IMCD's holistic approach to navigating the peri-menopausal period and beyond

The menopause is a time of significant change for a woman, it is not only the marked decline in reproductive functioning, but can be a time of life that brings many emotional, social, and situational changes that some women cite as leading to enlightenment and liberation. In Traditional Chinese Medicine, the menopause can be referred to as the ‘Second Spring’.(1) For many women, the menopausal period can be challenging and bring several symptoms that can impact both physical and psychological health. 

Menopause technically refers to the time 12 months after a woman’s last period. The build up to menopause, where many women find they notice changes, is termed the peri-menopause, although many people refer to the build up to the cessation of periods as the menopause. 

As the menopause is an expected transition, many women anticipate their own experience and typically have questions like when does the menopause start? or how long does the menopause last? Other common questions women have include what is the average age of menopause onset?

The answers to these questions can vary and depend upon each individual woman. Factors such as genetics, ethnicity, socioeconomic status, health, BMI, age of first period, lifestyle, diet, previous pregnancy, and any medication may all play a role.(2) 

Research does indicate that the average age for a woman to reach menopause is around the age of 51 but can it occur between 45 and 56 years.(3) Early menopause occurs before the age of 45 and premature menopause refers to the cessation of periods before the age of 40. 

It is the peri-menopausal period, which can last between four and eight years, where women report the physical and psychological changes that impact their day-to-day life.(4) 

The gradual alterations to oestrogen and progesterone levels, and the balance between the two, can mean that some women find that signs of menopause may build up. Some may be subtle to begin with and many women put them down to ‘being older’ or the situational stress women often find occurs in their 40s. Many women question whether they are having a ‘midlife crisis’ not realising it may be the menopause.

Menopause symptoms can vary greatly as oestrogen and progesterone play a role in many areas within the body. Oestrogen and progesterone are known to influence the cardiovascular system, the genitourinary tract, bones and joints, and brain functioning.(5)

This may, in part, explain why menopause symptoms can be so diverse. Physical symptoms commonly experienced include hot flushes, night sweats, itchy skin, urinary leaking, vaginal atrophy, palpitations, joint discomfort, and painful, heavy, and irregular periods. Psychological symptoms can be more subtle to start with but can include loss of libido, depression, anxiety, irritability, cognitive alterations like ‘brain fog’ and forgetfulness, and insomnia.(5) The effect of a combination of these symptoms can lead to much disruption, with as many as 96% of menopausal women stating they have a lowered quality of life.(6)

 

The most common treatment suggested in menopause is hormone replacement therapy (HRT). The combination of oestrogen and progesterone is known to alleviate many menopause symptoms, particularly physical symptoms. Regulated body identical hormones show greater safety than synthetic versions (7) and are available in a variety of preparations including tablets, gels, and sprays. 

An increase in an understanding of the value of dietary and lifestyle changes in menopause has led to many women being recommended to reduce alcohol intake, stop smoking, get good sleep, and eat a mediterranean-style diet rich in fibre, with a variety of fruits and vegetables and quality protein including legumes and omegas from oily fish, olives, and olive oil.(8)

Stress relief and activities such as physical exercise, yoga, pilates, meditation, and breathing techniques are also beneficial for menopause symptoms.(9-12)

Many women turn to traditional therapies such as Traditional Chinese Medicine or opt for ayurvedic treatment for menopause. Each woman will experience the menopause in their own specific way and so treatment options should be personalised. What may suit one woman may not be as effective for another, and there may be a degree of trial and error in finding the right combination of treatments to alleviate troubling symptoms. 

The use of nutraceuticals during the menopause is increasingly common - women are reaching out for natural ways to support hormones, tackle tricky symptoms or to build resilience. 

Hormone regulation and metabolism can be complex, and it is important to consider liver and gut health during the peri-menopause period. Supporting the gut microbiome through pre, pro, and postbiotics can bring significant benefits to many aspects of the menopause, not only encouraging a healthy gut environment, which can influence digestive health and elimination of wastes, but also influence mental health and wider aspects such a vaginal health.(13)

The use of plants with natural oestrogenic activities - phytoestrogens - can also bring relief from menopause symptoms, particularly physical symptoms such hot flushes and night sweats. Isoflavones, including soy isoflavones (genistein and daidzein), may assist in the reduction of the severity and frequency of symptoms such as hot flushes.(14 -16)

Other plants that have natural phytoestrogenic activities include lemon balm, sage, rosemary, black cohosh and St John’s Wort. These herbs bring benefits beyond just hormone balance, and many are known to have ‘adaptogenic’ properties, meaning they help the body to adapt better to changes – building resilience against stress and reducing psychological symptoms such as irritability, anxiety, and depression.(17)

Other adaptogenic herbs include rhodiola and ashwagandha, which offer adrenal support, regulating the stress response as well as influencing neurotransmitter function to support mood issues and fatigue.(18,19)

The key to experiencing a healthy, smooth transition through the menopause is to be proactive and take an all-round approach to health and lifestyle, supporting many body systems simultaneously.