Perimenopause, Menopause, Postmenopause: What’s the Difference?

They are all parts of the stage of a woman’s life when reproductive hormones naturally decline and she ceases to have a period. Menopause is technically diagnosed when you’ve gone one year without a menstrual cycle. According to the Mayo Clinic, 51 is the average age for that to happen in women in the United States.¹ Perimenopause, the period in which a woman begins the transition to menopause, usually starts in a woman’s 40s and comes with many of the same symptoms as menopause.

For most women, the most challenging symptoms of perimenopause and menopause are hot flashes and night sweats, sleep disturbances, mood (anxiety, irritability, mood swings, depression), and loss of libido. Most of these are related to decreasing levels of sex hormones, particularly estrogen and progesterone, but symptoms can be worsened by stress, a poor diet, lack of regular physical activity, and poor general health.

Kelly Andis, CN, a Nutritional Health Coach at Natural Grocers in Lakewood, Colorado, says cleaning up your diet is key. “For many women, sugar alone can increase unwanted menopausal symptoms.” Andis recommends avoiding sugar and grains and increasing your vegetable intake, along with taking steps to reduce stress as much as possible. She says that she has helped many women curb their menopausal symptoms with supplements, but if stress levels are out of control, or if they are eating a poor diet, symptoms will likely return.

Before you can effectively deal with hormonal imbalances and the symptoms that come as a result, it is crucial that you take care of your general health first. Build a healthy foundation with key supplements, including a multivitamin that will fill in the nutritional gaps missing in your diet (a multi will cover your bases, including the B-complex vitamins; however, if you opt out of a multi, consider taking a B complex supplement); vitamin D to keep your bones, immunity, and cardiovascular system in tip-top shape; magnesium and vitamin K2 to protect from osteoporosis; pre- and probiotics to improve your gut health; and whey protein and/or L-carnitine for building and maintaining muscle mass.

Once you have a healthy foundation, focus on supporting hormone balance. And remember to give it time to work—many supplements take from four to eight weeks to deliver results—and be consistent! According to Andis, consistency is key. “Hormones require consistency. Do not run out of the product [you are taking] and wait for a couple of weeks to buy more. By then, the body is starting to become unbalanced again.”

Indole-3-carbinol (I3C)

According to Lorna Vanderhaeghe, a women’s health expert and author of Sexy Hormones, perimenopause is a time in which your hormones can fluctuate wildly, with dramatic spikes and drops in estrogen levels, which lead to heavy and/or long periods, mood swings, fatigue, night sweats, uterine fibroids, weight gain, sleep disturbances, and low libido. So, while estrogen levels generally decline throughout perimenopause, they do so in an irregular manner, which can lead to estrogen imbalances. I3C is a compound found in cruciferous vegetables like broccoli and kale and research has shown that it maintains a healthy balance of estrogen by metabolizing more potent, cancer-causing estrogens into non-toxic forms. It also helps eliminate xenoestrogens, estrogen mimickers found in certain plastics, pesticides, conventional cleaning products, cosmetics, etc.

Try: 150-300 mg daily.²

Progesterone cream

While we often think of estrogen as the only hormone that dramatically decreases during menopause, progesterone levels decline more quickly than estrogen during the perimenopausal years. Progesterone naturally counterbalances estrogen, so this can cause some unwanted symptoms, especially in women who are estrogen dominant. There are progesterone receptors throughout the body—in the brain, the bones, the thyroid, and the breasts—and symptoms of low progesterone can include anxiety, irritability, elevated cortisol (the stress hormone), headaches, heavy and/or prolonged periods, weight gain, breast tenderness, and low bone density. Using a natural progesterone cream can improve these symptoms. On the flip side, progesterone is also important for a woman who has low estrogen levels, because the body converts progesterone into estrogen when levels get too low.^{3 4 5} Because progesterone directly affects hormone levels, and is a precursor to other hormones, it is important to follow the directions on the label and start at the lower dose to find the amount that works well for you.  

Black cohosh

The herb black cohosh is one of the most studied—and most widely used—natural treatments for menopausal symptoms and other female hormonal imbalances. It has been shown to be especially effective for reducing the severity and frequency of hot flashes, in addition to reducing other symptoms such as mild anxiety and depression, vaginal dryness, decreased libido, and sleep disturbances. Most research has found that women begin to see relief of symptoms between four and eight weeks of supplementing.

Try: 40-80 mg, twice daily.^{6 7 8 9}

Dong quai

This uterine tonic enhances metabolism, improves liver function (which improves the excretion of hormones), aids in the utilization of vitamin E, and has a mild sedative activity.10 Traditionally, dong quai is believed to have a balancing or “adaptogenic” effect on the female hormonal system. In Traditional Chinese Medicine, dong quai is rarely used alone and is typically used in combination with other herbs.^{11 12}

A general dosage suggestion for dong quai is between 500 and 750 mg, one to two times per day.¹³

Rhodiola

Recent research has found that black cohosh is even more effective when paired with the adaptogenic herb rhodiola. Rhodiola supports the body during mental and physical stress and has been studied for its ability to reduce anxiety, mental fatigue, stress, and depression. A study published in 2020 showed that a combination of black cohosh and rhodiola was “significantly superior” to black cohosh alone in reducing a number of menopausal symptoms, including hot flashes and sweating, sleep problems, depressed mood, irritability, anxiety, and both physical and mental exhaustion.

Try: 400 mg daily.^{14 15}

Sage

This herb may aid mood swings and hot flashes as well as reduce excessive perspiration due to menopausal hot flashes during the day or at night.¹⁶

A general dosage recommendation is 500 mg, one to three times a day.¹⁷

Shatavari

A supplement that Kathy Millington, RD, Nutritional Health Coach at Natural Grocers in Lincoln, Nebraska, likes to recommend for healthy sexual function in menopausal women is shatavari. “It's traditionally used in Ayurveda as the main tonic for the female reproductive system. It supports healthy libido and vaginal moisture, and I've had women report back to me that it worked well for them,” she says. Shatavari has hormonal balancing properties, and in Ayurvedic practice, it is said to balance excess pitta, or heat, in the body. Animal research has also found that shatavari has an anti-anxiety effect, similar to a common prescription anti-anxiety medication.¹⁸ 

Try: Doses start at 500 mg daily.¹⁹

Vitex (Chaste Tree)

Vitex supports healthy estrogen-to-progesterone balance in the body through several different mechanism of action.²⁰ Although commonly used for PMS and concerns during the childbearing years, vitex also has a strong history of relieving symptoms associated with menopause. In studies, it seems to be particularly effective at reducing vasomotor symptoms (think hot flashes and night sweats).^{21 22}

A general recommendation falls between 500 and 1000 mg one to three times a day for 3-6 months.²³

Folic acid

This B vitamin may not be the first supplement that comes to mind when building your menopausal supplement kit, but research has shown that it is effective at reducing both the frequency and severity of hot flashes in menopausal women. Hot flashes are the number one reason a woman seeks medical treatment during menopause; not only are they extremely unpleasant, but they can lead to insomnia and fatigue, behavioral changes, including depression and anxiety, memory and concentration problems, and decreased libido. They can decrease a woman’s quality of mental, physical, and social life. A placebo-controlled study conducted in Iran that included 70 menopausal women found that daily supplementation with 1 gram of folic acid significantly reduced the severity, duration, and frequency of hot flashes after four weeks, with no side effects.

Try: 1 mg daily for at least four weeks.²⁴

Herbal phytoestrogens

Phytoestrogens in herbs are capable of exerting estrogenic effects, although their activity compared with estrogen is only 2% as strong.²⁵ This low activity produces a balancing action of estrogen effects. If estrogen levels are low, the phytoestrogens will exert a slight estrogenic effect. If estrogen levels are high, the phytoestrogens compete with estrogen for absorption at the binding sites and there will be a decrease in estrogen effects.²⁶ A variety of herbs with weak estrogen-like actions, such as licorice, alfalfa, and red clover have traditionally been used for menopausal symptoms.²⁷

Proanthocyanidins

These compounds naturally occur in the fruit, bark, leaves and seeds of many plants. Sometimes called OPCs (oligomeric proanthocyanidins) or PCOs (proanthocyanidin oligomers), these compounds are polyphenols that offer significant health benefits. Proanthocyanidins are best known for helping the body fight free radicals and in particular for protecting the integrity of the blood vessels. However, in a lesser known role, they may also improve physical and psychological symptoms of menopause.^{28 29 30} It is somewhat of a mystery how proanthocyanidins impart their benefits because they don’t appear to alter hormone levels directly.³¹ The most concentrated forms of proanthocyandins are grape seed extract and a patented extract of maritime pinebark called Pycnogenol^®.     

Resveratrol Through Menopause and Beyond

When hormone levels decrease during menopause, the effects are widely felt throughout the body. In addition to affecting the sex organs, hormones, and estrogen specifically, affect bone development and strength, heart and blood vessel health, brain function, and mood balance. Resveratrol is a polyphenolic free radical scavenger found in many darkly colored foods, most famously wine. But resveratrol also has a lesser-known side, as a phytoestrogen also capable of supporting healthy blood vessel function and maintaining optimal circulation. Through these actions resveratrol is a powerful ally for women as they go through the menopause transition and beyond. In one study resveratrol reduced the number and intensity of hot flashes.¹  The largest, and longest-running study to date on resveratrol and women’s health, the Resveratrol Supporting Healthy Aging in Women (RESHAW) study, found that 75 mg of resveratrol twice daily for 12 months reduced overall pain scores, improved menopausal symptoms, and improved general wellbeing; it improved insulin sensitivity, cerebrovascular health, and cognitive function to ward off cognitive decline; and it improved bone mineral density, leading to a significant improvement in T-scores, which is associated with a reduced risk of major or hip fracture. ^{32 33 34}

The importance of slashing stress and supporting the adrenals

“Healthy adrenals are the key to an effortless menopause” according to Lorna Vanderhaeghe, author of Sexy Hormones. Natural practitioners agree that low adrenal function is one of the most common underlying causes of menopausal symptoms. This is why: The adrenals are an important part of the endocrine system, and though they are best known for producing the stress hormones cortisol and adrenaline, as the ovaries stop producing sex hormones the adrenals pick up the slack and start producing estrogen’s precursor hormones DHEA and androstenedione, as well as progesterone. But often, by the time a woman reaches the perimenopausal and menopausal years, her adrenal glands are so depleted that they are unable to produce adequate amounts of the sex hormones, and will instead prioritize production of cortisol. This can worsen menopausal symptoms and increase symptoms related to adrenal deficiency like fatigue and insomnia. Chronic stress depletes the adrenals, so it is critical to focus on reducing stress as much as possible. Also consider supporting adrenal health with supplements such as vitamin C, a B complex, and the adaptogenic herbs panax ginseng, shatavari, holy basil (tulsi), rhodiola. While a B complex and vitamin C are helpful for anyone to support adrenal function, you will likely have to try different adaptogenic herbs to see what works best for you.

A woman’s menopause experience is as unique as she is, but how healthy you are overall as you move into these years plays a huge role in how well your body adapts to the changes. Take care of your general health first, and then focus on lifestyle habits and specific herbs and nutrients to treat symptoms such as hot flashes, night sweats, insomnia, and anxiety. If one product or lifestyle change doesn’t work for you, experiment with others until you find the right combination, so you will not just survive, but thrive, through this time of life! Also consider visiting your local Nutritional Health Coach (NHC) to help you navigate these transformative years.

References

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