Menopause

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We hardly dare trust that this is a process of transformation – that out of the ashes will rise the phoenix of humanity.
— Lucy H. Pearce

There are 3.8 billion women in the world today, and each one will or has already, experienced menopause. It is estimated that around 25 million women enter menopause each year, so each woman is far from alone. The menopause experience varies considerably between women and across cultures and ethnicities but with a number of commonalities.

In Canada, the average age a woman will have her last menstrual bleed is 51 years, but it can be anywhere between age 42 to 55 years. Leading up to this moment, known as perimenopause, the majority of women will be aware of some hormone driven changes as her estrogen and progesterone hormones begin to decline and her ovaries produce less follicles (eggs). Signs that the body is responding and adapting to the hormonal transition may include irregular menstrual cycles, heavy bleeding, anxiety, hot flashes, mood changes, insomnia, weight change, skin changes, vaginal dryness, and bladder weakness.


At her first bleeding a woman meets her power. 
During her bleeding years she practices it. 
At menopause she becomes it. 
Traditional Native American saying
— Lucy H. Pearce, Moon Time: Harness the Ever-Changing Energy of Your Menstrual Cycle

There has been a shift in recent years that has seen women experience menopause more openly. Its hormone driven changes, its implications and its opportunities are being embraced rather than hidden away. Women, who yesterday discussed breastfeeding and stories of raising young children, are now sharing stories of their most recent incarnations and still swapping coping strategies and finding the humour in their awkward moments and discomfort. 

As narratives build and are shared, so the experience shifts to a more positive reframing of this profound biological imperative that is integral to every woman’s journey.

This metamorphosis heralds the end of the reproductive years and into this space a woman brings her experiences and her wisdom, an empowered self that can sit comfortably with the knowledge of her past while being ready to embrace more of life ahead. Lifespans are extending so that women can now expect to spend more than one third of their life in postmenopause. Improving and maintaining quality of life through self-care and nurturing habits will help ensure energy, vitality and well being as a women steps forward into this new space.


The Herbal Approach to Menopause

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Women have sought herbal medicine for relief during the menopausal transition throughout the ages.  There is now a substantial body of evidence supporting the effectiveness of non-pharmaceutical approaches to menopause.

There are a number of herbal, as well as, dietary and lifestyle strategies that can reduce menopausal symptoms and indeed, up to 70% of women seek a more natural approach to their menopausal care.

The most common reasons for seeking herbal treatment that I see in clinic are

  • hot flushes

  • insomnia

  • mood changes

Hot flushes are an unpredictable, visible and often uncomfortable manifestation of the changing hormonal milieu, and can frequently interfere with sleep and quality of life.

A herbalist is able to tailor the herbal approach to each woman and will create a formula to address the combination and intensity of symptoms that she is experiencing.

Nutritional needs also change following menopause and longer term health planning focuses on creating a nutritional plan to optimise bone and heart health.

Hot flushes and night sweats

Perhaps of all the experiences this is the most bothersome. Sage (Salvia officinalis) is commonly formulated along with other herbs that may include black cohosh (Cimicifuga racemosa), wild yam (Dioscorea villosa) red clover (Trifolium pratense), hops (Humulus lupulus), motherwort (Leonurus cardiaca). Although sage can be used alone if occasional hot flushes are the only symptom, other herbs that support the hormonal transition may be more effective over the longer term. There is also some research suggesting that sage may be useful in memory and mood enhancement.

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Red clover (Trifolium pratense), hops (Humulus lupulus) and sage (Salvia officinalis) are examples of phytoestrogen containing herbs. See my article on phytoestrogens for more information.

Poor sleep quality

With the reduction in hot flushes, sleep often becomes more settled. However, there are some herbs that can help to improve sleep quality when needed. These include passionflower (Passeflora incarnata), hops (Humulus lupulus), California poppy (Eschscholtzia californica), motherwort (Leonurus cardiaca), valerian (Valeriana officinalis)

Relaxants

The emotional changes that accompany menopause can be variable and even seemingly normal anxiety or worry can produce disproportionately severe hot flushes. Relaxant herbs such as Chamomile (Matricaria recutita), motherwort (Leonurus cardiaca), or valerian (Valeriana officinalis) may be indicated. Herbs with a more tonic effect may be added and include blue vervain (Verbena officinalis), St John’s wort (Hypericum perforatum), Rosemary (Rosmarinus officinalis).

Heavy menstrual flow

Heavy menstrual flow can leave a woman exhausted and sometimes depleted of iron. Tests are usually carried out prior to seeing a herbalist to rule out causes other than menopause for the heavy flow. For heavy menopausal flow astringent herbs are called for and might include yarrow (Achillea millefolium), lady’s mantle (Alchemilla vulgaris), nettle (Urtica dioica), shepherd’s purse (Capsella bursa-pastoris), or white deadnettle (Lamium album).

Adaptogens

Fatigue can be a part of the menopausal picture. It can be a busy time with aging parents, teenage children and work demands. Herbs with adaptogenic properties can be useful and might include eleuthero (Eleutherococcus senticosis), St John’s wort (Hypericum perforatum), oats (Avena sativa), blue vervain (Verbena officinalis) dong quai (Angelica sinensis), damiana (Turnera diffusa). Where adrenal support is indicated, liquorice (Glycyrrhiza glabra) or borage (Borago officinalis) may be useful.

Liver support

The western herbal tradition includes herbs to support the liver. Some women find that the hormonal changes result in constipation and herbs for the liver combined with some dietary modifications are usually all that is required to alleviate this. Some commonly used herbs include dandelion root (Taraxacum officinalis radix), yellow dock (Rumex crispus), and sometimes even milk thistle (Carduus marianus).

Vaginal dryness and inflammation

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As estrogen levels fall, the vaginal walls become thinner, while the protective acid mantle and mucus secretions are reduced. This often leads to dryness, inflammation and discomfort. Herbal approaches include local application of emollients using a moisturising base such as evening primrose oil, or vitamin E. Herbs such as Calendula (Calendula officinalis), marshmallow (Althea officinalis), comfrey (Symphytum officinalis) or aloe vera (Aloe barbadensis) may be added.  Calendula cream is particularly soothing and healing. Studies suggest that the internal herbal protocols utilising phytoestrogens may also slow down vaginal cell loss.

Another effective approach is to maintain regular lovemaking and orgasms. This helps to maintain a healthy blood supply to the vaginal area, keeps the walls supple and improves muscle tone, each of which helps to maintain vaginal integrity over the longer term.

Fluid retention

Some women find that they experience some bloating or fluid retention at this time. Reducing salt intake can be helpful. See my article on salt for some salt reduction strategies. Herbal infusions such as dandelion leaf (Taraxacum officinalis folia), nettle (Urtica dioica) or birch (Betula pendula), and parsley (Petroselinum crispum) added to the diet, can be helpful.


Nutrition

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Phytoestrogens

Phytoestrogens are an integral part of a natural approach to menopause and there are a number of herbs and foods that contain phytoestrogens.

See my article on phytoestrogens for a comprehensive overview of their actions and suggested foods that provide a rich source and useful dietary addition during and after menopause.

Vitamin E

There is some evidence to support the use of 200-400iu of vitamin E for hot flushes. Dietary sources of vitamin E include wheat germ, almonds, sunflower seeds, whole grains and green leafy greens. It would be difficult to reach 200-400iu through diet alone. However, vitamin E is quite a complex group of eight compounds and dietary sources provide all eight compounds. Therefore, including some vitamin E rich foods in the diet regularly would be prudent.  Check with your health care provider before taking vitamin E as it may be contraindicated in some health conditions and with medications such as blood thinners. 

Maca

I have been asked about the effectiveness of maca root for menopausal symptoms. Maca is a member of the mustard family, the same family as broccoli, cauliflower, and turnip and originates from the high Andes in Peru. Traditionally it has been used to increase libido in men and women, to improve fertility and has been called Peruvian ginseng. There is some evidence that it may help erectile dysfunction in men, and some mixed evidence about its efficacy in reducing menopausal hot flushes. The supplemental dose of 2-3 g that is suggested (around one teaspoon) provides very little nutrition, despite some claims, however, it is generally regarded as safe so should do no harm if a woman would like to try it.

Osteoporosis

See my article on osteoporosis.

A Note On Exercise

Exercise has a number of positive benefits for a woman and this holds true through menopause. A regular routine improves heart health, cholesterol levels, and high blood pressure, maintains a healthy weight and muscle mass and reduces bone loss. Moreover, it helps to improve mood and reduce anxiety. A mixture of strength training, aerobic activity and stretching such as yoga, appears to be the most beneficial. There is evidence to suggest that women who are exercising regularly have fewer menopausal symptoms and a lower risk of breast cancer.

If you would like to further discuss which foods and herbs may work best to meet your needs at this time, I would love to work with you. You can either book an appointment online or call 613 233 2040 to book your appointment. To ask a question you can click here.


All content provided on this website is for general information purposes only and is not intended to replace medical or specialist advice.

A qualified Medical Herbalist is always your best resource for information related to herbal medicines.

Registered Dietitians are a reliable and trusted resource for nutrition related information, always up to date and always ready to work with you to realise your goals.