THE FACTS : Officially beginning 12 months after the cessation of menstruation, menopause commences around the average age of 52.  However, it’s not unusual for menopause to start anywhere between the ages of 40 and 58, with symptoms often spanning as much as a decade.  These symptoms can occur due to the falling levels of estrogen and progesterone, which has a multifaceted impact on organs and tissues throughout the body.

THE ISSUES : With up to 80% of women experiencing symptoms, the  most common ones include  hot flushes, night sweats, vaginal dryness, mood swings, declining libido, insomnia, fatigue/lethargy, irritability, anxiety, depression, forgetfulness, heart palpitations, joint pain and even osteoporosis.

One of the associated effects of estrogen deficiency is an increased risk of osteoporosis.  This is due primarily to the 1-2% loss of bone density per year of menopause, as well as 10 years post menopause.  Estrogen decline can also cause conditions such as elevated cholesterol, cardiovascular disease, urinary tract atrophy and thrush.  The latter of these is caused by the depletion of lactobacilli, which triggers an increase in pH levels and vaginal colonization as a result of Enterobacter proliferation.

Following the Women’s Health Initiative elucidation of the long-term, adverse effects of hormone replacement therapy (HRT), especially the increased risk of thromboembolic accidents, coronary events, stroke and breast cancer, many women are seeking safer alternatives.   Fortunately, there is now a large body of evidence that supports the use of integrated medicines during the transition through menopause.

DIETARY INTERVENTIONS- THE THINGS YOU CAN CONTROL

One such element of integrated medicine is the evidence in favour of a diet high in phytoestrogens. Phytoestrogens are naturally occurring estrogen-like compounds found in plants, fruits, or vegetables and are commonly divided into 3 main classes: isoflavones, lignans, and coumestans.

Isoflavones are found in the legume family, with high amounts in soybeans and soy products.

Lignans are found in high-fibre foods such as unrefined grains, cereal brans, and beans, with flaxseed  being a particularly good dietary source of  lignans. A recent systematic review found that women who consumed protein bars containing flaxseed (410 mg of lignan) for  6 weeks reported a 50% decrease in hot flushes. Seed cycling can be helpful. To find out more read our Seed Cycling blog here

Coumestan rich foods include alfalfa and clover sprouts, peas, pinto beans, and lima beans.  While phytoestrogens structurally resemble estrogen, they have weak estrogenic activity that is expressed in the central nervous system, blood vessels, bone, and skin, but is insufficient to cause similar stimulation of breast or uterus.

HERBAL  MEDICATIONS – NATURAL SYMPTOM MANAGEMENT

Hops (Humulus lupulus) are not just used in beer brewing but are also very beneficial for the central nervous system due to its ability to dampen down tension and anxiety.  The active ingredient in hops, 8-prenylnaringenin, is a potent phytoestrogen and has been demonstrated to reduce vasomotor symptoms by improving the ability of the blood vessels to expand and contract. Numerous clinical trials have also documented significant reductions in the frequency of hot flushes, sweating, insomnia, heart palpitations and irritability in women who used a hops extract for 6 weeks.

In clinical practice, a combination of herbs is often used to support women during the transition through menopause. Korean ginseng (Panax ginseng), which is considered to be a “buried treasure medicine”, is another popular herb for active women suffering from fatigue. Ginseng’s active constituents include saponins, amino acids, vitamins (particularly folic acid and niacin), alkaloids, phenolic compounds, and flavonoids. Ginseng has been widely used in the traditional medicine to assist with building resilience to stress and used as an energizer, to treat sexual dysfunction and alleviate menopausal symptoms. One double blind placebo controlled clinical trial with 384 postmenopausal women demonstrated that ginseng significantly reduced depression and improved perceived well-being. Another study concluded panax ginseng improves exercise performance, energy utilization, and decreases fatigue.

Another popular herb is chasteberry, or vitex.  This herb has not only been found to treat PMS, but also reduce the occurrence or hot flushes and breast tenderness in perimenopausal women.  Vitex is used to support the transition from perimenopause to menopause due to its ability to increase progesterone levels and help maintain a healthy balanced between progesterone and estrogen.

For women experiencing persistent hot flushes or night sweats as a result of menopause, Red Clover (Trifolium Pratense) may often be prescribed.  This herb contains high levels of phytoestrogens for improving hormonal balance, as well as helping improve bone density in those at risk of osteoporosis.  2 separate clinic trials have shown that the isoflavones present in red clover inhibit bone resorption and therefore reduce the bone turnover. If you have concens about your bone health, you may find our Vitamin D blog here

Ginkgo Biloba is similar to red clover because of the phytoestrogens it contains and its ability to naturally elevate estrogen levels.  Studies show that Ginkgo Biloba can reduce mood fluctuations associated with both PMS and menopause, as well as improving libido in 84% of trial participants after 4 weeks.

Sage, most commonly prescribed as a tea, has long been used in the management of fevers.  However, there is also evidence to support the use of sage for menopausal hot flushes and night sweats.  A study that assessed the use of fresh sage leaves in food or as tea demonstrated that the intensity and frequency of hot flushes was significantly reduced over a period of 8 weeks with consistent use.

Hormones play an integral role in your health, and changes in hormone balances can be challenging. There are many different ways that nutrition can be used to navigate menopause, without having to experience the numerous, negative side effects of HRT.

As with any element of health, there is never a one-size-fits-all approach.  For further information on the suitability of these options for your particular situation, book in for an individual assessment with our Sports Naturopath Kate Smyth here.

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