Managing Menopause

Menopause brings the increased risk of osteoporosis, breast cancer or heart disease but, for many women, it is not the fear of those illnesses that most concerns them but how to cope with the debilitating symptoms that affect their daily lives: the hot flushes, vaginal dryness, joint pains, fatigue, headaches, irritability, insomnia, depression and decreased sex drive. The degree to which a woman experiences any or all of these symptoms is highly dependent on how good her nutrition is. Indeed, you don’t have to suffer at all.

Hot flushes – how to turn the heat down

Three-quarters of all British menopausal women, particularly those who are thin, experience some hot flushes. These are a result of increased activity of the hypothalamus gland in the brain, which makes two hormones – follicle stimulating hormone (FSH) and luteinising hormone (LH). Extra-high levels of these two hormones occur as the menopause approaches, in an attempt by the brain to stimulate any remaining eggs to develop. Meanwhile, oestrogen levels fall, ovulation becomes infrequent and progesterone levels decline rapidly. Using ‘natural’ or bio-identical progesterone cream has been shown to help.

Supplementation with phytoestrogens, which are structurally and functionally similar to the body’s own oestrogen, have been shown to reduce the frequency and severity of hot flushes. Four studies show that the oestrogen-like, plant-derived substances known as isoflavones, found in high concentrations in soy and red clover, approximately halve the incidence and severity of hot flushes.

I recommend fermented sources of soy where possible, including miso, tempeh, natto and tamari. Tofu, soya milk and soya yoghurt contain less phytoestrogens than fermented sources and also have other disadvantages, Highly processed forms of soy like burgers often have very little. Opt for organic, not genetically modified, sources of soya.

If you have disglycemia – which means your blood sugar level goes up and down like a yo-yo – you are much more likely to experience hot flushes. By keeping your blood sugar level even by following a low-GL diet [], you can considerably reduce the number of hot flushes you have.

Other nutrients that may help during the menopause are vitamins C, E and essential fats (both omega-3 and omega-6). Choose a vitamin C supplement that contains berry extracts rich in bioflavonoids, as there’s some evidence that these help too. When vitamin E levels are low, there is a tendency for FSH and LH to increase. Vitamin E also helps to stabilise hormone levels and has been reported to help alleviate vaginal dryness.

Helpful herbs
The most promising of the herbs used to treat the symptoms of menopause is black cohosh, which can help reduce hot flushes, sweating, insomnia and anxiety. Also encouraging is new research that seems to indicate that black cohosh neither increases cancer risk nor is anti-oestrogenic. It also helps relieve depression by raising serotonin levels. Even so, I’d recommend that you take black cohosh three months on, one month off, and avoid it if you are taking liver-toxic drugs or have a damaged liver. Take 50mg twice a day.

The other ‘hot’ herb for hot flushes is dong quai, whose scientific name is Angelica sinensis. In one placebo-controlled study from 2003, 55 postmenopausal women who were given dong quai and chamomile instead of HRT had an 80 per cent reduction in hot flushes. These results became apparent after one month. An earlier study didn’t find this effect, however. If you want to try dong quai, which doesn’t appear to have oestrogenic or cancer-promoting properties, I recommend 600mg a day for relief from hot flushes.

Another popular herb, Vitex agnus-castus (also called chaste- berry), can also help with hot flushes. Agnus castus’s therapeutic powers, proven in a series of double-blind trials in 2005, are attributed to its indirect effects on decreasing oestrogen levels while increasing progesterone and prolactin. Raised prolactin is known to lower oestrogen levels. In most trials, 4mg a day of a standardised extract (containing 6 per cent agnusides – one of the active ingredients) was used.

Side effects There are no known serious adverse effects from black cohosh or agnus castus (although it is always wise to be cautious about herbs during pregnancy and breast-feeding). Dong quai may thin the blood and is therefore contraindicated for women on blood- thinning drugs such as warfarin.

Exercise and belly breathing
Both regular exercise and learning how to breathe deeply have proven benefits for menopausal symptoms. According to a 2003 study conducted at Lund University in Sweden, if you stay active you can reduce the impact of menopausal symptoms. Researchers interviewed nearly 4,500 women 58 to 68 years old about their sociodemographic, lifestyle and current health conditions. They found that women who did more vigorous physical exercise were less likely to suffer from hot flushes.

The benefits of regular exercise throughout life cannot be overstated. Weight management, mood, concentration, sleep and memory may all be improved by good exercise, which helps to supply nutrients to the brain. Both improving your diet and increasing your exercise is the winning formula.

The basic principle of all breathing exercises is to use your diaphragm, rather than the top of your chest as we tend to do when we are anxious or stressed. If you’re unsure where the diaphragm is, it’s the dome- shaped muscle at the bottom of the lungs. Three trials have shown that this type of breathing can reduce the frequency of hot flushes by about 50 per cent.

Breathing in this way works best at the start of a hot flush. Breathing from the diaphragm is part of many health systems such as yoga. The exercise system Psychocalisthenics, which takes 15 minutes a day to do, combines this kind of breathing with exercises that keep you strong and supple. It is excellent for minimising menopausal symptoms and improving your vitality and mood.

Sexual problems

A lack of sex drive can result for a variety of reasons, not all nutritional.

Vaginal dryness is another reason for declining interest in sex. The vagina is kept moist because it produces vaginal secretions, but declining oestrogen levels tend to dry up these secretions. Supplementing vitamins A, C and E plus zinc, are also important for keeping vaginal membranes healthy and encouraging normal mucus production. These nutrients are available in good high-potency multivitamin and mineral supplements, which are worth taking on a daily basis. Vitamin E cream used locally has helped many women with vaginitis. There’s also evidence that a phytoestrogen-rich soya-based gel can help.

There are also natural hormone creams that help, especially if you are deficient in hormones; for example, progesterone. Natural oestrogen creams such as Ovestin, which provides the much gentler oestriol, have been successful in treating dryness and vaginitis and can also reduce the occurrence of urinary tract infections, restore normal vaginal mucus membranes, and provide the right environment in the vagina to inhibit the growth of unfriendly organisms. The late Dr Lee found that, when women used progesterone creams rubbed into the skin to treat their vaginitis, they experienced similar benefits to those using oestrogen cream. Progesterone cream is preferable for women who are advised against using oestrogen therapy because of a history of breast, ovarian or uterine cancer; however, hormonal creams should be given with the supervision of a medical doctor familiar with their use.

As a woman nears the menopause, mucus production in the vagina changes, alongside declining levels of oestrogen. Vaginal infections are more common at this time and women on the Pill appear more susceptible. The oral contraceptive pill suppresses natural hormone production and it may be as a result of this that mucus production is affected.

Natural progesterone can help post-menopausal women with recurring urinary and vaginal infections, helping to lessen symptoms and improve mucus production. Oestrogen replacement may be inappropriate for some women who might be at risk of breast or uterine cancer.


Women the world over sleep less as they get older, which may be a protective mechanism so that the young are protected by their elders in the small hours. As long as the sleep you experience is refreshing, if you wake up early it’s best to get up to do something productive and enjoy the peace, rather than worrying about not sleeping. For those of you who like to meditate, the early hours of the morning are reputed to be the best time and can compensate for sleep.

My favourite strategy for sleep is caffeine avoidance; taking a combination supplement providing both 5-HTP, magnesium and calming herbs an hour before bed; and listening to Silence of Peace as you go to sleep. If this doesn’t work, try melatonin, available on prescription or over the counter in most countries outside of the EU. Start with 3mg.

If you are not getting the sleep you need then read this report for the complete guide to a good night’s sleep.

Preventing headaches

Some headaches are caused by blood vessels in the head narrowing, possibly as a result of declining oestrogen levels, since oestrogen dilates blood vessels, improving blood flow. Coffee, alcohol and red wine frequently give rise to headaches, as can a food allergy, candidiasis, or glucose imbalance. Find out more about this here.

Reducing menopausal joint pains

There are many reasons for joint pains, but weight management, supported by a balanced diet and exercise, is key to preventing and managing joint pains; however, you may need to reconsider the type of exercise that is best for you at a later stage if you continue to have pain.

Vitamin B6 supplementation has been shown to help painful nodules on finger joints if treated early. Vitamin B6, like all B vitamins, is best taken as part of a B complex.

Food intolerance may become more prevalent at the menopause and can be a cause or contributor to joint pains. Wheat and dairy produce are the most common offenders.

The omega-3 fat, EPA, has potent anti-inflammatory properties and can help to reduce the inflammation that contributes to joint pain. Vitamin B6, B3, biotin, and vitamin C, plus the minerals zinc, calcium and magnesium, all play an important role in helping essential fats create anti-inflammatory prostaglandins. Too much red meat and full-fat dairy produce, on the other hand, help to create too much of a type of prostaglandin that in excess increases inflammation in the body. Culinary herbs like turmeric and ginger, as well as red onions and olives also contain natural inflammatories. Progesterone has anti-inflammatory properties. My book Say No to Arthritis explains everything you can do to banish joint aches and pains. Dr John Lee found with many of his patients that rubbing progesterone cream directly onto the joint or tissue that hurts was helpful. As previously mentioned, natural progesterone is best used under the direction of a medical doctor familiar with its use.

Preventing memory loss

If you are worried about losing your memory as you age I cannot stress enough how important it is to eat well now to prevent this happening; however, even this may not provide enough nutrients, especially vitamin B12, which is increasingly poorly absorbed as you age. All the evidence suggests that both age-related memory loss and Alzheimer’s is, in almost all cases, completely preventable if you follow the right diet, take the correct supplements and have a healthy and active lifestyle. (My book The Alzheimer’s Prevention Plan explains exactly how to do this.)

Hormones and your mind

There’s a strong link between hormones, your mind and mood. Serotonin, acetycholine and noradrenalin (made from dopamine) are thought to be the most important neurotransmitters involved in memory. Oestrogen stimulates receptors for serotonin and noradrenalin in the brain and also seems to slow the process of these neurotransmitters being broken down. Similarly oestrogen helps raise levels of acetylcholine.

Oestrogen appears to have a mild ability to dilate blood vessels, helping to improve blood flow and nutrient supply to the brain, and helping the brain to function more efficiently; however, studies using oestrogen hormone replacement therapy (ERT) have largely proved inconclusive. The risks and benefits also need to be considered in terms of the increased risk of breast and uterine cancer associated with ERT.

If you are concerned about your memory, or have a family history of early cognitive decline read The Alzheimer’s Prevention Plan and consider getting your homocysteine level tested as this is one of the best predictors of risk. Homocysteine is lowered by increasing your intake of vitamins B6, B12 and folic acid. A nutritional therapist can assess your risk and advise on how to reverse it.

Solving menopausal mood dips

The causes of depression are many, and some of them can be helped by nutrition. Causes can include neurotransmitter and hormonal imbalances, stress, blood sugar imbalances, nutrient deficiencies, secondary to chronic and life-threatening illness, chronic pain, loss and social deprivation. Our mood is very dependent on the foods we eat, so implementing a good low GL diet provides a sound basis for supporting your mood.

As discussed above, oestrogen appears to improve the function of serotonin and noradrenalin and, through this mechanism, improve mood; however, the risks and benefits of using HRT need careful consideration. For natural ways to improve your mood read this report.

Preventing associated increased risk of heart disease and stroke

Deaths related to disorders of the circulatory system have shown a steady decline since the 1970s, and particularly over the last decade; however, circulatory disorders remain the leading cause of death in women after the menopause.

Although oestrogen is known to reduce coronary heart disease and stroke in postmenopausal women, studies demonstrate that long-term use of HRT, or oestrogen replacement, can increase the incidence of breast cancer, stroke and heart attacks, not reduce it, as was suggested back in the 1980s and 1990s.

Apart from eating more fruit and vegetables, upping your intake of omega-3s from fish, nuts and seeds, and increasing your intake of homocysteine-lowering B vitamins is essential for reducing risk. Stroke and heart attack risk is better predicted by homocysteine than by cholesterol, and better lowered with B vitamins than drugs. Exercise also helps reduce risk, as does increasing your intake of antioxidant nutrients. All these steps help to reduce oxidative stress, which is the process by which we age. See this report for more help on reducing your risk of heart disease.


In summary, if you do your best to bring most of these pieces together into your diet and lifestyle, and take the right supplements, the chances are that any menopausal symptoms you experience will be minor and short-lived.

For more help and information read my book Balance Your Hormones.