Menopause - Naturopathic Approaches to Symptoms
by Philip Rouchotas, MSc, ND
Bolton Naturopathic Clinic
64 King St W
Menopause can be formally assessed when there has been no menstrual period for 12 months. At this point, the ovaries stop performing their function. The process happens gradually and is an individualized process. Some women experience a steady decline in the frequency of their menses, while others have sporadic menses until finally they stop. The average age of menopause is around 51, but there is a range of ages where it can happen. There’s no specific test that can be performed to identify exactly when a woman will experience menopause, although the age of the mother when she had menopause can be predictive. The time around when menopause is happening is called “perimenopause.”
There are a number of symptoms that women experience during this time. The main menstrual symptom is obviously irregular menses (and that could mean a number of things). But there are lots of systemic symptoms as well; common ones include vasomotor symptoms, insomnia, headaches, arthralgia, myalgia, dry vagina, urinary incontinence, urinary tract infections, and decreased libido. To make matters worse, many mental/emotional symptoms can also arise, like depression, mood swings, anxiety, and decreased concentration and memory. For these reasons, this period of life is usually not considered very pleasant. On the bright side, there are a large number of things that can be done to lessen the symptoms or to help women feel better.
The conventional treatment approaches include multiple medications. The most common and effective treatment option for relieving hot flashes is hormone therapy through estrogen replacement. Estrogen helps to prevent bone loss, and possibly benefits the heart as well. It can be delivered in multiple ways: pills, creams, and patches. To relieve vaginal dryness, estrogen can be given through a tablet or ring as well and directly applied to the vagina. Gabapentin is a seizure drug that can also reduce hot flashes. Finally, low-dose antidepressants are sometimes used. The SSRI class can decrease hot flashes.
Lifestyle and Behavioural Modifications
There are three extremely powerful lifestyle and behavioural modifications that should be considered when suffering from menopausal symptoms. The first is optimizing body mass index (BMI). Those who have a BMI of greater than 30 are more than twice as likely to have troubling vasomotor symptoms than those who have a BMI of less than 25. This means that if you are overweight—but especially if you are obese—, you should strongly consider weight-loss approaches. Dietary modification through a combination of caloric restriction or by substituting unhealthy foods for more fruits and vegetables can be the first step in such an approach. A good idea is using an app or a diet diary of some kind to start tracking how many calories are consumed each day, and then to calculate how many would be required each day. Then consume slightly less than what is required.
The second lifestyle and behavioural modification that can have a dramatic impact is smoking cessation. Smoking increases the severity and frequency of vasomotor symptoms. Therefore, if you smoke cigarettes or utilize tobacco, it is worthwhile making an effort to quit. There are numerous ways to go about this. There are several books written on the topic, you can utilize a smoking aid like the nicotine patch, you can consider medications, or you can consider any of the above in combination. A good deal of evidence shows that nicotine replacement therapy and the medications recommended for smoking cessation are quite effective. Many of the strategies people take to quit do not work, and people tend to relapse within six months. It is extremely important to consider all of the external and internal variables related to smoking, such as triggers and environmental circumstances. There are also clever ways you can trick your brain into decreasing the amount you smoke; for example, even just counting the amount of cigarettes you smoke daily and trying to smoke the same amount every day causes people to decrease the amount they smoke.
The third and final behavioural recommendation is exercise. Regular exercisers report 17% less vasomotor symptoms than nonexercisers. In this particular study, only 5% of highly physically active women experienced severe hot flushes as compared with 14–16% of women who had little or no weekly exercise. This is separate from BMI, smoking, or hormone replacement. In other words, exercising acts independently and can provide additional benefit above and beyond other therapies that are implemented.
Dietary Factors and Supplements
Aside from lifestyle and behavioural modifications, there are many more specific dietary and supplemental options that can be therapeutic; we will discuss some of them here. The first is emphasizing a whole-foods diet rich in phytoestrogens. Phytoestrogens contain a phenolic ring that allows them to bind to estrogen receptors. As a result, they may act like selective estrogen receptor modulators, a class of drugs used to treat menopausal symptoms and osteoporosis. They are hundreds to thousands of times weaker than endogenous estrogen, but can still produce a mild effect that can be beneficial. There are three major classes of phytoestrogens: isoflavones (found in soy and other legumes), lignans (found in flaxseeds), and comestans (found in sunflower seeds and sprouts). Consider consuming a variety.
Soy is recommended as a whole food; 20 to 60 g per day soy protein would deliver approximately 40 to 80 mg per day of isoflavones. This has been shown to reduce vasomotor symptoms. Soy also improves lipid profiles as well as bone density, and does not stimulate the endometrium. There are mixed studies with regards to the risk of break cancer due to soy consumption, but the latest and best evidence suggests it is completely safe and potentially even beneficial. Flaxseeds are recommended as a whole food as well. A study showed that 40 g per day, crushed in food, decreased vasomotor symptoms. Twenty grams is approximately equal to two tablespoons.
In terms of supplements specifically, vitamin E at 400–1200 IU per day has been studied in breast-cancer survivors and had a beneficial effect. Hesperidin, in combination with vitamin C, has been shown to tighten capillaries, relieve hot flashes, and reduce nocturnal leg cramps. Lastly, pycnogenol has been shown to decrease vasomotor symptoms and improve LDL/HDL ratios.
Putting it All Together
Menopause is a variable and often difficult time for many women. There are many issues that come to the forefront during this time, including the need for physical comfort and the desire to reduce the discomfort associated with many of the natural processes of menopause. There are also important mental/emotional symptoms to be aware of, including ones like depression and anxiety. If you are predisposed to one of these conditions, menopause may make things worse, so it’s important to be aware and prepare yourself by having a lot of support available.
We discussed a number of conventional treatments, including hormone replacement therapy and medications. We discussed multiple extremely powerful behavioural interventions—these included weight loss (especially if obese), smoking cessation, and exercise. The best part about these interventions it that they also improve numerous other health parameters, and they are often free or very cheap. Several dietary recommendations can be suggested; these include increasing dietary phytoestrogens, soy, and flaxseeds. The supplements mentioned were vitamin E, hesperidin and vitamin C, and pycnogenol. As always, it is prudent to work with your naturopathic doctor to discuss any therapies before initiating them on your own. Not every supplement is safe for every person, and doses and quality are variable. Your naturopathic doctor will work with you to identify the most effective ways to proceed, and can also include other therapies not discussed here, like botanical medicine and acupuncture.