Following on from our women’s health seminar I thought I would write a blog post documenting some of the interesting research that originally lead me to investigate whether or not it is possible to positively support menopause through diet and nutrition.

But first of all, what is menopause?

Menopause is the permanent end to menstruation. It can be accompanied by hot flushes and night sweats as the ovaries slow down in their production of oestrogen.  According to The National Institute of Aging, the average menopausal age is 51, but it can range from 40-60 and absence of periods for 12 months is deemed “menopause”. The period leading up to menopause, where periods may become irregular, heavier or lighter is known as perimenopause.

Symptoms of perimenopause and menopause may include hot flushes varying in intensity between 30 seconds and 10 minutes. This is often followed by sweating or the sweats may commonly occur at night. Other symptoms may include vaginal dryness or an increase (or more frequently a decrease) in libido and mood swings. A plethora of other symptoms may accompany menopause including memory loss, concentration loss and anxiety, but most notably menopause and decreased oestrogen is associated with bone loss and osteoporosis.

About 50% of premenopausal women and up to 85% of postmenopausal women experience hot flushes. They can begin 1-2 years before a woman’s last period and can last from 6 months to 15 years.

The actual physiology of hot flushes is poorly understood and the action of oestrogen on the central nervous system is complex.  Esterone is synthesised from antrostenodione by aromatase in the ovaries and adipose tissue in peri and postmenopausal women.

As oestrogen levels drop, there is decreased circulating endorphin and cathecol-oestrogens [1] ( any 2-hydroxylated oestrogen derivative- the compound that oestrogen is converted to ), which has a direct effect on the hypothalamus which is responsible for controlling appetite, sex hormones, sleep and body temperature.

There is a resultant increased seratonin and norepinephrine release [2] and a lowering of the thermoregulatory set point. Other sources [3] postulate mechanisms involving dopamine, hormone.

Heat loss mechanisms are then triggered by subtle changes in body temperature with resultant hot flushes. Although a specific biochemical trigger for hot flushes has not been found, triggers such as hot, spicy foods, hot drinks, caffeine, alcohol, stress and external environmental temperature changes lead to immediate changes in hormones and neurotransmitters which may proceed or coincide with a hot flush.

There have been a number of studies conducted to evaluate if there are any natural substances which are effective at reducing the severity of menopause symptoms.  I have collated some of this research together as you may find it useful.

Sage Extract –Although Sage has traditionally been used for years to treat sweating and menopausal flushes, in June 2011, the first published clinical trial [4] demonstrated that the mean number of intensity related hot flushes significantly decreased by 50% within 4 weeks and 64% in 8 weeks. The mean number of mild, moderate, severe and very severe decreased over 8 weeks by 46%, 62%, 79% and 100% respectively. And lastly the Menopause Rating Scale as evaluated by the treating physician decreased by 43%, 43%, 47% and 20% respectively.

Studies have previously been done [5] using Sage and Alfalfa, in 30 women the hot flushes completely disappeared and the other 10 in the study showed a decrease in symptoms thus leading the researchers to conclude that the combination was an effective treatment, without side effects for hot flushes.

Green Tea Extract - This has been included in my evaluation as the EGCG in Green Tea has been shown to improve a menopause induced overactive bladder. Post menopausal women may experience an overactive bladder or stress incontinence. Research in a rat model [6] demonstrated that Green Tea extract could reverse bladder dysfunction in a dose dependent fashion.

After menopause women’s LDL (bad cholesterol) level tends to rise, this is the main source of cholesterol build up and potential blockage in the arteries. Although high cholesterol itself does not cause symptoms, it is important to lower it to reduce the chance of heart attack or heart disease. Double blind, randomised placebo controlled studies in postmenopausal women suggest that EGCG has beneficial lowering effects on LDL cholesterol [7].

75-80% of endometrial cancers are Endometriod endometrial cancer. Risk factors for developing endometrial cancer are age and obesity. The majority of women who develop this have gone through the menopause.  A Japanese study in 2009 [8] concluded that patients given Green tea had a lower risk of Endometrail endometriod adenocarcinoma.

Marine pine bark has been shown to significantly reduce [9] signs and symptoms associated with menopausal transitions, notably hot flushes, night sweats, mood swings, irregular periods, loss of libido and vaginal dryness. In studies done on 200 peri-menopausal women [10] all menopausal transition symptoms improved.

Alfalfa contains phytoestrogens and is rich in magnesium, calcium, vitamins A, B6, B12 and D and has traditionally been used for helping women with menopause symptoms for centuries. It has been shown to be effective at reducing hot flushes and night sweats [11] when taken with sage.

There are two important things to consider if you decide to take a supplement containing Alfalfa or introduce it into your diet.  Make sure you look for a non-GM source as so much alfalfa is grown with the Roundup resistant gene that is causing so much controversy in the USA.  Also, Alfalfa contains large amounts of Vitamin K so give this careful consideration before introducing into your diet if you use warfarin or other anticoagulant medications.

Exercise: Regular physical activity [12] has been shown to decrease hot flushes and reduce night sweats.


1. Are catechol oestrogens obligatory mediators of oestrogen action in the central nervous system? I. Characterization of pharmacological probes with different receptor binding affinities and catechol oestrogen formation rates. Pfeiffer DG, MacLusky NJ, Barnea E, Naftolin F, Krey LC, Loriaux DL, Merriam GR.

2. Biochemical, metabolic, and vascular mechanisms in menopausal hot flashes. Freedman RR. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA.

3.The menopausal hot flush--anything new? Sturdee DW. Department of Obstetrics & Gynaecology, Heart of England NHS Foundation Trust, Solihull Hospital, Solihull B91 2JL, UK

4.First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Bommer S, Klein P, Suter A. A. Vogel Bioforce AG, Roggwil, Switzerland

5.Treatment of neurovegetative menopausal symptoms with a phytotherapeutic agent. [Article in Italian] De Leo V, Lanzetta D, Cazzavacca R, Morgante G. Istituto di Ginecologia e Ostetricia, Università degli Studi-Siena. Neuroprotection of green tea catechins on surgical menopause-induced overactive bladder   in a rat model.

6.Juan YS, Chuang SM, Long CY, Chen CH, Levin RM, Liu KM, Huang CH. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University,   Kaohsiung, Taiwan.

7.Effect of 2-month controlled green tea intervention on lipoprotein cholesterol, glucose, and hormone levels in healthy postmenopausal women. Wu AH, Spicer D, Stanczyk FZ, Tseng CC, Yang CS, Pike MC. Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA.

8.Case-control study of green tea consumption and the risk of endometrial endometrioid adenocarcinoma. Kakuta Y, Nakaya N, Nagase S, Fujita M, Koizumi T, Okamura C, Niikura H, Ohmori K, Kuriyama S, Tase T, Ito K, Minami Y, Yaegashi N, Tsuji I. Division of Gynecology, Department of Reproductive and Developmental Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

9.Supplementation with Pycnogenol® improves signs and symptoms of menopausal transition. Errichi S, Bottari A, Belcaro G, Cesarone MR, Hosoi M, Cornelli U, Dugall M, Ledda A, Feragalli B. Irvine3 Labs, Department of Biomedical Sciences Chieti - Pescara University, Pescara, Italy.

10.A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in peri-menopausal women. Yang HM, Liao MF, Zhu SY, Liao MN, Rohdewald P. Department of Obstetrics and Gynecology, Ham-Ming Hospital, Taiwan.

11.Treatment of neurovegetative menopausal symptoms with a phytotherapeutic agent. [Article in Italian] De Leo V, Lanzetta D, Cazzavacca R, Morgante G.Istituto di Ginecologia e Ostetricia, Università degli Studi-Siena.

12.Effect of aerobic training on hot flushes and quality of life—a randomized controlled trial Riitta Luoto, Jaana Moilanen, Reetta Heinonen, Tomi Mikkola, Jani Raitanen Eija Tomas, Katriina Ojala, Kirsi Mansikkamäai, and Clas-Håkan Nygård