Which foods and supplements can I try to alleviate menopausal symptoms?

Many women ask about diet and supplements that they can try to alleviate symptoms of menopause. In my view bioidentical hormones started at the time of menopause are a very effective way to alleviate symptoms.

What else helps with symptoms of menopause? Avoid alcohol, caffeine, spicy foods and sugar, all of which may worsen hot flushes. Generally sugar cravings are common when you are feeling exhausted but this frequently leads to crashes and mood swings in the longterm.

I get asked a lot about phytoestrogens such as soy: there seems to be some confusion about what they are. Phytoestrogens are naturally-occurring plant nutrients that exert a weak effect on the oestrogen receptor. Phytoestrogens are NOT hormones – eating phytoestrogens wont actually raise your oestrogen or progesterone blood levels, unlike taking bioidentical hormones which are hormones and will raise your hormone blood levels.Theoretically phytoestrogens might help modulate some symptoms of both high oestrogen (where they might block some of your own oestrogen interacting with its receptor) or low oestrogen (by exerting a weak effect on the oestrogen receptor). Soy and flax are the most potent phytoestrogens. The most current study on soy isoflavones and hot flushes showed benefit for the first 12 weeks but then no change or an increase in symptoms for the next 12 weeks. Based on these results, soy isoflavones in the treatment of vasomotor symptoms may not provide the relief we have come to hope for – and I have to say that in practice I don’t find that patients have noticed much difference from increasing phytoestrogens in their diet. Also, soy beans can be allergenic for some women.

Many women have heard about supplements and herbs for alleviating menopause symptoms, and here’s a list of the most researched botanicals. In my experience these tend to provide symptom relief at least in initial weeks/months, and can be helpful for milder symptoms.

Black cohosh can alleviate hot flushes: it is one of the most dominantly studied botanicals  -there are around 200 studies on black cohosh, and although not all show benefit for hot flushes, enough do. In a randomized, double-blind, controlled 3-month study in China, 244 menopausal women took 40mg/day of black cohosh and this significantly reduced symptoms at 12 weeks.[1]

Kava  may be beneficial for perimenopausal anxiety and hot flushes (there are 3 or 4 studies on this).

Maca is a traditional plant common to the Andes Mountains and has been used to improve sexual function. The evidence is limited – less than half a dozen studies – but two randomized controlled trials suggested a positive effect of maca on sexual dysfunction in menopausal women.[2]

Panax or red Ginseng may help hot flushes and fatigue: 72 postmenopausal women were randomly assigned red ginseng or placebo for 3 months. The red ginseng group had a reduction in flushes and menopausal symptoms and also some improvement in  LDL cholesterol after 12 weeks compared with placebo.[3]

Valerian can help hot flushes and insomnia –76 menopausal women received 225 mg valerian capsules three times per day or placebo: after 8 weeks the valerian group had significantly less severe hot flushes.[4]

Red clover may help depression and anxiety in menopause – 109 postmenopausal women took either 80mg of red clover extract or placebo for 3 months and the red clover group had a significant 75% reduction in anxiety and 78.3% reduction in depression.[5]

St John’s wort for hot flushes and mood disorders: St John’s wort is the most thoroughly researched natural antidepressant and it is also emerging as an important option for treatment of hot flushes, depression and mood swings, either by itself, or in combination with black cohosh (there have been some studies looking at the combination).

A study of St John’s wort liquid extract showed a statistically significant decline in hot flushes compared to placebo after 8 weeks[6] and another trial demonstrated that after 3 months of treatment, women in the St. John’s wort group reported significantly better quality of life scores and significantly fewer sleep problems compared to placebo.[7]

If you are taking any medications or have any illnesses, please discuss with your doctor before commencing any of these.

[1] Efficacy and tolerability of a medicinal product containing an isopropanolic Cimicifuga racemosa, aka black cohosh (iCR) extract was in Chinese women from five hospitals in China, with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone.

[2]Maca (L. meyenii) for improving sexual function: a systematic review.

[3] Effects of red ginseng supplementation on menopausal symptoms and cardiovascular risk factors in postmenopausal women: a double-blind randomized controlled trial. 

[4] The effects of valerian root on hot flashes in menopausal women.

[5] Improvement of postmenopausal depressive and anxiety symptoms after treatment with isoflavones derived from red clover extracts.

[6] Effect of St. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study.

[7] Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial.