Throughout history, menopause has been an incredibly misunderstood stage of life. Women were made to feel ashamed and embarrassed about the natural changes that their bodies were going through. To make matters worse, there was no one to discuss these changes with. Women were disregarded, so they often stayed silent about their symptoms for fear of being ridiculed or labelled as crazy. Fortunately, times have changed, and views surrounding menopause are finally shifting in a more positive direction. Women are feeling more empowered to openly discuss their symptoms and explore treatment options to alleviate their symptoms. There is no need to suffer in silence! What was once viewed as a disease, menopause is now being viewed as a very natural part of aging. It can be a time of renewal and rebirth, a fresh new chapter in life.
The journey through menopause can be a rocky one. For some women the experience can feel like a never-ending roller coaster ride, filled with extreme highs and lows, and twists and turns at every corner.
It is estimated that approximately 85-95% of women experience symptoms during the transition through menopause. For some, the “roller coaster ride” is short, but for other women, the transition through menopause can last for up to 10 years. The good news is, there are plenty of ways to make this transition easier, and women have far more options than ever before to thrive and not just survive throughout the various stages of menopause. Let’s discuss the three stages of menopause, and what menopausal symptoms can look like:
It is in this transition phase when hormones can fluctuate wildly, becoming completely unpredictable. Estrogen can be high, then progesterone can be low, and then the two may flip with progesterone being dominant and estrogen low. This can leave you feeling like a hot, moody mess. If perimenopause had an anthem, it would definitely be Katy Perry’s song Hot N Cold! It’s a wild ride, so hold on tight! This stage can last from anywhere between a few months to 8 years.
Ok, so menopause is technically a one day event. The day you reach 12 months with no period, you are officially in menopause. The day before that you are in perimenopause, and the day after that is post-menopause. You are likely still dealing with the same symptoms that you had in perimenopause, but hopefully symptoms are not as intense. Symptoms can continue on for several years after reaching menopause, sometimes lasting up to 10 years. It’s not all doom and gloom though, many women are happy to no longer deal with monthly menstrual cycles, and the onset of menopause can bring freedom from certain health conditions like fibroids, heavy bleeding, and painful periods that ruled over their life before.
This starts the day after you hit menopause, and it lasts for the rest of your life. Don’t worry, your menopausal symptoms won’t continue for the rest of your life! Symptoms may persist for several more years at this point, but the severity of those symptoms should wane and gradually disappear. Many women find that at this stage they start to embrace a new sense of self and a new way of life that embodies who they are now.
Menopausal symptoms tend to overlap throughout all three stages. Irregular cycles and heavy bleeding are the only symptoms that don’t overlap and occurs only during perimenopause. The list of symptoms that occur during perimenopause, menopause and postmenopause is incredibly long, too many to list, but here are some of the most common symptoms that women experience:
● Mood changes
● Depression
● Irregular, sometimes heavy periods(perimenopause)
● Headaches
● Palpitations
● Hot flashes
● Sweating
● Brain fog and memory issues
● Bladder changes (incontinence)
● Vaginal dryness
● Increased UTIs and Bacterial Vaginosis
● Reduced libido
● Sleep issues
● Dry skin and other skin changes
● Weight gain, especially midsection gain
● Fatigue
● Increased facial hair growth
● Hair thinning and loss
● Joint pain and muscle aches
Not everyone will experience these symptoms. Some lucky women go through this transition completely unscathed, they only notice when menstruation comes to an end. It’s interesting to note that women from certain cultures around the world deal with far less menopausal symptoms. Women from East Asian countries like China and Japan tend to deal with less severe symptoms than women from Canada, the U.S.A and the U.K (1). Diet can definitely play a role in reducing the severity of symptoms, as the Chinese and Japanese diet is usually quite healthy, containing a lot of phytoestrogens and antioxidant rich fruits and vegetables. Studies have also suggested that perspectives and cultural attitudes can play a big role in how women experience the severity of menopausal symptoms.
In Japan, menopause is known as Konenki. Konenki refers to a much longer transition in a woman’s life, and it roughly translates into a season of regeneration, or renewal. Japanese women often see this phase of life as a time of new growth during their midlife years.
In Japan, social status increases with age, and elderly people are revered, so this transition in life is viewed in a positive light. Changing the narrative on how menopause is supposed to be, and removing the negative connotations around menopause can potentially make for a much smoother transition during this phase of life.
There are many ways to cope with perimenopause and menopausal symptoms. Nutraceuticals are one of those ways that can help to ease symptoms and improve your overall well-being. Let’s explore some of the most common symptoms of perimenopause and menopause from our list above, along with supportive herbs and nutrients that may bring you some much needed relief.
Sudden hot flashes and sweating during menopause can come at the most inconvenient times during the day, or at night when you want to sleep. One minute you are peeling off your shirt because you feel like you are burning up, and the next minute you are layering up when the cold flash follows. Milk Thistle may help to reduce the frequency and severity of hot flashes. Most people know Milk Thistle as a liver supportive herb, but fewer people know of its uses during menopause. In a study conducted in 2020, participants taking 400mg of Milk thistle extract daily for 12 weeks had a reduction in both severity and frequency of hot flashes (2). Red Clover is another herb that may help with hot flashes due to its high isoflavone content. Some studies have shown that it may be helpful for reducing the frequency of hot flashes in menopausal women (3). If you are finding yourself drenched in sweat during a hot flash, you may want to try Sage. Sage has been traditionally used for hot flashes and sweating during menopause. In one clinical trial, participants reported a decrease in the frequency of hot flashes within 4 weeks of starting sage (4). Black Cohosh may also help to reduce a variety of menopausal symptoms, including hot flashes and night sweats. One study suggested that Black Cohosh may be just as effective as low dose transdermal estradiol for reducing menopause related symptoms(5).
Are you ready to step off of the emotional rollercoaster? Menopause can come with a lot of emotional ups and downs. Ashwagandha may help you to feel more emotionally stable and reduce anxiety levels. Through its ability to modulate activity of the HPA axis, Ashwagandha can help reduce cortisol levels, helping you to feel more calm. It is important to take Ashwagandha consistently for a minimum of 6 weeks to begin to fully experience its effects. St. John’s wort has also been shown to be effective at reducing symptoms of depression in women who are going through menopause (6). As an added bonus, it may also help to relieve other menopausal symptoms such as anxiety, irritability and hot flashes. Lastly, Rhodiola rosea is an adaptogenic herb that many women turn to in menopause to help modulate the stress response (lowers cortisol levels). Rhodiola may increase the activity of certain neurotransmitters (dopamine and serotonin), which play a role in regulating mood.
Loss of estrogen in late perimenopause and menopause can result in the loss of vaginal moisture. Vaginal dryness can cause an uncomfortable itchy feeling, and it can put a real damper on your sex life. Reduced estrogen levels also can affect vaginal flora. It can cause a decline in Lactobacillus bacteria that usually dominate the vaginal microbiome. This decline in Lactobacilli can cause a rise in pH of the vagina, which can lead to a rise in certain bacteria that can cause Bacterial Vaginosis. Taking a Probiotic that is predominantly Lactobacillus based can help prevent infections from happening. Some strains of Lactobacilli can also help combat vaginal dryness. Vaginal dryness and itchiness can also be relieved by daily use of a vaginal moisturizer that contains hyaluronic acid. Vaginal moisturizers help keep vaginal tissue more supple and elastic. Ginkgo Biloba may help with improving blood flow to the vagina and helping to increase sexual desire. A 2014 study showed that taking 120 – 240 mg/day of Ginkgo Biloba had a positive effect on sexual desire in postmenopausal women (7).
Fluctuations in hormones can cause sleep disturbances throughout all stages of menopause. Hot flashes and night sweats can keep you up at night and prevent you from getting a restful sleep. Getting better control over vasomotor symptoms can improve sleep quality. For some women, they simply just can’t fall asleep, or they feel anxious all the time. Gaba may help in this situation, as it calms the brain, decreases sleep latency, and it improves Non-REM sleep. Gaba can also help ease feelings of anxiety. Magnesium is another gem to try for improving sleep quality. Magnesium helps regulate certain neurotransmitters that impact sleep, it can reduce NMDA receptor activity (this induces muscle relaxation) and it may help with melatonin production in people who are magnesium deficient.
Wondering what happened to your waistline? Many women notice the weight shifting to their midsection during late perimenopause. That’s because the body shifts from an estrogenic state to a more androgenic state, which can lead to increased visceral fat storage. It is commonly thought that when menopause hits, the ovaries are no longer hormonally active. This is incorrect. Estrogen levels plummet at the time of menopause, but the ovaries continue to produce androgens for up to ten years after reaching menopause. This production continues to decrease over time, but it leaves women more likely to develop visceral fat. Visceral fat can be detrimental to cardiovascular health and can cause issues, such as insulin resistance and various inflammatory conditions. Berberine can help to restore insulin sensitivity and may help reduce visceral fat, as suggested in this study (8). Berberine can help regulate blood sugar, which can potentially keep your appetite in check, helping to prevent excess weight gain. Berberine also has many other benefits, including promoting a healthier gut microbiome and it may improve cardiovascular health.
Daily exercise is incredibly important at any stage in life. During menopause it can improve insulin sensitivity, reduce overall body fat, prevent sarcopenia (age related muscle loss) and improve cardiovascular health. Diet and Exercise can play a huge role in managing menopausal symptoms, as well as helping to prevent certain health conditions that tend to develop when estrogen levels decline. Incorporate these foods into your daily diet to help reduce menopausal symptoms and mitigate the risk of developing Cardiovascular diseases and Osteoporosis after the onset of menopause:
● Calcium rich foods: Calcium rich foods and calcium supplements can help with preventing postmenopausal Osteoporosis. Eat more calcium rich foods such as yogurt, low fat cheese, fish with bones (sardines and canned salmon), soy products (tofu), leafy greens, broccoli, and almonds. When consuming calcium rich foods for bone health, make sure to supplement with vitamin D3, vitamin K2 and other cofactors that help with calcium absorption.
● Antioxidant rich foods: Eat the rainbow! Antioxidant rich foods such as berries, citrus, dark leafy greens, cruciferous vegetables, mushrooms, peppers, tomatoes and carotenoid rich fruits and vegetables can help to lower inflammation and combat oxidative stress in the body. This can improve cardiovascular health and potentially help reduce vasomotor symptoms of menopause. Consuming a wide variety of antioxidant rich foods can also result in better moods, increased energy and a healthier gut microbiome.
● Healthy fats: Getting adequate healthy fats in the diet is important for heart health and brain health. Healthy fats can be found in salmon, sardines, mackerel, nuts and seeds, eggs, avocado and olive oil. It is important to get more Omega-3 in the diet than Omega-6. A 2:1 ratio is ideal for optimal health. Omega-3 can help stabilize blood sugar and may help to lower cortisol during times of stress. Try to avoid trans fats and limit your consumption of foods rich in saturated fats for optimal cardiovascular health.
● Adequate protein: Postmenopausal women can be at risk for sarcopenia (age related muscle loss). It’s important to get enough protein each day, approximately 1-2 grams/kg. Getting adequate protein can also positively impact bone density, increase energy levels and it can help to regulate blood sugar levels.Try to choose from lean protein sources, such as lean cuts of meat, eggs, low fat dairy and plant-based proteins (beans, lentils, tofu). Protein powder can be utilized if you find that your appetite has diminished and if it is difficult to eat enough protein rich foods each day.
● Foods rich in Phytoestrogens: Some women find that consuming a diet high in phytoestrogens helps with alleviating some of their menopausal symptoms. There are no convincing studies that support this, as you would have to consume fairly high amounts to exert any effect on the body. Regardless, these foods have numerous other health benefits that make them worth including in the diet anyways. Foods that are rich in phytoestrogens are soy products, flaxseeds, sesame seeds, lentils, legumes, berries, cruciferous vegetables, barley, oats, wheat germ, hops and tea.
● Fibre: Fibre rich foods can help improve gut health and cardiovascular health, as it may help to lower cholesterol. Fibre can also help stabilize blood sugar levels and promote satiety, both of which can help with maintaining a healthy weight. Aim for at least 25 grams per day from a variety of sources. Incorporate more fibre rich foods such as beans, legumes, whole grains, nuts, seeds, as well as fruits and vegetables into your daily diet.
● Probiotic rich foods: Probiotic rich foods can improve vaginal health and gut health. It may also help improve mood and reduce inflammation in the body. Kimchi, sauerkraut, miso, kombucha, kefir and yogurt are just some of the many probiotic rich foods that you can choose from. Try to include more of them in your diet each day.
Exercise is incredibly important for optimal health throughout all stages in life, but especially so as we get older. Exercise can help reduce menopausal symptoms, improve joint health and mobility, increase muscle mass, improve sleep quality, help improve insulin sensitivity, and it can be beneficial for improving mood and reducing anxiety. It can also help improve cardiovascular health and certain exercises, such as weight bearing exercise, can help increase bone density. The list of health benefits is extensive! Try to aim for at least 150 minutes of moderate-intensity aerobic activity each week, incorporate strength training exercises at least twice a week, and focus on exercises that help improve balance and build bone density.
Remember to always consult with your doctor before starting any new supplements or before making changes to your diet and lifestyle. Not all supplements are safe for everyone to take, and many of them can interact with medications or other nutraceuticals, potentially causing adverse effects. All information in this article is for educational purposes only and is not a substitute for professional medical advice.
Article written by Jennifer Fraser C.H.N.C.
References:
1. https://academic.oup.com/humupd/article/11/5/495/605995
2. https://pubmed.ncbi.nlm.nih.gov/32762030/
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC4678495/
4. https://pubmed.ncbi.nlm.nih.gov/21630133/
5. https://pubmed.ncbi.nlm.nih.gov/15969244/
6. https://pubmed.ncbi.nlm.nih.gov/31331546/
7. https://pubmed.ncbi.nlm.nih.gov/24949064/
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC3310165/#sec4
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