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Menopause is a natural phase in a woman’s life, marking the end of our reproductive years. Perimenopause, the transition period leading up to menopause, can last several years and is characterized by fluctuating hormone levels that often cause a variety of symptoms. These symptoms can range from hot flashes and night sweats to mood swings, insomnia, and decreased libido. As we look for ways to manage these symptoms, many of us turn to natural treatments as a way to avoid or complement hormone replacement therapy (HRT) and other medical interventions. This article explores various natural remedies and lifestyle changes that can help alleviate symptoms and promote overall well-being during perimenopause and menopause.

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What you eat on a daily basis can have an impact on your experience of perimenopause and menopause, and making strategic changes in your diet can help alleviate symptoms in some women.

Increase your intake of omega-3 fatty acids

Omega-3 fatty acids like those found in fatty fish (like salmon and mackerel), walnuts, and flaxseeds have been shown to help manage common perimenopause and menopause symptoms like hot flashes, night sweats, and depression. Omega-3s also have anti-inflammatory properties that can help reduce inflammation associated with hormonal fluctuations, improve mood, and support heart health.

Focus on protein

As women age, we tend to lose muscle mass. Increasing protein intake during perimenopause and menopause can help preserve muscle mass and strength. Good protein sources include lean meats, poultry, fish, eggs, dairy, beans, and lentils.

Eat more calcium- and vitamin D-rich foods

Declining estrogen levels during menopause can lead to rapid bone loss and an increased risk of osteoporosis. Consuming adequate calcium and vitamin D, both of which are essential for bone health, is crucial. Dairy products, leafy greens, and fortified foods are excellent sources.

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Limit processed foods, alcohol, and caffeine

Highly processed foods, alcohol, and caffeine can exacerbate menopausal symptoms like hot flashes, sleep disturbances, and mood swings. Opt for whole, nutrient-dense foods and limit your intake of these potentially aggravating substances.

Add more phytoestrogens

Some women find that adding more phytoestrogen-rich foods to their diet can help balance hormone levels and reduce symptoms like hot flashes. These plant-based foods have compounds that mimic estrogen in the body and include soybeans, flaxseeds, sesame seeds, and chickpeas.

A note about phytoestrogens

Keep in mind that overconsumption of phytoestrogens can worsen hypothyroidism in some cases. Studies show that supplementation with high-dose phytoestrogens (16 mg) in women with subclinical hypothyroidism can cause a three-fold increased risk of progressing to overt hypothyroidism.

Phytoestrogen-rich foods and supplements can also interfere with thyroid function, and research shows that women being treated for hypothyroidism may require an increase in the dosage of thyroid hormone replacement when increasing their intake of phytoestrogens from foods or supplements.

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Many herbal supplements have been traditionally used to alleviate menopausal symptoms. While scientific evidence varies, some herbs show promise in treating perimenopausal and menopausal symptoms.

Maca

Research has shown that supplements made from maca, a South American root vegetable, can help alleviate various perimenopausal and menopausal symptoms.

Maca has been shown to help regulate hormone levels and balance the hypothalamic-pituitary-ovarian (HPO) axis, which can become disrupted during menopause. Studies indicate that while maca itself is not estrogenic, it can help increase estrogen, progesterone, and testosterone levels and reduce follicle-stimulating hormone (FSH) and cortisol levels. This hormonal balancing effect can help reduce the severity and frequency of menopausal symptoms.

Studies have also found that maca can improve sexual function and libido in perimenopausal and menopausal women, potentially helping with issues like vaginal dryness.

Some research indicates maca may also have a positive impact on mood and cognitive function, helping to alleviate symptoms like depression and brain fog.

Note: Remember that when consumed raw, maca is goitrogenic and can potentially slow thyroid function. Also, most maca products in the U.S. are from China and are not organic. It’s best to choose a properly cooked or heated organic maca grown in its native habitat in the high Andes of South America.

Melatonin

As women head into perimenopause, levels of the hormone melatonin tend to decrease, and this appears to be related to other age-related hormonal changes, like reduced reproductive and thyroid functions, as well as increased levels of gonadotropins like luteinizing hormone (LH) and follicle-stimulating hormone (FSH). 

Dr. Walter Pierpaoli is an Italian/Swiss scientist who is best known for his groundbreaking research on the pineal gland – and melatonin, the hormone it produces – and their role in aging, which was popularized in his bestselling 1995 book “The Melatonin Miracle.” Dr. Pierpaoli recommends melatonin for women during perimenopause and menopause, citing its anti-aging and hormonal-balancing properties. Specifically, research shows that it can help regulate erratic menstrual cycles during perimenopause, relieve fatigue, and reduce some perimenopausal symptoms.  

In one study, researchers examined the effects of taking low dose melatonin (3-5 mg) in the evening on these age-related hormonal changes to see if it could impact menopause-related hormone levels. They recruited women aged 42 to 62 who were either perimenopausal (transitioning to menopause) or menopausal (post-reproductive) and randomly divided them into groups receiving either melatonin or a placebo. Results showed that women with low melatonin levels who took melatonin experienced:

• significant increases in thyroid hormones over three to six months
• significantly reduced luteinizing hormone (LH) levels in women in their 40s
• reduced follicle-stimulating hormone (FSH) levels
• improved mood, and less depression

Several studies have found that melatonin supplementation can improve sleep quality, help with falling asleep, and reduce sleep disruptions in women during perimenopause and menopause. This is likely due to melatonin’s role in regulating circadian rhythms, which can become disrupted during the menopausal transition.

Melatonin may also have other benefits for perimenopausal and menopausal women. It can regulate the hypothalamic-pituitary-gonadal axis and impact the production of hormones like estrogen, progesterone, and testosterone. Research has demonstrated that melatonin improves climacteric symptoms like hot flashes, night sweats, irregular periods, mood changes, sleep disturbances, and other common symptoms.

Other research suggests melatonin can help improve mood and well-being. Additionally, melatonin appears to play a role in maintaining bone density and strength, which can help prevent post-menopausal osteoporosis.

Black cohosh

Black cohosh, a perennial herb native to North America, has long been used to help alleviate the symptoms of perimenopause and menopause, including hot flashes, night sweats, mood changes, sleep disturbances, and vaginal dryness.

The exact mechanism by which black cohosh may help with these symptoms is not fully understood, but research suggests it may work in a few ways. Some studies indicate that black cohosh may have a mild estrogenic effect, helping to regulate hormone levels that fluctuate during the menopausal transition. Other research points to black cohosh’s potential ability to modulate serotonin pathways in the brain, which could help improve mood and sleep. Additionally, black cohosh may have anti-inflammatory and antioxidant properties that could help relieve specific menopausal symptoms.

When it comes to safety, black cohosh is generally well-tolerated, with only mild side effects reported in a small percentage of users, such as gastrointestinal discomfort.

It’s essential to choose a good quality black cohosh supplement. One to consider is Remifemin, which contains a proprietary and standardized extract of black cohosh that has been studied for its efficacy and safety in treating menopausal symptoms such as hot flashes and night sweats.

Red clover and soy

Soy and red clover supplements have been widely studied for their potential benefits in managing perimenopausal and menopausal symptoms.

Soy is a rich source of isoflavones, a type of phytoestrogen that can have estrogen-like effects on the body. Several studies have found that soy isoflavone supplements may help reduce the frequency and severity of hot flashes, a common menopausal symptom. A 2016 systematic review and meta-analysis of 62 studies involving over 6,600 women found that soy isoflavones were associated with modest reductions in hot flashes and vaginal dryness, though the effects were relatively small.

Like soy, red clover is a rich source of isoflavones that may help alleviate menopausal symptoms. A 2017 randomized controlled trial found that a combination of red clover extract and probiotics was more effective than a placebo in reducing hot flashes and night sweats in perimenopausal women. A 2016 review also suggested red clover may help improve vaginal dryness and atrophy, though its effects on other symptoms were less clear.

Both soy and red clover supplements appear to be generally well-tolerated in the short term, with only mild side effects like gastrointestinal issues reported. However, there are some long-term safety concerns, particularly around the potential impact of phytoestrogens on hormone-sensitive tissues like the breast and uterus, and these supplements are generally not recommended in women with a history of hormone-sensitive cancers and conditions.

Dong quai

Known as “female ginseng,” dong quai is a traditional Chinese herb used for centuries to address various female health concerns, including perimenopausal and menopausal symptoms. While the evidence on its efficacy is mixed, some studies suggest it may provide relief for specific menopausal issues.

A 2002 study found that a combination product containing dong quai, American ginseng, black cohosh, milk thistle, red clover, and vitex agnus-castus reduced hot flashes and night sweats and improved sleep quality in peri- and post-menopausal women. Another study showed a specific dong quai and chamomile product reduced hot flashes in menopausal women.

Dong quai is generally considered safe for short-term use, but it may increase sun sensitivity and interact with blood thinners and hormone-sensitive conditions like breast cancer.

Evening primrose oil

Evening primrose oil (EPO) has shown promise as a natural treatment for alleviating some of the common symptoms associated with perimenopause and menopause. EPO is a rich source of gamma-linolenic acid (GLA), an omega-6 fatty acid that can mimic the effects of estrogen in the body.

Several studies have examined the efficacy of EPO for managing menopausal symptoms. One randomized controlled trial found that EPO effectively reduced the frequency and severity of night sweats in post-menopausal women, though it did not significantly impact hot flashes. Another review noted that while the evidence is mixed, some studies have seen the benefits of EPO for relieving hot flashes and other vasomotor symptoms.

The proposed mechanism is that the phytoestrogens in EPO can help compensate for the drop in natural estrogen levels during menopause. By providing estrogen-like compounds, EPO may help alleviate symptoms like hot flashes, night sweats, mood changes, and vaginal dryness.

Overall, EPO appears to be a relatively safe and well-tolerated option that may provide modest relief for some menopausal symptoms. However, more high-quality research is still needed to establish its benefits definitively.

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Mind-body approaches like hypnotherapy, mindfulness meditation, and yoga can be effective in reducing menopausal symptoms such as hot flashes, sleep disturbances, irritability, anxiety, and depression.

Specifically, research has shown that:

• Hypnotherapy can improve hot flashes by up to 80%, making it more effective than many other treatments.
• Practicing a mind-body approach (mindfulness meditation) for eight weeks was effective in reducing the intensity of menopausal symptoms among women.
• Yoga-based programs, breathing practices, and other mind-body therapies may be beneficial for reducing vasomotor and other menopausal symptoms, though more rigorous studies are needed.

In general, women with higher mindfulness scores experience fewer menopausal symptoms, especially irritability, anxiety, and depression. Mindfulness and meditation may be promising tools to help women reduce menopausal symptoms and stress.

The scientific evidence indicates that exercise and physical activity can help alleviate various perimenopausal and menopausal symptoms in several ways.

• Reduced psychosocial and physical symptoms: Studies have found that moderate levels of physical activity are associated with reduced psychosocial and physical menopausal symptoms in perimenopausal women. Perimenopausal women who engaged in moderate physical activity reported significantly lower psychosocial and physical symptoms compared to those with low physical activity levels.
• Improved mental health: Exercise has been shown to have a positive impact on mental health during the menopausal transition, reducing symptoms like depression, anxiety, fatigue, and problems with memory and concentration.
• Decreased hot flashes: The evidence on the relationship between physical activity and hot flashes is mixed. Some studies have found that higher physical activity levels are associated with an increased risk of hot flashes. In contrast, others have reported that exercise can decrease the frequency and severity of hot flashes.
• Improved sexual function: While the evidence is limited, some studies suggest that regular exercise may help improve sexual function and reduce sexual dysfunction in menopausal women.
• Weight management: Physical activity can help maintain proper body weight and prevent gradual weight gain during the menopausal transition.

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Adequate, quality sleep is essential during perimenopause and menopause. Strategies to improve sleep include maintaining a consistent sleep schedule, creating a relaxing bedtime routine, keeping the bedroom cool and dark, and avoiding caffeine and screen time before bed. These can all help reduce perimenopause and menopause-related fatigue and sleep disruptions.

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The overall trend is clear: quitting smoking can significantly improve the quality of life for women experiencing perimenopausal and menopausal symptoms.

Research has shown that smoking can increase the frequency and severity of hot flashes, a common menopausal symptom. Smokers are also more likely to experience earlier menopause compared to non-smokers. This is because smoking can accelerate the depletion of ovarian follicles, leading to an earlier decline in estrogen levels and the onset of menopause.

In addition to hot flashes, smoking can exacerbate other menopausal symptoms, such as mood changes, sleep disturbances, and vaginal dryness. This is because smoking affects the body’s hormonal balance, which plays a crucial role in regulating these symptoms.

Quitting smoking, however, can help alleviate these menopausal symptoms. Within a short period, women who quit smoking may experience a reduction in the frequency and severity of hot flushes. This is because the body begins to recover from the adverse effects of smoking, allowing for improved hormonal regulation and better management of menopausal symptoms.

Moreover, research has found that quitting smoking can also reduce the risk of early menopause. Women who quit smoking, especially those who do so before the age of 25, have a risk of early menopause that is comparable to that of non-smokers. This suggests that the negative impact of smoking on ovarian function can be reversed, at least to some extent, by quitting.

It’s important to note that the benefits of quitting smoking may not be immediate, and the extent of symptom relief can vary among individuals.

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Acupuncture, massage, and cognitive behavioral therapy (CBT) are other helpful approaches for relief of perimenopausal and menopausal symptoms:

Acupuncture has been shown to have a positive and broad effect on perimenopausal depression and insomnia. Clinical trials and meta-analyses have found that acupuncture can improve mood, sleep, and vasomotor symptoms like hot flashes in perimenopausal women. It’s thought that acupuncture helps regulate hormones, neurotransmitters, and autonomic nervous system function.

Massage therapy can also help manage menopausal symptoms. Studies have found that reflexology and other forms of foot massage can significantly reduce the frequency and severity of hot flashes, as well as improve anxiety, depression, and sexual dysfunction in menopausal women.

Cognitive behavioral therapy (CBT) is an effective non-pharmacological approach for managing vasomotor symptoms, sleep disturbances, and mood changes associated with perimenopause and menopause. CBT teaches women to modify maladaptive thoughts and behaviors that can exacerbate menopausal symptoms. CBT-based self-help programs have been shown to reduce the severity and frequency of hot flashes and improve work productivity, sleep, and quality of life.

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Perimenopause and menopause are natural transitions in a woman’s life, but the associated symptoms can be challenging. By embracing natural treatments and making lifestyle changes, many women can find relief and improve quality of life during this time.

While many of these approaches have shown promise, consulting with healthcare professionals before starting any new treatment or supplement is essential to ensure safety and effectiveness. With the right combination of natural therapies and medical treatment and guidance, you can navigate perimenopause and menopause – as well as hypothyroidism –   with confidence and ease.

When it comes to managing menopause, an integrative approach that combines conventional and complementary therapies may be most effective. Paloma Health’s hormonal experts can work with you to develop a personalized treatment plan that addresses your symptoms and helps you regain hormonal balance to enjoy better health and quality of life.

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