Supporting Menopause

If you were heading off on a journey, you’d probably pack some bags, check you have everything you need and make any other essential preparations before you set out. In fact, there’s often lots of advanced planning and preparing involved to ensure the journey goes as smoothly and comfortably as it can.

Your health is a journey and this is also a great way to approach your health at different stages of life. With each life stage, a new health journey unfolds, and it makes complete sense to be as prepared as you can be.

The menopausal transition is one health journey in particular that really benefits from advance preparation; and just like any other journey or new venture, the more we invest in this, the smoother and more comfortable the transition is likely to be.

We all know it's going to come eventually - but why do some women sail through menopause without many issues, while others seem to suffer a myriad of symptoms? Many things contribute to how we transition through this phase including our genetics, lifestyle, environment and diet.

Ideally we should be considering the menopausal transition and making adaptations to our diet and lifestyle at least a decade before this journey begins. But don’t worry however, if you’re already experiencing symptoms; whilst it’s never too early to start thinking about this, it’s also never too late. Anything we can do to support this journey, at any point along the way is worthwhile and likely to make a difference.

Although it is a natural part of ageing, the menopause can elicit many symptoms that range from mild, uncomfortable or irritating, to completely debilitating. They can include hot flashes, night sweats, elevated heart rate, insomnia, irritability, depression, anxiety, brain fog, urinary issues, vaginal dryness and reduced libido. These symptoms can be extremely unpleasant, interfering with day-to-day functioning and leaving many feeling lost, so far removed from themselves, isolated or forgotten.

Conventional Western medical approaches can lead many women to feel there is something wrong with them when they start to approach the menopause, that menopause and peri-menopause are ‘disorders’ or an ‘illness’ that needs to be ‘cured’. Menopause is a fall in hormones  we all have our own journeys through this time.

the same way that puberty is a rise in hormones and we don’t view that as an illness (although many parents with teenage girls may disagree!!) or medicate this natural change. 

Our society overly values youthfulness and the respect that is naturally attributed to age in more traditional cultures, is not as apparent in our society, leaving women fearing the ageing process rather than celebrating the knowledge and wisdom they have to offer.

Time To Embrace The Journey

It’s time to celebrate age, to honour who we are, what we have experienced and what we have to offer. The menopausal transition shouldn’t be viewed as a set of symptoms that need to be suppressed, or ‘cured’, but rather as a journey to be embraced. Understanding the changes that are happening inside the body, and then providing the support that is needed to enable this to happen as smoothly and comfortably as possible is an empowering way to approach this transformative phase of a woman’s life. 

Our bodies and the way they are constantly adapting to maintain homeostasis and equilibrium, are remarkable, and our job is to provide the optimal fuel and environment to enable these incredible processes to happen. Wherever you are on the journey, be all there.

Stages of the Menopause Journey

Women typically begin to notice the affects of menopausal changes between the ages of 45 and 55. It is triggered by a decline in the production of oestrogen from the ovaries, eventually leading to the cessation of menstruation.

Pre-menopause
Monthly menstrual periods are regular and hormone levels are predictable throughout the cycle. Some early symptoms such as hot flushes and poor sleep may start to appear.

Peri-menopause
Ovarian function starts to decline, levels of oestrogen and progesterone start to fluctuate and periods can start to become irregular, with short cycles, long cycles or skipped periods.

There are a wide range of possible symptoms including hot flashes, insomnia, changes in cognitive function (memory, attention, clear thought, learning), night sweats, mood changes, anxiety, lowered resilience to stress, low libido, changes in skin tone and hair quality, weight change, joint pain, low energy and headaches and migraines.

The severity of symptoms and the length of the peri-menopause will vary for each individual woman. 

Post-menopause
A woman’s last menstrual period is defined as the menopause, and a full year must pass before a woman is post-menopause.

Ovarian function has now declined and our oestrogen levels drop, we don't need as much for the rest of our lives, but we do still need a small amount (see oestrogen functions below). When our ovaries no longer produce oestrogen the job falls to other areas in the body for the first time. One key site is our adrenal glands.

The adrenal glands control our response to stress. As hormone levels start to decline, particularly oestrogen, it’s crucial to pay particular attention to those adrenals to ensure we still have an adequate supply of oestrogen as we age. Chronic stress, even low grade will affect the adrenals ability to regulate the various hormones it produces. More on this later!

The Role of Oestrogen
Oestrogen has multiple roles within the body and this reduction can lead to not only symptoms strongly associated with menopause, such as hot flushes and night sweats, but also can be a trigger for chronic or more serious conditions.

Function of Oestrogen

• Puberty and Sexual Development – growth promoting hormone stimulating breast development, increased weight and height, pubic and axillary hair and beginning of menstrual cycle and ovulation during puberty. It also supports lubrication and integrity of vagina.
• Menstrual/ Reproductive Cycle – responsible for thickening of endometrial lining and supporting ovulation as well as maintaining pregnancy.
• Bone Density – triggers bone growth and development, especially during puberty but also helps to maintain bone density into adulthood by stimulating osteoblast (bone building cells) activity.
• Cardiovascular Health – shown to support blood vessel health and flexibility, support blood lipid balance and modulates inflammation. Additionally, oestrogen increases the production of nitric oxide which aids blood vessel relaxation.
• Cognitive Function and Mental Wellbeing  – oestrogen plays many roles in supporting cognitive health, including  supporting memory and stimulating serotonin production (our ‘happy’ hormone). In fact our sex hormones aren’t just sex hormones; they’re neuro steroids - oestrogen is linked with serotonin, progesterone with GABA (our calming neurotransmitter) and testosterone is linked with dopamine (involved with memory, movement, mood, attention).The concept of cognitive decline and brain fog associated with menopause– is very real.

From the above functions you can see that oestrogen is supporting wellness form many angles and why therefore menopausal women can experience adverse effects during, and after, this time. Menopause can increase the risk of cardiovascular disease, osteoporosis, depression and cognitive decline due to the lack of oestrogen. Therefore, these systems need to be supported.

Supporting the Journey 

Due to concerns surrounding the side effects of HRT, more and more women are looking to use natural alternatives to help with menopausal symptoms and to ease the transition in a healthy way. 

Providing natural support before and during the transition phase involves optimising health overall to ensure the body has everything it needs to deliver a smooth transition. Ideally support for the body would start as early as possible and long before any symptoms have started to appear. 

It’s never too early to start thinking about this. It’s also never too late, no matter where you are on the journey, whether you’re thinking 10 years ahead or are already experiencing symptoms, now is the time to take action.

1.Nurture Your Adrenal Glands

There are many good reasons to look after adrenal health in the peri-menopausal and menopausal period; one primary reason, as mentioned above, being that the adrenal glands can produce a form of oestrogen to help compensate for the decline in ovarian production, and they are involved in progesterone production too.

Fast-paced 21st century living can place tremendous strain on the adrenal glands; the hard-working part of your body that deals with stress. Many people are aware that they are ‘running on empty’ and ‘need to find more ways to relax’, yet life ‘busy-ness’ often gets in the way and it never actually happens. Whilst stress reduction is important for just about every aspect of your health, it is an absolute necessity for the menopausal transition and if this resonates with you, it’s time to take action now. 

The adrenal glands can be a significant help in supporting a smooth menopausal transition, but not if they are overworked, overtired and otherwise engaged dealing with stress elsewhere. Chronic stress not only reduces the adrenals function to provide sex hormones but it is a significant risk factor for lowered mental well-being and is often characterised by elevated cortisol. Research has shown that increased levels of cortisol can have a negative impact on mood during the menopausal transition. Anything therefore which can help to take pressure off, or support the adrenals during this transition is a highly positive move.

The first step to supporting adrenal health involves taking pressure off these hard-working glands wherever possible and this means really investing in self-care. And this is so important that it’s worth repeating; the menopausal transition really is the time to ramp up self-care as a number one priority.

Self-care means many different things to different people; it could be a daily walk in nature, a relaxing aromatherapy bath, weekly hot stone massage, curling up on the sofa with a chamomile tea and a good book or an uplifting movie, a good laugh with friends, a gentle run, yoga, T’ai chi, pilates, breathing exercises, talking therapies, mindfulness meditation, stroking the dog or anything else which helps to restore a sense of balance and calm. 

Whatever is normal for self-care during the course of a week needs to be increased; as this is the time the body really needs a bit of extra TLC. And this will help to nurture the adrenal glands so they can provide much needed support in other ways.

Key nutrients to consider for adrenal support include:

• Magnesium – Nature’s tranquiliser
  There is substantial evidence to support the use of magnesium in stress-related illness and mental health. Magnesium helps the body to maintain a balanced stress response, and mental and physical stress both increase magnesium elimination from the body.
  Multiple studies have now demonstrated improved stress response, anti-depressant and anti-anxiety effects of magnesium supplementation. In fact, magnesium’s calming and soothing effects are so widespread it is commonly referred to as ‘nature’s tranquiliser’ and this is what makes magnesium such an important support during the menopause.

• Ashwagandha (Withania somnifera) – Stress balance
  Ashwagandha is perhaps best known for its ability to balance stress and promote a calmer and happier sense of wellbeing. It is classified as an adaptogen, which describes its ability to balance the body’s response to stress. It is therefore a useful herbal support to consider during the menopause.
  Research has shown that supplementation with ashwagandha may help to bring biochemical markers of stress, including elevated cortisol, back into balance.6,7

• vitamin C and vitamins B5 & B6.

2. Balance Your Blood Sugar

The typical Western diet, packed full of sugary, processed, convenience foods, caffeine and alcohol, and often paired with poor sleep and chronic stress, is perfectly designed to disrupt blood sugar balance. Many people spend their lives on a blood sugar rollercoaster with rapid spikes produced after ingesting sugar followed by crashing lows as the body tries to restabalise and this will only serve to make the menopausal journey much more problematic.

When blood sugars drop the adrenals produces adrenaline & cortisol, so oestrogen production doesn’t get a look in and the body’s hormone balance is thrown into chaos. 

No matter what stage you are on the journey, whether you’re thinking a few years ahead, or experiencing troublesome symptoms now, taking steps to balance blood sugar is a non-negotiable for female hormonal balance. 

• Avoid refined carbs – the white foods: flour, pasta, bread and rice.
   
• Be aware of hidden sugars - not just in cakes and biscuits but found in ‘healthy’ dried fruits, juices and yoghurts.
  
  
• Stimulants - caffeine, alcohol and nicotine can increase your blood sugar levels, followed by that crash so avoid or reduce their use to b balance blood sugars.

3. Support Your Sex Hormones

Many of the symptoms associated with the perimenopause are due to fluctuating and declining levels of sex hormones, and this is a key area to support. 

In recent years the interest in soy foods for their hormone-balancing potential has increased. Scientists noticed that women eating a traditional Asian diet, containing a high proportion of soy foods, rarely experience menopausal symptoms. They’re also less likely to suffer from heart disease and breast cancer. 

Soy foods have been part of the Asian diet for thousands of years and are eaten daily in small amounts from childhood. Soy contains plant compounds called isoflavones. 

Isoflavones 

These have been extensively researched, particularly for their use during the menopause. They are a type of plant or ‘phyto’ oestrogen and and can exert weak oestrogen-like effects in various tissues, such as reproductive, cardiovascular and skeletal tissues. 

It is thought that it is these oestrogen-like effects, which make soy isoflavones so useful for supporting common menopausal symptoms. However, it has been estimated that isoflavones are only 1/400th to 1/1000th the potency of synthetic oestrogen - hence why they are not associated with the unwanted side effects of HRT. This is what makes isoflavones an obvious natural alternative to the more conventional hormone replacement therapy (HRT). They offer a weaker, plant form of oestrogenic support without some of the less desirable side effects of HRT. The main active components of soy isoflavones are daidzein, genistein and glycitein.

The association between soy consumption and reduction of menopausal symptoms was first described in 1992, and since then, the majority of studies carried out to assess the effects of isoflavones on menopausal symptoms have shown beneficial effects on night sweats, hot flashes and hot flushes. In addition, soy isoflavones have been found to have beneficial effects on bone health, cardiovascular disease risk and cancer risk. Research also shows supplementation with soy isoflavones to have a high safety profile (1-4).

What’s particularly interesting however is the effect that friendly bacteria have on their absorption. Whilst many women take isoflavones in supplement form as a natural support during the menopause, few complement this with a probiotic supplement or pay attention to their diet to ensure it feeds a healthy intestinal microflora.

It seems our composition of colonic microflora can significantly influence the biologic effects of isoflavones. In particular, some bacteria can convert the isoflavone daidzein into equol, which has even greater oestrogenic activity than daidzein.

The best way to increase your intake of dietary soy phyto-oestogens, is to focus on traditional, unprocessed, non-GMO and organic fermented soya products such as tempeh and miso, packaged as nature intended. 

Hops

Soy isoflavones have long been regarded as the best dietary source of phyto-oestrogens, however, more recently, a natural compound found in hops has also been found to have significant plant oestrogen activity.

Hops contains a substance known as 8-prenylnaringenin which is now considered to have higher oestrogen activity than soy isoflavones. It is still however a plant oestrogen and is significantly less potent than synthetic oestrogens.

In addition to benefits for reducing menopausal symptoms (3), hops have also been shown to be protective against cancer (5).

Hops and soy isoflavones can be safely combined to naturally support menopausal symptoms.

Other Phytoestrogens

Dietary phytoestrogens may also have a part to play in lower rates of breast cancer observed in Japanese women; it is thought that these weaker plant oestrogens may block stronger, more harmful oestrogens and thus confer a protective effect. In fact, including phytoestrogen-rich foods in the diet may be helpful for hormonal balance for women at any stage of life.

Other dietary sources of phytoestrogens include:
chikpeas (homous)
grains
split beans, pinto beans and lima beans (see dietary advice below), dried
flaxseeds (try to include 1tbs per day of ground flax)
sesame seeds
cruciferous vegetable vegetables - brocolli, cauliflower, cabbage, kale
garlic
grapes
dried fruit
berries
peaches

4. Help Your Body To Process Oestrogen Safely

Not only is it important to support your body’s ability to produce oestrogen during the menopausal transition, it’s also critical to ensure your body is processing oestrogen safely too. Many people are unaware that oestrogen isn’t just one hormone, but rather a collection of different hormones, and that these hormones, once used, must be processed and safely eliminated from the body. 

Two plant compounds in particular may be helpful in supporting this process - di-indolylmethane (DIM), a phytonutrient found in cruciferous vegetables such as broccoli, cauliflower, kale, watercress and dark leafy greens, and resveratrol found in red grapes, black grapes, blueberries and strawberries. It is recommended that women at any stage on the menopausal journey include plenty of these beneficial plant compounds in their diet.

Gut bacteria are important for just about every aspect of your health and we now know that they are important for safe oestrogen processing too. The best way to support a diverse population of gut bacteria is by consuming a rich variety of plant foods every week, and including a daily serving of either kefir, kombucha, sauerkraut or kimchi. A supplement containing high quality and researched strains of beneficial bacteria may provide useful additional support.

5. Reduce Your Toxic Load and Support Toxin Elimination

We all live in a toxic world and regularly come into contact with potentially harmful compounds on a daily basis. Unfortunately, many of these substances are known to be Endocrine-Disrupting Chemicals (EDCs), which in simple terms means they have the potential to disrupt hormonal balance. And when the body is working its way through the menopausal transition, the last thing you want to introduce is even more potential for hormonal imbalance! 

Amongst many other sources, EDCs are commonly found in pesticides, plastics, cosmetics and toiletries, household cleaning products. And whilst you can’t avoid toxins completely, you can go a long way towards reducing exposure if you take proactive steps to change your habits. 

Where possible eat more organically grown foods, drink filtered water and avoid plastic water bottles. When replacing food storage boxes invest in glass storage boxes and use natural and organic skin care products. 

In addition to reducing your overall toxic load, it’s important to support your body’s ability to safely eliminate the ones that you can’t avoid. Include plenty of water and fibre in your diet to support regular bowel elimination, regular exercise and / or sauna helps you to eliminate toxins through sweat and consider adding supportive compounds such as glutathione, alpha lipoic acid, turmeric, milk thistle, green tea and selenium.

6. Support Through Diet 

• Follow a Low Glycemic Index diet to balance blood sugar, reduce cortisol (those adrenals), avoid energy slumps and brain fog. 

• Eat 3 well balanced meals per day, choosing organic whole foods as much as possible. Include good quality protein (poultry, meat, fish, eggs, tofu, tempeh, chickpeas and legumes) and fats (nuts, seeds, olive oil, oily fish).
  
  
• Eat beneficial fats particularly omega 3 fats from seeds, nuts, avocados, oily fish.

• Increase the variety of fruit, vegetables and herbs, aim for 8-10 portions (8 veg, 2 fruit) daily and around 30+ different types each week, ‘Eat the Rainbow’.
  Include 1-2 portions of cruciferous vegetables (broccoli, broccoli sprouts, cauliflower, cabbage, brussels, kale) everyday. They contain a substance called indol-3-carbinol, which is converted into diindolymethane in the body and is used for healthy hormone balance in the body. 

• Eat Liver supportive foods such as artichoke, beetroot, fennel, greens, onions, garlic and ginger to help the body metabolise hormones and remove toxins.

• Reduce alcohol and caffeine, it’s more of a struggle for the liver to detoxify these things efficiently, during the menopause. Caffeine puts a lot of strain on the adrenals, it's not always easy to cut it out completely, but try to reduce to just 1-2 cups a day. Swap to herbal teas, look for teas with detoxing herbs such as nettle, dandelion and ginger, calming teas such as lemon balm and rooibos, adrenal supporting teas with ashwaganda.

• Gut health supportive foods - lots of fibre, pre and probiotic foods. Have a daily portion of fermented foods (keffir, sauerkraut, live yogurt, kombucha)

• Eat phytoestrogens rich foods as a priority, include several portions daily.
• Soy - edamame beans, miso, temph, tofu, 
• Nuts and seeds - flaxseed (ground 2tbs daily), chia, sesame, sunflower, walnuts, almonds, pistachios
• Legumes - chickpeas, lentils, mung beans, alfalfa
• Grains - quinoa, barley, oats, rye 
• Vegetables - carrots, fennel, garlic, onions 
• Fruit - Apples, Cherries, pomegranates, strawberries

• Avoid refined, processed, convince foods, they have little nutritional value, place excess burden on the liver.

7. Lifestyle Factors

• Regular exercise that raises the heart rate at least 4 times per week, this could be as simple as a brisk 20-30 minute walk
• Good sleep hygiene, ensuring you get adequate (8hours), quality sleep
• Self-care, reducing stress and finding ways to support your mental and emotional wellbeing. This should be of paramount concern, do things that fill you with joy, every day.

8. Natural Symptom Support

If you’re in the thick of experiencing hot flashes, night sweats, sleepless nights or any other symptoms commonly experienced during perimenopause, supplementation with targeted nutrient and botanical ingredients may provide extra support. 

I often recommend nutrition supplements because many people simply aren’t getting all the nutrients they need from their diets and sadly, the overall nutrient quality of our food has drastically decreased over the last few decades. 

In consultation I take a very individual approach, but key nutrients I often include: 

• Magnesium for its stress-protective, sleep-supportive, calming and mood-balancing effects. Magnesium has also been found to be a useful support for hot flashes. 

• Vitamin C helps to protect against harmful toxins and is a vital nutrient involved in the stress response. A major antioxidant to support healthy ageing.

• B complex, particularly vitamins B6, B12 and folate are often nicknamed ‘anti-stress’ nutrients for their powerful ability to balance mood and calm the nervous system. They are also important for the safe processing of oestrogen, supporting cardiovascular health and energy production.

• Omega 3 - a crucial building block in the production of hormones, supports cognitive function, joint pain and stiffness and menopause arthritis, inflammation reduction, blood sugar balance.
  
  
• Probiotics to support gut health, hormone balance and isoflavone absorption

Key botanicals can include:

• Adaptagenic herbs for their stress- protective effect - Rhodiola and ashwagandha (6)

• Shatavari to support natural hormonal balance

• Sage (7), which has a long history of traditional use in supporting a reduction in hot flashes, night sweats and associated climacteric complaints in menopausal women  

• Red clover (8), which is a rich source of phytoestrogens and commonly used as a traditional remedy to reduce high cholesterol, osteoporosis and menopausal symptoms such as hot flashes, night sweats, vaginal atrophy and dryness.
  
  
• Isoflavones and Hops

10. Post-menopause And Beyond

And finally, once hormone levels have stabilised and the transition from perimenopause to menopause has been made, it is important to support the new terrain of your body as it settles into this next phase. Regular intake of omega 3 fats found in nuts, seeds and oily fish provides important cardiovascular and cognitive support, whilst calcium, magnesium and vitamin D provides robust support for healthy bones. 

Regular exercise is an incredibly important lifestyle habit to nurture during this time, and has the capacity to support many of the most crucial areas of focus at this time. Exercise is beneficial for cardiovascular health, cognitive function, balanced mood, weight maintenance, calmness and stress resilience, and weight-bearing exercise supports strong healthy bones too!

I hope this has given you an insight in to how the menopause transition can be supported in natural way. Each persons journey is unique to them and each of us will require different levels of support in different areas depending on what symptoms are more prevalent. If you have any questions please reach out, I’m always happy to chat.  

References

1. Franco, OH, Chowdhury R et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis.  JAMA 2016 Jun 21;315(23):2554-63. Doi: 10.1001/jama.2016.8012

2. Schmidt M, Ariomand-Wolkart K et al. Consensus: soy isoflavones as a first-line approach to the treatment of menopausal vasomotor complaints.  Gynecol Endocrinol. 2016 Jun: 32(6): 427-30. doi: 10.3109/09513590.2016.1152240. Epub 2016 Mar 4

3. Liu J, Burdette JE et al. Evaluation of oestrogenic activity of plant extracts for the potential treatment of menopausal symptoms.  J Agric Food Chem 2001 May; 49(5): 2472-9

4. Washburn S, Burke GL et al. Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women.  Menopause 1999; 6(1): 7-13

5. Miranda CL, Yang YH et al. Prenylflavanoids from hops inhibit the metabolic activation of the carcinogenic heterocyclic amine 2-amino-3-methylimidazo 4, 5-F quinolone, mediated by cDNA expressed human CYP1A2.  Drug Metabolism and Disposition 28: 1297-1302 (2000).

6. Provino R. The role of adaptogens in stress management. Aust J Med Herbal 2010; 22:41–49

7. Dadfar F & Bamdad K. The effect of Saliva officinalis extract on the menopausal symptoms in postmenopausal women: An RCT. International Journal of Reproductive BioMedicine. 2019. Apr; 17(4): 287-292

8. Ghazanfarpour M, Sadeghi R et al. Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis. J Obstet Gynaecol 2016; 36(3)