Treating Menopause Symptoms Naturally

Today, we look at how specific foods have been shown in randomized controlled trials to improve the symptoms of menopause.

There is a great variety of symptoms suffered by women undergoing menopause. There are the so-called vasomotor symptoms––like night sweats and hot flashes, difficulty sleeping or full-on insomnia, vaginal dryness and pain during sex, as well as adverse effects on mood, including full-blown depression. Might exercise help? Exercise can certainly help with physical and psychological quality of life in general, but unfortunately there was no evidence for the effects of exercise on menopause-specific symptoms. You know researchers are getting desperate when they try to see if giving people pig placenta will help. Spoiler alert: it doesn’t.

Well, we know oxidative stress, which is a consequence of excessive free oxygen radicals or impaired antioxidant defense, is linked not only to diseases such as diabetes, obesity, and cardiovascular disease, but also menopausal symptoms like hot flashes. Low free oxygen radical defense is associated with more menopausal symptoms, just like having a diet with more antioxidants is associated with fewer menopausal symptoms. In fact, a high intake of fruits and vegetables may delay the onset of menopause in the first place, thought to be because the presence of antioxidants in fruits and vegetables may counteract the adverse effects of free radicals on the number of functional eggs you still have in your ovaries, whereas a reason high meat consumption has been related to degenerative diseases may not just be the saturated fat and cholesterol, but the pro-oxidation products generated during their production, storage, digestion, and metabolism of meat.

Similarly, since a proinflammatory diet has also been associated with higher menopause-specific somatic symptoms, meaning like hot flashes and sleep issues, that would mean moving toward a more plant-based diet packed with anti-inflammatory components like fiber, and away from proinflammatory foods containing saturated fat and cholesterol. No wonder whole plant foods intake has been associated with fewer menopausal symptoms.

In terms of specific foods, poultry and skim dairy products may be particularly bad, whereas soy milk seemed to help. So, women may derive benefit from lower consumption of poultry and skimmed dairy, and a greater consumption of vegetables and soy milk. You don’t really know, though, until you put it to the test. And indeed, women randomized to drink soy milk reduced their menopausal symptoms by 20 percent within 12 weeks.

No wonder that those eating strictly plant-based diets report less bothersome menopausal symptoms. Among women undergoing menopause, vegans reported less bothersome symptoms, and within the diet groups, more vegetables, and in the meat-eating group, less flesh food was associated with less bothersome symptoms as well. So, eating a plant-based diet may be helpful for women in their menopausal transition who prefer a natural means to manage their symptoms––consistent with all the other studies demonstrating reduced menopausal symptoms in those consuming greater quantities of plant-based foods and less meat.

But again, maybe there are other reasons healthier eaters have fewer symptoms. You can’t prove cause and effect until…you guessed it, an interventional trial to see if changing your diet actually reduces symptoms. And in this study, where women were encouraged to decrease fat and increase fruit, vegetable, and whole grain intake, they were significantly more likely to eliminate their vasomotor symptoms like hot flashes and night sweats compared to the control group; so, it’s certainly not all or nothing.

And within a plant-based diet, those randomized to a meat-free diet with daily flaxseed oil, walnuts, and almonds did better than those randomized to the same diet, but with daily extra-virgin olive oil. After 16 weeks, the vegetarian diet that was rich in omega-3s did better reducing vasomotor symptom frequency. In fact, even just two teaspoons worth of ground flaxseeds a day alone can significantly decrease menopausal symptoms to about the same extent as hormone replacement therapy, but without the side effects.

In our next story, does soy food consumption explain why Japanese women appear to be so protected from hot flashes?

When women hit menopause and their ovaries shut down, the estrogen level in their body drops 95%. This is good news for the endometrium—the lining of the uterus. Otherwise, the constant estrogen signaling could eventually result in endometrial cancer. In fact, maybe that’s why menopause evolved: to protect the uterus from cancer. Lower estrogen levels are also good for lowering breast cancer risk. “In postmenopausal women, relatively high [blood] levels of [estrogen] are associated with a more than [double] increase[d] risk for breast cancer.” Estrogen levels drop 95% at menopause, but not to zero, because other tissues can make estrogen—like our own fat cells. “[T]his probably explains the increase in [breast cancer] risk in obese postmenopausal women.” More fatty tissue means more estrogen production.

Now, we learned that soy phytoestrogens can block the production of estrogen, such that drinking a glass of soy milk with each meal can cut estrogen levels in half in premenopausal women. But levels in postmenopausal women are already down 95%, and because of that, many women suffer from hot flashes. Might lowering levels even further with soy make menopausal symptoms even worse?

Estrogen treatment is very effective in reducing menopausal symptoms. Unfortunately, the downside is not only the uterine cancer, but blood clots, strokes, “and cognitive impairment.” Taking progesterone-type compounds with the estrogen helps prevent the uterine cancer, but increases the risk of heart attacks; more stroke risk, breast cancer, more clots, and dementia.

So, what’s a woman to do? Well, the 80% hot flashes figure is not universal; maybe “80-85% in European and American women,” but it may be as low as just 15% in places like Japan. In fact, there’s not even a word for it in the Japanese language, which supports how relatively rare it is. Maybe the phytoestrogens in soy are helping?

“The association between soy product intake and the occurrence of hot flashes was examined” by following a thousand Japanese women before they started menopause, over time, to see who developed hot flashes and who didn’t. And, those women who were eating like four ounces of tofu a day appeared to cut their risk in half, compared to women who only ate like an ounce or two a day— suggesting soy products are “protective.” But, maybe soy intake is just a marker for a healthier diet overall?

A study in China found the consumption of “whole plant foods” in general seemed to be associated with decreased menopausal symptoms. So, to see if soy was something special, you’d have to put it to the test.

Studies like this, of soy phytoestrogens in pill form, showed extraordinary results—a significant drop in hot flash presence, number, and severity. From 100% of women suffering at the beginning, to only 31% suffering by the end of three months. The average number of hot flashes dropped from about 120 a month down to 12. But, the problem with studies like these is that there’s no control group to control for the placebo effect. If you look at all the hormone trials, even the women who got the placebo sugar pills had up to a 60% reduction in hot flashes over the years. That’s why any therapy “purported to reduce such symptoms must be assessed in blinded trials against a placebo…because of the large placebo effect…and also because…menopaus[al] symptoms often decline” on their own over time.

But, it’s important to recognize how powerful the placebo effect can be. Over the past 20 years, “more than 50 [clinical] trials have evaluated the effects of soy foods and [supplements] on the alleviation of hot flashes.” Compiling the best ones together, the placebo groups got about a 20% drop in hot flash severity. The soy groups achieved about a 45% drop. So, on average, the soy did about 25% better than control.

There have been two studies that compared soy phytoestrogens head-to-head against hormones. And, in one study, they actually seemed pretty comparable in terms of reducing hot flashes, muscle and joint pain, and vaginal dryness, compared to placebo—though in the other, soy did better than placebo. But estrogen and progesterone therapy did better than them both. But, the soy has the benefit of not increasing cancer, heart disease, and stroke risk.

Finally today, approximately half of the variability of age of menopause among women is explained by genetics. What behaviors or circumstances can help explain the rest?

Since 1970, the proportion of women having their first child after age 35 increased nearly tenfold. This may introduce a ‘‘longevity penalty’’ on their children (as those born to older mothers don’t tend to live as long), but mothers having children later tend to live longer themselves. For example, female centenarians were found to be nearly four times more likely to have had children after age 40 than women who died by their 70s.

This doesn’t necessarily mean delaying kids will make you live longer. Smoking, for example, could be a confounder—causing both early menopause and an early death. Or maybe delayed reproductive aging is just a sign of slower aging in general. However, some have suggested the biological changes of pregnancy might have a rejuvenating effect, even going so far as to suggest a parabiosis mechanism—bathing in the blood of babies, but just not in a Countess Báthory sort of way. To sort between these possibilities, researchers studied the longevity of brothers of women who gave birth after age 45, and that of their wives. The brothers with late-fertile sisters lived longer, but their wives did not. This suggests a genetic robustness cause, rather than a rejuvenation effect, and the fact that the longevity benefit didn’t extend to their wives suggests it’s not due to a confounder like socioeconomic strata.

On the other hand, women who experience extremely early menopause (the one percent who stop menstruating by age 39) may be at risk for diminished longevity, and should, therefore, be counseled to adopt a particularly healthy diet and lifestyle. Approximately half of the variability of age of menopause between women is explained by genetics. Other than smoking, what other behaviors or circumstances can help explain the rest?

Factors that don’t appear to affect the age of menopause include exercise, obesity, alcohol, coffee, or vitamin D status. Interestingly, women who’ve been married tend to arrive at menopause later. Some suggested it may be the influence of male pheromones (given the fact that exposure to male armpit odor makes women’s cycles more regular). But it turns out that male cohabitation alone doesn’t appear to matter. It may be the sex. Married older individuals tend to have more sex, and indeed, pre- and peri-menopausal women, average age 46, who reported sex weekly were 28 percent less likely to experience menopause over the subsequent decade than those reporting sex less than once a month. You can very well imagine how this could be a result of reverse causation, though. Instead of more sex leading to later menopause, a later menopause may have instead led to more sexual engagement.

The relationship between tobacco use and early menopause is thought to be mediated by the toxic effects on the ovaries of the polycyclic aromatic hydrocarbons (PAH) in the smoke. Among nonsmokers, this PAH exposure is almost entirely from food––mostly grilled, barbequed, and smoked meats. Could this explain why, in the Harvard Nurses’ Health Study II, higher plant protein intake was associated with a significantly lower risk of early menopause? Feed female monkeys a diet high in animal protein, and not only did they get more atherosclerosis, but also an acceleration of ovarian aging. Now, in the original Harvard Nurses’ Health Study, animal protein consumption was associated with infertility, such that replacing even replacing five percent of animal protein intake with plant protein could potentially cut the risk of infertility in half. But in the Nurses’ Health Study II, while plant protein appeared to delay menopause, animal protein intake was not associated with menopause age either way. And in the UK Women’s Cohort Study, those eating more animal protein were six percent more likely to experience a later menopause. The data is similarly conflicting in vegetarians.

Some studies found no difference, or a later age, of menopause in vegetarians. But others found an earlier age compared to nonvegetarians. For example, the largest study found that vegetarians reached menopause at an average age of 50.1 years, compared to nonvegetarians at 50.7 years. As I noted, premature menopause before age 40 may be detrimental for longevity, but being a little earlier within the normal range may actually be beneficial for cancer risk.

At the same age, breast cancer risk is about 40 percent higher in premenopausal compared to postmenopausal women––presumably due to higher exposure to the “necessary evil” hormone estrogen. Breast cancer risk is three percent higher for every year later a woman starts menopause, and five percent higher for every year earlier a girl starts menstruating. (On average, women whose periods hold off until age 15 appear to live the longest.) Vegetarian women tend to have lower estrogen levels, perhaps due to higher fiber intake, and interventional studies show that switching to a more plant-based diet can reduce circulating estrogen levels by more than 40 percent.

This could help explain why vegetarian girls may hit puberty later, and why those eating strictly vegetarian not only have lower cancer risk overall, but particularly lower risk for female-specific cancers. Age of menopause may not be a factor though, based on an interventional trial randomizing women on the verge of menopause (average age 49) to two years of a lower-fat diet to reduce breast cancer risk. The intervention group ended up eating more fiber (and, therefore, more plant-based), but though they did experience improvements in mammogram findings, the dietary shift failed to influence the timing of menopause.