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Although the menopause is dated from the last menstrual period, most women experience symptoms in the five to ten years beforehand, as the number of egg follicles (which produce oestrogen and progesterone hormones) dwindles. During this time, many women will notice a spectrum of troublesome symptoms, including:
If menopausal symptoms are interfering with your quality of life, talk to your doctor about the pros and cons of hormone replacement therapy (HRT), which can significantly reduce symptoms.
However, if you are unable or unwilling to take prescribed HRT (or can't get hold of it due to the current shortage), several helpful supplements are available.
Interestingly, a review of menopause treatments by the National Institute for Health and Care Excellence (NICE) concluded that isoflavones and black cohosh are more effective than placebo in treating hot flushes (but not better than prescribed HRT, which is as expected), so they are certainly worth considering.1
Women who follow an Asian diet, in which soy beans are a staple, report few, if any, menopausal symptoms. One reason is that their intake of isoflavone plant hormones is around fifty times higher than in the West. These isoflavones provide a natural oestrogen boost to reduce hot flushes, have a beneficial effect on cholesterol balance and memory, and can help with menopausal sleep disturbances such as insomnia.
Taking isoflavone supplements can reduce the frequency of hot flushes and their severity within 6 to 12 weeks.2 Overall, the results of 19 randomised controlled trials found that isoflavone extracts significantly reduced hot flushes by 39 per cent compared with placebo.3
Different women metabolise isoflavones in different ways, depending on the balance of bacteria within their large bowel. For example, those who possess good amounts of probiotic bacteria (think Lactobacilli and Bifidobacteria) can convert one soy isoflavone (daidzein) into a more powerful oestrogen called equol.
Those who can produce equol therefore obtain more benefits from soy isoflavones than those who don't, so eat live bio yogurt and / or take a probiotic supplement to help increase your equol production.
Black cohosh (Cimicifuga racemosa) is a wildflower native to Canada and the USA. Its roots and underground stem (rhizome) are a traditional herbal medicine used to relieve menopausal symptoms, and it appears to work through a direct action on the brain.
Black cohosh extracts have been shown to lower levels of LH (luteinising hormone) to help normalize oestrogen-progesterone balance. It also has an effect on dilation of blood vessels, to relieve hot flushes and night sweats and to improve low libido, anxiety, mood swings and sleep quality.
The results from seven clinical trials involving over 1,000 women aged from 40 to 60 years found that black cohosh extracts produced a significant improvement in menopausal symptoms. On average, symptoms were reduced by over a quarter (26 per cent) compared to placebo.
This is an impressive result given that placebo itself was found to reduce the severity or frequency of hot flushes by 25 to 30 per cent within four weeks of treatment.4
Sage leaf extracts contain several antioxidant polyphenols and essential oils which, together, have astringent and perspiration-inhibiting properties. It is traditionally used to relieve menopausal hot flushes and night sweats, although whether its actions are due to the presence of plant oestrogens, or an ability to stimulate natural oestrogen production, remains unclear.
Sage is also used to boost memory and concentration through an ability to inhibit cholinesterase, an enzyme that deactivates some neurotransmitters in the brain.
A study involving 69 women who had experienced menopausal symptoms for at least a year, and who had at least five flushes a day, found that sage leaf extracts reduced the frequency of mild hot flushes by 46 per cent, moderate flushes by 62 per cent, severe flushes by 79 per cent and stopped very severe flushes altogether.
The intensity of flushes overall was halved within four weeks and reduced by 64 per cent within eight weeks.5
Evening primrose oil (EPO) is a rich source of GLA: an essential fatty acid that helps to improve dry itchy skin and has a beneficial effect on calcium and hormone metabolism. Some GLA is incorporated into cell membranes, making them more flexible so that skin becomes noticeably softer and better hydrated within a few days.
Some GLA is also converted into hormone-like substances known as series 1 prostaglandins, which relax blood vessels to improve blood flow to the skin, decrease inflammation to reduce redness, and improve nerve function to reduce itching and discomfort.
It may also have a beneficial effect on hormone balance to reduce the severity of hot flushes and dry skin at the menopause. A study of perimenopausal women found that those who took EPO had significantly less severe hot flushes than those who took placebo.6
Sea buckthorn oil contains high levels of omega-7 fatty acids and is also rich in omega 9s and powerful antioxidants such as carotenoids and vitamin E.
Sea buckthorn oil is used in supplement form to improve hair and skin quality as well as reducing dryness throughout the body, including eczema, dry eyes, dry hair and vaginal dryness.
A study involving 98 postmenopausal women experiencing vaginal dryness, itching or burning found that sea buckthorn oil was significantly more effective than placebo in relieving symptoms. These findings were supported by a significantly better rate of improvement in the integrity of vaginal epithelium.7
Magnesium is a mineral needed for over 700 enzymes to work properly, so is involved in just about every metabolic reaction, including the production of energy and the synthesis of hormones.
Lack of magnesium contributes to many common problems such as insomnia, fatigue, weakness, muscle cramps and constipation. Low magnesium intakes are also associated with a raised blood pressure and poor glucose tolerance.
Magnesium regulates the movement of calcium in and out of bone cells, and is important for the prevention of osteoporosis in post-menopausal women.8 In fact, studies show that women with osteoporosis have significantly lower magnesium levels than similar women without osteoporosis, and that both men and women with the lowest magnesium and potassium intakes had a greater risk of hip fracture.9, 10
Taking magnesium supplements for two years has been shown to increase bone mineral density and prevent bone fractures in menopausal women.11
Adding magnesium flakes to a bath can also help you relax and promotes a good night's sleep.
St John's wort is a traditional herbal medicine used to relieve a low mood. Its vibrant yellow petals have numerous pinpoint glands that contain a fluorescent red dye. This dye contains substances such as hypericin and hyperforin, which have a natural antidepressant action.
St John's wort extracts lift mood by prolonging the action of a wide range of neurotransmitters in the brain including serotonin, noradrenaline, dopamine, gamma-aminobutyric acid (GABA) and L-glutamate to even out mood swings.12
St John's wort can also improve low sex drive, which often accompanies the menopause. After three months of taking supplements, 60 per cent of women with a low libido became interested in sex again. Eighty-two per cent also suffered less irritability, anxiety, low mood, hot flushes, sweating and disturbed sleep.
Before the trial, 60 per cent said that they were too exhausted for sex. At the end of the trial, none of them felt that way. They also reported increased self-esteem, as well as a marked increase in self-confidence and self-respect.13
Dr Sarah Brewer is Healthspan's Medical Director and holds degrees in Natural Sciences, Surgery and Medicine from the University of Cambridge. Having worked as a GP and hospital doctor, Dr Sarah now holds an MSc in Nutritional Medicine from the University of Surrey and specialises in nutrition. She is also an award-winning writer and author.
Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.
1 Sarri, G., Pedder, H., Dias, S., Guo, Y., & Lumsden, M. A. (2017). Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG: an international journal of obstetrics and gynaecology, 124(10), 1514–1523.
2 Taku, K., Melby, M. K., Kronenberg, F., Kurzer, M. S., & Messina, M. (2012). Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause, 19(7), 776–790.
3 Bolaños, R., Del Castillo, A., & Francia, J. (2010). Soy isoflavones versus placebo in the treatment of climacteric vasomotor symptoms: systematic review and meta-analysis. Menopause 7(3), 660–666.
4 Shams, T., Setia, M. S., Hemmings, R., McCusker, J., Sewitch, M., & Ciampi, A. (2010). Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Alternative therapies in health and medicine, 16(1), 36–44.
5 Bommer, S., Klein, P., & Suter, A. (2011). First time proof of sage's tolerability and efficacy in menopausal women with hot flushes.Advances in therapy, 28(6), 490–500.
6 Farzaneh, F., Fatehi, S., Sohrabi, M. R., & Alizadeh, K. (2013). The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial. Archives of gynecology and obstetrics, 288(5), 1075–1079.
7 Larmo, P. S., Yang, B., Hyssälä, J., Kallio, H. P., & Erkkola, R. (2014). Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study. Maturitas, 79(3), 316–321.
8 Zheng, J., Mao, X., Ling, J., He, Q., Quan, J., & Jiang, H. (2014). Association between serum level of magnesium and postmenopausal osteoporosis: a meta-analysis. Biological trace element research, 159(1-3), 8–14.
9 Odabasi, E., Turan, M., Aydin, A., Akay, C., & Kutlu, M. (2008). Magnesium, zinc, copper, manganese, and selenium levels in postmenopausal women with osteoporosis. Can magnesium play a key role in osteoporosis? Annals of the Academy of Medicine, Singapore, 37(7), 564–567.
10 Hayhoe, R. P., Lentjes, M. A., Luben, R. N., Khaw, K. T., & Welch, A. A. (2015). Dietary magnesium and potassium intakes and circulating magnesium are associated with heel bone ultrasound attenuation and osteoporotic fracture risk in the EPIC-Norfolk cohort study. The American journal of clinical nutrition, 102(2), 376–384.
11 Sojka, J. E., & Weaver, C. M. (1995). Magnesium supplementation and osteoporosis. Nutrition reviews, 53(3), 71–74.
12 Müller W. E. (2003). Current St John's wort research from mode of action to clinical efficacy. Pharmacological research, 47(2), 101–109.
13 Grube, B., Walper, A., & Wheatley, D. (1999). St. John's Wort extract: efficacy for menopausal symptoms of psychological origin. Advances in therapy, 16(4), 177–186.