You’ve probably heard some variation on the famous quote, “Nothing is said to be certain, except death and taxes.” But had it come from a woman rather than Benjamin Franklin, she might have added “menopause” as a third certainty.
A universal and normal part of aging for women, menopause is when you cease having a menstrual cycle — one full year without it, to be exact. Menopause typically happens between the ages of 50 and 52, when the body runs out of eggs for reproduction and the ovaries stop producing estrogen.
But your reproductive system doesn’t suddenly just close up shop overnight. The menopause transition, as it’s known, usually starts years earlier. Understanding how the transition progresses can help shed light on why symptoms happen and, even better, how to minimize them.
Menopause: Why It Happens + What to Expect
The transition of menopause typically begins around age 45 with a stage called perimenopause. It’s during this phase that most women start to experience telltale symptoms like hot flashes, mood swings, and vaginal dryness, along with other common ones you may not realize are associated, such as brain fog, weight gain, and sleep problems.
“A lot of the symptoms you experience in perimenopause aren’t due to declining estrogen, as is often believed, but rather irregular estrogen,” says Dr. Bill Rawls, M.D., medical director of Vital Plan. “The ovaries are running out of immature eggs to become follicles, which in a normal cycle produce increasing amounts of estrogen until the egg is released during ovulation, after which estrogen declines. Fewer eggs means fewer follicles, and therefore irregular estrogen production.”
In other words, instead of a neat and tidy decline in estrogen all the way to menopause, estrogen levels in perimenopause chart more like a jagged, irregular heartbeat, with lots of peaks and valleys, moving in a general downward direction, until estrogen eventually bottoms out. That unpredictable, up-and-down of estrogen is why irregular periods are another common part of perimenopause.
It also causes imbalances in your hypothalamic-pituitary-adrenal axis (HPA axis), that then play a role in triggering typical menopause symptoms. It’s called an axis because its three key parts — the brain’s hypothalamus and the body’s pituitary and adrenal glands — are constantly sending messages back and forth that help balance the hormones that keep your body functioning optimally.
“The hypothalamus senses everything that the ovaries are doing, and it’s the one pushing the ovaries through each cycle,” Dr. Rawls says. It sends messages through the pituitary and adrenal glands in the form of hormones and other neurotransmitters, and receives feedback from all over the body. Along with helping to ensure proper functioning of the ovaries, the hypothalamus is also a key control center for body temperature, metabolism, sleep, and many other functions.
“Initially, when the ovaries start producing irregular estrogen levels and the hypothalamus is getting these irregular messages, it goes, ‘Whoa, wait a minute, what’s going on?!’” Dr. Rawls says. “It’s essentially getting bad feedback.” Or, at least feedback it doesn’t expect. And that can throw things off in a way that may contribute to hot flashes, weight gain, and more, he says.
While you can’t necessarily avoid symptoms of menopause entirely, there are factors you have some control over that can make the transition better — or worse. For instance, says Dr. Rawls, if you eat a poor diet, you’re sedentary, and you’re chronically stressed or exposed to toxins, “it produces additional bad feedback that disrupts your HPA axis, too, which exacerbates the effects of menopause.”
The good news is, treating your body well can have the opposite effect. “Healthy habits help normalize the body’s signaling systems, which will help everything work better,” Dr. Rawls says. And it’s never too late or too early to begin: Whether you’re in your 30s or the thick of the menopause, adopting the right habits can significantly reduce the physical and mental angst that come with the transition. Here are the seven key things to focus on, starting now.
7 Natural Ways to Ease Menopause Symptoms
Get or Stay Active
Exercise is like an amazing (and free!) multivitamin; it does all sorts of good things for your health, from improving heart and brain function and metabolism to helping you sleep, quelling stress, and boosting your mood. These are all areas that tend to suffer in menopause, which is why physical activity has been shown to have a direct impact on menopausal symptoms.
For example, research has shown that women who are physically active have fewer physical and psychological symptoms of menopause compared to those who are sedentary. One reason may be that exercise helps protect you from obesity, which is key since carrying around extra weight has been linked to more frequent symptoms, including hot flashes that persist well after you’ve hit the one-year, menopause mark.
But even if you’re currently sedentary, overweight, and dealing with rough symptoms, starting to exercise now is still a smart move. In one study, women in both perimenopause and postmenopause who began exercising moderately three days a week for 12 weeks saw improvement in their sleep quality, insomnia symptoms, and mood compared to a control group.
If you’re plagued by hot flashes — which around 80 percent of menopausal women are — purposefully breaking a sweat may be less than appealing. But that’s actually all the more reason to increase the intensity and frequency of your sweat sessions. Why? Athletes’ bodies naturally regulate temperature better compared to those who are only moderately active (e.g. they only walk for exercise) or inactive. Plus, the more fit you are, the more efficiently your blood vessels carry heat to the surface of skin and release it.
The best part is that you don’t need to sign on to Olympics-level training to reap the benefits. Researchers asked women who were experiencing hot flashes to embark on a 16-week exercise program that gradually upped the intensity of workouts until they were jogging or biking at a sweat-inducing clip for 45 minutes, four or five times a week. After four months, not only did the women’s cardiovascular health improve significantly, they also reported less intense hot flashes and 60 percent fewer of them.
2. Eat Lots of Fruits and Veggies
Reducing your intake of sugar and other processed, simple carbs and fatty meat can help keep weight in check and stabilize blood sugar and insulin levels (which can improve energy and mood), Dr. Rawls says. Plus, it helps balance your body’s response to the hormonal fluctuations in menopause.
For example, one study found that vegans reported less bothersome physical symptoms than omnivores. Other research reported that women who ate mostly fruits and veggies but weren’t necessarily vegans had fewer general, physical and mental symptoms, while those whose diets were filled with sweets, solid fats, and snack foods experienced more symptoms.
When it comes to hot flashes, specifically — which tend to be one of the most common and troubling parts of the menopause transition — research shows a healthier diet truly helps. In one study, researchers followed more than 17,000 women ages 50-79 who were encouraged to eat more fruit, veggies, and whole grains and reduce their intake of fat. Over time, women who improved their diet and/or lost weight thanks to the dietary changes reported fewer or less severe hot flashes.
There are likely multiple ways a plant-rich diet helps balance your body’s response to fluctuating estrogen levels. For one, plant foods are high in fiber, which may play a role in estrogen metabolism and stabilizing the hormone, according to researchers. What’s more, they’re rich in antioxidants that help reduce the inflammation that may also exacerbate symptoms.
Another explanation may be that a whole-food, plant-filled diet helps maintain a diverse and healthy mix of gut microbes. Turns out, gut bacteria are involved in regulating estrogen, too, but when the balance of bugs are off (aka in dysbiosis, which is often due to a poor diet), it can reduce circulating estrogen. While more research needs to be done, that gut microbiome effect could, in theory, contribute to more and more intense menopause symptoms.
3. Prioritize Sleep
Along with exercise and a healthy diet, sleep is vitally important. While you snooze, your body goes to work, re-balancing hormones and clearing out cellular debris, as well as cleaning up, reshuffling, and otherwise organizing your brain’s “files,” a process that helps you think more clearly, Dr. Rawls says. So no matter your age or menopause status, establishing a consistent sleep routine now will have far-reaching benefits.
Following all the other healthy tips here will help improve sleep and make it easier to drift off, including:
- Exercise. It helps builds up adenosine, which is a natural chemical in the brain that helps you feel sleepy and that helps usher in sleep, Dr. Rawls says.
- Be mindful of your sleep hygiene. Make sure your room is cool, dark, and quiet; avoid watching or reading exciting or suspenseful shows, movies, or books before bed; switch off blue-light emitting phones and computers a few hours before turning in; and try to go to bed and wake up at the same time, working backward to ensure you can log a full 8 hours of shut-eye.
- Don’t switch on the lights. If you tend to wake up in the middle of the night, stay in the dark and instead try to do some deep breathing or meditation.
- Consider cognitive behavioral therapy. Research suggests that CBT, which includes changing behaviors around how you sleep and prepare for sleep, can help make it easier to fall asleep and cut down on middle of the night awakenings.
The problem, of course, is that sleep disturbances are a hallmark symptom of the menopause transition — up to 56 percent of women report problems. For a quarter of women, sleep issues are severe enough that they interfere with day-to-day functioning and qualify as clinical insomnia. Unfortunately, sleep problems can then compound other menopause symptoms, like brain fog, mood disturbances, weight gain (lack of sleep interferes with hormones related to metabolism), and stress, all of which may then make it even harder to sleep, trapping you in a vicious cycle.
One solution that can help you get back on track: Calming, sedative herbs and other natural remedies, such as bacopa, passion flower, motherwort, tart cherries, and magnesium. All work on specific sleep pathways that help you wind down, feel more relaxed, or otherwise promote a good night’s rest.
4. Help Balance Hormones with Herbs
“Humans are made up of 10 billion cells and 200 different types of cells, and the only way we can function as a unit is if all those cells are talking to one another,” Dr. Rawls says. “Hormones and neurotransmitters basically connect cells and allow them to communicate.” But when hormone production becomes erratic or drops off — as it does during the menopause transition and in the year or two following menopause — things don’t run as smoothly.
“Normal hormones levels are extremely dynamic, because the body is constantly self-adjusting based on feedback,” Dr. Rawls says. “Herbs help modulate hormones, and they can help the body balance its signaling systems during the menopause transition.”
He likes ashwagandha and berberine: They work directly on the HPA axis that plays a key role in temperature regulation, sleep, metabolism, energy, and other functions. As a gynecologist, he saw firsthand the effects of the herbs.
“In my practice, I found that these balancing herbs, along with good health habits like a healthy diet, keeping stress down, and staying physically active, made a big difference in minimizing menopause symptoms,” says Dr. Rawls.
5. Reduce Your Exposure to Environmental Toxins
When your body is already trying to adjust to irregular estrogen levels, it may be especially sensitive to artificial estrogenic and other chemical compounds in your environment, Dr. Rawls warns. So be sure to drink filtered water, and try to reduce use of plastic bottles and containers and other chemical-containing household products.
“So many chemicals are estrogenic compounds,” Dr. Rawls explains. “And every cell in the body has estrogen receptors. So if you’re pinging those receptors with abnormal estrogen continually, it can cause real problems.”
For example, studies have found a link between early menopause and a common family of chemicals called Polyfluoroalkyl chemicals (PFCs) — potential endocrine disruptors found in plastic food containers and stain- and water-resistant coatings on clothes, furniture and carpet. The findings reveal that women with higher levels of PFCs in their systems went through menopause at a younger age than those with lower levels.
While the research doesn’t definitively show that the chemicals cause early menopause — it could be that menopause somehow changes the way the body detoxifies itself of the chemical — it’s worth trying to reduce your exposure to all chemicals that could potentially interfere with your body’s natural hormonal activity, Dr. Rawls says.
6. Practice Mindfulness
Life can be stressful, and going through the menopause transition — with all its effects on sleep, mood, weight, and more — can add even more potential stress to your plate. Mindfulness could be one antidote.
Known as an effective way to reduce stress, a new study from the Mayo Clinic links the calming practice to fewer menopause symptoms. Researchers surveyed 1,744 women ages 40-65 and found that those with higher mindfulness scores reported fewer symptoms, specifically irritability, anxiety, and depression.
The first step, according to study authors, is to simply recognize that the brain is often on autopilot, and to try to switch it off. Then, take some time to sit quietly with your thoughts. You needn’t try to manipulate them or empty your brain; rather, notice your thoughts, emotions, and mental activity without judgment, letting thoughts come in and out of your brain.
You can practice mindfulness through traditional forms of meditation, including guided meditation (plenty of apps like Calm can help). Or simply spend several quiet moments throughout the day, taking deep breaths and checking in with yourself.
7. Consider Cutting Out Caffeine
Caffeine is a stimulant that blocks adenosine, the sleep-promoting chemical in your brain. So, if you’re experiencing sleep problems, it’s smart to limit your intake only to the morning, cut back on the amount, or possibly quit caffeine all together, Dr. Rawls says.
In particular, if you’re also struggling with hot flashes, try avoiding caffeine entirely to see if symptoms improve. In a study of more than 2,500 women, those who regularly consumed caffeine reported worse hot flashes and night sweats than those who didn’t.
Indeed, while menopause is a part of life for women, you don’t have to silently suffer through the often-debilitating and havoc-wreaking symptoms. And remember, if menopause is still years away for you, taking steps now to ingrain symptom-mitigating healthy habits is a worthwhile investment in your future wellbeing. Because while many menopausal symptoms subside after the transition, the choice to take care of yourself and your health will keep paying off long after the last hot flash cools.
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