The Second Spring

In Traditional Chinese Medicine, menopause has long been called the "second spring": not an ending, but a turning point, when the energy once given to fertility can be drawn back into a woman's own life, health and wisdom. It's a far cry from the way menopause is often described in the West, as a deficiency to be fixed. The truth is that menopause is a natural transition. How smoothly we move through it depends a great deal on the health of the body we bring to it.

What is really happening

Menopause is officially reached when you haven't had a period for 12 months. In the UK, the average age is 51. But the changes begin years earlier, in perimenopause, which often starts in the mid-40s and can last anywhere from four to ten years.

Perimenopause isn't a smooth decline. Progesterone, the calming hormone made after ovulation, usually falls first, as ovulation becomes less regular. Oestrogen, meanwhile, can swing wildly, sometimes higher than ever, sometimes very low, before it settles at a lower level. These swings, more than low hormones alone, explain why perimenopause can feel so unpredictable.

Oestrogen receptors are found throughout the body: in the brain, bones, heart and blood vessels, skin, joints, gut and bladder. This is why menopause can affect so much more than periods:

• hot flushes and night sweats
• broken sleep and waking in the early hours
• anxiety, irritability, low mood and loss of confidence (See Where Body Care Meets Mind.)
• "brain fog", poor concentration and forgetfulness
• aching joints and muscles
• dry skin, thinning hair, and vaginal dryness
• low libido and needing the loo more often

Hot flushes are the best-known symptom, and they can last far longer than many women expect. A large American study that followed women for many years found that hot flushes and night sweats lasted a median of about seven and a half years.¹

Why some women suffer more than others

Every woman goes through menopause, but not every woman struggles. Interestingly, studies of Japanese women in the 1980s and 1990s found that far fewer reported hot flushes than women in North America, and there wasn't even a common Japanese word for them.² Diet, culture and lifestyle all seem to play a part. From a naturopathic view, several systems shape how smooth the transition will be.

The stress connection

After menopause, the ovaries hand over much of their hormone work. The adrenal glands, along with fat tissue, continue to make small amounts of hormones that the body can turn into oestrogen. But the adrenals are also our stress glands. If years of pressure, poor sleep and over-commitment have left them stretched, they may have less to give. Many women find that perimenopause coincides with the most demanding years of their lives, caring for children, parents and careers all at once. (Read more in The Cortisol Clock and Filling Your Own Cup.)

Blood sugar

As oestrogen falls, the body tends to become less sensitive to insulin, and fat is more easily stored around the middle. Blood sugar dips can also trigger the release of adrenaline, which may set off a hot flush or wake you at 3am. Steadying blood sugar is one of the simplest, most effective things you can do. (See Balancing the Sugar Seesaw.)

The gut and the "estrobolome"

Your gut bacteria help to manage your oestrogen. A collection of microbes known as the estrobolome makes an enzyme that can reactivate oestrogen the liver has packaged up for removal, so it re-enters the body. A healthy, diverse gut helps keep this recycling in balance.³ Gut bacteria are also needed to turn plant oestrogens from food into their most active forms. (See The Master Regulator.)

Menopause is not an ending, but a turning point.

Eating for the second spring

• Plant oestrogens. Phytoestrogens are plant compounds with a gentle, oestrogen-like action. In a review of trials, soy isoflavones reduced how often hot flushes came by about a fifth more than placebo, and eased how severe they were.⁴ Choose traditional, whole and organic soy, such as edamame, tofu, tempeh and miso. Ground flaxseed is another rich source, along with chickpeas, lentils and other legumes.
• A Mediterranean way of eating. In a study following over 6,000 Australian women for nine years, those who ate a Mediterranean-style diet rich in fruit, vegetables, legumes and whole grains were less likely to report hot flushes and night sweats, while a diet high in sugar and saturated fat was linked with more.⁵
• Protein at every meal. Muscle and bone are lost more quickly after menopause. Protein helps protect both and keeps blood sugar steady.
• Omega-3 fats from oily fish, walnuts and flaxseed support mood, joints, skin and the heart.
• Bone-building foods. Leafy greens, sardines, tahini, almonds and calcium-set tofu. (Read more in Living Bones.)
• Notice your triggers. Alcohol, caffeine, spicy food and sugar commonly set off hot flushes. A simple diary can help you discover your own.

Lifestyle: the foundations

• Lift something heavy. Strength training is one of the best investments a woman can make at this time of life, protecting muscle, bone, blood sugar and mood. (See Born to Move.)
• Protect your sleep. Keep the bedroom cool, choose natural fibres for bedding and nightwear, and keep a regular bedtime. (See The Art of Sleep.)
• Calm the nervous system. Slow breathing, meditation and time in nature all lower stress hormones. Cognitive behavioural therapy (CBT) has also been shown to reduce how much hot flushes and night sweats bother women. (See The Healing Breath.)
• Stop smoking and keep alcohol low. Both are linked with more hot flushes and faster bone loss.

Herbs for the transition

Herbal medicine has a long tradition of supporting women through menopause, and some herbs have also been studied in clinical trials. These trials tend to be small: a plant can't be patented, so there's little commercial money for research, and a questionnaire can't capture everything a woman notices for herself. In herbal medicine, the right herb depends on the person. A woman with fierce hot flushes, a red face and restless nights is described as having too much "heat", and may be helped by cooling herbs. A woman who feels cold, tired and depleted needs something quite different. (See The Architecture of Balance.)

• Sage. A traditional remedy for excessive sweating. In a study of 71 women, a fresh sage preparation reduced hot flushes by half within four weeks and by nearly two-thirds within eight weeks.⁷ Sage is cooling and drying.
• Black cohosh. The most studied herb for menopause, with mixed results: some trials show benefits for hot flushes and others don't.⁸ Very rarely, it has been linked with liver problems, so it should only be used with guidance.
• Red clover. Rich in isoflavones. Results for hot flushes are mixed, though some studies suggest benefits for bone.
• Shatavari. A cooling, nourishing root from Ayurvedic medicine, whose name is often translated as "she who has a hundred husbands". It is traditionally used for dryness and as a women's tonic throughout life.
• Calming herbs such as lemon balm, passionflower and chamomile are traditionally used for anxiety and restless sleep.

Because the best herb depends on your constitution, your symptoms and any medicines you take, it's wise to see a qualified practitioner rather than self-prescribe.

At Rootwise, we see menopause as a time to rebuild and nourish, not simply to manage symptoms. With the right support, many women find their second spring is one of the most vital, confident seasons of their lives. (Read more about hormones in The Hormone Web.) None of these steps works alone: steadier blood sugar helps sleep, better sleep calms stress, and a calmer nervous system eases the whole transition. Tended together, they become far more than the sum of their parts. (See Vital Force.)