Functional Support for Menopause
Generally speaking, anticipating the onset of menopause can be frightening, anxiety-provoking, disheartening, and confusing for many women. The extensive list of possible symptoms and the physiological changes that may occur is daunting at best. Furthermore, there are the controversial and somewhat convoluted medical opinions involving the risks and benefits of the “much-advised” hormone therapy (HT). Wading the muddy waters of symptom management, disease prevention, and disease treatment leaves much to be desired.
That being said, while HT may be recommended for specific patients, and may even improve their overall outcomes, a holistic and integrative approach does offer hope and empowerment during a very natural part of every woman’s life. Diet, exercise, stress management, and dietary supplements can effectively manage menopausal symptoms in the majority of women without the use of conventional HT, though providers must account for the specificity of each woman and her individual health needs.
It is well understood that dietary intervention has great implications for overall health and protective benefits in certain disease processes. Nutrition plays a key role in potentiating positive outcomes for cardiovascular health, bone health, hormonal balance, and insulin resistance, all of which are associated with menopause. A diet that includes whole unprocessed foods such as whole grains, legumes, fruits and vegetables, minimally-processed proteins (especially fatty fish), and healthy fats (e.g. avocado oil, olive oil, flaxseed oil, pumpkin seed oil) while limiting simple carbohydrates, alcohol, sugar and salt can improve overall health and reduce the risks of associated diseases (1).
Studies examining the effects of soy foods in reducing hot flashes, bone loss, blood pressure, and risk of heart disease (HD) have conflicting results, though most show moderate effects towards relieving menopausal symptoms (1). Soy food consumption has shown some promise for lowering the risk of breast and endometrial cancer as well as improving arterial stiffness associated with HD, but its efficacy on bone health has yet to be determined (1).
One study seeking to understand the contradictory effects of soy found that women who are able to metabolize equol, a derivative of daidzein (a soy isoflavone), show significantly better improvement in menopausal symptoms than women who do not (2). This is due, in part, to specific bacterial flora in the gut that break down daidzein. Therefore, it may be imperative for practitioners to assess and/or improve a patient’s gut flora in order to improve the effectiveness of soy isoflavones in the diet (2).
Exercise and Stress Management
Exercise has significant benefits for overall health and well being, improving cardiovascular health and bone density, lowering body fat and BMI, increasing energy, and lowering stress (1). One study sought to examine the effects of Hatha yoga and physical exercise on blood sugar, thyroid-stimulating hormone (TSH), stress hormone (cortisol), and antioxidant levels (total plasma thiols), which are commonly altered during menopause (3). In doing so, the authors determined that yoga proved to be more beneficial than physical exercise in maintaining TSH levels, decreasing oxidative stress (no change in thiol levels), inducing a calm state of mind (lower cortisol levels) and improving blood sugar.
Certain nutritional and botanical supplements, such as vitamins E and C, carotenoids, soy isoflavones, coenzyme Q10, green tea, and garlic, promote the metabolism of estrogens to their anticarcinogenic breakdown products (1). Additionally, other herbal and nutritional supplements such as black cohosh, red clover, soy, maca, bioflavonoids, and kava have all shown scientific efficacy in the treatment of menopausal symptoms (1). Of course, some women have been shown to completely manage menopausal symptoms with nonhormonal supplements, while others were able to lower doses of HT by using them in combination.
In closing, the goal of this type of holistic or integrative approach is to provide relief from common menopausal symptoms, while preventing, treating, and/or minimizing the risks of osteoporosis, cardiovascular disease, breast cancer, stroke, diabetes mellitus, and other diseases common to perimenopausal and postmenopausal women. Of course, an individual's overall health, as well as severity of her symptoms should be considered when constructing a therapeutic protocol. As with anything in functional and holistic medicine, one size does NOT fit all.
1. Pizzorno, J. E., & Murray, M. T. (2013). Textbook of natural medicine (4th ed.). Philadelphia, PA, United States: Elsevier/Churchill Livingstone.
2. Jou, H.-J., Wu, S.-C., Chang, F.-W., Ling, P.-Y., Chu, K. S. and Wu, W.-H. (2008). Effect of intestinal production of equol on menopausal symptoms in women treated with soy isoflavones. International Journal of Gynecology and Obstetrics, 102(1), 44-49. doi: 10.1016/j.ijgo.2008.01.028
3. Chaturvedi, A., Nayak, G., Nayak, A. G., & Rao, A. (2016). Comparative assessment of the effects of Hatha yoga and physical exercise on biochemical functions in perimenopausal women. Journal of Clinical and Diagnostic Research : JCDR, 10(8), KC01–KC04. http://doi.org/10.7860/JCDR/2016/18891.8389ral medicine (4th ed.). Philadelphia, PA, United States: Elsevier/Churchill Livingstone.