Menopause is not a point in time it is normal process of hormone changes. Consider it like a mirror image of puberty, a process lasting months to years. On average I would estimate it is a process of change occurring over 18 months to 2 years. It is a fundamental shift in the physiology (normal function at cell level) of the body. Consider it like a major gear shift, a time of maximum change to a different energy flow. Change like this can be a stress on all the other body systems that are ticking along compensating for our little deficiencies but coping well enough. Suddenly they are thrown off course by this hormone upheaval leaving our Achille’s heels somewhat exposed.

The commonest presentations are hot flushes, changes in sleeping patterns, raised anxiety levels, increased joint aches and pains and reduced energy levels. It is often accompanied by lowering of libido and vaginal dryness.

So much for the bad news! However it is rarely reported that one third of women sail through with none of these problems and for one third the problems are a mild temporary inconveniences. Patients only need help if the minor problems go on for a prolonged length of time or if the problems are overwhelming.

Sometimes the problem itself is manageable but has secondary consequences that wear  patients down e.g. hot flushes cause disturbed sleep which over a period of several months leads to tiredness and reduced energy. Settling the hot flushes sorts out the sleep problems and energy levels improve.

Hot Flushes are very variable but can be very debilitating. They are usually time limited to 6-18 months if they reflect only hormone changes. However I often see patients with many years of hot flushes, after consideration most are due to factors other than hormone balance, or are post hormone imbalance i.e. the hormone balance at the menopause kick-started the hot flushes but other factors are involved in maintaining the flushes. These patients need an individual assessment to work out what the underlying problem is in their particular case.

As with any process of change getting the building blocks for good nutrition is a big help. Some foods are particularly helpful with this.

Food Building Blocks:

1. See leaflet on Hormone Balancing foods on www.healthandherbs.ie (attached). These are good for hormone balance for men and women also for teenagers. Plant oestrogens as part of the diet are uncontroversial for those with a family history of breast cancer, in fact they are likely to help prevent expression of a genetic tendency if included  regularly in childhood. Some controversy has been raised regarding plant oestrogens for patients with cancer which require discussion with a well qualified herbalist. It can be stated that there is no evidence that they cause harm, proving safety is however much more complicated.
2. See leaflet on Essential Fatty Acids on website as above (attached). These are particularly important for symptoms of anxiety and insomnia. They are also helpful for joint problems. Vitamin D is found in oily fish which also contributes to hormone balance.
3. Fibre in the diet is vital for ensuring daily bowel emptying. All hormone breakdown products are eliminated with Bile and Fibre! Not enough fibre in the diet or sluggish bile flow and production can exacerbate hormone balance problems at the menopause. A bowel motion a day keeps Hot Flushes at bay!
4. The problem of low Iodine is increasingly being recognised. Eat a little seaweed (a little carraigeen moss in steaming water for vegetables or add to casseroles, soups and stews).

Making suggested changes to your diet is also good for your heart, cancer prevention and cholesterol (after all cholesterol is a steroid related compound). They also give a calcium rich base, helpful for strong bones.

Exercise is more important than ever. It is easier to gain weight (and harder to lose it !) after the menopause. There are many suggested reasons, but many women take less exercise possibly because of feeling less energetic, poorer motivation fuelled by poor sleep. These factors go around in decreasing circles and the answer is to keep moving, vary the exercise and try new things! Stretching and strengthening exercise are particularly important for preventing bone thinning (osteoporosis).

Drink more water.
In combination with the Essential Fatty Acids water helps with skin tone and mental alertness. Two litres per day is ideal including the water in foods.

Herbs for Menopause.
I use all the herbs in my dispensary for menopausal patients because they present with all their ‘before menopause’ health issues and these are often exacerbated or exaggerated by the changes of the menopause. So start thinking about herbs from your own baseline e.g. if you are constipated deal with this first before wasting your money on hormone balancing herbs. Any digestive problems need to be sorted or you won’t be absorbing expensive supplements e.g. using phyto-soya supplements will not be helpful if you do not have normal gut flora (the balance of helpful to unhelpful bacteria in your gut) as they are not absorbed well under these circumstances. Use a probiotic for 6-8 weeks and then try the supplement again. Depending on the presentation I use Liver Herbs (e.g. Dandelion Root and/or Milk Thistle etc.), digestive herbs (e.g. Chamomile, Verbena etc.) nerviness to support the nervous system (e.g. St John’s Wort, Wild Oats, Chamomile etc.) and general tonics herbs (eg Siberian Ginseng). Probably as a last consideration I use herbs to directly influence hormone balance (e.g. Black Cohosh, Hops etc.). Herbs can be used for the perimenopause (around the time of menopause when periods are irregular) to tone the uterus and support the hormone cycle (e.g. Yarrow, Lady’s Mantle, Shepherd’s Purse etc.).

I will elaborate on a few of the commonly available herbs.

Dandelion Root.

This is helpful for promoting bile flow and cooling the body, it also has a mild laxative effect. It is greatly under-rated as is rarely included in supplements recommended for menopause. It can be very helpful for hot flushes and I almost always include it in treatment for menopausal problems. Usually taken as tincture 1 ml twice daily or decoction (put loose herb in water bring to boil and simmer for 5 minutes) 2 tsps per day and sip throughout the day hot or cold.

Chamomile

Again seldom included in proprietary blends. It is calming for the nervous system and soothing for the digestion. Particularly helpful for anxiety symptoms and insomnia. It is best taken as a loose herb made into a tea (3 tsps throughout the day). It is also available as tablets or capsules.

Lady’s Mantle.

This is a good tonic for the uterus and helpful for ‘normalising’ heavy irregular periods. Again it is best made as a loose tea (2 tsps per day or as tincture 1 ml twice daily).

St John’s Wort

This is a very safe herb particularly useful for anxiety and insomnia. It is available from Medical Herbalists see www.iimh.org for a list of medical herbalists in your area. As it can affect the availability of some prescribed medications it requires some guidance under these circumstances. It is a very safe and also well researched herb and I find it invaluable for severe menopause symptoms. It is particularly helpful when women have struggled for many months with debilitating symptoms and have become exhausted. It is restorative for the nervous system and promotes better quality sleep.

Siberian Ginseng.

This is what we call an ‘adaptogenic’ herb tonic. It is particularly useful for the menopause which causes stress due to a fundamental shift in the physiology (normal function at cell level) of the body due to hormone changes. It is also good for low energy specifically. I often combine it with a little Liquorice provided the Blood Pressure is normal. Again 1 ml Tincture twice daily or 2 tsps dried herb as a tea sipped throughout the day.

Hops.

This herb contains plant oestrogens and is particularly good for hot flushes causing disturbed sleep as it has sedative effects. It also stimulates bile due to its bitter taste. It stimulates a sluggish digestive system one of the few bitter herbs which can be used even with inflammation of the digestive system. It has a generally cooling effect on the metabolism. This is helpful for women who complain of being too hot, independently of  hot flushes. I avoid hops for women with a history of clinical depression as it has a slightly sedating action. This is tolerated by, and often helpful for, most people. Again 1ml tincture twice daily. The tea is quite unpalatable!

Wild Yam.

Again this is an oestrogenic herb. It was the original plant source for the Pill. It also has an anti-inflammatory effect particularly useful women who complain of aches and pains or stiffness of the joints. Again 1 ml tincture twice daily or decoct 2 tsps of dried herb.

Sage

This is indicated in many herbals as very helpful for hot flushes. I seem to have limited success with it. I include it in a blend with other herbs and it has a stabilising effect on the circulation. Dose suggested is 1tsp dried herb infusion once-twice per day or 20 drops tincture three times daily.

Black Cohosh

This is often the herb people think of first yet it is the one I mention last! This is the most specific hormone balancer, but unless the liver and digestion are working well, and the mind calmed you do not get value for money for your hormone balance! It has a wide range of actions helpful at the menopause, support for the nervous system (calming), muscle relaxant, antispasmodic and contributes to a healthy bone calcium profile.

Controversy surrounds it’s mode of action. It has an oestrogenic effect without having oestrogen-like molecules. It is specifically helpful for hot flushes. Dose 1ml tincture twice daily, 2 tsps dried herb sipped as an infusion throughout the day.

Do not take if there is a history of liver problems, or if you take medication that contributes to liver damage (eg. regular Paracetamol). Be aware of liver damage due to alcohol. Seek advice if you develop yellowing of the skin, loss of appetite, nausea, severe fatigue or darkening of the urine.

It is safe to use therapeutic doses over three months, then take a break for a few weeks before restarting. If you need it for longer than two courses I would recommend a professional herbal consultation. An association between Black Cohosh and liver problems is based on the weakest basis of anecdotal reports of a small number of cases, but should be borne in mind. Any concerns can be satisfied by a simple blood test.

Red Clover.

This herb is very gentle and un-heroic. It has an oestrogenic action helping with hot flushes, it also has a gently stimulating effect on the lymph collection system helpful for skin problems. A dose of 2-3 tsp as infusion daily or 1 ml of tincture three times daily is likely to be helpful.

This is a wide subject and I have tried to give an overview of some helpful approaches using herbal medicine. If symptoms are severe or prolonged or if these suggestions are tried over 2-3 months and are still having significant problems, I would suggest a consultation with a well qualified medical herbalist www.iimh.org .

Suggested tincture doses are 1:25-1:45% alcohol which are those most likely to be available over the counter. For tablets or capsules there is such a variation of doses I suggest following the advised directions for that product.

For further information or if you would like to order any of the herbs mentioned look up www.healthandherbs.ie or tel. the Health and Herbs Clinic on 091 583260.