Introduction
Menopause is a natural transition that occurs in women, typically between the ages of 45-55. During this time, hormonal changes can lead to various symptoms such as hot flushes, night sweats, mood swings, sleep disturbances, and bone density loss (Shifren et al., 2014; Santoro et al., 2015). While hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, some women prefer non-hormonal approaches, including dietary changes and supplements (The North American Menopause Society, 2022).
Navigating the world of supplements for menopause can be overwhelming, with countless products claiming to alleviate symptoms and improve overall health. This comprehensive guide aims to provide evidence-based information on the best supplements for menopause, focusing on key research findings and expert recommendations. By understanding the potential benefits and risks associated with various supplements, women can make informed decisions about their health during this transformative period.
Understanding Menopause and Its Symptoms
Menopause is defined as the permanent cessation of menstrual periods, marking the end of a woman’s reproductive years. The menopausal transition, also known as perimenopause, typically begins several years before the final menstrual period and can last for several years after (Santoro et al., 2015). During this time, women may experience a range of symptoms due to hormonal fluctuations, particularly the decline in oestrogen levels.
Common symptoms experienced by women during menopause include:
- Hot flushes and night sweats: Sudden feelings of heat, often accompanied by sweating and flushing of the skin (Shifren et al., 2014).
- Mood changes: Irritability, anxiety, and depression (Santoro et al., 2015).
- Sleep disturbances: Difficulty falling asleep or staying asleep, often due to night sweats (Shifren et al., 2014).
- Vaginal dryness and discomfort: Thinning and drying of the vaginal tissues, which can lead to pain during intercourse (Santoro et al., 2015).
- Bone density loss: Accelerated bone loss due to decreased oestrogen levels, increasing the risk of osteoporosis (Shifren et al., 2014).
These symptoms can vary in severity and duration among women, with some experiencing mild discomfort while others may have more severe and disruptive symptoms (Santoro et al., 2015). Hormonal changes during menopause can also impact overall health, increasing the risk of cardiovascular disease, cognitive decline, and other chronic conditions (Shifren et al., 2014).
The Role of Nutrition and Supplements in Managing Menopausal Symptoms
A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats is essential for promoting overall health during menopause (Kalinik & Ward, 2020). However, some women may benefit from additional nutritional support through dietary supplements to help alleviate menopausal symptoms and reduce the risk of chronic diseases.
Before starting any new supplement regimen, it is crucial to consult a healthcare professional to discuss potential benefits, risks, and interactions with existing medications (Kalinik & Ward, 2020). Some supplements may not be suitable for women with certain health conditions or those taking specific medications.
Probiotics and Gut Health
The gut microbiome plays a crucial role in postmenopausal health, influencing symptoms such as hot flushes, mood changes, and sleep disturbances (Chen et al., 2023). A healthy gut microbiome is characterised by a diverse array of beneficial bacteria that help maintain digestive function, immune health, and overall well-being.
The gut microbiome’s influence on postmenopausal health and symptoms
Recent research has highlighted the connection between the gut microbiome and postmenopausal health. A systematic review by Chen et al. (2023) found that postmenopausal women with a less diverse gut microbiome were more likely to experience severe menopausal symptoms, such as hot flushes, mood changes, and sleep disturbances. The authors suggest that the decline in oestrogen levels during menopause may contribute to alterations in the gut microbiome, which in turn can exacerbate menopausal symptoms.
Potential benefits of probiotics for maintaining a healthy gut microbiome and relieving menopausal symptoms
Probiotics are live microorganisms that, when consumed in adequate amounts, can provide health benefits by promoting a balanced gut microbiome (Sathyapalan et al., 2021). Some studies have investigated the potential of probiotics for alleviating menopausal symptoms and maintaining overall health during this transitional period.
A randomised, double-blind, placebo-controlled study by Sathyapalan et al. (2021) found that supplementation with a specific probiotic strain (Lactobacillus plantarum DR7) for 12 weeks significantly reduced hot flushes, improved sleep quality, and enhanced overall quality of life in postmenopausal women compared to a placebo group. The authors suggest that the probiotic may help modulate the gut microbiome and reduce inflammation, which could contribute to its beneficial effects on menopausal symptoms.
However, more research is needed to confirm the effectiveness of probiotics for managing menopausal symptoms and to identify the specific strains and dosages that may be most beneficial (Chen et al., 2023). As with any supplement, it is essential to consult a healthcare professional before starting a probiotic regimen to ensure safety and appropriateness for individual needs.
Vitamin D and Calcium
Vitamin D and calcium are essential nutrients for maintaining bone health, which is particularly important during menopause when the risk of osteoporosis increases due to declining oestrogen levels (Silva et al., 2023).
Prevalence of vitamin D deficiency in postmenopausal women and its impact on health
Vitamin D deficiency is common among postmenopausal women, with prevalence rates ranging from 30-90% depending on the population and geographical location (Silva et al., 2023). Low vitamin D levels can contribute to various health issues, including:
- Increased risk of osteoporosis and fractures (Silva et al., 2023)
- Cardiovascular disease (Silva et al., 2023)
- Cognitive decline and dementia (Silva et al., 2023)
- Mood disorders, such as depression (Silva et al., 2023)
Adequate vitamin D intake, either through diet, sunlight exposure, or supplementation, is crucial for maintaining optimal health during menopause.
Recommended daily intake of vitamin D and calcium for maintaining bone health
The recommended daily intake of vitamin D for women aged 51-70 years is 600-800 IU (15-20 mcg), while the recommended daily intake of calcium is 1200 mg (National Institutes of Health, 2021). However, some studies suggest that higher doses of vitamin D may be necessary to achieve optimal blood levels and support bone health in postmenopausal women (Ushiroyama et al., 2002; Kuang et al., 2020).
A meta-analysis by Kuang et al. (2020) found that the combination of vitamin K2 and vitamin D3 supplementation was more effective in improving bone mineral density and reducing fracture risk in postmenopausal women compared to vitamin D3 alone. The authors suggest that vitamin K2 may enhance the beneficial effects of vitamin D3 on bone health by promoting the activation of osteocalcin, a protein essential for bone mineralisation.
It is important to note that excessive intake of vitamin D and calcium can lead to adverse effects, such as kidney stones and gastrointestinal issues (National Institutes of Health, 2021). Therefore, it is essential to consult a healthcare professional to determine the appropriate dosage based on individual needs and health status.
Magnesium
Magnesium is an essential mineral involved in numerous bodily functions, including bone health, energy production, and muscle and nerve function (National Institutes of Health, 2021). During menopause, magnesium supplementation may help alleviate certain symptoms and support overall health.
Potential benefits of magnesium supplements, particularly magnesium glycinate, for menopausal symptoms
Magnesium supplements, particularly magnesium glycinate, have been studied for their potential benefits in managing menopausal symptoms. A double-blind, placebo-controlled clinical trial by Abbasi et al. (2012) found that magnesium supplementation (250 mg magnesium oxide twice daily) for 8 weeks significantly improved insomnia symptoms in elderly participants compared to a placebo group. The authors suggest that magnesium may help regulate neurotransmitters involved in sleep, such as gamma-aminobutyric acid (GABA).
Another study by Kawai et al. (2015) investigated the effects of the amino acid glycine on sleep quality and found that glycine supplementation improved subjective sleep quality and reduced fatigue in individuals with mild sleep complaints. As magnesium glycinate contains both magnesium and glycine, it may provide additional benefits for sleep quality and stress reduction in menopausal women.
Magnesium’s role in maintaining bone density and reducing the risk of osteoporosis
Magnesium plays a crucial role in bone health by regulating calcium metabolism and supporting bone mineralisation (National Institutes of Health, 2021). Low magnesium levels have been associated with an increased risk of osteoporosis and fractures in postmenopausal women.
A systematic review and meta-analysis by Veronese et al. (2017) found that higher dietary magnesium intake was associated with a 27% lower risk of osteoporosis in postmenopausal women compared to those with lower intakes. The authors suggest that magnesium may help maintain bone density by reducing inflammation and oxidative stress, which can contribute to bone loss.
Recommended forms of magnesium supplements, such as magnesium glycinate and magnesium citrate
When choosing a magnesium supplement, it is important to consider the form of magnesium as well as the dosage. Magnesium glycinate and magnesium citrate are two well-absorbed forms of magnesium that are less likely to cause gastrointestinal side effects compared to other forms, such as magnesium oxide (National Institutes of Health, 2021).
The recommended daily allowance (RDA) for magnesium is 320 mg for women aged 31 and older (National Institutes of Health, 2021). However, individual needs may vary depending on factors such as diet, health status, and medications. It is essential to consult a healthcare professional to determine the appropriate form and dosage of magnesium supplementation.
Phytoestrogens
Phytoestrogens are plant-derived compounds that have a similar structure to oestrogen and can bind to oestrogen receptors in the body, exerting weak oestrogenic effects (Chen et al., 2019). Some women may turn to phytoestrogens as a natural alternative to hormone replacement therapy for managing menopausal symptoms.
Definition of phytoestrogens and their oestrogenic effects in the body
Phytoestrogens are classified into several main categories, including isoflavones, lignans, and coumestans (Chen et al., 2019). Isoflavones, found primarily in soybeans and soy products, are the most well-studied phytoestrogens in relation to menopausal health.
When consumed, phytoestrogens can bind to oestrogen receptors in various tissues, such as the breast, bone, and brain, and exert weak oestrogenic effects (Chen et al., 2019). These effects may help alleviate menopausal symptoms and support overall health, although the evidence is mixed.
Sources of phytoestrogens, including soy isoflavones, red clover, and flaxseed
Soy isoflavones are the most common dietary source of phytoestrogens, with high concentrations found in soybeans, tofu, tempeh, and soy milk (Chen et al., 2019). Red clover (Trifolium pratense) is another rich source of isoflavones, particularly biochanin A and formononetin, which are converted to genistein and daidzein in the body (Ghazanfarpour et al., 2015).
Flaxseed is a rich source of lignans, another type of phytoestrogen that has been studied for its potential health benefits in menopausal women (Lambert et al., 2017). Lignans are converted by gut bacteria into enterolactone and enterodiol, which can exert weak oestrogenic effects in the body.
Mixed evidence regarding the effectiveness and safety of phytoestrogens for menopausal symptoms
While some studies have suggested that phytoestrogens may help alleviate menopausal symptoms, such as hot flushes and vaginal dryness, the evidence is mixed (Chen et al., 2019; Ghazanfarpour et al., 2015; Lambert et al., 2017).
A systematic review and meta-analysis by Chen et al. (2019) found that soy isoflavone supplementation significantly reduced the frequency and severity of hot flushes in menopausal women compared to placebo. However, the authors noted that the quality of evidence was low to moderate due to heterogeneity among studies and potential bias.
Another systematic review and meta-analysis by Ghazanfarpour et al. (2015) investigated the effects of red clover on menopausal symptoms and found that red clover supplementation significantly reduced hot flush frequency and severity compared to placebo. However, the authors cautioned that the included studies had limitations, such as small sample sizes and short duration, and that more research is needed to confirm the long-term efficacy and safety of red clover for menopausal symptoms.
Regarding flaxseed, a systematic review and meta-analysis by Lambert et al. (2017) found mixed results on its effectiveness for menopausal symptoms. While some studies reported improvements in hot flushes and other symptoms, others found no significant benefits compared to placebo. The authors concluded that more high-quality, long-term studies are needed to determine the efficacy and safety of flaxseed for menopausal health.
It is important to note that phytoestrogens may not be suitable for all women, particularly those with a history of oestrogen-sensitive cancers, such as breast cancer (Chen et al., 2019). Additionally, some studies have raised concerns about the potential long-term effects of high-dose phytoestrogen supplementation on endometrial and breast tissue (Chen et al., 2019). Therefore, it is essential to consult a healthcare professional before starting any phytoestrogen supplement regimen to discuss potential benefits and risks based on individual health status and medical history.
Black Cohosh
Black cohosh (Actaea racemosa) is a perennial herb native to North America that has been traditionally used for centuries to manage menopausal symptoms (Leach & Moore, 2012). The root and rhizome of the plant contain several compounds, including triterpene glycosides and phenolic acids, which are believed to be responsible for its potential therapeutic effects (Leach & Moore, 2012).
Traditional use of black cohosh for managing menopausal symptoms
Black cohosh has been used in traditional herbal medicine to treat a variety of women’s health issues, including menstrual irregularities, premenstrual syndrome, and menopausal symptoms (Leach & Moore, 2012). Its popularity as a natural remedy for menopausal symptoms has grown in recent years, particularly among women seeking alternatives to hormone replacement therapy.
Inconsistent evidence on the effectiveness of black cohosh for reducing hot flushes
Despite its widespread use, the evidence on the effectiveness of black cohosh for reducing hot flushes and other menopausal symptoms is inconsistent (Leach & Moore, 2012; National Institutes of Health, 2020).
A Cochrane systematic review by Leach and Moore (2012) evaluated the efficacy and safety of black cohosh for menopausal symptoms. The authors included 16 randomised controlled trials involving 2,027 perimenopausal or postmenopausal women. The review found insufficient evidence to support the use of black cohosh for menopausal symptoms, with most studies reporting no significant differences between black cohosh and placebo in reducing hot flushes or improving other symptoms.
However, some individual studies have reported positive effects of black cohosh on menopausal symptoms. For example, a randomised, double-blind, placebo-controlled trial by Shahnazi et al. (2013) found that a standardised black cohosh extract (6.5 mg daily for 8 weeks) significantly reduced the frequency and severity of hot flushes in postmenopausal women compared to placebo.
The inconsistencies in the evidence may be due to variations in the quality and composition of black cohosh preparations, as well as differences in study design and population characteristics (Leach & Moore, 2012). More high-quality, well-controlled studies are needed to determine the efficacy and optimal dosage of black cohosh for menopausal symptoms.
Precautions and potential interactions with medications
While black cohosh is generally considered safe when used in recommended doses for short periods (up to 6 months), it may cause side effects in some individuals, such as gastrointestinal upset, headache, and dizziness (National Institutes of Health, 2020). Rare cases of liver damage have been reported in association with black cohosh use, although a causal relationship has not been established (National Institutes of Health, 2020).
Black cohosh may also interact with certain medications, such as hormone replacement therapy, birth control pills, and blood pressure medications (National Institutes of Health, 2020). Therefore, it is essential to consult a healthcare professional before using black cohosh, particularly for individuals with pre-existing health conditions or those taking medications.
St. John’s Wort
St. John’s Wort (Hypericum perforatum) is a flowering plant that has been used for centuries in traditional medicine to treat a variety of conditions, including depression, anxiety, and sleep disorders (Abdali et al., 2019). In recent years, it has gained attention for its potential benefits in alleviating menopausal symptoms, particularly depression and hot flushes.
Potential benefits of St. John’s Wort for alleviating menopausal symptoms, particularly depression and hot flushes
A randomised, double-blind, placebo-controlled study by Abdali et al. (2019) investigated the effects of St. John’s Wort on menopausal
Conclusion
In conclusion, while certain supplements may provide relief from menopausal symptoms, it is crucial to approach their use with caution and under the guidance of a healthcare professional. A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats remains the foundation for promoting overall health during menopause. Regular exercise, stress management techniques, and maintaining a healthy sleep routine are also essential lifestyle factors that can help alleviate menopausal symptoms and improve quality of life.
The most promising supplements for managing menopausal symptoms include probiotics for maintaining gut health, vitamin D and calcium for bone health, magnesium for sleep and bone density, and phytoestrogens like soy isoflavones and red clover for reducing hot flushes. However, the evidence regarding the effectiveness and safety of these supplements is mixed, and more high-quality research is needed to confirm their benefits. Black cohosh, St. John’s Wort, DHEA, and ginseng have also shown potential for alleviating menopausal symptoms, but their efficacy and safety require further investigation.
Ultimately, the decision to use supplements for menopause should be made in collaboration with a healthcare provider who can assess individual needs, health status, and potential risks. By combining a nutrient-dense diet, regular physical activity, stress reduction techniques, and carefully selected supplements when appropriate, women can navigate the menopausal transition with greater ease and maintain optimal health during this transformative stage of life.
Key Highlights and Actionable Tips
- Menopause is a natural transition that occurs in women, typically between the ages of 45 and 55.
- Common symptoms of menopause include hot flushes, night sweats, mood changes, and sleep disturbances.
- Lifestyle changes such as regular exercise, a balanced diet rich in fruits, vegetables, and whole grains, and stress management techniques can help alleviate menopausal symptoms.
- Certain supplements, such as vitamin D, calcium, magnesium, and phytoestrogens, may be beneficial for managing menopause symptoms and supporting overall health.
- Always consult with a healthcare professional before starting any new supplement regimen to ensure safety and appropriateness for your individual needs.
How can I manage hot flushes and night sweats during menopause?
Hot flushes and night sweats are common symptoms of menopause. To manage these symptoms, try wearing lightweight, breathable clothing, keeping your bedroom cool at night, and practicing relaxation techniques such as deep breathing or meditation. Some women find relief from hot flushes by using a fan or taking a cool shower. Additionally, avoiding triggers such as spicy foods, caffeine, and alcohol may help reduce the frequency and severity of hot flushes.
Are there any natural supplements that can help with menopausal mood changes?
Some natural supplements that may help with menopausal mood changes include St. John’s Wort, which has been shown to improve mild to moderate depression, and omega-3 fatty acids, which have anti-inflammatory properties and may help regulate mood. Magnesium supplements may also be beneficial, as magnesium plays a role in the production of serotonin, a neurotransmitter involved in mood regulation. However, it is important to consult with a healthcare professional before taking any supplements, as they can interact with medications and have potential side effects.
Can dietary changes help alleviate menopause symptoms?
Yes, dietary changes can play a role in managing menopause symptoms. Eating a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help support overall health during menopause. Some specific dietary changes that may be beneficial include increasing intake of phytoestrogen-rich foods such as soybeans, flaxseeds, and legumes, which may help balance hormone levels, and reducing intake of processed foods, refined sugars, and alcohol, which can exacerbate symptoms such as hot flushes and mood changes.
How much calcium and vitamin D do I need during menopause?
Adequate calcium and vitamin D intake is important for maintaining bone health during menopause, as the decline in oestrogen levels can lead to increased bone loss. The recommended daily allowance (RDA) for calcium is 1,200 mg per day for women over 50, and the RDA for vitamin D is 600-800 IU per day for adults. Good dietary sources of calcium include dairy products, leafy green vegetables, and fortified foods, while vitamin D can be obtained through sun exposure, fatty fish, and fortified foods. If you are unable to meet your calcium and vitamin D needs through diet alone, your healthcare provider may recommend supplements.
What role does exercise play in managing menopause symptoms?
Regular exercise can play an important role in managing menopause symptoms and supporting overall health during this transition. Exercise can help reduce the frequency and severity of hot flushes, improve sleep quality, boost mood, and maintain bone density. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, along with strength training exercises at least twice per week. Low-impact activities such as walking, swimming, and cycling are good options for women during menopause. It is important to listen to your body and choose activities that you enjoy to help maintain a consistent exercise routine.
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