or ulcerative colitis. Avoid if pregnant. Use cautiously if breastfeeding.
  • Wild yam: It has been hypothesized that wild yam (Dioscorea villosa and other Dioscorea species) possesses dehydroepiandrosterone (DHEA)-like properties, and acts as a precursor to human sex hormones such as estrogen and progesterone. Based on this proposed mechanism, extracts of the plant have been used to treat menopausal symptoms such as hot flashes and headaches. However, these uses are based on a misconception that wild yam contains hormones or hormonal precursors - largely due to the historical fact that progesterone, androgens, and cortisone were chemically manufactured from Mexican wild yam in the 1960s. It is unlikely that this chemical conversion to progesterone occurs in the human body. The hormonal activity of some topical wild yam preparations has been attributed to adulteration with synthetic progesterone by manufacturers, although there is limited evidence in this area.
  • Avoid wild yam if allergic or hypersensitive to wild yam or any member of the Dioscorea plant family. Use cautiously with a history of hormone-sensitive conditions (e.g. breast cancer or endometrial cancer), asthma, blood clots, stroke, or diabetes. Avoid if pregnant or breastfeeding.
  • Yoga: Early evidence showed mixed results regarding yoga's effect on menopausal symptoms. Although early results are promising, more research is needed in this area.
  • Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
  • Fair negative scientific evidence:
  • Boron: It has been proposed that boron affects estrogen levels in post-menopausal women. However, preliminary studies have found no changes in menopausal symptoms.
  • Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate or glycinate. Avoid with history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions like breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.
  • Calcium: Stopping treatment with topical hormone replacement therapy and switching to treatment with calcium plus vitamin D made vaginal disorders, including vaginal atrophy and vaginal tissue thinning, worse in one study. Increases in painful or difficult intercourse and urinary leaks were reported. Menopausal complaints of hot flashes and night sweats were also worse than before calcium plus vitamin D therapy.
  • Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria or irregular heartbeat. Talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
  • Dong quai: Dong quai (Angelica sinensis), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It remains one of the most popular plants in Chinese medicine, and is used primarily for health conditions in women. Dong quai is used in traditional Chinese formulas for menopausal symptoms. It has been proposed that Dong quai may contain "phytoestrogens" (chemicals with estrogen-like effects in the body). However, it remains unclear from laboratory studies if Dong quai has the same effects on the body as estrogens, blocks the activity of estrogens, or has no significant effect on estrogens.
  • Dong quai supplements may increase the risk of bleeding in sensitive individuals, such as those taking medications to reduce blood clotting, including aspirin and warfarin (Coumadin®). Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae / Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with diabetes, glucose intolerance or hormone sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.
  • Evening primrose oil: Available studies do not show evening primrose (Oenothera biennis) oil to be helpful with flushing or bone metabolism during menopause. Small human studies also do not report that evening primrose oil is helpful for the symptoms of premenstrual syndrome. Larger, well-designed study is needed.
  • Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Causes and risk factors
  • Menopause:
  • Menopause begins naturally when the ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. The process usually begins in a woman's late 30s. By that time, fewer potential eggs are ripening in the ovaries each month, and ovulation is less predictable. Progesterone (the hormone that prepares the body for pregnancy) levels drop and fertility declines. These changes are more pronounced in the 40s, as are changes in menstrual patterns. The woman's period may become longer or shorter, heavier or lighter, and more or less frequent. Eventually, the ovaries shut down and there are no more periods. It is possible, but very unusual, to menstruate every month right up to the last egg is released, although a gradual tapering off is more common.
  • Early menopause is associated with the following factors: smoking; nulliparity - women who have never been pregnant; medically treated depression; exposure to toxic chemicals (such as pesticides); and treatment of childhood cancer with pelvic radiation or chemotherapy.
  • Menopause is usually a natural process. But certain surgical or medical treatments or medical conditions can bring on menopause earlier than expected. An oophrectomy (also called ovariotomy) is the surgical removal of the ovaries. Oophorectomies are most often performed in women due to diseases such as ovarian cysts or cancer, prophylactially to reduce the chances of developing ovarian cancer or breast cancer, or in conjunction with the removal of the uterus. A hysterectomy is a surgical procedure to remove the uterus, but not the ovaries. A hysterectomy usually does not cause menopause. Although women no longer have periods, their ovaries still release eggs and produce estrogen and progesterone. However, surgery that removes the uterus and the ovaries (called a total hysterectomy and bilateral oophorectomy) does cause menopause, without any perimenopausal phase. Instead, periods stop immediately and hot flashes and other menopausal signs and symptoms appear. Women that have their ovaries removed are at a decreased chance of developing breast cancer, ovarian cancer, and endometriosis.
  • Chemotherapy and radiation cancer therapies can induce menopause, causing symptoms such as hot flashes during the course of treatment or within three to six months.
  • Premature ovarian failure: Approximately one percent of women experience menopause before age 40. Menopause may result from premature ovarian failure, or when the ovaries stop working before age 40. This lack of ovarian function can stem from genetic factors or autoimmune diseases (such as lupus), but often no cause can be found.
  • PMS and related hormonal imbalances:
  • Premenstrual syndrome (PMS) is found in women all over the world. Up to 40% of women in their reproductive years experience some of the physical and emotional symptoms of PMS. Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition.
  • Mineralocorticoids: Mineralocorticoids are a group of hormones that regulate the body's fluids and electrolytes (such as sodium and potassium). Changing levels of mineralocorticoids may cause the bloated feeling that is common in women with PMS.
  • Prolactin: Prolactin stimulates breast development and the formation of milk during pregnancy and is associated with amenorrhea (abnormal absence of menstruation) and other gynecologic complications. Excess prolactin may cause the breast tenderness associated with PMS, although studies show that suppressing the secretion of excess prolactin does not relieve symptoms.
  • Prostaglandins: Prostaglandins are hormone-like substances that play a role in the luteal phase of the menstrual cycle, which occurs prior to bleeding. Changing levels of prostaglandins may be involved in PMS.
  • Neurotransmitters: Serotonin and gamma-aminobutyric acid (GABA) are chemicals in the brain that relay signals from one nerve cell to the next (called neurotransmitters). Low levels of serotonin have been linked to depression, and low levels of GABA are associated with anxiety, both symptoms of PMS.
  • Endorphins: Endorphins are neurochemicals that suppress pain and increase the threshold to painful stimuli. Low levels of endorphins may be involved in PMS.
  • Nutrition and exercise: Nutrition may play a role in PMS. Women can alleviate many symptoms by changing their diet. Eliminating certain foods or drinks often reduces symptoms to more tolerable levels. Imbalances in calcium and magnesium levels may trigger PMS symptoms. These two minerals affect nerve cell communication and blood vessel opening and closing, functions that may be involved in PMS symptoms (such as hot flashes). Other possible contributors to PMS include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances. Those who eat a lot of simple sugars (such as found in candy, juices, and soft drinks), may be more susceptible to mood swings and fatigue.
  • Hypoglycemia (low blood sugar) afflicts many PMS sufferers. Some researchers speculate that hypoglycemia is a precursor to PMS. Controlling blood sugar levels may be important in decreasing the symptoms of PMS.
  • PMS can also be affected by the amount of exercise the individual participates in and their diet. Studies have reported that women who exercise regularly are less susceptible to negative moods and experience fewer and less severe physical PMS symptoms than women who do not exercise or who exercise infrequently. A healthy diet, including fresh fruits and vegetables, may help decrease the symptoms of PMS.
  • Depression: Because depression-related symptoms are prevalent in women who suffer PMS, there may be an underlying psychological condition that causes or contributes to PMS. Approximately 60% of women with psychological disorders (including depression) also have PMS. More than 30% of women who suffer chronic depression experience their first depressive episode during a time of significant hormonal change (such as pre-menstrual). Studies have found that women who have seasonal affective disorder (SAD), a form of depression characterized by annual episodes of depression during fall or winter that improves in the spring or summer, are likely to also have premenstrual dysphoric disorder (PMDD).
  • PMS can be caused or aggravated by: stress; genetics - PMS is more likely in a woman whose mother had PMS; age - PMS is most common in women between the ages of 25-40; the number of children a woman has had - women with more children are more likely to suffer from PMS than women with fewer children; alcohol, sugar, and caffeine intake; hypothyroidism - low thyroid hormone levels; and depression.

Female conditions related to hormonal imbalances
  • Menopause:
  • Menopause, also known as "the change," is when a woman's menstrual periods stop altogether. It signals the end of the ovaries releasing eggs for fertilization. A woman is said to have gone through menopause when her menses have stopped for an entire year. Menopause generally occurs between the ages of 45-55, although it can occur as early as the 30s or as late as the 60s. It can also result from the surgical removal of both ovaries. A woman may still get pregnant during menopause until she has gone at least 12 months without menstruating (a period).
  • Changes and symptoms include: a change in menstruation (periods) - periods may be shorter or longer, lighter or heavier, with more or less time in between; hot flashes and/or night sweats; trouble sleeping; vaginal dryness; mood swings; trouble focusing; and hair loss on the head but increased hair on the face. About 85% of women experiencing menopause will have hot flashes.
  • All women will experience menopause. Menopause is not considered a disorder and most women do not need treatment for it. However, if symptoms are severe, medications may be used to help alleviate symptoms.
  • Researchers have estimated that more than 1.3 million women in the United States and 25 million women worldwide experienced menopause. There are about 470 million postmenopausal women worldwide, a number that is expected to increase to 1.2 billion by the year 2030.
  • Perimenopause: During perimenopause, the woman may begin to experience menopausal physical and emotional signs and symptoms, such as hot flashes and depression, even though they still menstruate. The average length of perimenopause is four years, but for some women this stage may last only a few months or continue for 10 years. Perimenopause ends the first year after menopause, when a woman has gone 12 months without having her period. Periods (menstruation) tend to be irregular during this time and may be shorter or longer or even absent.
  • Despite a decline in fertility during the perimenopause stage, individuals can still become pregnant. If the individual does not want to become pregnant, they may continue to use some form of birth control until menopause is reached.
  • Postmenopause: Postmenopause is a time when most of the distress of the menopausal changes have faded. Hot flashes may seem milder or less frequent and energy, emotional, and hormonal levels may seem to have stabilized. During postmenopause, women are at a higher risk for developing osteoporosis (bone loss) and heart disease, due to the decrease in circulating estrogen. The postmenopausal phase begins when 12 full months have passed since the last menstrual period. After menopause (postmenopause), women are more vulnerable to osteoporosis (bone loss) and heart disease, in part due to estrogen imbalance.
  • Women may become pregnant during menopause.
  • Premenstrual syndrome (PMS):
  • Menstruation, commonly referred to as a period or menses, is the periodic discharge of blood and mucosal tissues from the uterus in non-pregnant women, usually occurring at four week intervals. Every month, a woman's body prepares for pregnancy. If no pregnancy (fertilization of the egg) occurs, the uterus sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus, or womb. The blood passes out of the body through the vagina. Periods usually start around age 12 and continue until menopause (generally between the ages of 45-55). Most periods last from three to seven days.
  • Premenstrual syndrome, or PMS, is a group of symptoms that start one to two weeks before the period (called the luteal or secretory phase). Four out of 10 menstruating women suffer from PMS. There have been as many as 150 symptoms associated with PMS. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. The most common symptoms are: irritability, anxiety, depression, headache, bloating, fatigue or excessive tiredness, feelings of hostility and anger, and food cravings, especially for chocolate or sweet and salty foods. Breast tenderness is also common in women during PMS.
  • The exact causes for PMS are not known. One theory points to low levels of the hormone progesterone. Others link it to nutritional deficiencies, such as calcium and magnesium. To be classified as PMS, symptoms must occur between ovulation and menstruation - that is, anytime within two weeks before the menstrual period and disappear shortly after the period begins.
  • For some women, symptoms of PMS are minor and may last only a few days before menstruation. For others, they can be severe and last the whole two weeks before every period.
  • While not all women have PMS, it's estimated that 70-90% of women who menstruate experience premenstrual symptoms. And another 30-40% of individuals suffering from PMS have symptoms severe enough to disrupt their lives. Severe PMS is seen in 3-8% of women.
  • Other conditions due to hormonal imbalances:
  • Premenstrual dysphoric disorder (PMDD): Premenstrual dysphoric disorder (PMDD) is a condition where women suffer from many of the physical symptoms of PMS, often more severely than other women. In addition, they experience debilitating emotional symptoms such as feelings of hopelessness, isolation, and extreme mood swings. Women with family members (a mother or sister) who have PMDD may be genetically predisposed to experiencing PMDD.
  • Dysmenorrhea: Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary. Primary dysmenorrheal is severe and frequent menstrual cramping caused by severe and abnormal uterine contractions in women. Painful menstrual periods may be caused by another medical condition present in the body, such as pelvic inflammatory disease (PID) or endometriosis. Pelvic inflammatory disease (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus), and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. Endometriosis is when the tissue that lines the uterus is found to be growing outside the uterus, usually due to hormonal fluctuations. Secondary dysmenorrhea is caused caused by another medical condition, such as endometriosis (abnormalities in the lining of the uterus), adenomyosis (nonmalignant growth of the endometrium into the muscular layer of the uterus), pelvic inflammatory disease, uterine fibroids, cervical narrowing, uterine malposition, pelvic tumors, or an IUD (intra-uterine device). This condition usually occurs in older women.
  • Amenorrhea: Amenorrhea is a menstrual condition characterized by absent menstrual periods for more than three monthly menstrual cycles. Amenorrhea may be classified as primary or secondary. Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in women during puberty or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years. Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for three or more months in the absence of pregnancy, lactation (the ability to breastfeed), cycle suppression with systemic hormonal contraceptive (birth control) pills, or menopause.
  • Menorrhagia: Menorrhagia, also known as hypermenorrhea, is the medical term for excessive or prolonged menstrual bleeding and for periods that are both heavy and prolonged. Normal menstrual flow produces a total blood loss of 30-40 milliliters (about two to three tablespoonfuls). An individual's period may be regular or irregular, light or heavy, painful or pain-free, long or short and still be considered normal. Menorrhagia refers to losing 80 milliliteres or more of blood during the menstrual cycle.
  • Osteoporosis: Osteoporosis is a disease associated with a gradual thinning and weakening of the bones. It occurs most frequently in women who have gone through menopause. Declining estrogen levels during the first postmenopausal decadelead to rapid bone loss. Increased fracture risk maybe reversed by estrogen replacement therapy. The bone-protectiveeffects of estrogen may involve suppression of inflammatorychemicals called cytokines. Cytokines, such as interleukin-1 (IL-1) and tissue necrosis factor-alpha (TNF-?), promote bone loss and bone resorption. Without estrogen, such as in postmenopause, bones may become weak. As bones become thinner and weaker, they also become increasingly susceptible to fractures. Over the course of time, tiny bone fractures in the spine can lead to stooped posture and loss of height. If left untreated, postmenopausal osteoporosis can lead to constant back pain, disabling fractures, an increase in hip and leg fractures, and lost mobility.
  • Polycystic ovary syndrome: Polycystic ovary syndrome (PCOS) is a common condition characterized by irregular menstrual periods, excess hair growth, and obesity, though it can affect women in a variety of ways. A cyst is a closed sac- or bladder-like structure that is not a normal part of the tissue where it is found. Polycystic ovary syndrome affects about one in 10 women in the United States and is the leading cause of infertility in women. Early diagnosis and treatment of polycystic ovary syndrome can help reduce the risk of long-term complications, which include diabetes and heart disease.
  • Vaginitis (yeast infection): Vaginitis, or yeast infection, is irritation and/or inflammation of the vagina. Vaginitis is a very common disease affecting millions of women each year. The three most common vaginal infections are bacterial vaginosis (caused by the bacterium Gardnerella), Candida vaginitis (caused by yeast infection or Candida albicans), and Trichomonas vaginitis (caused by the protozoan Trichomonas vaginalis). Hormonal vaginitis is usually found in postmenopausal or postpartum (after childbirth) women. In these women, the estrogen support of the vagina is poor. Irritant vaginitis can be caused by allergies to condoms, spermicides, soaps, perfumes, douches, lubricants, and semen. Irritant vaginitis can also be caused by hot tubs, abrasion, tissue, tampons, or topical medications. Yeast infections are also common in women during menstruation.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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