EVIDENCE-BASED PRACTICES USED FOR THE SYMPTOM MANAGEMENT OF MENOPAUSE

Abstract

Menopause is not a disease yet it causes symptoms that affect 25% of women’s quality of life and require treatment. The highest scientific evidence involving complementary and alternative treatments used to reduce these symptoms. The study found that hormone replacement therapy and complementary and alternative treatments (yoga, acupuncture, massage, herbal medicine and vitamins) led to a decrease in vasomotor and urogenital symptoms, sleep problems, mental problems and an increase in women’s quality of life. Therefore, determining the effectiveness of medical and alternative treatments with studies that have the highest level of evidence can contribute to the literature. This may prove beneficial for reducing the menopausal symptoms that women experience and improve their quality of life.

Keywords

• Menopause,evidence,alternative treatment

MENOPOZDA SEMPTOM YÖNETİMİNDE KULLANILAN KANITA DAYALI UYGULAMALAR

Abstract

Menopoz bir hastalık değildir ancak kadınların yaklaşık %25’inin yaşam kalitesini bozan ve tedavi gerektiren semptomlara neden olmaktadır. Bu semptomları azaltmak için birçok tamamlayıcı ve alternatif tedaviler uygulanmaktadır. Bu derlemede sık görülen menopozal semptomların giderilmesinde uygulanan yöntemler kanıt düzeylerine göre değerlendirilmiştir. Hormon replasman tedavisi ve tamamlayıcı-alternatif tedavilerin (egzersiz, yoga, akupunktur, masaj, bitkisel tedaviler ve vitaminler) vazomotor ve ürogenital semptomlarda azalma, uyku problemlerinde, psikolojik sorunlarda azalma ve kadınların yaşam kalitesinde artış sağladığı saptanmıştır. Bu nedenle tıbbi ve alternatif tedavilerin literatüre katkıda bulunacak kanıt düzeyi yüksek çalışmalarla etkinliğinin belirlenmesi, kadınların menopozda yaşadıkları semptomların iyileştirilmesinde ve yaşam kalitesinin geliştirilmesinde yararlı olabilir.

Keywords

• menopoz,kadın sağlığı,kanıt

References

1. 1. Atasü T, Gezer A. Menopoz: tanım ve terminoloji. Menopoz, tedavisi ve kanser. İstanbul, Nobel Tıp Kitabevleri. 2001; 13-26.
2. 2. Shea JL. Chinese women’s symptoms: relation to menopa¬use, age and related attitudes. Climacteric. 2006; 9(1): 30-39.
3. 3. Görsel E, Çakıroğlu F. Me¬nopoz döneminde kadın. Ankara Üniversitesi Basımevi, Ankara. 2007. p. 1-13.
4. 4. Özcan H, Oksay Ü. Menopoz döneminde semptom yönetiminde kanıta dayalı uygulamalar. Göztepe Tıp Dergisi. 2013; 28(4): 157-63.
5. 5. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015; 57(Suppl 2): 222-232.
6. 6. Col NF, Guthrıe JR, Polıtı M, Dennersteın L. Duration of vasomotor symptoms in middle-age women: a longitunal study. Menopause. 2009; 16(3): 453-7.
7. 7. Coşkun AM. Kadın sağlığı ve hastalıkları hemşireliği el kitabı, Koç Üniversitesi Yayınları, 1. Baskı, İstanbul. 2012. p. 443-57.
8. 8. Depypere HT, Comhaire FH. Herbal preparations for the menopause: beyond isoflavones and black cohosh. Maturitas. 2014; 77(2): 191-4.

9. 9. Heyerick A, Vervarcke S, Depypere H, Bracke M, De Keukeleire D. A first prospective, randomized, double-blind, placebo-controlled study on the use of a standardized hop extract to alleviate menopausal discomforts. Phytomedicine. 2010;17(6): 389-96.
10. 10. Erkkola R, Vervarcke S, Vansteelandt S, Rompotti P, De Keukeleire D, Heyerick A. A randomized, double-blind, placebo-controlled, cross-over pilot study on the use of a standardized hop extract to alleviate menopausal discomforts. Phytomedicine. 2010; 17(6): 389-96.
11. 11. Mohammad-Alizadeh S, Mirghafourvand M, Aghamiri V, Nazemiyeh H. Efficacy of hop (Humuluslupulus L.) on early menopausal symptoms in perimenopausal women: a randomized double blind placebo-controlled trial. Sci J Kurdistan Univ Med Sci. 2014; 19(3): 12-22.
12. 12. Aghamiri V, Mirghafourvand M, Mohammad-Alizadeh S, Nazemiyeh H. The effect of Hop (Humulus lupulus L.) on early menopausal symptoms and hot flashes: a randomized placebo-controlled trial. Complement Ther Clin Pract. 2016; 23:130-5.
13. 13. Chen SN, Friesen JB, Webster D, Nikolic D, Breemen RB, Wang ZJ, Fong HHS, Farnsworth NR, Pauli GF .Phytoconstituents from Vitex agnus-castus fruits. Fitoterapia. 2011; 82(4): 528–533.
14. 14. Lucks BC. Vitex agnus castus essential oil and menopausal balance: a research update. Complementary Therapies in Nursing and Midwifery. 2003; 9(3): 157-160.
15. 15. Abbaspoor Z, Hajikhani NA, Afshari P. Effect of Vitex agnus-castus on menopausal early symptoms in postmenopausal women: a randomized, double blind, placebo –controlled study. British Journal of Medicine & Medical Research. 2011; 1(3): 132-140.
16. 16. Mazaro-Costa R, Andersen ML, Hachul H, Tufik S. Medicinal plants as alternative treatments for female sexual dysfuntion: utopian vision or possible treatment in climacteric women? J Sex Med. 2010; 7(11): 3695-714.
17. 17. Laakmann E, Grajecki D, Doege K, zu Eulenburg C, Buhling KJ. Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecol Endocrinol. 2012; 28(9): 703-9.
18. 18. Van Die MD, Burger HG, Bone KM, Cohen MM, Teede HJ. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2009;16(1): 156-63.
19. 19. European Medicines Agency. Science Medicine Health. Assessment report on Angelica sinensis (Oliv.) Diels, radix. 2013. Available from: https://www.ema.europa.eu/en/documents/herbal-report/final-assessment-report-angelica-sinensis-oliv-diels-radix-first-version_en.pdf
20. 20. Chang A, Kwak BY, Yi K, Kim JS. The effect of herbal extract (EstroG-100) on pre-, peri- and post-menopausal women: a randomized double-blind, placebo-controlled study. Phytotherapy Research. 2012; 24(4): 510-516.
21. 21. Low Dog T. Menopause: a review of botanical dietary supplements. Am J Med. 2005; 118 Suppl 12B:98-108.
22. 22. Bayles B, Usatine R. Evening primrose oil. Am Fam Physician. 2009; 15;80(12):1405-8.
23. 23. Farzaneh F, Fatehi S, Sohrabi MR, Alizadeh K. The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial. Archives of Gynecology and Obstetrics. 2013; 288(5): 1075-1079.
24. 24. Cancelo Hidalgo MJ, Castelo-Branco C, Blumel JE, Lanchares Pérez JL, Alvarez De Los Heros JI; Isona Study Group. Effect of a compound containing isoflavones, primrose oil and vitamin E in two different doses on climacteric symptoms. J Obstet Gynaecol. 2006; 26(4): 344-7.
25. 25. Uyar B, Sivrikoz ON, Ozdemir U, Dasbasi T, Sacar H. Histological investigation of the effect of soybean (Glycine max) extracts on the collagen layer and estrogen receptors in the skin of female rats. Clinics (Sao Paulo). 2014; 69(12): 854-61.
26. 26. Dash S, Kadam S. Study of soya (Glycıne Max L. Merr.) on menopausal syndrome; an extra pharmacopoeıal drug. ResearchGate. 2017.
27. 27. Albert A, Altabre C, Baró F, Buendía E, Cabero A, Cancelo MJ, Castelo-Branco C, Chantre P, Duran M, Haya J, Imbert P, Julía D, Lanchares JL, Llaneza P, Manubens M, Miñano A, Quereda F, Ribes C, Vázquez F. Efficacy and safety of a phytoestrogen preparation derived from Glycine max (L.) Merr in climacteric symptomatology: a multicentric, open, prospective and non-randomized trial. 2002; 9(2): 85-92.
28. 28. D'Anna R, Cannata ML, Marini H, Atteritano M, Cancellieri F, Corrado F, Triolo O, Rizzo P, Russo S, Gaudio A, Frisina N, Bitto A, Polito F, Minutoli L, Altavilla D, Adamo EB, Squadrito F. Effects of the phytoestrogen genistein on hot flushes, endometrium, and vaginal epithelium in postmenopausal women: a 2-year randomized, double-blind, placebo-controlled study. Menopause. 2009; 16(2): 301-6.
29. 29. Khaodhiar L, Ricciotti HA, Li L, Pan W, Schickel M, Zhou J, Blackburn GL. Daidzein-rich isoflavone aglycones are potentially effective in reducing hot flashes in menopausal women. Menopause. 2008; 15(1): 125-132.
30. 30. Messina M. Soy and health update: evaluation of the clinical and epidemiologic literatüre. Nutrients. 2016; 8(12): 754.
31. 31. Booth NL, Piersen CE, Banuvar S, Geller SE, Shulman LP, Farnsworth NR. Clinical studies of red clover (Trifolium pratense) dietary supplements in menopause: a literature review, Menopause. 2006; 13(2): 251-64.
32. 32. Hidalgo LA, Chedraui PA, Morocho N, Ross S, San Miguel G. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005; 21(5): 257-64.
33. 33. Coon JT, Pittler MH, Ernst E. Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis. Phytomedicine. 2007; 14(2-3): 153-9.
34. 34. Myers SP, Vigar V. Effects of a standardised extract of Trifolium pratense (Promensil) at a dosage of 80 mg in the treatment of menopausal hot flushes: A systematic review and meta-analysis. Phytomedicine. 2017; 15(24):141-147.
35. 35. Fugh-Berman A ve Kronenberg F. Red clover (Trifolium pratense) for menopausal women: current state of knowledge. Menopause. 2001; 8(5): 333-7.
36. 36. Ehsanpour S, Salehi K, Zolfaghari B, Bakhtiari S. The effects of red clover on quality of life in post-menopausal women. Iran J Nurs Midwifery Res. 2012;17(1): 34-40.
37. 37. Colli MC, Bracht A, Soares AA, de Oliveira AL, Bôer CG, de Souza CG, Peralta RM. Evaluation of the efficacy of flaxseed meal and flaxseed extract in reducing menopausal symptoms. J Med Food. 2012; 15(9): 840-845.
38. 38. Brooks JD, Ward WE, Lewis JE, Hilditch J, Nickell L, Wong E, Thompson LU. Supplementation with flaxseed alters estrogen metabolism in postmenopausal women to a greater extent than does supplementation with an equal amount of soy. The American Journal of Clinical Nutrition. 2004; 79(2): 318–325.
39. 39. Ghazanfarpour M, Sadeghi R, Latifnejad Roudsari R, Khadivzadeh T, Khorsand I, Afiat M, Esmaeilizadeh M. Effects of flaxseed and Hypericum perforatum on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women: a systematic review and meta-analysis, Avicenna J Phytomed. 2016; 6(3): 273-83.
40. 40. Simbalista RL, Sauerbronn AV, Aldrighi JM, Arêas JA. Consumption of a Flaxseed-Rich Food Is Not More Effective Than a Placebo in Alleviating the Climacteric Symptoms of Postmenopausal Women. The Journal of Nutrition. 2010; 140(2): 293-297.
41. 41. Pruthi S, Qin R, Terstreip SA, Liu H, Loprinzi CL, Shah TR, Tucker KF, Dakhil SR, Bury MJ, Carolla RL, Steen PD, Vuky J, Barton DL. A Phase III, Randomized, Placebo-Controlled, Double-Blind Trial of Flaxseed for the Treatment of Hot Flashes Menopause. 2013; 20(4): 401-8.
42. 42. Wilson DR. Uses and side effects of black cohosh for menopause. Medical News Today. 2017. Available from: https://www.medicalnewstoday.com/articles/317530.php.
43. 43. Ünlüer E. Postmenepozal kadınlar¬da yılan otu tedavisinin vasküler elatisite, kan lipd profili ve vazomotor semptomlar üzerine etkilerinin araştırılması. Yayınlan¬mamış Uzmanlık Tezi, T.C. Sağlık Bakanlığı Bakırköy Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul, 2005, 41-2.
44. 44. Drewe J, Zımmermann C, Zahner C. The effect of a Cimicifuga racemosa extracts Ze 450 in the treatment of climacteric complaints--an observational study. Phytomedicine. 2013; 15;20(8-9): 659-66.
45. 45. Osmers R, Friede M, Liske E, Schnitker J, Freudenstein J, Henneicke-von Zepelin HH. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 2005; 105(5 Pt 1):1074-83.
46. 46. Uebelhack R, Blohmer JU, Graubaum HJ, Busch R, Gruenwalk J, Wernecke KD. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol. 2006; 107(2 Pt 1):247-55.
47. 47. Bai W, Zepelin HH, Wang S, Zheng S, Liu J, Zhang Z, Geng L, Hu L,Chunfeng J, Liske E. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas. 2007; 20;58(1): 31-41.
48. 48. Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet Gynecol. 2008;199(5): 455-66.
49. 49. Sarri G, Pedder H, Dias S, Guo Y, Lumsden MA. Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG. 2017; 124(10): 1514-1523.
50. 50. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012; 12(9):CD007244.
51. 51. Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, Oliver-Williams C, Muka T. Use of Plant-Based Therapies and Menopausal Symptoms, A Systematic Review and Meta-analysis. JAMA. 2016; 21;315(23): 2554-63.
52. 52. Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, Oliver-Williams C, Muka T. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA. 2016; 315(23): 2554-63.
53. 53. Al-akoum M, Maunsell E, Verrea¬ult R, Provencher L, Otıs, H, Dodın S. Effects of Hypericum Perforatum (St. John’s Wort) on Hot Flashes and Quality of Life in Perimenopausal Wo¬men: A Randomized Pilot Trial. Menopause. 2009; 16(2): 307-14.
54. 54. Abdali K, Khajehei M, Tabatabaee HR. Effect of St John's wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause. 2010; 17(2): 326-31.
55. 55. Chung DJ, Kim HY, Park KH, Jeong KA, Lee SK, Lee YI, Hur SE, Cho MS, Lee BS, Bai SW, Kim CM, Cho SH, Hwang JY, Park JH. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J. 2007; 30;48(2): 289-94.
56. 56. Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas. 2007; 57(4): 405-14.
57. 57. Journal of Obstetrics and Gynaecology Canada (JOGC). Managing Menopause, No. 311. 2014; Replaces No. 222, 2009.
58. 58. Zhang X, Shu XO, Li H, Yang G, Li Q, Gao YT, Zheng W. Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Arch Intern Med. 2005; 165(16): 1890-1895.
59. 59. Luoto R, Moilanen J, Heinonen R, Mikkola T, Raitanen J, Tomas E, Ojala K, Mansikkamäki K, Nygård CH. Effect of aerobic training on hot flushes and quality of life--a randomized controlled trial. Ann Med. 2012; 44(6): 616-26.
60. 60. Haimov-Kochman R, Constantini N, Brzezinski A, Hochner-Celnikier D. Regular exercise is the most significant lifestyle parameter associated with the severity of climacteric symptoms: a cross sectional study. Eur J Obstet Gynecol Reprod Biol. 2013; 170(1): 229-34.
61. 61. Daley A, MacArthur C, Mutrie N, Stokes-Lampard H. Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2007; 17;(4):CD006108.
62. 62. Daley AJ, Thomas A, Roalfe AK, Stokes-Lampard H, Coleman S, Rees M, Hunter MS, MacArthur C. The effectiveness of exercise as treatment for vasomotor menopausal symptoms: randomised controlled trial. BJOG. 2015; 122(4): 565-75.
63. 63. Newton KM, Reed SD, Guthrıe KA, Sherman KJ, Booth-Laforce C, Caan B, Sternfeld B, Carpenter JS, Learman LA, Freeman EW, Cohen LS, Joffe H, Anderson GL, Larson JC, Hunt JR, Ensrud KE, LaCroix AZ. Efficacy of yoga for vasomotor symptoms: a randomized controlled trial. Menopause. 2014; 21(4): 339-46.
64. 64. Saensak S, Vutyavanich T, Somboonporn W, Srisurapanont M. Relaxation for perimenopausal and postmenopausal symptoms. Cochrane Database Syst Rev. 2014; 20;(7):CD008582.
65. 65. Nedstrand E, Wyon Y, Hammar M, Wijma K. Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom. J Psychosom Obstet Gynaecol. 2006; 27(4): 193-199.
66. 66. Zaborowska E, Brynhildsen J, Damberg S, Fredriksson M, Lindh-Astrand L, Nedstrand E, Wyon Y, Hammar M. Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies. Climacteric. 2007; 10(1): 38-45.
67. 67. Lindh-Åstrand L, Nedstrand E. Effects of applied relaxation on vasomotor symptoms in postmenopausal women: a randomized controlled trial. Menopause. 2013; 20(4): 401-408.
68. 68. Dodin S, Blanchet C, Marc I, Ernst E, Wu T, Vaillancourt C, Paquette J, Maunsell E. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews. 2013; 1-3.
69. 69. Avis NE, Legault C, Coeytaux RR, Pian‐Smith M, Shifren JL, Chen W, Valaskatgis P. A randomized, controlled pilot study of acupuncture treatment for menopausal hot flashes. Journal of the North American Menopause Society. 2008; 15(6): 1070‐8.
70. 70. Joshi S, Khandwe R, Bapat D, Deshmukh U. Effect of yoga on menopausal symptoms. Menopause Int. 2011; 17(3): 78-81.
71. 71. Kung YY, Yang CC, Chıu JH, Kuo TB. The relationship of subjec¬tive sleep quality and cardiac autonomic nervous system in postmenopausal women with ınsomnia under auricular acupressure. Menopause. 2011; 18(6): 638-45.
72. 72. Abedian Z, Eskandari L, Abdi H, Ebrahimzadeh S. The effect of acupressure on sleep quality n menopausal women: a randomized control trial. Iran Journal of Medical Sciences. 2015; 40(4): 328-34.
73. 73. Hachul H, Garcıa TKP, Macıel AL, Yagıhara F, Tufık S, Bıtten¬court L. Acupuncture ımproves sleep in postmenopause in a randomized, double-blind, placebo-controlled study. Climacterium. 2013; 16(1): 36-40.
74. 74. Whiskey E, Werneke U, Taylor D. A systematic review and meta-analysis of Hypericum perforatum in depression: a comprehensive clinical review. Int Clin Psychopharmacol 2001; 16:239–52.
75. 75. Röder C, Schaefer M, Leucht S. Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John’s wort. Fortschr Neurol Psychiatr. 2004; 72(6): 330-43.
76. 76. Hartley DE, Heinze L, Elsabagh S, File SE. Effects on cognition and mood in postmenopausal women of 1-week treatment with Ginkgo biloba. Pharmacol Biochem Behav. 2003; 75(3): 711-20.
77. 77. Kim KH, Kang KW, Kim DI, Kim HJ, Yoon HM, Lee JM, Jeong JC, Lee MS, Jung HJ, Choi SM. Effects of acupuncture on hot flushes in perimenopausal and postmenopausal women‐a multicenter randomized clinical trial. Journal of the North American Menopause Society. 2010;17(2): 269‐80.
78. 78. Kazemzadeh R, Nikjou R, Rostamnegad M, Norouzi H. Effect of lavender aromatherapy on menopause hot flushing: A crossover randomized clinical trial. Complement Ther Med. 2013; 21(3): 158-63.
79. 79. Darsareh F, Taavoni S, Joolaee S, Haghani H. Effect of aromatherapy massage on menopausal symptoms: a randomized placebo-controlled clinical trial. Menopause. 2012; 19(9): 995-9.
80. 80. Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA. 2003; 289(21): 2827-34.
81. 81. Pebdani MA, Taavoni S, Seyedfatemi N, Haghani H. Triple-blind, placebo-controlled trial of Ginkgo biloba extract on sexual desire in postmenopausal women in Tehran. Iran J Nurs Midwifery Res. 2014; 19(3): 262–265.
82. 82. Formoso G, Perrone E, Maltoni S, Balduzzi S, Wilkinson J, Basevi V, Marata AM, Magrini N, D'Amico R, Bassi C, Maestri E. Short term and long term effects of tibolone in postmenopausal women, Cochrane Database Syst Rev. 2016; 12;10:CD008536.
83. 83. Ziaei S, Kazemnejad A, Zareai M. The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet In¬vest. 2007; 64(4): 204-7.
84. 84. Somunkiran A, Erel CT, Demirci F, Senturk ML. The effect of tibolone versus 17β-estradiol on climacteric symptoms in women with surgical menopause: A randomized, cross-over study. Maturitas. 2007; 20;56(1): 61-8.
85. 85. Carbonel AA, Baracat MC, Simões RS, Simões MJ, Baracat EC, Soares JM Jr. The soybean concentrated extract proliferates the vagina of adult rats. Menopause: The Journal of The North American Menopause Society. 2002; 9(2): 85-92.
86. 86. Oh KJ, Chae MJ, Lee HS, Hong HD, Park K. Effects of Korean red ginseng on sexual arousal in menopausal women: placebo-controlled, double-blind crossover clinical study. The Journal of Sexual Medicine. 2010; 7(4): 1469-1477.
87. 87. Kim SY, Seo SK, Choi YM, Jeon YE, Lim KJ, Cho S, Choi YS, Lee BS. Effects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women: a double-blind randomized controlled trial. Menopause: The Journal of The North American Menopause Society. 2012; 19(4): 461-466.
88. 88. Ma D, Wu L, He Z. Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause 2013; 20(11): 1216-26.
89. 89. Morelli V, Naquın C. Alternative therapies for tran¬ditional disease states: menopause. Am Fam Physician. 2002; 66(1): 29-34.
90. 90. Somekawa Y, Chiguchi M, Ishibashi T, Aso T. Soy intake related to menopausal symptoms, serum lipids, and bone mineral density in postmenopausal Japanese women. Obstet Gynecol. 2001; 97(1): 109-115.
91. 91. Wei P, Liu M, Chen Y, Chen DC. Systematic review of soy isoflavone supplements on osteoporosis in women. Asian Pac J Trop Med. 2012; 5(3): 243-8.
92. 92. Karadavut Kİ, Başaran A, Çakçı A. Osteoporoz tedavisinde vitamin D’nin yeri. Geriatri. 2002; 5(3): 115-122.
93. 93. Richy F, Schacht E, Bruyere O, Ethgen O, Gourlay M, Reginster JY. Vitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures: a comparative meta-analysis. Calcif Tissue Int. 2005; 76(3): 176-86.
94. 94. Massonı AM, Menoya I, Bocanera R, Pezzotto SM, Mario E, Morosano ME. Hypovitaminosis D and associated risk factors in postmenopausal women. Health. 2014; 6(11): 1180-90.
95. 95. Mata-Granados JM, Cuenca-Acevedo JR, Luque de Castro MD, Holick MF, Quesada-Gómez JM. Vitamin D insufficiency together with high serum levels of vitamin A increases the risk for osteoporosis in postmenopausal women. Arch Osteoporos. 2013; 8: 124.
96. 96. Nelson HD, Humphrey LL, Nygren P, Teutsch SM, Alan JD. Postmenopausal Hormone Replacement Therapy. JAMA. 2002; 288(7): 872-881.