The Menopause Transition

February 25, 2015 Updated: February 25, 2015

Menopause is a transition in life that women sometimes dread, anticipating the discomfort of hot flashes along with other symptoms such as nervousness, depression, irritability, and mood swings.  Women can come to feel badly about themselves and have a poor body image, in part, because of negative perceptions associated with menopause, some of which are fostered by our culture.  Research has shown that women who develop more positive perceptions of menopause tend to experience less severe menopausal symptoms than women perceiving this transition as a disease.

Traditional medicine views menopause as a time of lowered estrogen levels, which are believed to be at the heart of menopausal symptoms.  Hormonal replacement therapy and non-hormonal treatments to treat discomfort such as anxiety and depression also are in the realm of traditional medicine. 

While focusing on estrogen levels has led to treatment options, in my view treatment of menopause should be expanded to include measures of adrenal and thyroid function, which when out of sync have symptoms similar to those of menopause. Some women may have menopausal symptoms triggered by adrenal weakness or exhaustion and/or an underactive thyroid. These same conditions can exacerbate menopause symptoms resulting from low estrogen levels.

More and more women are moving away from traditional hormonal and non-hormonal treatments and using alternative therapies, such as herbs, massage, breathing techniques, and exercise. Unfortunately, research shows that doctors often do not discuss these options with women who themselves are generally not open about their alternative therapy treatment choices. This can lead to possible drug-herb interactions and mistrust in the doctor-patient relationship.

The literature is mixed on the benefits of alternative therapies and it appears to be a matter of experimentation to determine if a particular therapy is effective. Acupuncture, in particular, has shown some promise when applied to points related to menopausal symptoms. Yoga-based programs, moderate exercise, and breathing practices also show some promise. In terms of supplementation, black cohosh has been found to be effective in managing menopause symptoms, but no long term data is available.  Any consideration of supplementation should be discussed with your doctor and taken under supervision.

In terms of nutrition, an anti-inflammatory diet can help to manage low-grade inflammation that has been associated with menopause.  This means consuming lots of fresh vegetables, fruits, and grains/nuts/and seeds in moderation. They all contain anti-oxidants to help fight inflammation. 

Eliminating sugar and starchy foods is crucial from a holistic point of view because it is believed that when insulin levels increase with sugar consumption to help clear sugar from the blood, cortisol levels rise, which may contribute to an experience of hot flashes.  Complex rather than simple carbohydrates help to balance blood sugar.

Consuming an overly acidic diet also can increase inflammation. Sugar, flour, beans, grains, fish, poultry, meat, and eggs are all acid-forming while fruits, vegetables, seaweeds, and salt are alkalizing to the body. Cold-water fish, such as salmon, sardines, anchovies, and herring, are high in anti-inflammatory omega-3 fatty acids. Fish oils are anti-inflammatory while vegetable oils such as corn, safflower, soybean, and sunflower can increase inflammation in the body.

Soy seems to have modest benefit for hot flashes, but studies are not conclusive.  High doses of isoflavones from whole foods have been recommended to ease menopause, which are typically at a level of 60 mg. daily. Many processed foods contain trans-fats that can increase inflammation. Fried foods, baked goods, and stick margarine are especially high in trans-fats.  Foods high in glycemic load (e.g. carrots, beets, white rice, bagels, and waffles) increase the risk of inflammation as well.

Anti-inflammatory spices, such as turmeric, rosemary, and ginger, can be added to cooked foods. George Mateljan in his book, “The World’s Healthiest Foods: Essential Guide for the Healthiest Way of Eating,” reports that some women experience hot flashes after eating spicy foods. Foods in the nightshade family also have been reported to increase inflammation. Popular nightshades include common peppers, eggplants, potatoes, and tomatoes.

There is much that can be done to help women have an easier transition through menopause. Following these guidelines is a step in the right direction. Sharing the experience of menopause, whether with friends, relatives or in a menopause group, also can be a means of emotional support and understanding.