I've had the opportunity to help clients dealing with menopause with their symptoms through means of botanical medicine, food extracts/vitamins, homeopathy, flower essences, and adjunctive hormone therapy. So, I’m sharing with you below the most effective naturopathic treatments I've seen in practice for hot flashes, depression/anxiety, brain fog, and other symptoms during perimenopause.
Maca is mainly known as an adaptogenic herb from the Andes Mountains. However, there is research out there saying that it is also beneficial for perimenopausal symptoms. In post-menopausal women, this herb has been shown to reduce blood pressure and relieve symptoms of depression. In animal studies, Maca has been shown to be an effective hormone balancer for menopausal symptoms. Studies so far have not shown any contraindications to using Maca. However, science it always changing, and new updates might be coming out as you read this.
Dong quai has hormone-modulating qualities to it, which can be helpful for women during perimenopause, where natural estrogen levels decline. A thing to note about this herb is that it is usually used in combination with other herbs in Chinese medicine as a female tonic. So, the synergistic qualities of these Chinese herbal combinations may potentiate the effects of each other, basically leading to better results. Do know that Dong quai does have interactions with many drugs, especially blood thinners. So, make sure to talk to a naturopathic doctor before taking this to ensure safe use.
Black cohosh is one of the biggest-researched herbs for menopause. Research has shown that this herb is better at reducing hot flashes than Fluoxetine, a commonly prescribed pharmaceutical for hot flashes. However, this same study showed that Fluoxetine was better at reducing depression scores in menopausal women compared to Black cohosh. Studies also indicate that it is effective at reducing hot flashes when used in combination with other hormone-balancing herbs.
Rheum rhaponticum. The extract ERr 731 from this plant has been shown to greatly reduce hot flashes in menopausal women when taken daily for 12 weeks. How does it do this? The extract contains phytocompounds that target estrogen receptors to cause these effects. It should be noted that these phytocompounds are selective - they do not target estrogen receptors in the breast or uterus. So, the risk of breast and uterine cancer from this extract is minimal. The common side effects from this extract have been gastrointestinal upset, rash, and headache.
Note: I usually do not recommend natural progesterone creams with wild yam and other botanicals. Trials that initially looked at natural progesterone creams used animal models, which showed great efficacy. However, human trials have shown that humans cannot metabolize the natural substances found in natural progesterone creams to actually make active progesterone in the human body.
Food, Food Extracts, & Supplements
Genistein. Yes, this is a soy isoflavone. But, before we get into it, let's talk about soy and breast cancer. Soy has estrogenic and anti-estrogenic activities and research shows that soy has does not lead to an increased risk in breast cancer in women with a history of breast cancer. If you have any questions or concerns about this, comment below. To continue with genistein, it has been shown to significantly reduce hot flashes in menopausal women without any adverse change to the endometrium and vagina. Genistein has also been shown to increase cardiac function in postmenopausal women with metabolic syndrome.
GABA/4-amino-3-phenylbutyric acid HCl (phenibut). Okay, this one isn't plant-based. GABA is actually made from a probiotic and phenibut is a supplement made in a lab. I just had to put this one in since I have seen it to be so helpful. GABA is a neurotransmitter naturally made in the brain to induce concentration and relaxation. Phenibut acts the same way as GABA, and is known to relieve tension, fear, and anxiety. Both of these can ultimately be used to improve quality of sleep. I have seen GABA and phenibut being effective for menopausal clients who wake up in the middle of the night due to hot flashes. I have also helped menopausal clients with mild-to-moderate anxiety wean off their anxiety medications by using GABA supplementation. However, I have yet to see any research that directly studies GABA or phenibut supplementation in menopausal women with mood disorders and insomnia.
MTHFR nutraceuticals: vitamin B12, folate, SAMe, B6, B1, B2. Methylation and mood are connected via a process that involves enzymes called MTHFR and COMT. MTHFR reacts with B12 and folate to move around carbon groups (aka methyl groups) to make chemicals bioactive. SAMe and B6 are involved with COMT and neurotransmitters, which can influence mood in people with anxiety and depression. B1 and B2 come into play by acting as activators to other enzymatic processes in the body that also play roles with MTHFR and COMT. These vitamins can be directly obtained from a plant-based diet. However, if there are mutations in any of those two enzymes, you may need to supplement with activated forms of those vitamins. I have seen methylation support to play large roles in determining mood stabilization for some individuals. However, much like with GABA and phenibut, I have yet to see any research that directly studies methylation nutraceuticals in menopausal women for mood support. I will also cover MTHFR, enzyme mutations, and the field of nutrigenomics to great extent in a future post.
Flax seeds. Ground flax seeds were shown to improve cardiovascular risk in postmenopausal women. Studies show that flax seeds are able to reduce total cholesterol and LDL levels alongside reducing inflammatory markers. Consumption of flax seeds are also associated with reduced risk for breast cancer in women.
Ignatia. This homeopathic remedy is known for a depression that is associated with a feeling of imperfection. Those in an Ignatia state have ideals of something, and when they don't meet those ideals, they fall into a deep sadness with possible cramping pains.
Lachesis Those in a Lachesis state are very untrusting. They also experience sudden heat flushes and clammy sweats and feel generally worse with scarves around their neck or with constricting clothing.
This flower remedy is helpful for periods of change. According to Dr. Edward Bach, this remedy is "For those who have definite ideals and ambitions in life and are fulfilling them, but on rare occasions are tempted to be led away from their own ideas, aims and work by the enthusiasm convictions or strong opinions of others. The remedy gives constancy and protection from outside influences."
Those who would benefit from this flower essence tend to be impatient and has lots of energy, much like they're in a rush to go. The description Dr. Edward Bach provides for Impatiens state is "Those who are quick in thought and action and who wish all things to be done without hesitation or delay. When ill they are anxious for a hasty recovery. They find it very difficult to be patient with people who are slow as they consider it wrong and a waste of time, and they will Endeavour to make such people quicker in all ways. They often prefer to work and think alone, so that they can do everything at their own speed."
Aspen is a great flower essence for those who feel anxious and fearful. According to Dr. Bach, this state is characterized by "Vague unknown fears for which there can be given no explanation, no reason. It is a terror that something awful is going to happen even though it is unclear what exactly. These vague inexplicable fears may haunt by night or day. Sufferers may often be afraid to tell their trouble to others."
Mustard is another energetic remedy for depression. This state is characterized as a deep gloom, much like homeopathic Black cohosh. Those in a mustard state, according to Dr. Bach, are "Those who are liable to times of gloom or even despair, as though a cold dark cloud overshadowed them and hid the light and the joy of life. It may not be possible to give any reason or explanation for such attacks. Under these conditions it is almost impossible to appear happy or cheerful."
Olive is for those who just feel tired and worn out. This state reminds me of an adrenal fatigue picture that could play a role in menopausal mental states. According to Dr. Edward Bach, Olive is for "Those who have suffered much mentally or physically and are so exhausted and weary that they feel they have no more strength to make any effort. Daily life is hard work for them, without pleasure."
Synthetic hormone therapy & Bioidentical/compounded hormone therapy. I'm going to cover this in another post since this one is a huge topic. The main thing with this is to know the pros and cons of each class of hormone therapy. So, stay tuned for this one if you're wanting to find out more info on it.
I usually use a combination of these modalities alongside lifestyle modifications to help reduce the symptoms of menopause. Why? I know that every individual is different and that every person will react to different things and that treatment individualization is the best way to tackle the symptoms of menopause. So, seeing a naturopathic doctor or a doctor versed in integrative menopause management would be your best best so that you don't waste your money on treatments that might not work. I also like to use an individualized plan with the first 3 modalities first before resorting to hormone therapy if symptoms are minor to reduce potential harm from exogenous hormones (I'll talk about the adverse effects of hormone therapy in another post soon, I promise). Another thing to note is that combining therapies without the supervision of a doctor may lead to harmful consequences. Comment below if you have any questions or comments!
about the author
Dr. Bryant Esquejo is a California-licensed naturopathic doctor practicing in the Silver Lake neighborhood in Los Angeles, California. You can book an appointment with him here and follow him on social media here.
He received his Bachelor’s Degree in Biology from San Diego State University in 2012 and his naturopathic medical degree from the National University of Natural Medicine in 2016. In his practice, he aims to help patients achieve optimal health and wellness by focusing on hormonal and thyroid health; adrenal dysfunction and stress-related chronic fatigue; gastrointestinal health; anxiety and depression; and nutrigenomics. He uses a variety of integrative modalities to assess and treat patients, such as bioenergetic muscle testing; advanced and basic functional laboratory assessment; therapeutic nutrition; lifestyle medicine; nutraceutical, vitamin, mineral, and herbal supplementation; intravenous micronutrient therapy; and energetic medicines, such as constitutional homeopathy and flower essences.
This article was previously published on Dr. Esquejo’s blog.
Anderson, Shanna, et al. “Anxiety and Methylenetetrahydrofolate Reductase Mutation Treated With S-Adenosyl Methionine and Methylated B Vitamins.” Integrative Medicine: A Clinician's Journal, vol. 15, no. 2, Apr. 2016, pp. 48–52.
Circosta, Clara, et al. “Estrogenic Activity of Standardized Extract Of Angelica Sinensis.” Phytotherapy Research, vol. 20, no. 8, 2006, pp. 665–669., doi:10.1002/ptr.1928.
D'anna, Rosario, et al. “Effects of the Phytoestrogen Genistein on Hot Flushes, Endometrium, and Vaginal Epithelium in Postmenopausal Women.” Menopause, vol. 14, no. 4, 2007, pp. 648–655., doi:10.1097/01.gme.0000248708.60698.98.
Gregorio, Cesare De, et al. “Genistein Supplementation and Cardiac Function in Postmenopausal Women with Metabolic Syndrome: Results from a Pilot Strain-Echo Study.” Nutrients, vol. 9, no. 6, July 2017, p. 584., doi:10.3390/nu9060584.
Heger, Marianne, et al. “Efficacy and Safety of a Special Extract of Rheum Rhaponticum (ERr 731) in Perimenopausal Women with Climacteric Complaints.” Menopause, vol. 13, no. 5, 2006, pp. 744–759., doi:10.1097/01.gme.0000240632.08182.e4.
Kaszkin-Bettag, M, et al. “Efficacy and Safety of the Special Extract Rheum Rhaponticum (ERr 731Â®) in Perimenopausal Women with Climacteric Complaints.” Zeitschrift fÃ¼r Phytotherapie, vol. 27, no. S 1, 2006, doi:10.1055/s-2006-954885.
Kaczor, Tina. “The Effects of Soy Consumption on Breast Cancer Prognosis.” Natural Medicine Journal, Natural Medicine Journal, Nov. 2014, www.naturalmedicinejournal.com/journal/2013-01/effects-soy-consumption-breast-cancer-prognosis.
Lapin, Izyaslav. “Phenibut (Î²-Phenyl-GABA): A Tranquilizer and Nootropic Drug.” CNS Drug Reviews, vol. 7, no. 4, July 2006, pp. 471–481., doi:10.1111/j.1527-3458.2001.tb00211.x.
Lowcock, Elizabeth C., et al. “Consumption of Flaxseed, a Rich Source of Lignans, Is Associated with Reduced Breast Cancer Risk.” Cancer Causes & Control, vol. 24, no. 4, 2013, pp. 813–816., doi:10.1007/s10552-013-0155-7.
Mandelli, Laura, et al. “Interaction between Serotonin Transporter Gene, Catechol-O-Methyltransferase Gene and Stressful Life Events in Mood Disorders.” The International Journal of Neuropsychopharmacology, vol. 10, no. 04, July 2006, p. 437., doi:10.1017/s1461145706006882.
Meister, Maureen, et al. “Effects of Flaxseed on Cardiovascular Disease Risk Factors in Menopause.” Nutrition and Diet in Menopause, 2013, pp. 201–211., doi:10.1007/978-1-62703-373-2_15.
Nagamma, Takkella, et al. “Effect Of Phytoestrogens On Lipid Profile: Mini Review.” Asian Journal of Pharmaceutical and Clinical Research, vol. 10, no. 2, Jan. 2017, p. 50., doi:10.22159/ajpcr.2017.v10i2.15684.
Oktem, Mesut, et al. “Black Cohosh and Fluoxetine in the Treatment of Postmenopausal Symptoms: A Prospective, Randomized Trial.” Advances in Therapy, vol. 24, no. 2, 2007, pp. 448–461., doi:10.1007/bf02849914.
Stojanovska, L., et al. “Maca Reduces Blood Pressure and Depression, in a Pilot Study in Postmenopausal Women.” Climacteric, vol. 18, no. 1, July 2014, pp. 69–78., doi:10.3109/13697137.2014.929649.
Tremellen, Kelton. Nutrition, Fertility, and Human Reproductive Function. CRC Press, 2015.
Williamson-Hughes, Patricia S., et al. “Isoflavone Supplements Containing Predominantly Genistein Reduce Hot Flash Symptoms.” Menopause, vol. 13, no. 5, 2006, pp. 831–839., doi:10.1097/01.gme.0000227330.49081.9e.
These statements have not been evaluated by the Food and Drug Administration. There are no financial ties to any supplement companies, pharmaceutical companies, or to any of the products mentioned in this post. This post is not meant to treat, cure, prevent, or diagnose conditions or diseases and is meant for educational purposes. As always, please consult your doctor before trying any new treatments or supplements.