Menopause is one of those events in a woman’s life that can be filled with anxiety and dread or embraced as the end of her childbearing years and the beginning of her journey as a wiser, older woman.
In the same way we prepare for a baby by following a preconception care plan, we should prepare for menopause to minimise the impact it can have on our daily lives.
During the perimenopause stage we may notice drier skin, irregular periods that may be lighter or heavier, mood swings and trouble sleeping. This may be accompanied by lower oestrogen levels but not always. It is at this stage when we first notice symptoms that we take our cue to prepare for the next 5 to 10 years ahead (sometimes longer). When I first noticed these symptoms myself at the age of 41, I immediately did a day 3 FSH and oestradiol test which revealed elevated FSH (a sign of depleting egg reserve and declining oestrogen levels).
What is Menopause?
Menopause is also known as the ‘change of life’ or ‘transition.’ This important and sometimes difficult time in a woman’s life occurs when the ovaries stop producing eggs and monthly periods also stop. Most women experience this between the ages of 45 and 60, with the average age being 51 years. Menopause has officially been reached when you have had 12 months without having a single period. Strictly speaking, “menopause” is an event which happens over one day, the next day, you are considered to be “post-menopausal”. The ovaries have essentially stopped making hormones and you can no longer become pregnant (pregnancy is unlikely during the perimenopause stage although it can still happen). This new stage in life is embraced by many women but others may find it particularly confronting for a variety of reasons.
What is Perimenopause?
Perimenopause is the period that links the reproductive childbearing years and menopause. This transitionary period is different for every woman but usually lasts about 5 to 10 years. The hormonal fluctuations in this period of a woman’s life can often lead to uncomfortable symptoms. Every woman will experience this period differently, some women will not even notice any symptoms while others may be debilitated, which can deeply affect quality of life. Symptoms can happen all the time or come and go, depending on other contributing factors.
Common Symptoms during Perimenopause and Menopause
Typical symptoms that women may experience during this period include irregular menstrual cycles during perimenopause, mood changes, sleep disturbances, hot flushes and night sweats, vaginal and urinary symptoms and muscle and joint pain. Women may also experience headaches and migraine, forgetfulness, lack of self-esteem, fatigue and reduced libido. A woman may experience all these symptoms or none at all.
The Important Role of the Adrenals During Menopause
The adrenal glands have a strong influence on many aspects of our health and wellbeing throughout our life. Let’s face it, daily stress is inevitable, however the health of our adrenal glands can impact our ability to cope and manage stress on a day-to-day basis. The importance of healthy adrenal function during menopause is commonly overlooked or dismissed, but the key role they play during these years cannot be underestimated.
During the transition period of menopause, as we know, the ovaries stop producing eggs and decrease their production of reproductive hormones such as progesterone and oestrogen. To make up for the lack of sex hormones, a woman’s adrenal glands start to pick up the slack for the ovaries. The adrenals, like the ovaries, are also able to produce progesterone as well as other precursor hormones to oestrogen and testosterone, known as DHEA and androstenedione. Up until menopause, the adrenal glands’ role in producing reproductive hormones has always been minimal. However, the adrenals have a big job throughout our lives and are also still responsible for the production of the ‘stress hormones’ - cortisol, aldosterone and adrenaline, as well as some other important hormones such as DHEA.
Many women have a huge amount of stress in their lives, the daily juggle of managing family, households and careers can take its toll on the adrenal glands. By the time they get to menopause, the adrenals may be severely depleted. This may result in their inability to produce enough hormones to take up the slack for the ovaries. Additionally, if chronic stress is present during this time, the adrenal glands are still required to produce large amounts of stress hormones such as cortisol and adrenalin and may not be able to keep up with the demand for the production of sex hormones and their precursors. This can also lead to an increase in menopausal symptoms experienced. For example, increased production of cortisol can increase core body temperature which in turn contributes to the development or worsening of hot flushes. You can see that keeping the adrenals healthy is such an important factor in a smoother menopausal transition.
Treating the Symptoms of Menopause Naturally
It is unfortunate that most women will seek help for menopausal symptoms when they are experiencing severe symptoms such as hot flushes and night sweats rather than seeking help when they first notice symptoms during the perimenopause stage.
Going back to my own story, I treated myself in the same way I had treated clients in the past. I knew that I immediately had to start taking Chaste Tree to keep my cycle regular and support progesterone levels alongside DHEA (bioidentical hormone therapy) to support my adrenals and assist hormone production. DHEA converts into testosterone and testosterone is converted into oestrogen via an enzyme called aromatase.
For me, when I first started taking DHEA (prescribed by my holistic doctor), I experienced a boost in libido, energy and started sleeping better. After taking this bioidentical hormone for a year or so, my FSH declined to normal levels (less than 10) and my oestrogen increased. To keep my oestrogen levels under control, I started taking herbs to assist oestrogen clearance alongside Prometrium (bioidentical progesterone) from days 15 to 25 of my cycle.
Speaking from experience, this combination works. Upon seeing the results of my blood test 9 years ago, my GP said she expected my periods to stop within the next 5 years. Up until a couple of years ago, I still had a regular 28-day cycle and it’s my belief that I managed to delay menopause by taking bioidentical hormones in combination with herbs. My periods are now irregular and I would expect to reach menopause in the next year or so, bang on in line with the average age of 51 years. I sleep well with the assistance of sleep herbs and keep my Irritability under control with my “PMS Bundle” Female Balance, Calm & Sleep Support and Bone & Muscle Support.
When oestrogen levels start to decline, this is usually when menopausal symptoms such as hot flushes and night sweats commence. There are a lot of theories around why some women are more prone to hot flushes than others. Serotonin is closely linked with oestrogen and that is one theory behind why SSRI’s (antidepressants) are a successful treatment for hot flushes. The health of the adrenals are another theory linking high stress levels and caffeine consumption with an increased tendency to hot flushes.
As naturopaths and herbalists, we take all of this into consideration when treating someone holistically. The best herbs I have found for supporting serotonin are St John’s Wort and Saffron with plenty of clinical evidence behind both herbs. Rehmannia is my favourite adrenal tonic for during the day for menopausal women, and Withania my favourite PM adrenal herb to help combat the effects of stress on the body and reduce cortisol levels.
Hot flushes are accompanied by a sharp rise in luteinising hormone (LH) levels and this is one of the theories behind the prescription of black cohosh which is known to reduce LH levels. Black cohosh is also a selective oestrogen receptor modulator, helping to bind to oestrogen receptors and mimic the effect of oestrogen.
Aside from DHEA to support oestrogen levels, red clover is known to contain isoflavones, an active constituent in the plant that is oestrogenic.
Night sweats can be debilitating. Women have told me that they were so bad their sheets were saturated and they would have to get up in the middle of the night to change them. Sage and zizyphus are renowned herbs to reduce night sweats with the added benefit of zizyphus assisting sleep. Valerian and hops are well-known herbs to help you drop off to sleep, with hops having the additional benefit of being oestrogenic. If sleep is an issue, I recommend the combination of Calm & Sleep Support one hour before bed, followed by Menopause Night Formula at bedtime.
Bulgarian Tribulus leaf has been shown to increase DHEA naturally. I have been scouring the globe for this unique raw material and now I have finally found it, I have switched to this rather than taking DHEA. You can find it in Ultimate Libido & Hormone Support.
Lifestyle Tips for Menopause
Fortunately, there are so many tools we can use to ease the symptoms of menopause. The following simple steps can make a world of difference in managing commonly experienced symptoms:
- Nutritious diet – choose a wide variety of plant foods, whole grains, lean meat, fish or chicken. Include foods rich in phytoestrogens such as soy, tofu, whole grains and legumes. Phytoestrogens may mimic the action of oestrogen in some women which may assist with managing symptoms.
- Regular exercise – to support heart, adrenal and thyroid health. Aim for 30-45 minutes per day and include weight bearing exercises to decrease the risk of osteoporosis. Some studies have suggested that exercise can reduce hot flushes.
- Relaxation and managing stress levels – this may help to improve hot flushes as well as mood and sleep imbalances. Try mindfulness exercises and connecting with nature on a regular basis.
- Prioritising sleep – use lightweight sleepwear and bedding to assist with night sweats. Ensure a dark and cool temperature to promote restful sleep.
- Manage weight – women who are overweight may have more hot flushes than women in a healthy weight range.
- Avoid hot flush triggers such as spicy food, caffeine and alcohol.
- Quit smoking – those who smoke may experience an earlier menopause with increased adverse symptoms.
I’m yet to experience any hot flushes or night sweats and my experience with perimenopause has been relatively smooth. I put this down to the combination of the DHEA I took in early perimenopause and Prometrium along with selected herbs to help reduce the effects of stress on my body, assist with sleep and improve my memory and concentration.
I hope every woman can be inspired to prepare for this stage of her life to make her journey smoother.
