Want to not be the cool kid at your next party? Say the word “menopause.” Hot flashes, night sweats, vaginal lubrication, cooling off in front of the fridge, “The Change,” “The Big M.” Yeesh. Menopause makes you feel vulnerable—and reminds everyone else that they can’t stay young forever. No one wins.
But guess what: If you’re a woman (or love one), menopause could be coming up faster than you think. Now’s the time to prepare your body, with the exercise and supplements you need to face it with grace. And maybe in the process, we can destigmatize the whole thing. Because somehow, Helen Mirren and Meryl Streep got through it, and you’d party with them, right?
Menopause isn’t officially reached until you haven’t had a period for an entire year, and when you get there is largely determined by the one thing in this chapter you can’t control: genetics. For most women it tends to hit closer to the mid- to late-40s. (About two million women each year reach menopause—that’s 6,000 every day.) But many woman start seeing symptoms of perimenopause—the five- to twelve-year transition that leads up to menopause—as early as their 30s.
Wait, five to twelve years? Yes, your hormones can go haywire for that long, thanks to fluctuating estrogen levels. Erratic periods are usually the first sign of perimenopause, says gynecologist Sara Gottfried, M.D., founder of saragottfriedmd.com, a virtual integrative medicine practice based in Berkeley, Calif. They can get closer together or farther apart, heavier or lighter, longer or shorter.
According to a 2010 study published in the Journal of Mid-Life Health, 20% of women in perimenopause report severe symptoms; 60%, mild symptoms; and 20%, no symptoms. “Your ovaries are making less progesterone, a hormone that calms the nervous system,” says Gottfried, “so you may become more irritable or anxious, and see your PMS go from bad to worse.”
And yet, “You can actually sail through this transition,” says Christiane Northrup, M.D., author of The Wisdom of Menopause. “And if you enter menopause in optimal health, your symptoms will not be as severe or you may not even experience any at all.” It all comes down to paying attention to certain health and lifestyle habits that make good sense no matter how young (or old) you are.
Given the uncertainly of hormone therapy—and the high price of health care—natural remedies are more relevant than ever. So instead of reaching for Advil, Ambien or Paxil to treat hot flashes, cramps, insomnia and other symptoms, try the techniques below. “Treating yourself with lifestyle and home remedies is the easiest, least invasive and sometimes the most effective treatment,” says Rosemary Gladstar, founder of Sage Mountain Herb Center in Barre, Vt., and author of the classic Herbal Healing for Women.
Stress. You don’t outgrow it, so there’s no stopping the constant flood of the fight-or-flight stress hormone cortisol, which depletes the adrenal glands. This can make fatigue, brain fog and hot flashes particularly bad during perimenopause, says Susan Doughty, A.P.R.N.-C.N.P., an OB-GYN nurse practitioner and cofounder of New England WomenCenter in Portland, Me. “That’s because when estrogen levels dip, the adrenals increase cortisol production,” she says. Basically, you’re getting a double whammy of the stress hormone during the transition to menopause. Also, cortisol levels are normally highest in the morning, then drop throughout the day. “But in perimenopause, cortisol stays elevated, so falling and staying asleep become difficult,” Doughty says.
ACTION PLAN: Ease stress, reduce cortisol production and facilitate sleep with relaxation techniques such as meditation, breathing exercises, yoga, tai chi or massage, Doughty advises. We all know that cardio can also alleviate stress, but don’t overdo it: “Pushing yourself so hard that you’re left feeling depleted can weaken your adrenals even further,” Northrup says.
Holly Lucille, N.D., a naturopathic doctor in West Hollywood, Calif., also advises patients to support exhausted adrenals with adaptogenic (aka stress-busting) herbs such as licorice root, ashwagandha and rhodiola. Try Gaia Herbs Adrenal Health ($30 for 60 capsules; gaiaherbs.com).
Wonder Bread, not wonderful. Northrup notes that foods high in simple carbohydrates, such as white flour, pasta, bread and rice, as well as sweets and processed foods, raise cortisol levels. As noted above, this can exacerbate perimenopause symptoms, including exhaustion, mental fogginess and hot flashes. Eating too many of them also spikes blood sugar, which can lead to cravings and overeating; the resulting weight gain makes certain symptoms worse (see “3 Perimenopause Pointers”).
ACTION PLAN: Choose carbohydrates in their whole-food form such as vegetables and whole grains over white-flour pasta, crackers and cookies, and include quality proteins and healthy fats at each meal, advises dietitian Ashley Koff, R.D. “Eating flaxseeds, which are high in omega-3 fatty acids, and cruciferous vegetables helps your body metabolize estrogen, which will balance its fluctuating levels,” she adds. Other good omega-3 sources include wild salmon, hemp or chia seeds, and walnuts. A 2011 study in the journal Menopause reported that omega-3s decreased depression, hot flashes, brain fog, vaginal dryness and night sweats in women approaching menopause.
During perimenopause, estrogen that’s not counterbalanced by progesterone can slow the production of thyroid hormone, triggering weight gain, fatigue, depression, mental fogginess and other symptoms. In fact, about 25% of women discover they have low thyroid, or hypothyroidism, during perimenopause.
ACTION PLAN: Have your thyroid hormone levels tested by an endocrinologist or naturopathic physician, Northrup advises. Low levels are easily remedied with thyroid medication.
“If a woman believes she will have a difficult time [with menopause], it can become a self-fulfilling prophecy,” notes Doughty. Indeed, according to a 2011 study published in Clinical and Experimental Obstetrics & Gynecology, menopausal women who exhibited negative attitudes about entering menopause experienced more severe symptoms.
ACTION PLAN: Northrup suggests looking at perimenopause as an opportunity to make positive changes by dealing with issues and problems you may have been ignoring for years. “At perimenopause, you come to a crossroads in your life where you have to choose between one path that says ‘grow’ and the other that says ‘stagnate,’ ” she says. As such, it’s often an ideal time to assess things like your career, relationships or general health and well-being and take proactive steps toward self-improvement. She also advises seeking the guidance and support of women you know who are thriving after menopause.
If the prospect of menopause is really taking a psychological toll, try working with a therapist who specializes in cognitive behavioral therapy (CBT), advises Marianne Brandon, Ph.D., a clinical psychologist in the Washington, D.C., area. “CBT retrains your brain to let go of anxiety and self-defeating thoughts and subsequent reactions,” she says.
While healthy lifestyle changes will likely lessen the severity of perimenopause symptoms, you may still experience them to some degree. If any of the following hit, try the corresponding natural remedies.
Solution: Sage (Salvia officinalis)
“Sage has been passed down from generation to generation in Western herbal tradition as the surefire cure for hot flashes,” explains Sheila Kingsbury, N.D., of Bastyr University in Kenmore, Wash. It’s such an effective astringent that it has been approved in Germany as a treatment for excessive sweating for both women and men. “Sage was also used in Native American cultures to clear negative energy so it may help ease some of the irrational fears that can cycle through your head during perimenopause,” says herbalist Margi Flint, author of The Practicing Herbalist.
DOSAGE: Steep one tablespoon dried sage in one cup of hot water for 15 minutes or longer to make a tea; strain and cool. Drink up to three cups a day. If you don’t like the taste, put the tea into a spray bottle (after it has cooled completely) and spritz it on your neck.
Also, the black cohosh in Remifemin has been found to reduce hot flashes, night sweats, mood swings and irritability by 70%.
DOSAGE: Lucille 20 milligrams twice a day for 12 weeks
TRY: Remifemin ($20 for 60 tablets; remifemin.com)
And omega-3 fatty acids have also been found to lower the frequency of hot flashes.
DOSAGE: 1 tablespoon daily
TRY: Spectrum Essentials Organic Flax Oil with Cinnamon, a blood-sugar stabilizer ($10 for 8 ounces; amazon.com)
Solution: Yarrow (Achillea millefolium)
Yarrow is the go-to herb for menstrual bleeding, says Gladstar. “It slows excessive bleeding, relieves pelvic congestion, reduces cramping and flushes out the liver so estrogen and progesterone are processed more efficiently,” she says.
DOSAGE: Two droppers of tincture every 30 minutes until bleeding slows
TRY: HerbPharm Yarrow ($33 for 4 ounces; amazon.com)
Solution: Valerian (Valeriana officinalis)
Many studies have affirmed the safety and efficacy of valerian for treating garden-variety insomnia—a common problem during perimenopause. “It works in the same way that Valium or Xanax do, but the effect is much milder. There is no hangover afterward nor any risk of addiction,” says Kingsbury. There’s just one catch: “It’s a reliable sedative for most people, but a small percentage will get jazzed up instead,” she cautions.
DOSAGE: Two 500-milligram capsules one hour before bedtime as needed
TRY: Nature’s Way Valerian ($11 for 90 capsules; vitamanshoppe.com)
CONTRAINDICATION: Do not take valerian if you’re taking prescription sleep aids.
Solution: Ashwagandha (Withania somnifera)
In ayurvedic tradition, ashwagandha is the great revitalizer, says ayurvedic practitioner Will Foster of Knoxville, Tenn. “It’s an adaptogen that helps balance out scattered energy, which means that when stress or hormonal changes leave you feeling drained, ashwagandha can help fill up your tank.” The herb means “smell of horse,” a deliberate nod to the strength and vitality of horses, says Foster. “Take ashwagandha when you need to boost your horsepower.” It also may boost libido.
DOSAGE: Two 500-milligram capsules two times every day
TRY: Putian’s Pride Ashwagandha Standardized Extract ($12 for 60 capsules; puritan.com)
Solution: Water hyssop (Bacopa monnieri)
Used in Western European, Chinese and Indian herbal traditions, water hyssop is called brahmi in Sanskrit, which means “consciousness.” It can help if you feel particularly distracted before or during your period; it’s also good for everyday focus. “Bacopa monnieri can sharpen concentration, memory and overall intelligence, and it also improves longevity,” says Foster. “Its ability to improve mental performance [by enhancing nerve impulses between cells in the brain] has been documented in multiple studies in the United States and abroad.”
DOSAGE: One 500-milligram capsule twice daily. Foster suggests starting off slowly—perhaps with a 100-milligram dose twice per day—and increasing the dosage in 100-milligram increments up to the recommended 1,000 milligrams a day. “If the herb makes you feel spacey [or increases existing feelings of spaciness], contact your ayurvedic practitioner for guidance on dosing,” he advises.
TRY: Nature’s Answer Hyssop Herb ($6 for 90 capsules; iherb.com)
Also, several studies have found that omega-3 fatty acids improve memory and cognitive functioning in older adults.
DOSAGE: 1,000 milligrams of fish oil supplements daily
TRY: New Chapter Wholemega Whole Fish Oil ($9 for 30 softgels; amazon.com)
Solution: Magnesium and calcium
DOSAGE: Experts recommend a combination of magnesium (150 to 300 milligrams daily) and calcium (500 to 600 milligrams twice per day).
TRY: Natural Vitality Natural Calm Magnesium Plus Calcium, Raspberry-Lemon Flavor ($16 for 30 packets; drugstore.com)
Solution: Peruvian maca root
Studies have found that Peruvian maca root can increase sex drive as well as ease anxiety.
DOSAGE: 500 to 1,000 milligrams daily
TRY: Navitas Naturals Raw Maca Powder ($25 for 16 ounces; navitasnaturals.com)
Solution: Kudzu
Studies show that Pueraria mirifica, or Thai kudzu, exhibits an estrogen-like effect that boosts vaginal elasticity and lubrication, similar to hormone replacement therapy.
DOSAGE: Follow package recommendations.
TRY: Solgar PM PhytoGen Complex ($17 for 60 tablets; amazon.com)