Q. Do you think that the use of natural progesterone cream - as in Dr John Lee - is effective? I have read Lesley Kenton’s book Passage To Power and her arguments are very persuasive. Could you give your opinion?

Natural progesterone is manufactured in a laboratory from wild yam and the end product is the HORMONE progesterone. I am a herbalist [says Jean Hailes naturopath Sandra Villella] and therefore do not use natural progesterone as it is a hormone. The argument for using progesterone and not oestrogenic compounds is controversial and I do not personally recommend its use.

Progesterone cream has been shown in some studies to be poorly absorbed through the skin and if used with prescribed oestrogen therapy may not protect the endometrium or lining of the uterus as it should.

Q. Is Lethicin a useful supplement?

Lecithin is useful for reducing risk of cardiovascular disease and has some antioxidant properties. It tends to lower cholesterol and triglycerides and can help to increase levels of ‘good’ (HDL) cholesterol.

Q. Is Flaxseed oil or Primrose beneficial? If so, what are the known benefits at this time of life?

Evening primrose oil may be useful for PMS, sore breasts or dry skin, but it has been shown to be no better than taking a dummy pill for the treatment of hot flushes. Flaxseed oil does not contain phytoestrogens – Eating the seeds is better. It may be a useful dietary supplement to provide the good oils we cannot make in our body.

Q. I try to get all my nutrients from food sources. Is it really necessary to take calcium supplements?

Post-menopausal women need at least 1200-1500mg of calcium each day (three glasses of milk or equivalent). Women who have difficulty consuming this amount should take a calcium supplement at night.

Q. If on HRT is it OK to take natural remedies as well?

It really depends on the combination of medicines. Some combinations of natural products should not be taken simultaneously with drugs. In addition, there are quite a few contraindications for hormonal drugs with both herbs and supplements. It is wise to consult a practitioner.

Q. What do you think about the phytoestrogen creams that are available over the counter?

Usually phytoestrogens are eaten in the form of soy beans, in other legumes such as chickpeas, lentils, lima beans etc, as well as soy bean products such as tofu and soy milk. Phytoestrogens that are eaten are likely to be absorbed better, making them more useful to the body than phytoestrogens that are applied to the skin.

Q. Is chemically induced menopause better treated with natural therapies?

Chemically induced menopause can be difficult to treat because the woman does not go into the menopausal transition slowly and progressively, giving the body time to adjust to the hormonal changes menopausal transition brings. Natural therapies are a good option and many women find them very helpful at this time.

On some occasions, natural therapies are the only option for those women who have medically induced menopause. An example of this is when menopause occurs after drug treatment for oestrogen-receptor positive breast cancer. These women would normally be advised not to take hormone replacement therapy (HRT) and herbal medicine is generally considered a better option. At other times, hormone replacement therapy would not be contraindicated and a decision could be made to use either treatment according to its merits in that particular case.

Q. Does the application of Wild Yam cream on the skin cause vaginal bleeding in a post menopausal woman?

All vaginal bleeding after menopause needs to be checked by your doctor. It would not be usual for wild yam cream to cause this bleeding and investigation of the cause is essential.

Q. Can one take Chinese herbs as well as western medicine to relieve menopause symptoms?

Yes, it is possible to take both together, but this is not usual in the case of menopausal hot flushes. It would really depend on why the herbs and western medicines are being taken simultaneously.

Q. My friend suggested to me that I try Vitex agnus cactus. Are you able to help with information on its benefits and availability?

This herb should not be self prescribed. You need to see a naturopath or herbalist. It is not usually taken when postmenopausal.

Q. Are there any natural substances available for aches and pains?

If you referring to aches and pains during menopausal transition, these can be usually helped with good quality fish oils, which have natural anti-inflammatory effects. As discussed above, you should seek advice if you also take other medications.

Q. Should I be taking a calcium / magnesium supplement during menopause?

After menopause for at least 5 years, your recommended daily allowance for calcium is 1500 mg, which is very difficult to obtain from your diet. It is advisable to take a supplement to make sure that your total calcium intake (i.e. that from your diet and from a supplement) is at this level. The recommended magnesium intake is around 800-1000 mg and the same principles apply.

Q. If considering natural therapies, how can I be sure that I will have the same level of coverage as from hormone replacement therapies?

Symptom relief is a good indicator. If symptoms decrease to a level that is comfortable, or disappear entirely, the natural therapies are doing their job as far as symptoms are concerned. Bone health is another important consideration in menopause and you need to take steps to ensure bone mineral retention.

You can maximise your bone health by ensuring adequate intake of minerals, especially magnesium and calcium. Because of the amount of these minerals that you need, augmenting your dietary intake with a well-absorbed supplement with vitamin D is a good option. Weight-bearing exercise is also absolutely essential. These exercises send a message to the brain that your bones need to be maintained. Additionally, lifestyle choices are important – limit coffee and alcohol intake, get adequate sleep and eat well.

Q. You mentioned that libido herbs are really feel good herbs. Which is a good one to take?

Prescribing herbs for libido requires individual assessment and advice.

Q. Do you think any of the natural products that you can buy at a pharmacy are safe and of any value or should they be more tailored to the individual?

Some may be useful for some women. Often tailor made are more specifically suited and therefore tend to work better. Also, some practitioner brands are better quality.

Q. What was the herb recommended for wakefulness at night (sounded like "nathalia")?

Withania somnifera

Q. How effective is a combination of Remifemin and St John’s Wort for a multitude of perimenopausal symptoms, especially dreadful insomnia / forgetfulness/ a very 'fuzzy' mind / hot flushes?

Some data suggests this combination is useful for perimenopausal symptoms including some of these you have listed. You would need to ensure that it is good quality St John’s wort.

Q. Why do you recommend taking calcium at night and not in the day? Isn't it better to have a tablet in the morning and another at night? I also take vitamin D but read often that one should take calcium and magnesium together. What does magnesium do, and what foods can I find it in naturally? Thanks

At night, calcium may help to relax muscles (also magnesium) and therefore may help sleep. It may also be absorbed more effectively overnight, because it is not competing with food and other supplements for absorption.

Good supplements for bone health in perimenopause/menopause contain well-absorbed calcium and magnesium in a ratio of 2:1.  Magnesium is also found in wholegrain cereals, seeds and nuts (especially Brazil nuts), soy beans and tofu, sea-weed, shrimp and smaller amounts in avocado and banana.

Q. When I take calcium of a night I do not sleep well, so have been taking of a morning. Will it work as well or would there be a better time?

It is unusual for calcium to cause poor sleep – Usually it improves sleep. Perhaps it is the type of calcium supplement you are taking. Look for a calcium supplement that also has magnesium with it, in a ratio of 2:1 calcium to magnesium. Have a small amount of yogurt or milk with the supplement to assist absorption.

Q. Is Remifemin a product that has any proven results with menopause? Is there a time limit on taking it?

Only take as long as symptoms persist. Remifemin contains the herb Cimicifuga racemosa (Black cohosh) and for reasons that are not clear, sometimes women find one preparation of Black cohosh works well to control their symptoms while another won’t. If you have tried one Black cohosh preparation and your symptoms have persisted, it may be worth seeing a practitioner who can prescribe another Black cohosh preparation to see if you can get better symptom control.
Usually, ‘menopausal symptoms’ are helped by dietary and lifestyle choices as well. Some common ones are limit coffee and alcohol or do away with them entirely, eat well, exercise daily and keep stress to a minimum.

Q. I have stopped taking Remifemin (after 2 yrs) as I was having abdominal pains. I feel certain it’s related and have had check with LMO re pains - no cause found. I did feel better taking Remifemin but don't feel comfortable taking it now. Are abdominal pains a side effect?

Abdominal pains are not common, but they are one of the most common side effects with any medication including Remifemin.

Q. I am 47 and recently changed my contraception to a low dose. I have experienced mood swings, less bleeding with my periods, low libido and (while not having hot flushes) I perspire a lot...to the point I have to change my shirt half way through the day. Is there a natural therapy that can improve these symptoms? I don't want to go back on a higher dose of oral contraceptive.

There are a number of reasons why you might be experiencing these symptoms and it would be a good idea to have a consultation in person to ascertain why you might be experiencing these, so you would be wise to consult your GP. A consultation with a natural therapist would also be a good idea (probably!)

Q. If taking a supplement such as Promensil, will menopause symptoms return when you stop taking the supplement?

There is no evidence that Promensil helps with menopausal symptoms.

Q. Whilst using HRT [Hormone Replacement Therapy], can other natural remedies be used? How are these introduced and pharmaceutical treatment reduced gradually? How do you know when to reduce HRT?

Generally speaking, some natural therapies can be used at the same time as pharmaceuticals and some cannot – It really depends on the drug, the natural therapy used and the complaint. Therefore it is advisable to inform both the doctor and naturopath/herbalist of the medicines.

Hormone replacement therapy is weaned under the guidance of your doctor when symptoms have been alleviated. This may mean, however, that the symptoms may return or they may not. There is only the need to introduce natural therapy options if the symptoms are still bothersome.

Q. I know your naturopath mentioned black cohosh but I've read that there are concerns with safety?
Q. I have read black cohosh can cause liver problems. What is your opinion?

The Therapeutic Goods Administration (TGA) considers black cohosh as safe for use in perimenopausal women. All black cohosh products must contain a warning identifying the potential risk of liver damage - however liver damage as a result of black cohosh use is extremely rare. If you experience any symptoms of liver damage ( jaundice, dark urine, nausea, vomiting, diarrhoea, weight / appetite loss,  tiredness) please cease use immediately and consult your doctor.

For more information see Black cohosh and liver damage.

Q. Does 'Remifemin' increase your oestrogen levels?

Remifemin contains a herb called black cohosh, which is taken to relieve mild menopausal symptoms but it does not increase oestrogen levels.

Q. Are you telling us that all the 'over the counter' is just a waste of money? I have used Remifemin for over a year but not sure if it does anything as I don’t have anything to compare it with?

Remifemin is a good quality over the counter product. It should be used only while symptoms persist. To establish whether it is working, compare symptoms pre taking the Remifemin with the symptoms now. Symptoms like hot flushes, vaginal dryness and/or insomnia should improve and this is an indication that the medication is suitable. Women who do not have these menopausal symptoms should not be taking it.

Q. I have been told that high doses of vitamin E (1000-1500 mg daily) can eliminate hot flushes, is it a valid option?

Apparently there is some evidence that it may be useful – I have not read the research myself but anecdotally some oncologists and breast cancer specialists recommend it for their patients. To test the validity, see if symptoms reduce when taking it.

Q. Is cold pressed flaxseed oil beneficial? I know Sandra said the only way to take linseed/flaxseed was to grind it freshly... I keep the flax oil in the fridge in its carton. Has it already lost its usefulness when I buy it?
Q. Is linseed oil OK to take or does it go rancid?

It is the linseeds and NOT the oil that contain the phytoestrogens, so the oil will provide some essential fatty acids (provided it is kept in fridge) but not the phytoestrogenic actions.

Content updated 26 August 2011