Menopause: Pharmaceutical and Natural Supports

Entering menopause can be uncomfortable and disruptive, but there are ways to ease the transition
BY Allison Williams TIMEMay 8, 2022 PRINT

Older adult women are often left to suffer from hot flashes, mood changes, sudden fluctuations in energy, weight gain, and drastic change to the body they’d previously known. “Welcome to menopause, and good luck!” seems to be the message for many of them.

Please know, not only are you not alone, but there are ways to help work through this phase of life both with pharmaceuticals and naturopathic therapies.

Menopause isn’t a disease, but a natural part of a woman’s life. There are cycles and rhythms in all aspects of nature, and a human being also experiences cycles and rhythms. You cross into menopause 12 months after your last menstrual cycle. It’s normal for women to go through a transition period called peri-menopause during which there is irregularity in cycling and signs of menopause begin to appear.

Common Signs of Peri-Menopause and Menopause 

  • Irregular menses
  • Mood changes
  • Anxiety, depression, anger, irritability
  • Fatigue
  • Sleep disturbances
  • Weight gain
  • Appetite changes
  • Skin changes
  • Low libido
  • Vaginal dryness
  • Blood pressure changes
  • Decline in bone density
  • Hot flashes, sweating
  • Brain fog, memory loss

Common conventional therapy includes antidepressants, hormone therapy, vaginal estrogen, gabapentin, blood pressure medications, and osteoporosis medications where indicated, but other options do exist.

Hormonal Therapy

The symptoms of menopause are the consequence of declining progesterone, estrogen, and testosterone. Thus, many women feel drastic improvements with hormone replacement therapies. Estrogen replacement is one of the most common therapies and has been shown to improve cognitive function, decrease hot flashes, and improve bone density. (Bone density is a huge issue later in life and important to address sooner rather than later.)

It’s imperative that estrogen be paired with progesterone to ensure that the body doesn’t enter a state of unopposed estrogen, which may increase the risk of breast and uterine cancer. Furthermore, progesterone isn’t only protective against breast cancer, but helps calm down the central nervous system, improve mood, and improve sleep quality.

Hormone replacement therapies aren’t without controversy. Research has linked them to several potential health risks. One consequence of that is that health agencies, including the FDA, have advised these therapies not to be overused. Another consequence of that research is drug makers marketing bio-identical hormones.

The term “bio-identical hormones” has become a buzzword in anti-aging circles, but it simply means that the hormones introduced to the body are identical to the hormones the body would naturally create. It’s best to mimic the body’s natural hormone molecules as much as possible, as this decreases the likelihood of harmful long-term effects. Synthetic non-bioidentical hormones have been associated with an increased risk of hormone-linked breast and gynecologic cancers, blood clots, heart attack, and stroke.

While the marketers of bio-identical hormones present them as a safer option, the FDA and the American Cancer Society have noted there are no large-scale, well-designed studies to support those claims.

As a result, clinicians must still use caution and follow the FDA guideline to use the lowest possible dose for the shortest amount of time to provide symptom relief.

Testosterone and DHEA replacement are also bio-identical hormone therapies that help provide symptom relief in menopausal women. Androgen therapy has been shown beneficial in improving low libido, as well as improving cognition, mood, and bone density.

Lifestyle Therapy

A big part of naturopathic medicine is encouraging the body to heal and support itself. This involves using lifestyle, nutritional, herbal, and regenerative therapies. These therapies work by supporting a woman’s basic physiology. And because menopause is a natural process, and there are risks associated with hormone replacement therapies, it’s best to use natural approaches before pharmaceutical options when responding to menopause.

Even if these approaches don’t provide complete relief, they can lessen the dosage requirements for women who go on to seek hormone replacement therapy.

Nutrition plays a huge role in modulating weight gain, mood, and supporting the body in creating its own hormones and neurotransmitters. Maintaining good blood sugar levels by eating more protein, fasting intermittently, and completely avoiding sugar often makes a huge impact on hot flashes, depression, and unwanted weight gain during menopause. If you want to know how your diet is serving you, speak with your doctor about testing your blood sugar, insulin, and hemoglobin A1c (HbA1c) to ensure they are in optimal ranges.

Getting proper sleep is also important. It helps reduce stress and the toll stress-triggered hormones and inflammation take on the body. Cognitive behavioral therapy has been used to treat insomnia experienced by menopausal women with good results. It helped improve participants’ ability to get to sleep, however, some still experienced waking through the night.

Herbal Therapy

Nature has provided us with additional tools to help regulate hormones in all stages of life. The use of herbs in treating menopause has been done for centuries. The herbs that follow are only a few that have been used and studied.

Black cohosh, Actaea racemosa, is an excellent herb to help with menopausal symptoms as it helps modulate hormones, relax the nervous system, and offers anti-depressant support. It’s also well known to help reduce hot flashes.

A 2013 study by researchers in Germany showed that black cohosh improved menopausal symptoms to a greater degree than placebo. This herb can be taken as a single herb but is also found in combination products for hormone modulation. The recommended dose can range from 40 mg to 2 grams per day of powdered dry root depending on symptoms and health history.

Maca, Lepidium meyenii, is another effective herb for hormone modulation and has also long been used to improve libido and fertility.

Animal studies have shown the potential for maca to help reduce the negative impacts of estrogen loss on bone density, which would be a boon to patients prone to osteoporosis.

However, caution should be used, as some research suggests maca may upregulate processes that increase certain breast cancer cells to migrate. Most of my patients prefer maca in glycerite form instead of eating the plant, the taste is somewhat like butterscotch. But it’s also readily available in supplement form.

Lastly, dong quai, Angelica sinensis, is another herb used for centuries to help women manage the symptoms of menopause.

It’s a potent hormone modulator and helps lower blood pressure and decrease systemic inflammation. The research on dong quai used alone for menopause is mixed, some studies show little to no improvement from controls.

That said, clinically speaking, I see phenomenal results utilizing dong quai in combination with black cohosh, maca, and other hormone modulating herbs rather than any herbs used alone. There is a synergistic effect appreciated in herbal medicine that continues to be studied and evaluated. Just as medications may interact with each other, herbal constituents interact with each other and can sometimes compound effects that benefit the patient.


If you’re experiencing menopausal symptoms, where should you start? Work on diet, sleep, and lifestyle interventions. Layer on supportive herbs per your physician’s advice and consider hormonal therapy as a last resort to further support your long-term health and a healthier and less symptomatic transition to menopause.

Allison Williams
Naturopathic Doctor
Dr. Allison Williams is a naturopathic doctor and professor. She has a passion for helping people improve their health and well-being so that they can live life to the fullest. She works with patients in Arizona, as well as, offers consultations out-of-state and internationally. For more information, visit ​
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