More than eight years have passed since the landmark Women’s Health Initiative study linked synthetic estrogen (Premarin) and progestin (Provera) to increased risk of heart disease and breast cancer. And, according to recent studies and industry sales figures, menopausal women seeking symptom relief are still steering clear of prescription hormones in favor of dietary supplements and other natural alternatives.

“Many women can manage their symptoms just fine using herbs and supplements,” says Pacific Palisades, Calif.-based women’s health specialist Hyla Cass, MD, author of 8 Weeks to Vibrant Health (Take Charge Books, 2008).

According to IMS Health, a Norwalk, Conn.-based market research firm for the health-care industry, prescriptions for hormone therapy plunged from $57.9 million in 2004 to $40.4 million in 2009. Meanwhile, a 2008 study in the journal Menopause found that 80 percent of women now use complementary and alternative medicine to lessen symptoms. And according to Nutrition Business Journal, sales of supplements for menopause relief grew 4 percent annually between 2000 and 2008, to $334 million.

The category appears to be leveling off, with sales in the natural channel dipping 1.2 percent between May 2009 and May 2010, according to SPINS, a Schaumburg, Ill.-based market research firm. (One notable exception was topical preparations—like over-the-counter progesterone creams—which spiked almost 14 percent during the same period.)

But with 6,000 women embarking on “the change of life” each day, according to the North American Menopause Society, and growing evidence showing natural products can ease menopausal mood swings, hot flashes and lost libido, health experts say retailers face a great opportunity to help women choose the product that’s right for them. “Women respond differently to products depending on where they are in the menopause progression and what their symptoms are,” says Cass.
Following is a primer to help you educate your customers on top menopause supplements.

Insomnia and moodiness
Chaste tree berry (Vitex agnus-castus). Insomnia, mood swings, tender breasts and irregular periods are often the first signs of perimenopause (the three- to 10-year period leading up to the halt of menses), and the culprit is often a dip in the calming sex hormone progesterone, says Laurie Steelsmith, ND, author of Natural Choices for Women’s Health (Three Rivers Press, 2005). Steelsmith says the herb chaste tree berry, also marketed as vitex, is among the most widely used phytoprogesterones—plant compounds that mimic progesterone in the body and may indirectly help boost progesterone production.

An April study of 67 Chinese women found that those who took standardized vitex daily for three cycles reported far greater improvements in insomnia and moodiness than a placebo group. And a 2007 trial of 50 women age 44 to 65 showed that those who took vitex saw a 69 percent decrease in night sweats.

Progesterone cream. Low-dose bioidentical progesterone creams are also available. (Although prescription varieties contain an average of 10 percent progesterone, over-the-counter versions, by law, must contain less than 30 percent.) “I tell women who wake up in the middle of the night with insomnia to place a dab on their neck, and it will help them fall back asleep,” Cass says. “It’s safe and quite effective.” Unlike the synthetic Provera, bioidentical progesterone (often derived from plant sterols in wild yams or soy) has a molecular structure identical to that of the progesterone our own bodies make—a fact that has led many practitioners to theorize that it is safer. (The science is still young, but studies are underway.)

The debate continues over just how much topical progesterone is absorbed into the bloodstream. One 2005 review in the journal Menopause concluded that even small amounts applied topically make their way quickly into the tissues. Your customers’ best bet, according to Steelsmith: Start with a small amount of low-concentration cream, and boost it (after consulting with a health care practitioner) if they don’t see results.

Hot flashes
Black cohosh (Cimicifuga racemosa). Black cohosh root is, by far, the most researched herb for menopause relief, says Cass. A 2010 meta-analysis showed that in six out of nine recent trials, the botanical worked better than placebo. A 2006 study of 301 women found that those who took black cohosh for 16 weeks halved their hot-flash incidences; the placebo group improved by 20 percent.

Another recent trial found that black cohosh extract was as effective as low-dose prescription estrogen for the treatment of menopause-induced hot flashes, anxiety and depression. “It works, and there is excellent data behind it,” says Mary Jane Minken, MD, clinical professor of obstetrics and gynecology at the Yale University School of Medicine.

Scientists long assumed that black cohosh was a general phytoestrogen, acting on estrogen receptors throughout the body to quell symptoms. But recent research has called that theory into question, suggesting it may instead work on the central nervous system and “have no estrogenic effect on the breast or endometrium [the inner membrane of the uterus],” says Minken. This makes it a safer option, she says, for women with a history of breast cancer who cannot take estrogen.

Soy. Another promising hot-flash remedy is soy, which is rich in an estrogen-like isoflavone called genistein. One 2009 Johns Hopkins study of 93 women found that those who ate 20 grams of soy protein daily for 12 weeks saw marked improvement in hot flashes and night sweats; the placebo group saw no change. Although the American Cancer Society has expressed concern about its estrogenic effects on breast tissue, a 2009 study of 73,000 Chinese women found no link between soy consumption and breast cancer.

Libido
Maca root (Lepidium peruvianum). Ask Amherst, Mass.-based ethnobotanist and herb consultant Chris Kilham for his top recommendation for boosting libido, and he chooses Peruvian maca root hands down. “It is a powerful sex enhancer, and it has absolutely zero toxicity,” he says. As an adaptogen (or stress modulator), maca root has long been used in Peru to help the body maintain healthy hormone levels in the face of stress or illness.

Now it is gaining popularity elsewhere, as a small but growing body of evidence suggests it can boost libido and ease menopausal symptoms. One 2009 study of 17 women and three men on antidepressants (which can often dull libido) found that those who took 1.5 to 3 grams of maca daily saw “significant improvement” in sexual function. Another 2006 study found that women who took 2 grams of proprietary maca daily saw their estrogen levels rise, while levels of the stress-hormone cortisol fell, and insomnia and hot flashes decreased.

Pueraria mirifica (PM). Cass says a common cause of sexual dysfunction in menopausal women is vaginal dryness, a result of dipping estrogen levels. One possible remedy: pueraria mirifica. The Asian botanical (aka Thai kudzu) contains a compound called miroestrol, which was shown in a 2007 study to have estrogen-like effects on vaginal tissue, similar to prescription estrogen but without the side effects.

Lisa Marshall is a Longmont, Colo.-based freelance writer.