Top Menopause Tips

By Dr. John Neustadt

Although women spend 30%-40% of their lives in menopause, obstetricians and gynecologists get little formal education about menopausal health.¹  The transition into menopause is a seminal event in a woman’s life. It signals the end of her reproductive years and is often accompanied by uncomfortable, even debilitating, symptoms.  

Up to 75% of women experience hot flashes that can frequently last five years and, in some cases, ten years or longer.² Women going through menopause also often experience night sweats, difficulty sleeping, decreased mood, feeling anxious, fatigue, weight gain, bone loss, insulin resistance, vaginal dryness, increased cholesterol, and thinning skin.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) remains one of the best ways to manage menopausal symptoms; however, one study in the early 2000s cast doubt on its safety. The study reported findings from the Women’s Health Initiative (WHI) randomized placebo-controlled trial (RCT). The researchers concluded that HRT could increase a woman’s risk of cardiovascular disease and blood clots that could lead to heart attacks and strokes. For decades after, doctors were fearful of prescribing HRT.

As a result, millions of women suffered. However, later studies clarified that HRT risk depends on whether estrogen is taken with progesterone and how the estrogen is administered. HRT can be taken orally, through the skin as a transdermal cream, or as a time-release implant. For healthy women without any underlying medical issues, transdermal HRT has not been linked to a higher risk of blood clots.³

Beyond improving menopausal symptoms, HRT also reduces disease risks and all-cause mortality. Women in the National Osteoporosis Risk Assessment (NORA) taking hormone replacement therapy had a 40% lower risk of hip fractures compared to women who had never used hormone replacement therapy.⁴ Numerous other studies have confirmed the ability of HRT to improve bone density and maintain strong bones alone and in combination with progesterone.^5,6 

HRT is also associated with a 48% lower risk of coronary heart disease and 38% lower all-cause mortality.^7,8 When started less than six years after menopause, HRT is also associated with less progression of atherosclerosis.⁹ 

There are certain people, however, for whom HRT can create dangerous risks, especially in women with a history of hormone receptor-positive breast cancer. A systematic review and meta-analysis pooled data from four randomized clinical trials with 4050 women with a history of breast cancer. In patients with hormone receptor-positive breast cancer, such as estrogen receptor-positive breast cancer, there was an 80% increased risk of recurrence compared to placebo. This was not the case in women without hormone-positive breast cancer.¹⁰ Ensuring you’re thoroughly screened before taking HRT is essential to ensure safety.  

Diet

Eating healthy is one of the most important things you can do for yourself. Diet is the foundation of overall health and longevity. Studies have shown that a healthy diet reduces your risk of dying and can reverse your biological age. Eating healthy also reduces your risks of health issues like heart disease, diabetes, cognitive decline, and bone loss.

Plant-based diet
A plant-based diet that includes soybeans has been associated with significant improvements in menopausal symptoms, especially hot flashes. A randomized, controlled clinical trial of 84 postmenopausal women ages 40-65 demonstrated that a low-fat vegan diet with half a cup of non-genetically modified soybeans daily significantly reduced the frequency and severity of moderate-to-severe hot flashes and improved sexual function. The total number of hot flashes decreased by 79% in the women following the special diet and by 39% in the control group. Moderate-to-severe hot flashes decreased by 88% in women following the diet compared to 34% in the control group.¹¹  

While eating more whole foods is healthy, vegans and vegetarians are at higher risk for osteoporosis. A 2021 systematic review and meta-analysis of seventeen studies with nearly 14,000 volunteers concluded that vegan and vegetarian diets are associated with lower bone mineral density.¹² This might be because these diets put people at risk of protein insufficiency.  

Other researchers found that vegans and vegetarians also don’t consume enough of the healthy omega-3 fats essential for heart, mood, and brain health.^13,14  

Mediterranean diet
Following a Mediterranean diet is associated with fewer menopausal symptoms. Women following this diet, rich in vegetables, fruits, whole grains, legumes, and healthy fats like extra-virgin olive oil, experience lower severity of menopausal symptoms, including emotional symptoms and hot flashes.¹⁵  

Supporting these findings, researchers looked at the dietary patterns of postmenopausal women. They found that those who more closely followed a Mediterranean Diet had an incredible 20% decreased risk of hip fractures.¹⁶ Hip fractures are the most dangerous type of fracture. If you have bone loss and break a hip, your risk of dying is increased for up to 10 years.¹⁷ Reducing hot flashes and hip fracture risk simply by changing your diet is a no-brainer. 

Processed foods
While it’s essential to focus on what foods you can add to your diet, equally important is reducing foods that worsen menopausal symptoms and cause other health problems.  A cross-sectional study indicated that the more people adhere to a whole plant foods diet, the lower their menopausal symptoms. However, the study also found that the more processed foods someone ate, the greater their symptoms. This means that in addition to following a plant-forward diet, reducing the amount of processed foods you eat is also important.¹⁸

Exercise

People can do many types of exercise; however, clinical trials don’t show consistent improvements in menopausal symptoms. Therefore, it’s essential to realize that because one type of exercise didn’t work for you, another might. The overall health benefits of exercise are indisputable for mood, bone health, strength and balance, and more. Keep trying different types of exercise until you find the ones that work best for you.  

Mind-body exercises
such as tai chi, yoga, Pilates, qigong, and mindfulness-based stress reduction have been shown to significantly improve bone mineral density, sleep quality, feeling anxious, mood, and energy in perimenopausal and postmenopausal women.  

Yoga, in particular, has demonstrated effectiveness in helping women feel better. A systematic review and meta-analysis of thirteen clinical trials with 1306 volunteers showed that yoga significantly improved many menopausal symptoms. The women who regularly practiced yoga had lower total symptoms, better psychological health, and fewer hot flashes than women who did not practice yoga.¹⁹ 

Resistance training
Resistance exercises improve bone mineral density, reduce the frequency of hot flashes, and burn fat in postmenopausal women.²⁰  

In a clinical trial with 58 women with a mean age of 55, fifteen weeks of resistance exercise reduced hot flashes by at least 50% in nearly half of the volunteers. Women did six exercises three times a week: seated resistance machines and two body-weight exercises that included chest presses, leg presses, seated rows, leg curls, latissimus dorsi pull-downs, leg extensions, crunches, and back raises. The women did two sets of 8–12 repetitions of the seated exercises, with a two-minute rest between sets. Additionally, two body-weight exercises were done to exhaustion (approximately 20 repetitions per set).²¹  

While resistance exercise is healthy, modifying your exercises to ensure your safety if you have osteoporosis is essential. For example, a clinical trial in the 1980s showed that women doing crunches (e.g., sit-ups) increased their risk for vertebral fractures.²² 

Aerobic exercises
have shown inconsistent results but can still be beneficial for some menopausal symptoms. For instance, aerobic exercise has been associated with improved blood pressure and quality of life scores in postmenopausal women.²³ 

Dietary Supplements

Several dietary supplement nutrients have been shown in clinical trials to reduce menopausal symptoms: 

Isoflavones
Isoflavones are bioflavonoids abundant in soybeans, red clover, and alfalfa. Intestinal bacteria metabolize isoflavones into bioactive compounds, including S-equol, which is for the benefits seen in clinical trials. S-equol improves hot flashes by binding to and activating estrogen receptors.²⁴  

Isoflavones and S-equol have effectively reduced hot flashes and other challenges women experience with menopause. For example, soy isoflavones at 90 mg/day, red clover isoflavones at 80 mg/day, genistein at 30 mg/day, and S-equol at 10-30 mg/day have significantly reduced hot flashes and promoted a healthy mood.^25-27 

Black Cohosh (Cimicifuga racemosa)
Black cohosh extracts, in doses ranging from 40-80 mg/day, have been shown to improve overall menopausal symptoms, including hot flashes. However, a meta-analysis of studies concluded that women taking black cohosh did not experience improvements in mood or feeling anxious.²⁸ 

Vitamin E
Vitamin E supplementation has been shown to influence postmenopausal hot flashes and promote healthy lipid profiles. Typical doses used in studies range from 400 to 800 IU/day.²⁹

Vitex (Vitex agnus-castus)
Vitex is a plant native to the Mediterranean countries. It has a long history of traditional uses, including helping women ease menopausal symptoms. In a clinical trial with 52 postmenopausal women 48-58 years old, half took 30 mg of Vitex daily or placebo for eight weeks. Compared to the placebo group, the women taking Vitex had significant improvements in mood and hot flashes. Feeling anxious decreased by 75.6% and hot flashes by 27%.³⁰

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