By Chris D. Meletis, ND\nIf you've started to go through peri-menopause or menopause, chances are good you’re experiencing some frustrating moments. Hot flashes and night sweats are not only the most common symptom of menopause,1 they’re also the most uncomfortable. My patients tell me it feels like someone has sparked a campfire inside your body. And it’s not bad enough that you feel like you’re about to spontaneously combust. Hot flashes come with a number of other problems, too, such as palpitations, anxiety, feeling pressure in the head and chest, nausea, and lack of concentration. When all those symptoms go away, you might even experience chills. For most women, hot flashes last from between a few seconds to a minute. For an unfortunate few, they can last up to an hour!2\nMenopause also produces some unpleasant symptoms in your urogenital tract, including:2\n\nIncreased frequency of urination\nPainful urination\nVaginal itching and burning\nIncontinence\nVaginal dryness (also known atrophic vaginitis)\nPainful sex\nIncreased frequency of urinary tract infections\n\nWhat Causes Menopausal Symptoms?\nIf you’re suffering from menopausal symptoms, blame it, at least in part, on the ovaries. Changes in their structure and function lead to problems like hot flashes. Numbers of follicles in your ovaries start to decline as you go through menopause. Before menopause, there are ten times more follicles in a woman’s ovaries compared with after menopause.2 There are almost no follicles in the ovaries of postmenopausal women. The changes in ovarian function are associated with a dramatic shift in hormonal balance, a drop in estrogen, and an increase in follicle-stimulating hormone (FSH) and luteinzing hormone (LH). The increase in FSH and LH are accompanied by a decrease in progesterone, a hormone involved in calm mood, happiness, and many other aspects of health. The dip in your progesterone levels is what causes the permanent end of your monthly period.2 Your estrogen levels also drop as you go through menopause, leading to many of the urogenital symptoms I mentioned above. The average age of menopause is 50 years; however peri-menopause often starts 5 or more years earlier. And, in women of African origin, menopause frequently occurs sooner.2\nLifestyle Approaches to Soothing Menopause Symptoms\nMenopause is a normal part of life. But that doesn’t mean it’s easy. However, you can reduce the symptoms that come with it. The two natural ways to reduce menopause symptoms include lifestyle approaches and dietary supplements (which I'll talk about later).\nThings to Avoid\nSome things are known to worsen menopausal symptoms, at least in some women. Alcohol, caffeine, wearing tight clothing, eating spicy foods, and high levels of stress are linked to worse symptoms.1,2 Likewise, smoking or exposure to cigarette smoke are known to make symptoms worse.1\nThings to Add to Your Life\nTo reduce the number of hot flashes you experience and prevent some other menopausal symptoms, try increasing the amount of exercise you do daily. One randomized, controlled study found that only 10 minutes of stretching exercises before bed reduced menopausal symptoms such as hot flashes and depression.3 In another randomized, controlled trial, women with hot flashes went through exercise training for six months.4 Compared with women in a control group, those who exercised experienced an improvement in their hot flashes and this improvement lasted for four years after the initial exercise training. Plus, exercise—especially when combined with a healthy diet—reduces the fat that builds up around the belly after menopause.5\nIn addition to exercising, my menopausal patients who are under a lot of stress benefit from participating in stress-control activities such as meditation, yoga, spending time in nature, and deep breathing exercises.\nBotanicals and Vitamins for Natural Menopausal Symptom Relief\nA number of natural substances can help reduce your hot flashes and make them more endurable, as well as improve other menopausal symptoms. These can work especially well when combined with the lifestyle approaches I mentioned above. Here are some of the botanicals and vitamins best researched for their ability to support the health of menopausal women. Some of my patients choose to take some or all of these natural ingredients individually, and some choose a comprehensive supplement like Balance Blend that contains a combination of herbs, vitamins, minerals, and other specialty nutrients.\nMaca\nStudies have shown this botanical may reduce hot flashes in menopausal women.6 It also supported healthy levels of blood pressure and improved depression in a study of postmenopausal women.7 Another study in postmenopausal women found Maca reduced depression and improved menopause-related sexual problems.8\nMaca also acts as an adaptogen. In other words, it nourishes your adrenal glands.9 These little glands produce DHEA, which are converted to other hormones including estrogen. This can help make up for your ovaries' weakening ability to produce estrogen, keeping you more resilient during and after menopause.\nBlack Cohosh\nKnown for its ability to support many aspects of menopausal health, this botanical improves sleep and reduces hot flashes, sweating, anxiety, and depression.10-13\nChaste Tree Berry\nStudies have shown this botanical is one of the menopausal women’s best friends. It can reduce hot flashes, especially when combined with some of the other botanicals and vitamins mentioned in this article.14,15 It’s thought to soothe your hypothalamic-pituitary axis, which regulates your stress levels and the health of your adrenals.2\nHops\nA phytoestrogen, hops can reduce hot flashes and improve other menopausal symptoms.2,16\nFolate\nFolate is important for reducing menopausal discomfort. Unfortunately, many women have a gene mutation (MTHFR) that keeps their body from digesting folic acid. They lack optimal function of the enzyme needed to change folic acid into its more biologically active form. However, supplementing with 5-methyltetrahydrofolate (5-MTHF) bypasses the need to convert folic acid into folate. 5-MTHF is already in the form needed for your body to digest it. That’s especially important during menopause because MTHFR mutations are linked to depression in menopausal women.17,18\nWhat’s more, in postmenopausal women, folate is associated with maintaining healthy blood pressure.19 MTHFR mutations are also associated with breast health in postmenopausal women,20 while 5-MTHF is associated with bone mineral density.21\nLicorice\nGlycyrrhiza glabra (licorice) is another botanical weapon in the battle against hot flashes.2 It contains a number of compounds beneficial to menopausal women.2\nDIM\nDerived from cruciferous vegetables like broccoli and cauliflower, diindolylmethane (DIM) helps your body use estrogen through a health-promoting pathway.22 In this way, it protects against less-than-favorable estrogen metabolism. This is important for breast health in menopausal and postmenopausal women.22\nVaginal Moisturizers and Lubricants\nAs discussed above, the hormone changes that accompany menopause cause dramatic changes to vaginal tissues and vaginal fluids. Now known by the term Genitourinary Syndrome of Menopause, many menopausal women complain of a range of symptoms including dryness, burning, and itching, as well as painful intercourse. To soothe these uncomfortable symptoms, many women benefit from using a vaginal moisturizer daily, and choose to use a lubricant during sex. I always encourage my patients to select a high-quality product that is pH matched for menopausal women (around 5) and does not include harsh chemicals like paraben preservatives. Also important is to find a product that doesn’t contain glycerol or hormones.\nHope for Hot Flashes and Other Menopause Symptoms\nIf you’re going through a tough time during menopause, you can find natural relief. Lifestyle approaches like exercise can keep you feeling your best. And botanical supplements can make your change of life less of a miserable experience and more of an opportunity to be the healthiest you can be. Making sure you’re getting the nutritional support your body needs to stay on top of its game during this challenging time is also essential. So, don’t forget B vitamins, vitamin D, and other foundational nutrients.\nDr. Chris Meletis\nDr. Chris Meletis is an educator, international author and lecturer. His personal mission is “Changing World’s Health One Person at a Time.” Dr Meletis has authored 18 books and over 200 national scientific articles in journals including Natural Health, Alternative and Complementary Therapies, Townsend Letter for Doctors and Patients, Life Extension, Natural Pharmacy, and PubMed.gov articles.\nDr. Meletis served as Dean of Naturopathic Medicine and Chief Medical Officer for 7 years for the National College of Naturopathic Medicine (now the National University of Natural Medicine). He was awarded the 2003 Physician of the Year by the American Association of Naturopathic Physician of the Year by the American Association of Naturopathic Physicians. He has a deep passion for helping the underprivileged and spearheaded the creation of 16 free natural medicine healthcare clinics in the Portland metropolitan area of Oregon.\nReferences:\n1. Dennerstein L, Smith AM, Morse C, et al. Menopausal symptoms in Australian women. Med J Aust. 1993 Aug 16;159(4):232-6.2. Kargozar R, Azizi H, Salari R. A review of effective herbal medicines in controlling menopausal symptoms. Electron Physician. 2017 Nov 25;9(11):5826-33.3. Kai Y, Nagamatsu T, Kitabatake Y, Sensui H. Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial. Menopause. 2016 Aug;23(8):827-32.4. Mansikkamäki K, Nygård CH, Raitanen J, et al. Hot flushes among aging women: A 4-year follow-up study to a randomised controlled exercise trial. Maturitas. 2016 Jun;88:84-9.5. van Gemert WA, Peeters PH, May AM, et al. Effect of diet with or without exercise on abdominal fat in postmenopausal women - a randomised trial. BMC Public Health. 2019 Feb 11;19(1):174.6. Comhaire FH, Depypere HT. Hormones, herbal preparations and nutriceuticals for a better life after the menopause: part II. Climacteric. 2015 Jun;18(3):364-71.7. Stojanovska L, Law C, LaiB, et al. Maca reduces blood pressure and depression, in a pilot study in postmenopausal women. Climacteric. 2015 Feb;18(1):69-78.8. Brooks NA, Wilcox G, Walker KZ, et al. Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content. Menopause. 2008 Nov-Dec;15(6):1157-62.9. Gonzales GF. Ethnobiology and Ethnopharmacology of Lepidium meyenii (Maca), a Plant from the Peruvian Highlands. Evid Based Complement Alternat Med. 2012;2012:193496.10. Jiang K, Jin Y, Huang L, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-67.11. Ross SM. Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract. 2012 Jan-Feb;26(1):58-61.12. Rostock M, Fischer J, Mumm A, et al. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints - a prospective observational study. Gynecol Endocrinol. 2011 Oct;27(10):844-8.13. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol. 2005 Jan;20(1):30-5.14. Chopin Lucks B. Vitex agnus castus essential oil and menopausal balance: a research update. Complementary Therapies in Nursing and Midwifery. 2003;8:148-54.15. Erkkola R, Vervarcke S, Vansteelandt S, et al. A randomized, double-blind, placebo-controlled, cross-over pilot study on the use of a standardized hop extract to alleviate menopausal discomforts. Phytomedicine. 2010 May;17(6):389-96.16. Aghamiri V, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Nazemiyeh H. The effect of Hop (Humulus lupulus L.) on early menopausal symptoms and hot flashes: A randomized placebo-controlled trial. Complement Ther Clin Pract. 2016 May;23:130-5.17. Różycka A, Słopień R, Słopień A, et al. The MAOA, COMT, MTHFR and ESR1 gene polymorphisms are associated with the risk of depression in menopausal women. Maturitas. 2016 Feb;84:42-54.18. Słopień R, Jasniewicz K, Meczekalski B, et al. Polymorphic variants of genes encoding MTHFR, MTR, and MTHFD1 and the risk of depression in postmenopausal women in Poland. Maturitas. 2008 Nov 20;61(3):252-5.19. Cagnacci A, Cannoletta M, Xholli A, et al. Folate administration decreases oxidative status and blood pressure in postmenopausal women. Eur J Nutr. 2015 Apr;54(3):429-35.20. Naushad SM, Pavani A, Rupasree Y, et al. Association of aberrations in one-carbon metabolism with molecular phenotype and grade of breast cancer. Mol Carcinog. 2012 Oct;51 Suppl 1:E32-41.21. Golbahar J, Aminzadeh MA, Hamidi SA, Omrani GR. Association of red blood cell 5-methyltetrahydrofolate folate with bone mineral density in postmenopausal Iranian women. Osteoporos Int. 2005 Dec;16(12):1894-8.22. Dalessandri KM, Firestone GL, Fitch MD, et al. Pilot study: effect of 3,3'-diindolylmethane supplements on urinary hormone metabolites in postmenopausal women with a history of early-stage breast cancer. Nutr Cancer. 2004;50(2):161-7.