The menopause is called ‘The Change’ for a reason. It is a time when fundamental physiological shifts happen for a woman, often accompanied by changes in other aspects of her life – children leaving home, retirement, and grandparent-hood. And yet this time can be beset by unpleasant symptoms and worrying about health problems to come in later years. One-third to one-half of a woman’s life will be lived after her menopause these days – she might as well enjoy it! Taking a positive and practical approach to managing the physical symptoms and health issues associated with the menopause is one positive step you can take to ensure that you enjoy this time, and the years that follow the menopause, to the full.

The menopause is the time when menstruation ceases, heralding the end to a woman’s reproductive life. The ten years before this, usually from the ages of 45-55 is called the peri-menopause. One in a hundred women will experience an early menopause, anything from their teens (only a few years after they start menstruating) to the age of 35. At the menopause the levels of oestrogen drop to around 40% of the levels that are produced during a woman’s reproductive life, while progesterone drops to only about one per cent. Of immediate concern, during the time of hormonal fluctuations, are symptoms such as hot flushes, decreased libido and vaginal dryness. All of these have a foundation in hormonal shifts. And later on, the most important health issues are the increased risks of osteoporosis and an increased risk of heart disease.

There are interesting differences in the way that women from different cultures experience the menopause, with women in Japan and other eastern countries complaining of very few menopausal problems. In Japan they do not even have a word for hot flushes.

Many women are increasingly unhappy about turning to HRT to resolve menopausal problems, and are interested in a natural approach. In any event only one in ten women manage to stay on HRT in any event because it does not agree with them. This is just as well as there is an increased risk of breast cancer related to long term use of HRT. The benefits of HRT which are usually mentioned relate to protection against cardiovascular disease and osteoporosis. And yet cardiovascular problems are largely dietary and lifestyle problems and while hormones can be protective in early years they do not address the underlying causes. Research has also shown that osteoporosis risk catches up in women who use HRT when compared to women who do not use it, by the time they are about 75 years old. This is the time when the most debilitating fractures happen anyway, so HRT does not seem to able to protect in the long term, but only in the short term while it is being taken.

Soya is a source of phytoestrogens isoflavones. They seem to have a hormone replacement effect once our own natural oestrogen supplies begin to wane. The mild oestrogen effect of soya can ease menopausal symptoms for many women, without creating oestrogen-related problems. The oestrogenic effect of soya isoflavones is probably what accounts for the scarcity of menopausal symptoms in countries like Japan, where large amounts of soy are eaten. Soya also probably helps to counter the effects of damaging environmental oestrogens which we get from farming chemicals and plastics, and which are linked to hormone cancers such as breast and ovarian cancer.

Many studies have shown that around 100 grams/4 oz of soya protein daily leads to a significant reduction in the number of hot flushes after only four weeks, and a nearly reduction after about twelve weeks. These are extremely positive results to achieve in such a short time. If plant oestrogens, which we can get from soya, wholegrains and legumes are incorporated into the diet in a significant way for a longer time during the ten years before the actual menopause then even better results may be expected.

Sources of phytoestrogens, which are sufficiently strong to help limit menopausal symptoms are linseeds, chickpeas, pulses, wholewheat and oats. There are around 300 different plant foods which give us protection and a diet rich in vegetables, grains and pulses, as well as soya and linseeds is likely to be the answer to many menopausal problems.

Caffeine, alcohol and high stress levels are all implicated in worsening hot flushes. Hot flushes are rare in vegetarian societies, again confirming that a high vegetable based diet can help, and suggesting that meat consumption may worsen the situation.

It can be helpful to take supplements to reduce hot flushes. Many women find they can contain their hot flushes by taking 800 ius of vitamin E for at least three months. It is effective for about 50% of women, but if after three months the vitamin E is not helping, it is necessary to try other tactics. Vitamin E should not be used at this level if you are taking blood-thinning medication such as Warfarin, as it can thin the blood further. Other supplements can help: Two grams daily of vitamin C with bioflavanoids in the formula. It is best to take a non-acidic version such as magnesium ascorbate or potassium ascorbate. Magnesium (300 mg daily) and folic acid (400 mcg daily) can help to provide relief. Evening primrose oil, starflower oil or borage oil giving 200 mg of GLA can also reduce hot flushes. Several herbal preparations can help including the Chinese herb Dong Quai (Chinese angelica) and Black Cohosh.

Regular exercise has particularly important health ramification for women approaching, and who are beyond their menopause. Weight bearing exercise is one of the more important factors in reducing the risk of osteoporosis, while the links between a healthy cardiovascular system and exercise have also been established without question. Exercise has positive effects on blood pressure, blood fats, cholesterol and blood sugar control - all of which affect cardiovascular health.

It has also been shown that women who are sedentary are more likely to have moderate or severe hot flushes when compared to women who exercise. Hot flushes may be due in part to low levels of endorphins in the brain – our pleasure chemicals. Levels of endorphins can be improved by exercise. You are never too old to start an exercise programme, and after only ten weeks of regular sessions a moderate degree of fitness can be achieved. If you are particularly unfit, or have existing severe osteoporosis it is best to consult your doctor before beginning a programme.

Headaches and migraines often become worse with the menopause. Avoid trigger foods which contain amines: cheese, wine, oranges, chocolate, yeast, pickles, alcohol. Other triggers are commonly eaten foods such as wheat, diary products and caffeine. Ginger can help to reduce headaches and migraines by dilating blood vessels in the head and chewing a small cube of fresh ginger, or taking supplements, is a quick remedy. Tensions can also build up and having a neck massage can help – if strains persist then it is worth visiting a chiropractor or osteopath.

Insomnia can be a problem, especially if hot flushes and night sweats are keeping you awake. Obviously, dealing with the hot flushes is the first step. The herb Valerian can help to induce sleep, but should not be taken alongside other sedatives. Aromatherapy oils to use in your bath or in a diffuser just before bedtime are lavender, geranium and marjoram all of which have a calming effect.

If mild to moderate depression is a problem at this time, it is well worth using the herb St John’s Wort, but not alongside other anti-depressants. Taking kava kava helps to curb anxiety.

Dry vagina problems can impact upon libido. Phytoestrogen-rich foods such as soy have been shown to have a beneficial affect on vaginal tissue. An active sex life helps to keep vaginal tissues healthy by improving blood flow to the area. If sex becomes uncomfortable use a lubricating gel. Drinking lots of water, 2 litres daily, helps to keep tissues hydrated. An energy boosting diet with loads of vegetables, fruits and juices can help to keep the spark alive.

Memory loss is often reported and, once again, addressing blood sugar problems may be the best remedy. B-vitamins are important for memory function, and the herb Gingko Biloba helps to combat problems with an effective memory.

Weight gain of around 7lbs around the menopause is not unusual, but if it goes much beyond that make sure that you are keeping up your exercise levels, eating healthy meals, and have your thyroid levels checked by your doctor. If bloating is a problem have a wheat-free trial period for a month to see if this has any impact (you can find many wheat-free recipes and suppliers throughout this magazine).

Natural progesterone cream used in the perimenopausal and post-menopausal phases has been shown to increase bone density and improve cardiovascular health. The cream has also been used to reduce hot flushes, improve libido and combat vaginal dryness. It may be the case that, if natural progesterone is not successful on its own, some oestriol cream may need to be used alongside it. Oestriol is the type of oestrogen which is not involved in an increase in risk of hormonal cancers. While some people view natural hormone creams as just another form of HRT they have important applications and are probably considerably safer than the synthetic versions. You will need to find a friendly doctor as these are prescription items (see information below).

Factors, which increase osteoporosis risk, include sugar, salt, alcohol, coffee, animal proteins (including milk!) all of which leach calcium out of the bones. Smoking and stress also take their toll. On the other hand, diets high in vegetables and fruits as well and nuts and seeds (for their calcium and magnesium and essential fats), as well as oily fish and soya are protective. Weight bearing exercise is highly protective. A dietary supplement, ipriflavone, which is an organically synthesised derivative of phytoestrogenic isoflavones, seems to be a safe way to increase bone density. Fluoride is best avoided because while it hardens teeth, it also hardens bone and so interferes with turnover and bone building activity.

© Suzannah Olivier 2000

For more information read Balancing Hormones Naturally Click here.