For far too long, many women have felt embarrassment or confusion at every stage of womanhood. Menopause is no exception. Even though more than half the population will go through the natural transition of menopause, I’ve certainly seen in my clinical practice that many women are surprised at how difficult they have found the symptoms. From changing periods – to their eventual absence - and all the hormonal fluctuations that go with this. Women can experience hot flushes, mood changes, body aches, brain fog, dry skin and vaginal soreness to name a few. Our risk of things like heart disease and osteoporosis can also rise with the onset of menopause, as the oestrogen levels that our bodies have been used to, begin to fall.
But it is not all bad news. It is rare for mammals to even experience menopause – this phenomenon only happens to giraffes and a few species of whale. Both these groups are highly matriarchal – whale families often form in grandmother-led pods, and similarly giraffe females stop reproducing early so they can help look after their grandchildren. Menopause serves an important purpose, as a time that allows us a longer life - with whatever purpose we attach to it. If we know what to look out for, we can alleviate the symptoms that we experience. For many women, it's the stage at which they feel the most empowered. The Chinese medicine term for this time of life is ‘the second spring’ with a lifetime of wisdom to share and the confidence to fully embrace who we are.
So what are my top ten tips for making your menopause transition smooth sailing?
Tip 1 - Eat more fruit and veggies
From the title of my book ‘The Plant Power Doctor’, my first piece of advice should come as no surprise! Crucially, a diet rich in fruits and vegetables can help prevent a number of menopause symptoms. Fruits and veggies are full of nutrients and can help you feel full, so they’re great for weight maintenance and giving your health a boost. They may also help prevent a variety of diseases, including heart disease, cancer and diabetes. Fruits and vegetables may also help prevent bone loss, which is important for women to consider in the post-menopausal years. One observational study of 3,236 women ages 50 to 59 found that diets high in fruit and vegetables may lead to less bone loss, and indeed nutrient poor diets are a risk factor for osteoporosis. A HIGH FIBRE diet encourages gut motility too and supports a healthy microbiome – which is also instrumental in hormonal regulation. Recent research shows us it is the variety of plant-based foods that really benefit your gut microbiome and have a positive ripple effect on your whole health. These are your vegetables, wholegrains, beans, pulses, nuts and seeds.
Tip 2 - Talk
Believe it or not, menopause symptoms and their severity can be impacted by cultural differences and feelings of isolation amongst women. Anthropologists have found that in societies where menopausal transition is seen as a way of increasing a woman’s social status, menopausal symptoms seem to be less severe and less prevalent. It is certainly complex, but a feeling of confidence in what to expect, as well as the camaraderie of knowing you are not alone, can really boost your mood during this transition. It could also be beneficial to talk to an employer about menopause issues – many women have said they would like their workplace to understand how to support menopause transition, given that the menopause affects many work colleagues, suppliers and consumers. Many companies now have menopause training workshops with the aim of supporting staff, improving well-being and reducing the need for time off with symptoms.
Tip 3 - Consume SOY
Soy beans are not only a complete source of protein, but they also contain phytoestrogens, which are naturally occurring plant compounds that can mimic the positive effects of oestrogen in the body, without wide effects. The high intake of edamame beans, tofu, tempeh and miso in countries such as Japan is thought to be the reason why menopausal people in these places rarely experience hot flushes. There are also so many other health benefits, including reducing cholesterol and blood pressure - a daily portion of soy is worth a try! Think of sources of soy like edamame beans and tofu rather than supplements or processed foods or soy sauce! For additional benefits with hormone balance, you could also add a daily portion of ground flax seeds, or milled hemp seeds to your cereal, porridge or smoothies for an omega three rich boost!
Tip 4 - Move your body
We don’t have enough evidence to show whether exercise actually helps to treat hot flushes, but moving our bodies can help to improve energy and metabolism, support healthier joints and bones, reduce stress and help us sleep better at night. These things are all important to reduce the effects of hormone fluctuations on our bodies. There was a study in Korea that looked at the effects of a 12-week walking exercise program – they found that the exercise improved physical and mental health and overall quality of life in a group of 40 menopausal women. Regular exercise is also associated with better overall health and reduced risk of cancer, stroke, high blood pressure and heart disease, type 2 diabetes and being overweight. Weight bearing exercise is also really helpful for maintaining bone strength -and aiming for at least three weight bearing or resistance based exercises a week will be great for maintaining muscle strength, agility and bone strength. Doesn’t matter how, where or when. Just move. Start small and work your way up – could you walk around the house a bit more? Take a daily walk? Even standing outside and doing some gentle squats can be a fantastic start.
Tip 5 - Top up vitamin D and calcium stores
Vitamin D is actually a hormone that we make mostly through exposure to the sunshine. It can improve kidney and immune function as well as being important for bone strength. Muscle cells have special receptors for Vitamin D in their nucleus, which promote muscle growth and can also improve balance. Having adequate Vitamin D levels will therefore also reduce your risk of falls moving past menopause and into later life. There is actually an association between low vitamin D and loss of muscle mass, muscle weakness and impaired balance in older people. I’d advise unless you know your Vitamin D levels, a simple 1000iu supplement daily should be adequate. Other supplements that may be useful depending on your general health could be Vitamin B12, omega threes and perhaps a general multi-vitamin including iodine and selenium too. Calcium rich foods to enjoy could include green leafy vegetables like chard, other vegetables like cabbage and broccoli, nuts, sesame seeds, dried fruit, pulses (especially white beans) and tofu. You can also buy fortified foods and drink, like breakfast cereal and plant-based milks or cow’s milk.
Tip 6 - Cut the cocktails
You may have noticed how alcohol affects you even more than it did when you were in your twenties? There is a reason for this! The lower metabolic rate we will often experience around menopause means alcohol is slower to metabolise; we may have less enzymes to help us break it down (reduced amounts of alcohol dehydrogenase) and this could make hot flushes, night sweats, insomnia and anxiety worse. My advice? Cut back on the booze and it will save you money too!
Tip 7 - Think about protein
Regularly eating protein rich foods throughout the day can help prevent the loss of lean muscle mass that occurs with age. Higher protein diets can help with weight loss because they enhance fullness too. But be aware that protein sources can vary. Processed meats are defined by the WHO as a class 1 carcinogen, and evidence suggests that when we prioritise plant proteins, we have a higher chance of experiencing a longer life compared to the regular prioritisation of animal sourced proteins. Make sure each meal includes a protein source – some ideas include lentils, seeds, beans, nuts and potentially protein powders such as hemp and pea. Eating protein optimizes blood sugar management, which is essential for hormone regulation during menopause.
Tip 8 - Find something/someone you love
Menopause transition can be hard, and so finding people or causes to support and enjoy can boost your wellbeing in unexpected ways. Finding a supportive peer group also means you are likely to be able to provide loving mentorship to others in a way that fills your own cup too. Activities where you can meet like-minded people are great ways to connect – you could look into yoga classes, mindfulness, meditation, breathwork, an art class, a photography group, a running or a book club – anything that lights you up and helps you to light up those around you will be a huge advantage when dealing with physical and mental symptoms of menopause.
Tip 9 - Prioritise sleep
It can be hard with hot flushes, a potential for increased anxiety and being drenched in sweat each night! Not only that, but menopausal changes can affect your pineal gland’s secretion of melatonin – the sleep hormone - as well. What can you do to reclaim your shut eye? Regular bedtimes in a cool room can help, as well as avoiding alcohol, limiting your access to screens at night, as well as trying blue light blocking glasses, and crucially for many, reducing caffeine intake. Or at least ensuring no caffeinated tea or coffee or cola drinks past midday.
Tip 10 - Consider HRT or supplements
There are reasons why hormone replacement therapy is not always a suitable option for menopause; a previous history of breast cancer or uncontrolled high blood pressure are the two most common reasons to avoid HRT. But for many people, it can be a hugely helpful option. It is worth discussing this with your GP if you are experiencing symptoms of menopause or if you have concerns about osteoporosis prevention. There is an important window of opportunity for maintaining bone strength and reducing long term risks of heart disease with the use of HRT, and although it could be useful for other symptoms after that time, it is most useful for long term health when started within the first five years of perimenopause.
Natural supplements may also help treat menopause symptoms, but more evidence is needed about their safety and effectiveness, as well as accurate dosages and combinations. The most common supplements for reducing symptoms of menopause include black cohosh, red clover, prebiotics, probiotics, maca powder, sage leaf capsules, evening primrose oil to name a few. Remember pre-biotics and probiotics come in food as well as in supplements - prebiotics stimulate the growth of good bacteria, and these include garlic, onions, leeks, asparagus, chicory, ginger, cabbage, beetroot, bananas, blueberries, and apples. 
Probiotic foods contain live bacteria and yeasts and may help restore the natural balance of gut bacteria. These include kefir, live yoghurt (can be live coconut yoghurt), kombucha, sauerkraut, kimchi and live apple cider vinegar. Hanna’s Multi Strain Biotic has been used by her community for the relief of perimenopausal symptoms too!
References:
https://pubmed.ncbi.nlm.nih.gov/21179049/