Menopause

By midlife, finally being free of our recurring menstrual cycle and its associated hormonal changes is a welcome relief for most women. While many women experience a gentle transition to this new phase of life, others find the transition isn’t so smooth.

Common occurrence— different experience

Many women experience minimal discomfort during the transition to menopause; however, many more suffer undesirable symptoms such as fatigue, mood swings, hot flashes, sleep disturbances, depression, and low libido. Osteoporosis and an increased risk of breast cancer or heart disease are additional concerns for women beyond menopause.

What is menopause?

Menopause is a natural midlife process occurring for most women between the ages of 42 and 56, with the average age being 51. Also known as the climacteric, this period signifies the end of a woman’s reproductive years with the cessation of menstruation.

The term menopause originates from the Greek words mens (monthly) and pausis (to end). A woman’s menopause is considered “natural” when there is an absence of the menstrual period for 12 months. In medical terms, an “unnatural” menopause is one that follows a hysterectomy (removal of uterus) or oophorectomy (removal of ovaries).

Menopause involves some intense changes. Understanding the biochemistry of this transition period will help to manage symptoms effectively.

First comes perimenopause

Perimenopause is the transitional period leading up to menopause—which is the complete cessation of menstrual periods—and is otherwise known as the menopausal transition. During this period, which typically begins in the early to mid-40s, menstrual cycles become irregular as hormone levels fluctuate. As estrogen levels rise and fall, menstrual cycles can lengthen or shorten, and women can experience menopause-related symptoms.

The estrogen effect

The rising and falling of estrogen levels during perimenopause can create a number of symptoms, though not all women experience all of these symptoms.

Hot flashes and night sweats

Vasomotor symptoms such as hot flashes and night sweats are the most common and disruptive complaints during menopause. Estrogen is related to temperature regulation in the body, and as hormone levels decline, peripheral and core body temperatures increase, resulting in a visible flush on the chest, neck, and face. This can be experienced as moderate or intense feelings of heat resulting in sweating, and episodes can last from 30 seconds to 5 minutes.

Sleep quality

Estrogen also influences neurotransmitters such as serotonin, norepinephrine, and dopamine, which regulate mood and sleep quality. Arousals and disruptions of sleep can also be caused by hot flashes. Over time, inadequate and unrefreshing sleep can also lead to chronic sleep deficits, significantly impaired alertness and mental acuity, carelessness, and decreased work productivity.

Memory loss and mood

There is a widespread distribution of estrogen receptors throughout the brain, hence a continual loss of estrogen may contribute to neurological complaints such as memory loss and decreased mental clarity. Sleep disturbance caused by hot flashes can lead to fatigue, irritability, and cognitive impairment.

Several studies show an estrogenic link to anxiety and depression during menopause, through its modulation on neurotransmitters in the central nervous system. In particular, estrogen is involved in the synthesis of serotonin and facilitates its release in the brain, thereby enhancing mood and regulating emotions. This unique interplay between serotonin and estrogen can explain the disturbances in mood as estrogen levels drop.

The dry spells

With the decrease in levels of estrogen, women may suffer symptoms such as vulvar and vaginal dryness, burning, and irritation. Estradiol (the primary form of estrogen) is vital in maintaining the elasticity and health of genital tissues. Low libido is also common, as sexual responsiveness diminishes due to estrogen insufficiency.

Dry eyes, dry mouth, and reduced skin elasticity are other symptoms associated with menopause.

Dangerous treatment?

Until recently, women who were experiencing symptoms of menopause were often prescribed hormone replacement therapy (HRT), consisting of estrogen with or without progestin. But with the results of the HRT arm of the long-term and wide-ranging Women’s Health Initiative study, and the subsequent conclusion that there were more risks than benefits among the women using HRT, the number of women taking HRT has dropped dramatically.

These potential risks have prompted women to seek natural alternatives and complementary therapies to alleviate symptoms.

A safer, natural approach

A woman’s perception of her well-being comprises physical, emotional, mental, sexual, and social aspects related to good health. It is upsetting and unsettling to feel “out of sorts” and anxious, or to experience sudden memory lapses and embarrassing hot flashes around colleagues or loved ones. More than ever before, women are seeking explanations and safer, effective solutions to address these concerns.

Diet plays a big role

A healthy hormone-balancing diet that incorporates whole grains, good fats, plenty of fruits and vegetables, lean meat and fish, and plenty of water is not only the best way to maintain overall health, but also a good strategy for relieving menopausal symptoms.

Limit your intake

Some foods and beverages can be triggers for the frequency and severity of hot flashes. Try limiting your intake of the following foods:

• sugar
• alcohol
• caffeine
• very spicy foods

Get omega-3s

Not only are omega-3 essential fatty acids good for our hearts, but they have also been shown to reduce the frequency of hot flashes, depression, and mood disturbances. They may also protect against breast cancer.

The following foods are rich in omega-3 fatty acids:

• oily fish, including salmon, sardines, tuna, lake trout, and herring
• flaxseeds and flaxseed oil
• soybeans and soybean oil
• walnuts and walnut oil
• hemp hearts and hemp oil

Phytoestrogens

Of particular interest to women affected by the symptoms of menopause are foods high in phytoestrogens, which are mainly derived from plant sources and mimic the biological effects of estrogen. Also known as isoflavones, these compounds have been shown to alleviate hot flashes.

Epidemiological data comparing Asian and Western diets suggest decreased menopausal symptoms among Asian women given the higher intake of soy in these countries. The following foods are rich in phytoestrogens:

• soy
• tofu
• tempeh
• miso
• flaxseeds
• beans
• cranberries

Isoflavone supplements also exert protective effects on bone density, minimizing osteoporosis as well as improving cholesterol balance.

Herbs

In the herbal arena, black cohosh, St. John’s wort, chaste tree berry, red clover, and ginseng have also demonstrated efficacy in alleviating certain menopausal symptoms.

Black cohosh

Women have used black cohosh for treating hot flashes and mood disturbances for centuries. Current research seems to support this traditional use. A randomized, double-blind, controlled three-month study in five centres in China, which enrolled 244 menopausal women, showed a clear benefit in relieving hot flashes.

The effect of black cohosh appears to work through serotonin and inflammatory pathways. The phytoestrogens in black cohosh may also have a protective effect against bone loss. It is important to note, however, that prolonged use of this herb in high dosages may be linked to liver toxicity.

St. John’s wort

St. John’s wort has been evaluated in randomized control trials highlighting this herb as an effective antidepressant and mood stabilizer. Combining this herb with black cohosh has yielded superior efficacy for menopausal symptoms, including hot flashes and vaginal atrophy (a condition caused by lower estrogen levels in which the vaginal walls become thinner, drier, and often inflamed). Chaste tree berry is another herb often combined with black cohosh to improve mood and hot flashes.

Red clover

Another phytoestrogenic herb, red clover has demonstrated improvement of menopausal complaints, including reduced hot flashes. It also has been associated with increases in HDL (good) cholesterol; stronger, more flexible arteries; and a slowing of bone loss in pre- and postmenopausal women.

Ginseng

Ginseng is a well-known modulator of stress levels and has been described by the German Commission E as “a tonic for invigoration and fortification in times of fatigue, debility, declining work capacity, and concentration.” As such, studies have shown favourable effects on fatigue, insomnia, and well-being in menopausal women.

Exercise

Regular physical activity has many positive benefits for women before, during, and after menopause:

• weight management
• heart health
• mood control
• energy enhancement
• sleep improvement
• bone health

Although exercise has benefits for some specific symptoms of menopause, including insomnia and depression, a 2013 study found no benefit for the relief of hot flashes.

Mind/body exercises

Studies have suggested that perceived control over symptoms such as hot flashes can affect their severity. Mind/body exercises and therapies such as yoga and tai chi, as well as biofeedback and paced respiration, also lessen the intensity of hot flashes and anxiety by inducing relaxation. Similar effects have been noted with massage therapy, which also decreases raised cortisol levels from stress or pain, while increasing serotonin levels to enhance mood.

It is important to remember that menopause is a natural process of life, which can be managed well with appropriate physical, mental, and emotional support. During this phase, a woman’s life can be complex as she resides within a changing body—physically, hormonally, and emotionally. A multitude of factors are at play, making it important to seek out knowledgeable health practitioners to address menopausal symptoms safely and effectively.