Mood swings, hot flushes and night sweats? Remember that menopause is not a disease, it won’t last forever, and natural therapies can be very helpful.

Menopause is a natural part of life, marking the end of our fertile years. But in our youth-focused culture, it can be treated like a dirty little secret and is rarely discussed openly.

Often, women will never have considered how their own personal journey through this time of transition will play out, until they get their first signs of change.

In an ideal world, there would be a period of gentle transition starting in your 40s where your body adjusts slowly to the gradual decrease in hormones, so that by the time your periods eventually stop, the process is all but completed. You are officially considered menopausal once you haven’t had a period for more than 12 months.

It’s a common misconception that the symptoms we associate with menopause in the West, such as hot flushes, insomnia and irritability, only occur once the menstrual cycle stops. It is actually the transition to menopause, or perimenopause, that is usually the most challenging time and some women will start to experience symptoms while they still get regular periods. Perimenopause and menopause are all part of the same continuum.

Signs and symptoms

Various factors dictate the start of perimenopause.

Women with a history of smoking are far more likely to experience earlier hormonal changes, due to accelerated ovarian ageing.

Having a healthy diet and lifestyle during your 20s and 30s helps to preserve ovarian function and protect against early perimenopause.

Other issues, such as how old you were when you got your first period, ethnicity and body mass index, also influence the age of perimenopause onset.

Speaking with your mother about her experiences may help, as genetic factors definitely play a role.

If you are in your 40s and starting to experience symptoms, it may be worthwhile having your hormones tested. A simple blood test will clarify matters: elevation of follicle-stimulating hormone and a decrease in oestrogen are markers that you’re starting perimenopause.

The female reproductive hormones are delicately balanced during our fertile years. As ovarian function starts to wane the master hormone, oestrogen, starts to decrease, along with other sex hormones.

These hormones play a much more complex role in our health than just reproduction and this is evidenced by the broad range of symptoms experienced during perimenopause and menopause. Hot flushes, depression, insomnia, irritability, anxiety, low libido, vaginal dryness, low energy, weight gain, back, neck and muscle pain are the most common symptoms of perimenopause. They can vary widely in severity; some women experience only mild symptoms, while others’ symptoms are so severe they significantly impact their life.

The intensity of these changes can cause women to reach for a quick solution. Often younger perimenopausal women are put on the oral contraceptive pill and older women may be offered hormone replacement therapy. These medications can stop symptoms, but there are a range of risk factors that need to be considered, including the fact that long-term hormone supplementation increases the risk of certain oestrogen-dependent conditions in susceptible women.

Another factor to consider is what happens when you eventually come off hormone supplementation. The sudden withdrawal of hormones can put you right back where you started.

Thankfully, natural medicine offers some very effective solutions.

Meal plans

There is a big disparity between the experiences of menopause in women from Western cultures and that of their Asian sisters. Hot flushes are reported by only 10 percent of Chinese women, while approximately 75 percent of Western women get them.

The reason for this contrast lies in the diet. Typical Western diets are much higher in animal protein and fat, which is associated with higher oestrogen levels. Westerners also consume far less fibre, which is needed to support healthy hormone metabolism.

Traditional Asian diets are rich in plant foods that provide beneficial phytoestrogens, such as isoflavones, flavones, coumestans, and lignans. These compounds bind to oestrogen receptors on the cell and exert weak oestrogenic activity. A diet high in plant phytoestrogens reduces the symptoms of menopause and softens the effects of decreased oestrogen.

It is thought that Western women have generally higher oestrogen levels due to dietary factors and therefore experience a far greater drop in oestrogen levels at perimenopause, causing more severe symptoms; while Asian women with a higher intake of phytoestrogens and fibre in the diet have a more gentle transition. It is essential to have ample vegetables in the diet. A good rule of thumb is to include two to three handfuls at each meal, which also boosts overall vitamin, mineral and antioxidant intake.

Cruciferous vegetables – broccoli, cabbage, Brussels sprouts, kale, cauliflower, bok choi and other leafy greens – are particularly beneficial as they support healthy liver function and effective hormone metabolism.

An increase in vegetables will also add beneficial fibre. A fibre-rich diet will ensure healthy bowel function and improve oestrogen metabolism and hormone health by encouraging effective elimination. Other great fibre foods include legumes – lentils, chickpeas and kidney beans – that have the added benefit of providing phytoestrogens, which reduce symptoms of menopause.

Exert yourself

Exercise is not only nature’s best antidepressant and energy booster, it also helps you maintain muscle mass, which in turn drives metabolism and keeps weight in check.

We start to lose bone mineral density during menopause, so regular weight-bearing exercise, a diet rich in calcium and vitamin D, and healthy exposure to sunlight are essential at this time to keep bones strong. Interestingly, regular exercise actually improves oestrogen metabolism.

Even though we are not making as much oestrogen as we used to, healthy hormone metabolism helps to lessen symptoms. Regular exercise has been shown to improve oestrogen metabolism, which partly explains why it reduces symptoms of menopause. Menopausal women who participated in a supervised regular exercise program over 12 months experienced significantly fewer symptoms than their non-exercising counterparts and reported an increase in their quality of life.

So the message is: Move! It doesn’t matter what type of exercise you do as long as it’s regular weight-bearing exercise. Thirty minutes, five times a week will get the best results.

Heal with herbs

Herbal medicine has long been used to support every stage of women’s hormonal health and is particularly effective in treating menopausal symptoms.

Black cohosh, wild yam and red clover are traditionally used to support women during menopause, because they are rich in phytoestrogens, which decrease hot flushes and minimise other symptoms; they also regulate hormone production.

Dong quai can be a lifesaver for perimenopausal women who are experiencing erratic periods and hormonal fluctuations. It has a balancing effect on hormones and gently regulates periods.

St John’s wort is an effective antidepressant herb which can be used to elevate mood and stabilise erratic emotions. It has a soothing effect on the nervous system and can also promote deeper sleep.

Other herbs, such as skullcap, oats and lemon balm, nourish the nervous system and soothe anxiety.

To tame night sweats, take 5 to 15 drops of sage tincture three times a day in half a cup of water. This herb has astringent qualities that can help ease abnormal sweating in a day or so.

Withania, rehmannia and licorice are adaptogenic herbs that have a beneficial effect on the adrenal glands and modulate the stress response. They are extremely useful if irritability and exhaustion are present.

Zizyphus and sage are particularly beneficial for hot flushes, acting specifically to reduce sweating.

However, as every woman’s experience of perimenopause and menopause is different, there is no ‘one size fits all’ approach to treatment. Herbal medicine needs to be prescribed individually after consultation with a qualified practitioner to get the best results.

Chill out

Stress management is vital during this phase of your life. Hormonal changes can cause a rollercoaster of emotions – irritability, anxiety and depression – which are worsened by broken sleep, due to night sweats.

Exercise is one of the best ways to manage stress; meditation, massage, yoga or tai chi are also very beneficial.

Remember, in many traditional cultures women who have reached this stage of life are held in a position of respect in their community, as it signifies experience and wisdom. In the West, however, it is seen as a sign of ageing and this can be quite challenging for women. Counselling can be of great benefit to help women adjust, especially if perimenopause has started at a younger age.

Top up your levels

While having a healthy balanced diet should be your first choice to provide a good range of nutrients, supplementation can also benefit women during perimenopause.

• B group vitamins: Support the nervous system during stress; B6 is particularly important to assist with hormone balance.
• Magnesium: Nourishes the nervous system, relaxes the body, and promotes restful sleep. It works synergistically with vitamin B6 to support healthy nervous system function and mood and also assists with hormone balance.
• S-adenosyl methionine (SAMe): Supports serotonin production and helps to stabilise mood.
• Flax seeds: Provide a valuable source of phytoestrogens. Clinical studies show that 40g of crushed flaxseeds daily provides significant relief from menopausal symptoms.
• Calcium, phosphorus, vitamin D: Perimenopause is the perfect time to start thinking about supporting your bone health with these important nutrients.

This article first appeared in Nature & Health magazine.
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