Hi Sandra, I'm in my late forties and starting to experience what I assume is peri-menopause - hot flushes, trouble sleeping and more irritable than usual. It has coincided with a big project at work so I have been stressed too. Any suggestions for what might help? Thanks, Jayne.

Hi Jayne, thanks for your question. The emergence of peri-menopausal symptoms as the demands of your work life increase is unlikely to be coincidental.

Peri-menopause usually occurs between the ages of 45 to 55 and is characterised by a decline in the regularity of ovulation and associated fluctuations of the two main sex hormones produced during a woman's monthly cycle. We hear a lot about the effects of declining oestrogen during peri-menopause, but progesterone is equally as important; it acts as a natural anti-anxiety and anti-depressant, calming the brain and protecting against stress, worry and insomnia. Declining progesterone is one of the reasons that women are three times more likely to suffer anxiety, depression, and insomnia during the five years before menopause.

Your adrenal glands take over the production of progesterone after menopause, however these glands also respond to stress. A high stress lifestyle places increased demands on their hormone-producing capability, and usually results in worsening peri-menopausal symptoms.

Adrenal and nervine tonic plants can smooth the peri-menopausal transition, relieving symptoms such as anxiety, irritability and sleep challenges. Licorice (Glycyrrhiza glabra), a potent adrenal tonic, improves resistance to stress and is useful in times of increased demand. It contains a plant compound called glycyrrhizin that is structurally similar to our stress hormones, sending a message to the body that the stress response is activated and further stimulation is not required. In addition, the steroid-like compounds in Licorice can act as oestrogen precursors, giving it mild oestrogenic properties, useful for when oestrogen production declines.

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St. John's Wort (Hypericum perforatum) is another fantastic aid for peri-menopausal symptoms exacerbated by stress. A natural anti-depressant, it enhances serotonin production, helping to calm the brain, alleviate anxiety and enhance sleep. In addition, it has been shown to reduce the hot flushes associated with peri-menopause in clinical trials.

Both plants combine well with Motherwort (Leonurus cardiaca) and Lavender (Lavandula angustifolia). Physicians have written about Motherwort's nerve soothing properties for over 2000 years. It helps to ease menopausal symptoms that are caused by the rapid decline of oestrogen and is particularly beneficial for anxiety and insomnia that includes heart palpitations.

Lavender is a good remedy for easing irritability, mild anxiety, worrying, stress and exhaustion. It is used to balance emotions, uplift the spirits and relieve mild depression.

Sage (Salvia officinalis) also deserves special mention, since it is the most important herb to reduce excessive sweating. It has phyto-oestrogenic properties and is clinically proven to significantly reduce or completely stop hot flushes and night sweats in peri-menopausal women.

The above plants can be combined and consumed as a medical tea throughout peri-menopause until a new hormonal regime is established. Between one and three cups daily is required, with the upper dose usually necessary when challenged by stress and temperature regulation. It can also be consumed as an evening drink half an hour to an hour before bedtime for a restful sleep. If your hot flushes can be triggered by hot liquids, let your drinks cool down a bit before you consume them.

Other measures for supporting a smooth menopausal transition include a healthy diet, and avoiding foods that can aggravate hot flushes such as spicy foods, alcohol and caffeine. A moderate exercise regime, stress management strategies and sufficient rest and sleep are also crucial to ensuring this time is transformed from challenging to manageable and even enjoyable.

If this condition worsens or does not improve, see your leading healthcare professional.

References
Gordon, J., et al (2015). Ovarian Hormone Fluctuation, Neurosteroids and HPA Axis Dysregulation in Perimenopausal Depression: A Novel Heuristic Model. American Journal of Psychiatry, 172(3): 227-236.

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Uebelhack, R., Blohmer, J., Graubaum, H., Busch, R., Gruenwald, J., & Wernecke, K (2006). Black cohosh and St. John's Wort for climacteric complaints: a randomized trial. Obstetrics and Gynecology, 107 (2), 247-255.

Bommer, S., Klein, P., & Suter, A. (2011). First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Advances in Therapy, 28(6), 490-500. doi: 10.1007/s12325-011-0027-z