Menopause

At some point in a women’s life, she must experience a phase called menopause. Menopause occurs 12 months after amenorrhoea—the absence of a menstrual period.

[5]— and marks the end of female fertility. 
Although it can occur at any age, majority of women experience menopause between the ages of 45 and 55 [7].
 Even though menses can end abruptly at any time, women typically experience a menopausal transition [5] which occurs before the onset of the menopause. During this time, periods become more irregular and with different bleeding characteristics (lighter or heavier periods). 
On average, women in the UK enter menopause at the age of 51[5]; however, some women, 1 out of every 100, start their menopause before the age of 40 and experience the so-called premature menopause.

The menopause is often linked to several common symptoms that are usually quite predictable. However, each woman perceives them quite subjectively and with different threshold levels. The most common symptoms are [3, 7]:

• hot flashes
• night sweats
• mood changes (low mood/ anxiety)
• insomnia or sleep problems
• libido decrease
• vaginal dryness
• headaches

These symptoms are quite difficult to manage for most women. For this reason, menopause can become a real nightmare. 
All these symptoms are principally caused by a decrease in the sex hormone levels [7]. Interestingly enough, these hormones do not regulate only the female fertility and sexual behaviour, but also a lot of other physiological processes influencing the general well- being of a woman. 
For most women, the symptoms generally begin during the menopausal transition and last for the next four years following their last period. However, 1 in every 10 women have symptoms that can last for 10 or 12 years [7].

What are the strategies to alleviate the symptoms?

1. Hormone Replacement Therapy
2. Diet
3. Physical Activity
4. Other life style habits
5. Natural remedies and other complementary therapies
6. Hormone Replacement Therapy

Many women resort to the use of “Hormone Replacement Therapy” (HRT) to alleviate symptoms. This therapy can be prescribed only by a doctor after a careful evaluation of both the symptoms and the general health of the patient. It consists of the administration of hormones— principally oestrogens and progesterone— that alleviate the symptoms of the menopause [5]. HRT can be administered in multiple forms including tablets, patches, and gels. Although this therapy is very effective in relieving the symptoms associated with oestrogen withdrawal (i.e. night sweats, hot flushes, sleep disturbance etc.), it can also cause some of the following side effects:

• breast tenderness [7]
• 
vaginal bleeding [7]
• headaches [7]
• an increased risk of myocardial infarction, strokes, and breast cancer [5]

Diet

As with many bodily functions, diet plays a very important role in menopause. During this phase, women experience a lot of changes in their physiological asset. Therefore, it is very important to ensure that all the principal nutrients are present in the body. Moreover, a good diet helps to decrease the risk of gaining weight which is another typical problem of women experiencing menopause. The following tips are crucial in maintaining a healthy diet [8]:

• Eat a balance and healthy diet containing all of the principal micro and macro nutrients
• Eat at least 5 portions of fruit or vegetables per day. They are very important sources of vitamins, minerals and fibres.
• Eat a good amount of starchy products, and try to lower the intake of fatty foods.
• Have a correct intake of vitamin D and calcium.

Focus on Vitamin D and Calcium

Vitamin D and calcium are two of the most important nutrients that support healthy bones. During menopause, bone strength decreases as a result of the drop in sex hormone levels, thus increasing the possibility of developing osteoporosis.

Having the correct intake of vitamin D and calcium helps to strengthen the bones and decrease the risk of bone concerns [2].

Physical activity

Having a good level of physical activity (PA) coupled with maintaining a balanced and healthy diet is highly recommended for women going through menopause. Being physically active can help reduce the flashes, improve the mood, and strength the muscles and the bones. The recommendations for people 18-64 years old are [9]:

• At least 150 minutes of moderate intensity aerobic physical activity per week. (bouts of 10 min minimum)
• At least two days per week of strength exercises for all the major muscles groups.

Other life style habits

Many other life style factors could contribute to a women’s comfort level as she is experiencing menopause. For example, it was found that women who smoked tend to suffer from more severe flashes than women who were non- smokers [8]. Moreover, smoking increases the risk of osteoporosis.

Also, limiting the amount of alcohol that you consume can help to alleviate some symptoms.
Finally, the maintenance of a correct BMI is highly recommended. Besides being bad for one’s health in general, being overweight also causes menopausal symptoms to be more severe [8].

Natural remedies and other complementary therapies

Botanical remedies are increasing in popularity among women going through menopause. Women decide to take these remedies for different reasons including:

• inability to take HRT due to health concerns (breast or endometrial cancer, high risk of thromboembolism etc.)
• low HRT tolerance
• anxiety concerning the side effects of HRT
• desire to try something completely natural to alleviate symptoms

Some natural (botanical) products seem to be effective in alleviating menopausal symptoms. Products with estrogenic activity have been the most popular.
Isoflavones are natural substances with a structure and a mechanism of action similar to the human oestrogens. They are defined as a selective oestrogen receptor modulator [6]. In other words, they can bind to the same receptors as oestrogen and exert similar effects. The principal products containing isoflavones are:

• Soy (Fact: Asiatic women, having a high intake of soy products, suffer from fewer menopausal symptoms, especially hot flashes [3].)
• Red Clover 
The European Food Safety Agency (EFSA) recently concluded that a daily intake of 35-150 mg of isoflavones does not cause any adverse effects on the health of menopause women (breast, uterus and thyroidal gland health, in particularly). Several studies have reported good results for the treatments of hot flashes using isoflavones [6]. In fact, research suggests that soy isoflavones could also be useful in alleviating the symptoms of osteoporosis [4, 6]. 
Finally, women with a high intake of isoflavones have a lower risk of suffering from breast cancer [6].

Additionally, there are some studies that seek to investigate the progestogenic and the serotonergic activities of some plant base products. There is some speculation that these products have the potential to ameliorate the menopausal symptoms. However, more research is needed in this field.

Other complementary therapies exist with the goal of improving the general well-being of women going through menopause without targeting a specific symptom. These types of therapies include yoga, massage, acupuncture [1], aromatherapy etc. Even if their efficacy has no scientific basis, they still can be a useful tool in helping women feel relaxed, fit, and energised [8].