Menopause is a normal part of a woman’s life cycle marked by the permanent cessation of menstrual periods. It is clinically defined as 12 consecutive months without menstruation. This transition most commonly occurs between the ages of 45 and 55, with the average age in the United States being 52.
Each year, it is estimated that approximately 2 million women in the United States enter perimenopause, the transitional phase leading up to menopause. While menopause itself is a natural biological process, about 20% of women experience symptoms severe enough to significantly impair quality of life.
During this transition, ovarian hormone production declines, including estrogen, progesterone, and testosterone.
Perimenopause typically lasts about four years, though it may extend up to eight years in some women. During this time, menstrual cycles often become irregular, with changes in both cycle length and bleeding patterns.
Common symptoms during perimenopause and menopause include:
Among these, hot flashes are the most frequently reported symptom, affecting approximately 60% to 80% of women during the menopausal transition.
Menopause is considered a natural biological transition, not a disease. As ovarian hormone production declines, the body is biologically equipped to compensate through other tissues and organs.
The therapeutic goal during menopause is to support this transition and manage symptoms safely and effectively, using individualized hormone-balancing strategies. As an integrative doctor I have many options to help women relieve their symptoms and optimize their overall health.
Lifestyle interventions play an important role in managing menopausal symptoms.
Several dietary supplements have demonstrated benefit in reducing menopausal symptoms:
Black Cohosh
A meta-analysis of studies using black cohosh extracts showed significant improvement in overall menopausal symptoms, including hot flashes.
Maca
Clinical studies using Maca extract have demonstrated reductions in hot flashes, night sweats, and additional symptoms such as:
In postmenopausal women, 1,000 mg twice daily significantly improved both the frequency and severity of menopausal symptoms. Similar benefits were observed in perimenopausal women using the same dose and extract type.
Siberian Rhubarb (Rheum rhaponticum)
Extracts from this plant have been shown in research to safely and effectively reduce menopausal symptoms, with high patient satisfaction ratings.
For women experiencing intense menopausal symptoms or those with specific risk factors such as osteoporosis, hormone replacement therapy can be highly effective.
Hormones that may be prescribed by knowledgeable clinicians include:
The approach described emphasizes the use of bioidentical hormones and the avoidance of synthetic hormones. Bioidentical hormones are structurally and functionally identical to those produced by the human body, allowing for more physiologic hormone support during perimenopause and menopause. Modern research has shown that hormone replacement is very safe and does not have the breast cancer risk that it was once thought to have.
Menopause represents a normal, biologically programmed transition supported by adaptive hormonal pathways throughout the body. While symptoms can be significant for some women, a combination of dietary changes, lifestyle strategies, targeted supplementation, and individualized hormone therapy can provide effective and safe symptom relief when appropriately applied.
References
Barnard, Neal D., Hana Kahleova, Danielle N. Holtz, Fabiola Del Aguila, Maggie Neola, Lelia M. Crosby, and Richard Holubkov. 2021. “The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): A Randomized, Controlled Trial of a Plant-based Diet and Whole Soybeans for Postmenopausal Women.” Menopause The Journal of the North American Menopause Society 28 (10): 1150–56. https://doi.org/10.1097/gme.0000000000001812.
Hasper, Ilona, Boris M. Ventskovskiy, Reinhard Rettenberger, Peter W. Heger, David S. Riley, and Marietta Kaszkin-Bettag. 2009. “Long-term Efficacy and Safety of the Special Extract ERr 731 of Rheum Rhaponticum in Perimenopausal Women With Menopausal Symptoms.” Menopause the Journal of the North American Menopause Society 16 (1): 117–31. https://doi.org/10.1097/gme.0b013e3181806446.
Herber-Gast, Gerrie-Cor M, and Gita D Mishra. 2013. “Fruit, Mediterranean-style, and High-fat And -sugar Diets Are Associated With the Risk of Night Sweats and Hot Flushes in Midlife: Results From a Prospective Cohort Study.” American Journal of Clinical Nutrition 97 (5): 1092–99. https://doi.org/10.3945/ajcn.112.049965.
Meissner, Henry. 2006. “Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium Peruvianum Chacon): (III) Clinical Responses of Early-postmenopausal Women to Maca in Double Blind, Randomized, Placebo-controlled, Crossover Configuration, Outpatient Study.” International Journal of Biomedical Science 2 (4): 375–94. https://doi.org/10.59566/ijbs.2006.2375.
Meissner, H O, A Mscisz, H Reich-Bilinska, W Kapczynski, P Mrozikiewicz, T Bobkiewicz-Kozlowska, B Kedzia, A Lowicka, and I Barchia. 2006. “Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium Peruvianum Chacon): (II) Physiological and Symptomatic Responses of Early-Postmenopausal Women to Standardized Doses of Maca in Double Blind, Randomized, Placebo-Controlled, Multi-Centre Clinical Study.” PubMed 2 (4): 360–74. https://pubmed.ncbi.nlm.nih.gov/23675005.
Meissner, Henry, H Reich-Bilinska, A Mscisz, and B Kedzia. 2006. “Therapeutic Effects of Pre-Gelatinized Maca (Lepidium Peruvianum Chacon) Used as a Non-hormonal Alternative to HRT in Perimenopausal Women - Clinical Pilot Study.” International Journal of Biomedical Science 2 (2): 143–59. https://doi.org/10.59566/ijbs.2006.2143.
Sadahiro, Ryoichi, Lillian Nohara Matsuoka, Bing-Syuan Zeng, Keng-Hsu Chen, Bing-Yan Zeng, Hung-Yu Wang, Che-Sheng Chu, et al. 2023. “Black Cohosh Extracts in Women With Menopausal Symptoms: An Updated Pairwise Meta-analysis.” Menopause The Journal of the North American Menopause Society 30 (7): 766–73. https://doi.org/10.1097/gme.0000000000002196.
