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Managing Vasomotor Symptoms: Non-Hormonal Drugs, Lifestyle Changes, and Nutrients to Ease Menopausal Discomfort

Updated: Jun 27


A menopause woman working out

"Welcome to Menopause! ...when your joints are creaky, your bladder is leaky, and you have a fanny drier than the Kalahari Desert..."

Menopause is having a huge moment in time. From Halle Berry shouting "I'm in Menopause!" on the steps of congress or Auntie Tab keeping us in stitches over the shenanigans of Ms. Catherine, menopause is taking up space and we are all here for it.


It's about DAMN time!


Women's health issues continue to be overlooked, avoided, or dismissed on so many different levels within society, especially within our healthcare system. Too often, we are dismissed by our doctors, provided minimal to no guidance on what to expect, and only offered hormonal replacement therapies (HRTs) as a source of symptom relief. Very rarely are we provided a well rounded treatment plan that address the 6 Pillars of Lifestyle Medicines (nutrition, physical activity, restorative sleep, stress management, positive social connection, and avoidance of risky substances) that has a center focus on a more natural approach to managing menopause.


For once, time, attention, and resources are being allocated to raise awareness about menopause, fund more in-depth women health-related research, and find non-hormonal solutions to address this natural progression that happens in every woman's life.


Hot flashes, disruption of sleep, and mood changes are a few of the most common reported symptoms associated with menopause. For many women, these disruptions have a huge negative impact on the quality of life. Hormone therapy is the first step in treating menopause symptoms in women. Due to the conflicting medical guidance related to hormone replacement therapy, it is often not a choice many women will make due to concerns related to the reported risk factors.


New Non-Hormonal Drug May Be A Life Changer


Bayer has recently announced its findings from their OASIS clinical trials. This 4 phase clinical trial is currently assessing the efficacy and safety of a non-hormonal drug to address vasomotor (VMS) symptoms associated with menopause. The results from phases 1 and 2 have been released and findings show the drug, Elinzanetant, is effective in improving vasomotor symptoms, sleep disturbances, and mood changes menopausal women. Three levels of VMS were examined. Those levels ranged from mild VMS (mild sensation of heat without sweating), moderate (sensation of heat with sweating but able to continue activity), and severe (a sensation of heat with sweating, causing cessation of activity). Sleep disturbances included an examination of sleep quality, sleep depth, restorative sleep, difficulties getting to sleep or staying asleep. Mood disruptions were examined as interaction with others, physical functioning and sexual functioning.


According to Bayer, Elinzanetant has shown a significant reduction in frequency and severity of VMS symptoms.


Phases 3 of the trial will examine long term use, expanding from 26 weeks to 52 weeks, while phase 4 will examine the efficacy of the drug in women receiving endocrine therapy for treatment or prevention of breast cancer.


While no safety concerns were observed, the research study acknowledges some mild liver function abnormalities that were resolved during the study. Phase 3 of the trials will continue to monitor for elevated liver enzymes by administering liver function testing during the first 9 months, as recommended by the FDA.


If approved by the FDA, Elinzanetant will be the second non-hormonal drug to address VMS symptoms in menopausal women.


Unfortunately, insurance companies are "reluctant to pay for newer menopause treatments." Some insurance companies are suggesting women try two non-FDA approved treatments before pursuing new therapy treatment and coverage like Veozah, which can cost at least $550 per month.


"...The overall benefit vs risk of taking non hormonal medications to mitigate the symptoms associated with menopause, should be weighed; especially when non-pharmacological studies have been done to determine that changes in diet can be as effective as taking the medication." -Dr. Raegan J. Francis, PharmD

Lifestyle + Nutrition: A Natural Approach to Menopause


Lifestyle and nutrition has a direct impact on every aspect of your health. This point can not be overstated. What you do and what you consume has a greater influence over how your body feels and functions. While pharmaceuticals are necessary to manage and treat conditions, farmaceuticals have the potential to better manage, treat, and reverse symptoms.


Too often, lifestyle activity and daily nutrition habits are treated as footnotes instead of a primary aspect of any treatment plan.


Menopause, or what I often refer to as "No Estrogen" is an eventful time in life. One day you can take on the world, the next day you are Thanos's snaping finger. In other words, things are out of balance. To help you get things back in balance, we want to provide a natural approach to menopause and treating vasomotors symptoms, sleep, and mood changes.


Life without estrogen changes metabolism, energy levels, and can increase the risk for osteoporosis. Staying physically active and maintaining a well-balanced diet has a positive impact over your health, wellness, and countering the evils of "no estrogen!"


A recent 12-week study examined the prevalence of vasomotor symptoms and the outcomes related to diet. The study noted the low prevalence of VMS in areas like Japan, China, and rural Mexico where traditional diets are rich in grains, legumes, vegetables, and other plant based foods. For example, hot flashes were reported by only 10% of women in China, 17% of women in Singapore, 22% of women in Japan, while 75% of women over the age of 50 in the United States reported having VMS. The higher prevalence in the US was associated with following a Westernized diet, including higher consumption of red meat, low fiber, and high fat.


The results of the study showed women who received the dietary intervention had an 88% reduction in moderate-to-severe vasomotor episodes.


The dietary intervention followed a more plant based diet with included increasing whole grains, fruits, vegetables, soy isoflavones (ex: soybeans), and reducing dietary fat. These foods are high in fiber, low in fat, promote weight loss, and improves the growth of gut bacteria.


6 Foods You Should Eat To Improve VMS


  1. Fruit and Vegetables: Fruit and vegetables (FV) are essential to a healthy, well-balanced diet. Consuming more fruits and vegetables daily increases your dietary fiber intake, vitamins, minerals, and antioxidants. In addition, dark, leafy green vegetables like spinach and greens are great sources of calcium. Green vegetables like broccoli, Brussel sprouts, asparagus, and kale help to reduce the severity of hot flashes. Tip: Eat the rainbow daily. Literally. #EatinColor

  2. Whole Grains: Whole grains are a great source of fiber and B vitamins. Examples include brown rice, whole wheat breads like Dave's Killer Bread, quinoa, oats, etc. The first ingredient on the product should read whole wheat or whole grain.

  3. Protein: Women going through menopause should increase their daily protein intake. The decline in estrogen due to menopause is linked to decreased muscle mass and bone strength. Dietary guidelines recommend 1-2 grams of protein per kg of body weight. (Ex. 160lbs = 72.7kg = 72.7g - 145g of protein per day) Quality protein sources include: beans, legumes, eggs, meat, fish, daily products, protein powders, ready made shakes, or bars.

  4. Healthy Fats: A decline in estrogen is also linked to increase risk for fractures. Adding dairy products helps to maintain a daily intake of calcium, phosphorus, potassium, magnesium, and vitamins D and K. Health fat sources include: greek yogurt, milk, cheese, keifer, whey products, casein, sour cream, cream cheese, lactose-free milk, soy milk,.

  5. Healthy Fats: Consume foods rich in Omega-3 fatty acids. Foods include: fatty fish such as salmon, seeds like flaxseed, chia, seeds, and healthy oils like olive oil or avocado oil.

  6. Phytoestrogen Foods: Phytoestrogens are compounds in foods that act as estrogen in the body. Foods include: soybeans, chickpeas, peanuts, flaxeseed, grapes, berries, plums, and teas (green and black tea).


References
  1. Barnard, N. D., Kahleova, H., Holtz, D. N., Znayenko-Miller, T., Sutton, M., Holubkov, R., Zhao, X., Galandi, S., & Setchell, K. D. (2022). A dietary intervention for vasomotor symptoms of menopause: A randomized, controlled trial. Menopause, 30(1), 80–87. https://doi.org/10.1097/gme.0000000000002080

  2. Bayer. (2024, May 16). Elinzanetant significantly reduces frequency and severity of hot flashes. Bayer United States. https://www.bayer.com/en/us/news-stories/elinzanetant

  3. Kennard, A., Lindo, F. M., Ring, M., Alli, B., Khan, N., Potter-McQuilkin, D., Papia, G., Teng, R., McKendree, R., Thompson-Olson, M., & Tollefson, M. (2024). Lifestyle Medicine and vasomotor symptoms: An analytic review. American Journal of Lifestyle Medicine. https://doi.org/10.1177/15598276241232359

  4. NBCUniversal News Group. (2024, May 16). New nonhormonal menopause drugs ease symptoms but face insurance hurdles. NBCNews.com. https://www.nbcnews.com/health/health-news/non-hormonal-menopause-drugs-symptoms-insurance-hurdles-rcna152439

  5. Pinkerton, J. V., Simon, J., Panay, N., Seitz, C., Parke, S., Caetano, C., Mellinger, U., Haseli Mashhadi, N., Haberland, C., Atanackovic, G., Holz, C., Mao, G., Morrison, M., Nisius, S., Schaefers, M., & Zuurman, L. (2024). Design of oasis 1 and 2: Phase 3 clinical trials assessing the efficacy and safety of elinzanetant for the treatment of vasomotor symptoms associated with menopause. Menopause. https://doi.org/10.1097/gme.0000000000002350

  6. Seitz, A. (2024, May 3). Halle Berry shouts from the Capitol, “I’m in Menopause” as she seeks to end a stigma and win funding. AP News. https://apnews.com/article/halle-berry-menopause-8fe88d4fd3d4e81a0ddcbedb12a35e08








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