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Menopause
11th Apr, 2023

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An overview of perimenopause and menopause

Menopause is the natural end of menstrual periods and marks the end of fertility. Natural menopause occurs when the ovaries stop producing eggs and oestrogen levels are reduced. It is diagnosed 12 months after the last period. The years leading up to that point, when women have hormonal fluctuations and irregular menstrual patterns, are called the menopausal transition or perimenopause.

The menopausal transition most often begins between ages 45 and 55, with the average age being 51 to 52. It usually lasts about four years but can last for over a decade and causes symptoms in about 80% of women. Many factors can influence hormone production, which triggers menopause, including genetics, diet, and lifestyle factors. Although this is a natural process, it can be challenging and produce a range of symptoms.

Other women may experience early menopause because of premature ovarian insufficiency (POI), infection, autoimmune disorders, cancer treatments, hysterectomy, and removal of the ovaries (oophorectomy).

The primary symptoms of menopause are hot flashes and night sweats, which are associated with sleep disturbances and mood disorders. Severe symptoms affect about 20% of women and can significantly impact daily activities and quality of life. The menopausal transition affects each woman uniquely, and the long term may lead to changes in body composition, cardiovascular health, bone density and cancer risk.

Conventional treatments for menopause include hormone replacement therapies, vaginal oestrogen, antidepressants, gabapentin, and medication to reduce blood pressure or prevent osteoporosis. Hormone replacement therapies may be effective in reducing symptoms; however, some may be associated with adverse side effects such as headache, fatigue, nausea/vomiting,  vaginal bleeding,  breast pain, and increased risk of breast cancer. A wide range of herbal, nutritional and lifestyle interventions can support symptom relief.

 

Menopausal stages

Reproductive stage
  • Regular menstrual cycles.

Early perimenopause
  • Variable cycle length.
  • Symptoms of hormonal changes.
  • Can still become pregnant.

Late perimenopause
  • Cycles lengthen to three to twelve months apart.
  • Variable cycles can last for four years.
  • Vasomotor symptoms often begin during this phase.

Menopause
  • Twelve months with no menses.
  • Ovaries stop producing eggs.
  • Average age is 51 years.

Post menopause
  • Four or more years with no menses.
  • Increased risk of osteoporosis and cardiovascular disease.

 

Common menopausal symptoms

  • Hot flushes
  • Night sweats
  • Insomnia and difficulty sleeping
  • Difficulty concentrating and brain fog
  • Impaired memory
  • Anxiety
  • Irritability
  • Depression
  • Muscle/joint pains
  • Tiredness and low energy
  • Vaginal dryness
  • Painful intercourse
  • Low libido
  • Crawling sensations on the skin (called formication)
  • Hair thinning or loss
  • Dry skin
  • Headaches and migraines
  • Sore breasts
  • Heart palpitations.

 

Spotlight on hot flashes and night sweats

Hot flashes and night sweats are the most common symptoms of menopause, occurring in more than 70% of women and lasting up to 10 years after menopause. They emerge as oestrogen levels decline. There is also a link between the state of the nervous system, adrenal function, and the hypothalamus-pituitary-adrenal (HPA) axis.

The intensity and duration vary widely between women. Some will begin experiencing them in their mid-30s and continue to experience them well after menopause. Other women will not experience them until menopause or at all.

Each hot flash can last from a few seconds to hours. They typically start in the chest area and spread to the upper chest, neck and face. The flushes may feel like a burning, overheating sensation and may spread over the whole body. Feelings of anxiety, heart palpitations and rapid breathing are also common.

 

Holistic treatment aims

  • Support secondary hormone production, relieve menopausal symptoms and support overall heart, metabolic, cognitive and bone health.

 

Herbal recommendations

*Please consult your health professional for the prescription of herbal, nutritional and lifestyle recommendations.

Vitex agnus-castus (Chaste Tree Berry)
  • Used to relieve symptoms associated with female hormonal imbalances in infertility, menstrual disorders, premenstrual disorders, and menopause.
  • May improve menopausal symptoms including hot flashes, sleep disturbance, anxiety, urinary incontinence, and vaginal dryness.
  • May be useful for the relief of PMS symptoms in perimenopausal women with irregular cycles.
  • May benefit withdrawal from hormone replacement therapy.

Actaea racemosa previously Cimicifuga racemosa (Black Cohosh)
  • May be beneficial for alleviating night sweats and hot flashes.
  • Exerts beneficial effects on bone metabolism and may be useful in the prevention of osteoporosis.
  • Has been associated with liver damage in some people; however, long term (12 months) studies show that it is safe in healthy menopausal women.

 

Glycyrrhiza glabra (Liquorice)
  • May relieve severity and reduce incidence of menopausal hot flashes.
  • ·Caution: liquorice may increase blood pressure and is contraindicated in liver disease.

Humulus lupulus (Hops)
  • The female flowers have been used traditionally to treat sleep disturbances and menopausal symptoms.
  • There is some clinical evidence for improving menopausal symptoms including hot flushes, as well as improvement in anxiety, depression, and sexual dysfunction.

Leonuris cardiaca (Motherwort)
  • Frequently used in traditional Chinese medicine to aid the nervous system and improve menopausal related night sweats, insomnia, anxiety, and sleep.
  • A heart tonic which may improve heart palpitations, particularly with nervousness.

Salvia officinalis (Sage)
  • Widely used to help support temperature balance in the body, reducing hot flushes, night sweats and excessive sweating.
  • Supports the nervous system and improves thought, clarity, and nervous exhaustion.
  • Often taken as a cool tea to relieve menopausal symptoms.

Asparagus racemosa (Shatavari)
  • A traditional Ayurvedic (Indian) herb used as a general female tonic.
  • Thought to help with libido and may help menopausal complaints such as hot flashes.
  • · Preliminary evidence suggests it may improve muscle function in postmenopausal women.

Trifolium pratense (Red Clover)
  • One of the most widely researched botanicals for menopause.
  • Clinical studies demonstrate its beneficial effects on menopausal hot flashes, cholesterol levels, vaginal health, and sexual wellbeing.

Panax ginseng (Korean ginseng)
  • An adaptogenic herb that may improve menopausal symptoms, stress, fatigue, physical exhaustion, sexual function and stamina.
  • Has been associated with postmenopausal vaginal bleeding (bleeding after menopause).

Ziziphus jujuba (Ziziphus)
  • A frequently used herb in traditional Chinese medicine that aids the nervous system and helps improve night sweats, insomnia, anxiety, and palpitations.
  • Often used in combination with liquorice for sleep disturbances and mood symptoms in menopause.

Angelica sinensis (Dong quai)
  • One of the most widely used traditional Chinese herbs for women’s health, including period pain, menstrual irregularity and menopause.
  • May be beneficial for relieving hot flashes, although more clinical trial data is needed.

Hypericum perforatum (St John’s wort)
  • Antidepressant herb which may improve hot flashes, menopausal symptoms, and depression in postmenopausal women.

Passiflora incarnatus (Passionflower)
  • Limited clinical evidence suggests it may improve menopausal symptoms such as mood, muscular pain, hot flashes, formication, headache and fatigue.

Dioscorea villosa (Wild yam)
  • Traditionally used to help support menopause via its oestrogenic effect on balancing hormones.
  • Has been used to support the management of hot flushes associated with low oestrogen, although evidence is lacking.
  • May reduce high cholesterol, a common occurrence in menopause.

Valeriania officinalis (Valerian)
  • A medicinal herb with benefits for improving sleep and reducing anxiety.
  • Can improve the quality of sleep in postmenopausal women.
  • Can decrease frequency and severity of hot flashes.   

Silybum marianum (Milk thistle)
  • A powerful antioxidant herb with liver-protecting, anti-inflammatory and antidiabetic actions.
  • Stimulates bone mineralisation and may prevent or delay bone loss in postmenopausal women.
  • Can decrease frequency and severity of hot flashes. 

 

 

Nutrient recommendations

B vitamins
  • Play many roles in the body and are particularly important for heart health, brain and nervous system function, and reducing fatigue.
  • Vitamins B6, B9 and B12 are important for reducing heart disease risk in postmenopausal women. 

Magnesium
  • Involved in over 600 processes in the body, but important for heart and bone health.
  •  Helps regulate heart rate and rhythm and supports a healthy heart muscle, while also helping to maintain healthy blood pressure.

Calcium
  • Calcium needs increase with age due to hormonal changes during menopause that can affect bone health.
  • Calcium supplementation (plus vitamin D) reduces total bone mineral density loss in menopause by 0.4% per year.

Vitamin C
  • Reduces oxidative stress that occurs during menopause.
  • Can improve blood vessel function and bone mineralisation in postmenopausal women.

Vitamin D
  • Important for bone and muscle health, and immune function.

Vitamin E
  • Taken alone, or in combination with omega-3 or curcumin, can reduce hot flashes.
  • Can be used as a lubricant for the vagina, which can become dry during menopause.

Essential fatty acids
  • May decrease frequency and severity of hot flashes and night sweats.
  • Supports heart health, reduces blood pressure, and maintains normal triglyceride and cholesterol levels.

Zinc
  • Helps to maintain collagen and tissue health and can help relieve vaginal dryness during menopause.

Probiotics
  • Various lactobacillus strains can benefit a range of menopausal symptoms, including vaginal dryness, mood, hot flashes, and weight gain.

 

 

Diet and lifestyle recommendations

Dietary inclusions
  • Phyto-oestrogens are compounds in foods that act as weak oestrogens in the body and can reduce hot flashes and improve bone and heart health. Sources include:

o   Soybeans and soy products (tempeh, tofu, soy milk)

o   Sprouted beans – alfalfa, redo clover, mung beans, split peas

o   Nuts and seeds – flaxseeds/linseeds, sunflower seeds.

  • Calcium and vitamin D-rich foods to support bone health, including:

o   Calcium-rich foods: dairy products, soybeans, tofu, sardines, salmon, egg yolk, green leafy vegetables, tahini, and brazil nuts.

o   Vitamin D-rich foods: egg yolk, fatty fish like salmon, tuna and mackerel.

  • Good quality protein-rich foods to support muscles and bone health include eggs, meat, fish, legumes and dairy products, and protein powders.
  • A diet rich in fresh fruit, vegetables, whole grains, legumes, nuts, and seafood.  

Dietary exclusions
  • Avoid foods and stimulants that can cause hot flashes, including chilli, spicy foods, caffeine and alcohol.
  • Limit the intake of refined sugar, foods high in salt and highly processed and fatty foods.

Stress reduction
  • Yoga, tai chi, deep breathing, vagal nerve stimulation, counselling/psychology, and mindfulness meditation.

Exercise
  • Incorporating a mix of daily exercise can improve menopausal symptoms and have long term benefits for improving heart and bone health, including:

o   Low/high-impact exercise (e.g. jogging, running and brisk walking) to improve bone density

o   Weight or resistance training to strengthen and increase muscle mass and increase balance and coordination.

o   Stretching and balancing to improve mobility and balance and minimise falls.

Body temperature regulation
  • Slight increases in body temperature can trigger hot flashes. Try to keep cool by dressing in light layers of clothing, opening windows or using a fan or air conditioner, sipping a cold drink, and applying a wet cloth to the skin.

 

Seek Medical Care

This is not an all-inclusive, comprehensive list. Consult a qualified healthcare provider before starting any therapy. Application of clinical judgement is necessary.

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