Editor’s note: The word “women” in this piece references some of the people who experience physiological menopause, but we understand that this term isn’t 100 percent inclusive, and inclusion is important. Menopause may also affect transgender, nonbinary, and gender-nonconforming people.
As a physician, woman, and mother, caring for and connecting with women has always been near and dear to my heart. Over the years, I’ve had the privilege of walking next to many women as they moved beyond their childbearing years. These experiences, along with countless hours of research, have allowed me to gain deeper insight into the menopausal journey, and I’m eager to share this knowledge in the interest of supporting women during this powerful change.
Before I get into some of the options available for managing symptoms, I want to clearly state that menopause need not be viewed as some sort of dreaded disease. Each woman goes through many reproductive phases over her lifetime, yet modern medicine has medicalized just about every aspect of these reproductive phases and transitions; each person must find a way to balance the symptoms she finds challenging with the predetermined practices that modern medicine assumes best for all women during menopause. Menopause is a transition, a gateway to the next part of our lives. Often, with lifestyle adjustments and natural approaches, the journey can be one of enlightenment and awakening.
Perimenopause: The Transition Begins
Perimenopause marks the end of a woman’s reproductive years. Assuming she has a uterus, this stage typically begins when a woman’s menstruation becomes irregular and estrogen levels fluctuate, and closes when a full calendar year passes without a menstrual period at all. Many women report experiencing more menopausal symptoms during perimenopause than at any other time in the menopause transition. Because menopause happens midlife when women tend to experience other aspects of aging, perimenopause is even more challenging to both recognize and manage.
So, when does perimenopause end and menopause begin? In women over 45, absent or irregular periods (along with the presence of symptoms, such as hot flashes) are usually enough to merit the “diagnosis” of menopause. Younger women who think they may be experiencing early menopause will need to work with a medical professional who can check hormone levels and administer other diagnostic tests.
For those who have had a hysterectomy, menopause may be harder to recognize. When a woman’s uterus and ovaries are removed, menstrual periods stop, hormone levels drop quickly, and menopausal symptoms may begin right away. If ovaries are kept after a hysterectomy, however, they may continue to produce estrogen until a woman’s menopausal years. In this case, menopausal symptoms may occur earlier than the average age. In both cases, because of a lack of menstruation, the transition becomes more difficult to recognize and diagnose.
The Many Faces of Menopause
It’s only natural that a shift as significant as menopause can be accompanied by symptoms. The hormone estrogen specifically prepares the body for fertilization, implantation, and nutrition of human embryos. As reproductive viability declines with age, ovulation changes and the natural rise and fall of estrogen levels decreases, becomes erratic, or stops abruptly altogether. Shifts in hormone levels cause a variety of symptoms. However, not all women experience these symptoms; roughly 30 percent of women move through the transition without any notable hot flashes, for example. But aside from changes in menstruation and declining fertility, the classic symptoms of menopause include hot flashes, night sweats, flushing, vaginal dryness, painful intercourse, insomnia, and other sleep disturbances.
Other symptoms that can be associated with menopause are:
- Difficulty concentrating and “brain fog”
- Frequent urination or incontinence
- Depression, anxiety, or moodiness
- Weight gain
- Dry eyes
- Muscle and joint pain
- Dental changes, such as dry mouth and gum disease
Given the list of often unpleasant menopause symptoms, it’s not surprising that many women look to their health care providers for relief. Unfortunately, one of the most frequently prescribed treatments, hormone therapy, isn’t always the safest option. We know that it can increase the risk of stroke, cardiovascular disease, memory loss, and breast cancer. Hormone therapy isn’t an option for women with an increased risk of cardiovascular disease, blood clots, or breast cancer.
If you do decide to use hormone therapy, the type of hormone and its delivery matters. There is evidence that estrogen delivered through the skin rather than orally may be less risky when it comes to blood clots. However, The Women’s Health Initiative found that, while estrogen alone decreased breast cancer incidence, estrogen plus progestin caused a significant increase. For women with a uterus, natural progesterone instead of synthetic progestin may be a safer choice, as it doesn’t appear to be associated with an increased risk of blood clots or breast cancer when taken in combination with estrogen.
I believe most women are intuitively drawn to natural medicine, and surveys from countries around the world support this observation. When transitioning through menopause, there are alternatives to potentially risky treatments such as hormone therapy. Though you should still discuss treatment options with a medical professional before deciding which is right for you, here are some of my favorite plant remedies for menopause.
1. Soy and Soy Isoflavones
Not only is the humble soybean a good source of protein, but it may also help alleviate menopause symptoms. A 2012 meta-analysis of clinical trials concluded that soy isoflavones reduce the frequency of hot flashes by 20.6 percent and the severity by 26.2 percent, above and beyond the placebo results. Supplements containing a minimum of 19 milligrams of genistein, an isoflavone in soy, were twice as effective when compared with those containing lower levels. Previous concerns about an association between soy intake and cancer risk appear to be unfounded. The North American Menopause Society concluded that soy isoflavones do not increase risk of breast or endometrial cancer, and positions by the American Cancer Society and the American Institute for Cancer Research agree that women with breast cancer can consume soy foods safely
I recommend adding more whole non-GMO soy foods to your diet during menopause. But how can you get to that magic number of 19 milligrams of genistein? One cup of soy milk has 7 grams of protein and 6 milligrams of isoflavones (4 milligrams of genistein); 3 ounces of soft tofu provides 8 grams of protein and 20 milligrams of isoflavones (10 milligrams of genistein); and 3 ounces of cooked tempeh comes in at 13 grams of protein and a whopping 30 grams of isoflavones (18 milligrams of genistein). Or, if you don’t like eating soy, you can purchase soy isoflavone supplements.
2. Black Cohosh Root/Rhizome (Actaea racemosa, Cimicifuga racemosa)
Historically used to treat conditions such as melancholy and rheumatic pain, black cohosh is often recommended to help relieve both physical and psychological symptoms of menopause. More than 18 studies have shown that black cohosh improves hot flashes and night sweats. While two studies funded by the National Institutes of Health failed to show any benefit for black cohosh over a placebo for menopausal hot flashes, a systematic review found that black cohosh significantly reduced depression and anxiety in every clinical study included in the review. Women also reported less joint pain compared with a placebo. These findings are much more in line with its traditional use.
While black cohosh appears to be safe overall, quality can be a problem. A 2018 study found that many commercially available black cohosh products indicate adulteration. This is concerning, because rare reports of liver damage associated with black cohosh are thought to be due to adulteration. Look for a high-quality product, such as those from Gaia Herbs or Nature’s Way. The dose varies based on the type of extract, so use as recommended by the manufacturer.
3. St. John’s Wort (Hypericum perforatum)
Several studies show that St. John’s wort extract reduces hot flashes and improves quality of life for menopausal women, both on its own and in combination with black cohosh. A systematic review of clinical trials confirms that St. John’s wort is superior to a placebo for relieving menopause symptoms. This should not ultimately be that surprising, since antidepressants are used in conventional medicine to relieve menopause-related symptoms in women who can’t take hormone therapy. I often recommend an eight-week trial of St. John’s wort standardized extract at a dose of 900 to 1,500 milligrams per day, taken in divided doses. While it’s quite safe, check with your health care professional or pharmacist before using St. John’s wort if you’re taking any prescription medication, as it has some contraindications.
4. Maca (Lepidium meyenii)
Native to the Peruvian Andes, maca, a member of the mustard family, has been prized for centuries for its strengthening and aphrodisiac properties. A systematic review of four randomized controlled trials found that maca had favorable effects on menopause symptoms. Another review that included two trials found a positive effect on libido in menopausal women.
How much maca do you need? The science says 3 to 5 grams per day. Some high-quality maca powders in the marketplace provide 5 grams of maca per teaspoon, so I recommend women just toss it into their smoothies, as it’s been used as a food for centuries and is quite safe.
Pycnogenol is a plant extract from the bark of the French maritime pine. Studies have shown that it has beneficial effects on blood pressure, arthritis, and muscle pain. In one double-blind, placebo-controlled study, 170 perimenopausal women were given 30 milligrams of pycnogenol or a placebo twice daily for a period of three months. While results showed a strong placebo response, pycnogenol was especially effective for improving symptoms, such as hot flashes and sleep problems, which were significantly better after four weeks with pycnogenol than they were with a placebo. Pycnogenol is typically taken at a dose of 50 to 100 milligrams twice per day. For women who might be dealing with joint pain, hot flashes, and poor sleep, pycnogenol is worth a try. To date there are no significant safety concerns.
Other Herbal Options
Other botanicals have shown evidence, either scientific or based on traditional use, that they help ease menopause symptoms. These include:
- Sage (Salvia officinalis) to help ease hot flashes.
- Kava (Piper methysticum) to help with anxiety in perimenopause.
- Siberian rhubarb (Rheum rhaponticum) to help ease hot flashes.
- Motherwort (Leonurus cardiaca) to help relieve palpitations.
- Chaste tree berry (Vitex agnus-castus) to help with irregular menses.
- Yarrow (Achillea millefolium) for use during heavy periods.
Only you can choose the right approach to help you transition through menopause, and I hope you take a moment to pause and reflect on your unique body. This transition is a rite of passage. But, unlike puberty or pregnancy, think of all the experience you’ve gained over the decades on your way to menopause, and how that wisdom will guide you as you change.
If you’re relatively healthy, you’ll likely live another 30 or 40 years. That’s a lot of life! How do you see yourself at 70 or 80? Close your eyes to see the elder you. Embrace her. When I close my eyes, I envision myself as creative, playful, and happy, with a strong innate healing power. Holding that vision helps me make better choices in my life. Maybe your elder self will inspire you to do the same.
Plants aren’t the only way to naturally ease menopause symptoms. Other healing modalities have been shown to provide effective, drug-free relief.
Research indicates that women who receive cognitive behavioral therapy experience significant improvement in symptoms such as hot flashes; hypnosis has also yielded positive results. In one study, 187 women who were experiencing at least seven hot flashes per day were randomly assigned either to a group receiving five weekly hypnosis sessions, or to a control group. After 12 weeks, the women in the hypnosis group showed significant improvement in hot flashes, sleep quality, and treatment satisfaction compared with the control. Many psychologists practice hypnosis, which may be covered by your insurance. On the other hand, many women enjoy using self-hypnosis apps or CDs as an inexpensive and effective approach.
Numerous studies have found acupuncture beneficial for relieving hot flashes and improving quality of life for menopausal women, too. It can work well for treating sleep issues related to menopause; a systematic review and meta-analysis of 31 randomly controlled trials found that acupuncture is associated with a significant reduction in menopause-related sleep disturbances. While some insurance companies include acupuncture as a covered expense, many do not. If cost is an issue, check to see if any local acupuncturists offer a sliding scale. Acupuncture schools are also a great option, as students must see a certain number of patients to receive a license, and the supervised sessions are offered at a steep discount.
Internationally recognized in the field of women’s health, Dr. Tieraona Low Dog has written five books, published more than 50 peer-reviewed scientific articles, and served as adviser on complementary medicine to the White House. She teaches integrative medicine from her home in New Mexico. Learn more at Dr. Low Dog.