Health, Menopause
Us women can now expect to spend as many as half our years in the post-menopausal phase of life. Hooray – no more periods and no more bother with contraception.
Some quickly adapt to falling oestrogen levels and notice few, if any, problems. Others experience a range of symptoms from hot flushes and night sweats to low energy and loss of sex drive that make life a misery. Although menopausal symptoms usually subside within five years of your last period, they can last for seven years or longer.
Hormone replacement therapy (HRT) is the perfect solution if you are willing and able to take it. But there eventually comes a time when you need to stop using it to balance the risks and benefits. When that day arrives, or if you are unwilling or unable to start it in the first place, what are your other options?
Exercise is universally recommended as increased blood flow appears to increase the production of oestrone – a weak oestrogen hormone that you continue to make in your adrenal glands and fat cells after the menopause. Oestrone is the main reason why women who are overweight may experience fewer menopausal symptoms than those who are underweight, although this isn’t an excuse to accept middle-aged spread! Surprisingly, however, new guidelines from the European Menopause and Andropause Society found little published evidence to support the beneficial effects of exercise for hot flushes, although it was shown to improve quality of life (especially yoga), the ability to think straight and to maintain mobility. Given that regular exercise is associated with a significant reduction in the risk of dying from any medical cause, at any age, it’s definitely worth staying as active as possible even if it doesn’t reduce your menopausal symptoms.
Other lifestyle changes worth exploring include cutting back on caffeine, spicy foods and alcohol as these can trigger a hot flush through effects on blood vessel dilation. You could, of course, avoid these three ‘culprits’ altogether but that is a step too far for those of us who enjoy them.
Don’t smoke: On average smokers experience the menopause two years earlier than non-smokers and have more severe symptoms as chemicals in cigarette smoke reduce lowers oestrogen levels through an adverse effect on the ovaries.
Certain plant hormones such as isoflavones and lignans interact with human oestrogen receptors. Although their action is much weaker than human oestrogens, they provide a useful boost when hormone levels fall at the menopause.
To increase your intake of natural plant hormones, aim to eat more beans (especially chickpeas, lentils and soy bean products), vegetables (especially exotic members of the cruciferous family such as Chinese leaves and kohlrabi, pumpkins, sweet potatoes, fruit, nuts, seeds and wholegrains.
Aim to eat at least one serving of legumes (eg chickpeas, lentils, soy) every day, three servings of soy foods (eg tofu, edamame, soy yogurts) per week, and use soy milk regularly (eg with cereals in place of cows’ milk). Add soy beans to soups, stews, chilli, stir fries, risotto, salads and vegetarian dishes. You can even add soybean protein powder to smoothies and shakes.
Flaxseed are often recommended for their oestrogen content, but eating them whole won’t help – they need to be ground to release their phytoestrogens. And, although flaxseed oil provides a healthy blend of fatty acids, it contains very few phytoestrogens.
Soy isoflavone supplements are also available with recommended doses ranging from 40mg to 100mg daily. A large analysis of data from 19 randomised controlled trials showed that taking isoflavone extracts can significantly reduce the frequency and severity of hot flushes by over 20% compared with inactive placebo. Benefits are usually noticed within 6 weeks.
Dietary isoflavones are mostly consumed in an inactive form. Once you eat them, intestinal bacteria digest them down to release their active versions ready for absorption. Some of these beneficial bacteria also convert an isoflavone called daidzein into a more powerful phytoestrogen called equol. Whether or not you are an equol producer or a non-equol producer depends on the types of gut bacteria your harbour. Less than 20 of the thousands of different bacterial species that can live in the human gut are able to convert daidzein to equol. These include some of the probiotic lactic-acid producing species of Lactobacilli and Bifidobacterium. Many people don’t ‘own’ these bacteria, and among western adults only 25% to 30% are equol producers. Among vegetarians, one study found the frequency of equol producers was as high as 59% (compared with 25% for non-vegetarians), suggesting that a plant-based diet may allow equol-producing bacteria to flourish.
When following an isoflavone-enriched diet, it’s worth eating live Bio yogurt on most days to increase the chance of retaining equol-producing bacteria in the gut. Digestive bacteria are also available in fermented milk drinks and as supplements. These are especially important after taking antibiotics which dramatically reduce the level of beneficial, probiotic bacteria present in your intestines.
Sex hormones are processed in the liver and secreted via bile into your intestines. Dietary fibre binds these hormones so that when following a high fibre diet, more oestrogen is flushed from your body. When your diet is low in fibre (from eating processed rather than whole grain foods, and not getting 5-a-day fruit and veg) a greater amount of sex hormones remain free to be reabsorbed back into the circulation so your levels rise. This is one reason why people following a low fibre diet have a greater risk of developing hormone-dependent cancers such as those of the breast or prostate gland.
Women who’ve followed a less healthy, low-fibre diet before their menopause have adapted to relatively high levels of circulating oestrogen and tend to experience more severe hot flushes when their oestrogen production declines. Unfortunately, a sudden switch to a healthier, high fibre diet at this time of life will cause oestrogen levels to fall even further, as the extra fibre will bind what little oestrogen you still produce. Slowly increasing your intake of fibre (and fluid to avoid bloating and constipation) will help you adapt better.
Researchers who followed over 6000 women through a natural menopause found that those eating the most fruit (strawberries, pineapple, melon, apricots and mango) or following a Mediterranean-style diet (garlic, peppers, mushrooms, salad greens, pasta and red wine) were, on average, 19% less likely to report hot flushes and night sweats compared with those not following these patterns of eating. In contrast, those following a high-fat-and-sugar diet (sweet biscuits, cakes, jam, meat pies and chocolate) were 23% more likely to experience symptoms.
While it’s a good idea to cut back on fat in general (to reduce calories), concentrate on obtaining essential fatty acids that contribute to a healthy hormone balance, reduce inflammatory reactions and improve cholesterol balance such as the monounsaturated and omega-3s found in nuts, olive oil, rapeseed and flaxseed oils, avocados and oily fish.
A large analysis of 12 studies found that acupuncture can significantly reduce the frequency and severity of hot flushes to improve quality of life.
For those unwilling or unable to take HRT, your doctor does have other prescription options up their sleeve. Some antidepressant drugs (eg paroxetine, venlafaxine, desvenlafaxine) have been shown to decrease both the frequency and severity of hot flushes, as has a drug called gabapentin used to treat nerve pain. Clonidine is a non-hormone drug that prevents blood vessel dilation and helps to improve menopausal hot flushes. However, these are all associated with a range of potential side effects so they tend to be reserved for women in whom HRT is contraindicated.
A number of herbal remedies can reduce hot flushes and night sweats, of which the following are the most effective in my experience.
Black cohosh is believed to reduce menopausal symptoms through a direct action on the brain. It has been shown to lower levels of LH (luteinising hormone) which helps to normalize oestrogen-progesterone balance. It also has an effect on dilation of blood vessels, and can help to relieve hot flushes, night sweats, low libido, anxiety and mood swings. Black cohosh is often used together with soy isoflavones.
Sage leaf extracts are used to relieve menopausal hot flushes and night sweats as well as to improve memory.
Rhodiola helps to reduce stress and improves energy levels to help overcome anxiety and fatigue.
NB Before taking supplements, check with a pharmacist if you are taking other herbal or prescribed medications to rule out any interactions.
Dr Sarah Brewer is a Medical Nutritionist follow her Nutritional Medicine blog and her tweets @DrSarahB
