These hormonal shifts can cause a broad range of symptoms, many of which can be managed with supplements and lifestyle changes. This guide provides a breakdown of how natural supplements can help manage the stages of perimenopause and menopause and can help support or ease symptoms.
What is Perimenopause?
Perimenopause marks the years leading up to menopause, characterised by a gradual decline in ovarian function. During this period, oestrogen and progesterone levels fluctuate, leading to physical and emotional symptoms often associated with perimenopause. This hormonal fluctuation causes ovulation to be inconsistent, resulting in irregular periods, either with skipped cycles, longer or shorter cycles, or heavier or lighter bleeding- this unpredictability of the menstrual cycle is a hallmark of perimenopause.
The erratic nature of oestrogen production contributes to many other symptoms, including hot flashes, mood swings, and sleep disturbances. Hot flashes are caused by vasomotor instability, a condition where fluctuating oestrogen levels disrupt the body’s ability to regulate temperature. The hypothalamus, which controls body temperature, becomes more sensitive to slight changes in core body heat, triggering hot flashes as the body attempts to cool down.
Hormonal fluctuations during perimenopause, especially with oestrogen and progesterone levels, directly impact neurotransmitters in the brain, including serotonin and GABA. Serotonin regulates mood and emotional well-being, and its imbalance can lead to mood swings, irritability, and increased anxiety or depression. Progesterone has a calming effect on the brain, so its decline can make perimenopausal women more prone to irritability or emotional fluctuations.
Oestrogen helps regulate metabolism and fat distribution, so as levels drop, metabolism slows down, and the body tends to store more fat, particularly around the abdomen, resulting in weight gain [2].
Testosterone, an androgen hormone, plays a key role in sexual desire in both men and women. During perimenopause, levels of androgens, including testosterone, begin to decline. This decrease in testosterone can lead to a reduced libido (sex drive) and less interest in sexual activity. The reduction in oestrogen can also contribute by causing vaginal dryness and discomfort during intercourse, making sexual activity less enjoyable.
What is Menopause?
Menopause is officially diagnosed after a woman has gone twelve consecutive months without a menstrual period, signalling the end of ovarian hormone production and the transition into post-reproductive life. Unlike perimenopause, which is characterised by fluctuating hormones, menopause marks a more permanent and significant drop in oestrogen and progesterone levels. This decline has widespread effects on several body systems.
Oestrogen, which plays a protective role in cardiovascular, bone, and skin health, decreases sharply during menopause. This drop in oestrogen is responsible for common symptoms like hot flashes, as the hypothalamus, the body’s temperature regulator, struggles to maintain normal body heat. Additionally, low oestrogen levels lead to the thinning of vaginal tissues, causing dryness and discomfort during intercourse, and contribute to bone density loss, increasing the risk of osteoporosis. As with perimenopause, and due to the drop in oestrogen and progesterone levels, menopausal symptoms also include thinning hair, dry skin, irritability, mood swings, and sleep disturbances [5].
Supplements for Perimenopause and Menopause Management
Ashwagandha
Ashwagandha is beneficial for women going through perimenopause due to its adaptogenic properties, which help the body modulate stress and maintain hormonal balance. During perimenopause, fluctuating oestrogen and progesterone levels can lead to increased stress, anxiety, mood swings, and disrupted sleep. Ashwagandha helps regulate cortisol, the body’s primary stress hormone, which can become elevated during this phase and further disrupt hormonal balance. Additionally, ashwagandha supports adrenal health, which is crucial during perimenopause when the ovaries gradually reduce hormone production, and the adrenal glands take over some hormone regulation [1].
Magnesium
During the transition into menopause, hormonal fluctuations can increase stress levels and cortisol production. Elevated cortisol can disrupt the balance of other hormones, leading to symptoms such as mood swings, anxiety, and sleep disturbances such as hot flashes and night sweats. The hypothalamic-pituitary-adrenal axis (HPA) is the system that controls the release of cortisol into the body.
Magnesium supports the proper functioning of the HPA axis by influencing the signals between the hypothalamus, pituitary gland, and adrenal glands. In this way, adequate magnesium levels ensure that cortisol levels are appropriately regulated and prevent excessive cortisol secretion. By helping to normalise cortisol levels, magnesium supports overall hormonal balance and reduces stress-related symptoms. Magnesium also supports relaxation and improves sleep quality by regulating brain neurotransmitters that influence sleep, such as GABA [3].
Omega-3 Fatty Acids
Omega-3 fatty acids, particularly DHA (docosahexaenoic acid), play a vital role in maintaining brain health and emotional well-being, which is especially important during menopause when fluctuating hormone levels can significantly impact mood. DHA is a structural component of brain cell membranes and helps keep these membranes fluid and flexible, which is essential for efficient communication between brain cells.
When cell membranes are healthy and flexible, they facilitate better signaling between neurons, which supports cognitive function and overall brain health. During menopause, when hormonal changes (especially declining oestrogen levels) affect brain function and mood changes, maintaining the health of these cell membranes with DHA becomes crucial for sustaining memory, focus, and mood stability [7].
Vitamin D
Vitamin D aids in calcium absorption which is crucial for bone strength and formation and works synergistically with oestrogen to support bone health. Without adequate vitamin D, the body cannot absorb enough calcium, which can impair bone health.
Oestrogen is important for maintaining bone density, so during menopause when oestrogen levels significantly decline, bone resorption outpaces bone formation. This results in bone loss and an increased risk of developing osteoporosis, a condition characterised by weakened bones that are more susceptible to fractures. In this way, adequate vitamin D levels ensure that bones remain strong as oestrogen levels fluctuate during perimenopause or decline in menopause [6].
NMN
NMN is a precursor to NAD+ (nicotinamide adenine dinucleotide), a molecule that is crucial for energy production in cells. As women age and enter menopause, NAD+ levels naturally decline, which can lead to fatigue, decreased metabolism, and age-related symptoms. By supplementing with NMN, NAD+ levels can be restored, helping boost mitochondrial function and energy production, which is particularly useful in counteracting the fatigue and metabolic slowdowns associated with menopause.
Sulforaphane
Sulforaphane is a potent compound present in cruciferous vegetables such as broccoli, Brussels sprouts, and cauliflower, recognised for its antioxidant and detoxifying abilities. Women experiencing perimenopause and menopause often face hormone fluctuations that can elevate oxidative stress and inflammation, leading to symptoms like hot flashes, mood swings, and a higher risk of hormone-related cancers. Sulforaphane mitigates these effects by neutralising free radicals and activating the body’s natural detoxification processes, especially in the liver, to eliminate excess hormones like oestrogen. Additionally, it boosts the production of Phase II detoxification enzymes, which are essential for metabolising and excreting harmful substances and surplus hormones.
What is Hormone Replacement Therapy?
Hormone Replacement Therapy (HRT) is a medical treatment designed to relieve symptoms of perimenopause and menopause by supplementing the body with hormones that are naturally in decline, primarily oestrogen, and in some cases, progesterone. There are two main types of HRT: oestrogen-only therapy (for women who have had a hysterectomy) and combined oestrogen-progesterone therapy (for women who still have their uterus). The therapy works by restoring hormone levels, which can help manage menopausal symptoms.
HRT is effective in reducing the frequency and severity of vasomotor (nerves and mechanisms that regulate the contraction and relaxation of blood vessels) symptoms like hot flashes and night sweats, which are triggered by the hypothalamus’s (a crucial part of the brain that regulates various physiological processes) impaired ability to regulate body temperature due to low oestrogen levels.
HRT is also protective against osteoporosis, a condition exacerbated by oestrogen deficiency that may lead to reduced bone density and an increased risk of fractures. Furthermore, when started in early menopause, HRT may provide cardiovascular benefits by improving cholesterol levels and arterial function. Oestrogen also plays a crucial role in lipid metabolism; when oestrogen is replaced through HRT, it helps to increase levels of high-density lipoprotein (HDL), or “good” cholesterol, which protects the arteries by transporting cholesterol away from them and back to the liver for excretion.
It is important to note, however, that studies have shown that certain forms of HRT, especially combined oestrogen-progesterone therapy, may increase the risk of breast cancer, blood clots, and stroke. The increased risk of blood clots is due to the oestrogen component’s effect on liver protein production, which can lead to enhanced clotting factors. In terms of breast cancer, the risk may increase with long-term use of combined HRT, as progesterone appears to promote the growth of hormone-sensitive breast cells. These risks are generally higher for older women with pre-existing conditions, so HRT should be carefully tailored to each individual’s health history [8].
Navigating perimenopause and menopause can be challenging due to the hormonal shifts that impact various aspects of physical and emotional health. Understanding the key symptoms of both stages can help women take proactive steps in managing these transitions. Supplements such as magnesium, omega-3s, sulforaphane, and others play an important role in alleviating many of these symptoms by supporting hormonal balance, mental health, and overall well-being.
Remember to always consult your healthcare provider before starting a new supplement regime to ensure it fits your personal health requirements.
Reference |
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1. Stylist. Best hormone-supporting supplements. [Internet]. Available from: stylist.co.uk |
NICHD. About menopause | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development. [Internet]. Available from: https://www.nichd.nih.gov/health/topics/menopause. |
3. Borel M, Tardy AL, Galan P, et al. Magnesium intake and risk of hormone-related cancers in women. J Nutr. 2021;151(2):387-398. Available from: oup.com |
4. Mayo Clinic. Menopause – Symptoms and causes [Internet]. Available from: mayoclinic.org |
5. Cleveland Clinic. Menopause: Symptoms, Causes, Diagnosis, Treatment. [Internet] Available from: clevelandclinic.org |
6. Osteoporosis Canada. Vitamin D and Calcium: What You Need to Know [Internet]. Available from: osteoporosis.ca |
7. Harvard T.H. Chan School of Public Health. Omega-3 Fatty Acids: An Essential Contribution [Internet]. Available from: hsph.harvard.edu |
8. National Center for Biotechnology Information. Hormone therapy [Internet]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000– [updated 2021 Jan 5; cited 2024 Sep 20]. Available from: ncbi.nlm.nih.gov |