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Perimenopause refers to the time of body’s natural transition to menopause. Women start perimenopause at different ages. It can begin 2-10 years before menopause, when the ovaries gradually make less estrogen. It starts in their 40s, but may start even in 30s. In case of some women, perimenopause can last only few months, whereas in others it can last several years. The average length of perimenopause time is about four years. Oestrogen and progesterone fluctuate wildly in perimenopause and ovulations become irregular. In the perimenopause estrogen and progesterone levels spike and drop suddenly and gradually decline.
The menopause is a time during which levels of the female sex hormones estrogen and progesterone, which control women’s menstrual cycle, decline leading to the permanent absence of the menstruation.
The declining levels of these hormones during menopause may lead to the following symptoms: Hot flushes, Night sweats, Fatigue, Sleeplessness, Difficulty concentration, Mood swings, Irritability, Panic attacks, Anxiety, Feelings of sadness, Depression, Memory lapses or loss, Lack of motivation, Tension, Heart palpitations, Headaches, Bloating, Weight gain, Muscle tension, Joint pain, Vaginal dryness, Loss of libido, Frequent urination, Urinary tract infections, etc.
Hormonal changes related to menopause (and perimenopause) may also play a role in lung function decline (causing shortness of breath and other symptoms) since they can lead to systemic inflammation and the bone-thinning disease osteoporosis. Researchers suggest that osteoporosis can compress the height of the chest vertebrae, limiting air intake, thus contributing to the shortness of breath.
It is important to remember that the above listed symptoms are not always linked to the menopause. For example, nutritional deficiencies, low serotonin, deficiency of adrenal hormones, or low glucose levels (hypoglycaemia) can trigger many of the above symptoms.
Fortunately, not all but most women experience some menopausal symptoms. Also the severity and duration of these symptoms vary from woman to woman. Unpleasant menopausal symptoms are often regarded as the “normal” stage of life, but there are reasons to believe that they can be actually the result of years of nutritional deficiencies, unhealthy diet, chronic psychological stress, lack of regular physical activity and other elements of an unhealthy lifestyle. According to one renowned expert, “the only normal menopausal symptom should be the absence of menstruation”.
Hormonal imbalance before and during menopause can be exacerbated by many different factors such as lack of physical activity, environmental toxins, fear and negative attitude toward menopause, or chronic emotional stress.
However, the strongest negative influence on hormonal balance seems to be imposed by an unhealthy refined diet which is deprived of various essentials nutrients such as magnesium, zinc, B vitamins, vitamin E, and vitamin C that are required by the body to make hormones including progesterone and oestrogen and maintain their balance.
It is believed that the key reason why in Asian countries (such as Japan, Korea or China), much smaller percentage of women experience bad menopausal symptoms is that they do not share unhealthy western diet and lifestyle habits (1, 2).
– There are reasons to believe that due to severe soil depletion and refined diet majority of people in the UK are very deficient in minerals including magnesium and zinc. Magnesium and zinc not only allow the body to absorb calcium, thus preventing osteoporosis during menopause, but they also play important role in maintaining healthy nervous system function as well as maintaining normal levels of progesterone and oestrogen.
– Researchers from the University of Massachusetts Amherst, demonstrated that participants who had normal vitamin D levels were less likely to experience menopause symptoms, compared to those who had less vitamin D (3). Vitamin D deficiency also plays important role in the prevention of osteoporosis during menopause. It is essential in helping human organism to properly absorb and use calcium which helps to keep spine and bones strong. Without vitamin D, our body begins to robe the bones and spine of calcium. Please, keep in mind that if you are deficient in magnesium, vitamin D will not be converted into its final form in your body, thus remaining inactive and useless. Since most of us are deficient in magnesium, vitamin D should always be supplemented with 200-400mg of elemental magnesium per day.
– A daily dose of vitamin E was found to be helpful in alleviating hot flashes and other signs of menopause (4).
– B vitamins are very important during menopause (5). They are essential for proper hormonal balance and nervous system function. Their deficiency can cause hormonal imbalance, fatigue, slow metabolism (overweight), and poor mental health. Folate (vitamin B9), vitamin B5 (pantothenic acid) and B6 (pyridoxine) are very important for the body to make many of the mood-regulating hormones including progesterone, oestrogen, and serotonin.
Apart from good quality multivitamin-mineral supplements that contain all mentioned above nutrients, including magnesium, zinc, vitamin D3, B-complex, vitamin E and C, the following nutritional supplements and herbs can be offered by health stores and pharmacies to support women before and during menopause:
– Soya isoflavones (daidzein and genistein) are famous for their safe oestrogen-regulating properties (although it may depend on one’s capacity to convert the isoflavone daidzein to equol that has greater oestrogenic activity than daidzein itself) (8). In the past, trials studying the effects of these isoflavones on hot flushes and other menopause symptoms have given mixed results, but now a new meta-analysis combining data from 17 different studies provides strong support for their efficacy (9). The analysis revealed that an average intake of 54 milligrams per day of soy isoflavones for between six weeks and 12 months was associated with an average 21% reduction in the frequency of hot flushes, compared with placebo. However, soya supplements don’t seem to be equally effective in regulating oestrogen and alleviating menopause symptoms in women. It is so because isoflavones from soya can be significantly more effective in women whose colon is inhabited by probiotic bacteria able to convert soya isoflavones into equol (isoflavandiol metabolized from daidzein by bacterial flora in the intestines). Unlike endogenous oestrogenic hormones such as estradiol are steroids, equol is a non-steroidal estrogen. Equol has been also suggested to be responsible for enhancing many other health benefits of soya. However, some sources state that only about 30-50% of people have intestinal bacteria that make equol from daidzein. Some studies also indicate that in Japan, Korea, or China over 50%, while in Western countries only 25 to 30% of the adults are able to produce equol after eating soy foods containing isoflavones. Also vegetarians and vegans due to diet higher in fibre are more capable of converting daidzein to Equol. There are over twenty different types of intestinal probiotic bacteria that have the ability to convert daidzein into equol but two strains Eubacterium ramulus and Flavonifractor plautii are particularly active in this process. Both species are normally highly prevalent in healthy human gut but due to numerous factors including antibiotics, diet high in sugar and deprived of fibre many women today are low in probiotic bacteria and therefore may experience less or even no benefits from soya flavonoids. For this reason it is highly recommended to use soya isoflavones together with good probiotic formulas such as ColiProbio or UltraProbio.
– Red clover contains isoflavones, which work as phytoestrogens, with possible benefits for menopause (10). It may help reduce cholesterol levels and protect against osteoporosis by reducing bone loss. Red clover may assist in the relief of menopausal symptoms as it is rich in phytonutrients and phytoestrogens, which are similar in shape to the female hormone called estrogen.
– In one study with 51 menopausal women Ashwagandha was very beneficial in helping body to normalise oestrogen and easy hot flashes, mood fluctuations, sleep issues, irritability and anxiety (11).
– Maca is a plant that grows in central Peru and it is traditionally used for female hormone imbalance, menstrual problems, tiredness, and signs of menopause and osteoporosis. Although maca doesn’t contain any hormones, yet it has a rare set of nutrients that nourish the endocrine system and may help support normal levels of oestrogen, progesterone, testosterone, or DHEA (12). As an adaptogen herb, maca has been used to lower the effects of stress by decreasing cortisol levels. It is believed it can also help reduce hot flashes and weight gain while improving libido and energy.
– Studies have demonstrated beneﬁts of Rhodiola in promoting hormonal balance by improving adrenal function (13). It also helps reduce fatigue and enhances mental function.
– Evening primrose oil and Star flower oil supplements (both high in gamma linolenic acid) are known to have beneficial effect on hormonal balance, immune and nervous system. In 2013, the results of a randomized clinical trial which looked at the effects of evening primrose oil on 56 menopausal women (aged 45–59 years), was published. These women took two 500 milligram capsules of evening primrose oil or a placebo every day for a total of six weeks. The researchers then compared hot flashes between the two groups and found that oral evening primrose oil decreased the intensity of hot flash attacks and decreased the life disruption that results from these attacks (14).
– Supplements containing Omega 3 fats (such as molecularly distilled fish oils or flax oil) have been suggested by research to have a calming effect on the nervous system enhancing brain health and mental well-being (15).
In preventing and dealing with menopause symptoms it is important to understand that there are reasons to believe that it is even more important to focus on increasing progesterone than oestrogen. First of all, body uses progesterone to make oestrogen. In addition, progesterone regulates oestrogen levels and prevents its dominance. It means that without healthy levels of progesterone, oestrogen can be not only too low but also too high, thus increasing risk of breast cancer, obesity, depression, heart attacks or strokes.
Before menopause starts a still menstruating woman can maintain and increase progesterone by taking the following supplements:
– Zinc acts on multiple organs of the body that are implicated in progesterone production including the pituitary gland and ovaries. Zinc increases levels of follicle stimulating hormone, which in turn causes ovulation and also stimulates the ovaries to produce estrogen and progesterone.
– The most important nutrient for maintaining normal progesterone levels before menopause is vitamin B6 which is absolutely crucial for the development of the corpus luteum (a gland produced in ovaries after the egg is released) out of which progesterone is produced. Therefore, vitamin B6 is necessary for preventing progesterone deficiency and through progesterone for balancing other hormones including oestrogen.
– Also vitamin C is required to assist the body in producing progesterone (16). In a 2003 study, women who took 750 mg of vitamin C increased their progesterone levels by 77 percent! It is important to remember that in order to be effective vitamin B6 must be taken with zinc as without zinc vitamin B6 won’t help to cope with low progesterone! You need to take daily dose of about 20 to 50mg of zinc (such as zinc citrate) after breakfast.
– Magnesium regulates the pituitary gland, which in turn controls the production of FSH (follicular stimulating hormone), LH (luteinizing hormone), and TSH (thyroid stimulating hormone) that in turn regulate the production of progesterone and oestrogen.
– Also amino acid L-arginine is known to help increase progesterone levels. The Journal of Ovarian Research found that supplementing with L-arginine helps to increase progesterone. The researchers reported that 70% of participants benefited from L-arginine. Menstrual blood flow was improved in all women that took L-arginine. (17)
– The most popular herb believed to increase and balance progesterone before menopause is Agnus castus (Vitex). Agnus Castus (known also as Vitex, Chaste Berry or Monk’s Pepper) is a large shrub (native to the Mediterranean region of southern Europe) with lilac or white flowers and small fruits. Agnus castus works by stimulating the body to produce more natural progesterone (18).
Unfortunately, once the menstrual cycle stops, the ovaries can’t produce progesterone any more since corpus luteum (out of which progesterone is made) ceases to appear in ovaries. However, since the body still needs progesterone it continues producing it in the adrenal glands and nerve cells.
Unfortunately, since due to chronic stress and nutritional deficiencies many menopausal women suffer from adrenal fatigue and poor nervous system function their adrenals and nerves are unable to take over the function of ovaries and make enough progesterone.
For this reason it is also crucial to recover from adrenal fatigue and strengthen nerves by learning to control stress, regular exercise, healthy high in nutrients unrefined diet and by using various supplements including zinc, B vitamins, magnesium, vitamin D, and antioxidants as well as adaptogenic herbs and foods such as maca, rhodiola, and ashwagandha.
Postmenopause refers to the years after menopause. During this stage of woman’s life menopausal symptoms, such as hot flashes, may ease or disappear for many women. However, as a result of lower levels of estrogen, postmenopausal women may still be at higher risk for a number of health conditions, such as depression, osteoporosis, or heart disease. For this reason they should continue using previously mentioned vitamins, minerals as well as some of the herbal supplements that support general health, energy levels, metabolism and nervous system function. In addition they should keep on implementing principles of healthy lifestyle such as regular physical activity, positive thinking and stress control, as well as healthy unrefined diet high in nutrients, antioxidants, and fibre.
Written by Slawomir (“Swavak”) Gromadzki, MPH