All women experience it and the symptoms can be horrible – hot flushes, insomnia and depression. But there are ways of making the menopause a positive experience

IT HAPPENS to all women at some stage – the M-word, that is.

You know menopause is creeping up on you because there are warning signs. Your periods will become irregular, you may start waking at night and may experience a burning-up or hot-flush sensation.

Menopause can happen any time between the ages of 45 and 55, although symptoms often kick off prior to this, sometimes as early as late 30s.

Once it begins, for many women the automatic next step is hormone replacement therapy (HRT), prescribed by a GP. Taken over the course of a year or two, it can help with the transition.

However, in the last few years views on the effectiveness of HRT have started to change. Despite being seen as a bit of a miracle cure in the 1970s, following some fairly comprehensive studies in 2002, 2003 and 2007,HRT is now viewed with concern and GPs are increasingly reluctant to prescribe it, as the studies confirmed links between HRT and breast cancer, heart disease and even Alzheimer’s.

While it does offer relief from physical symptoms such as hot flushes, and protects against brittle bones, it looks like HRT's disadvantages far outweigh its benefits. Some health experts argue that it is of no benefit at all to anyone beyond the very early stages of menopause.

Replacing HRT Hilary Wakeman is a Church Of Ireland priest, a writer, poetry editor and grandmother. Like her own mother, she reached menopause at 46. She suffered hot flushes, night sweats, palpitations, insomnia and some depression. After a chat with her very supportive female GP, she made the decision to begin a course of the oestrogen-based cream form of HRT.

Two years later, reports of the link between HRT and breast cancer convinced her to stop using it, and although there was some return of her problems they were, she says, much milder.

On the whole, Hilary’s experience of HRT was a positive one. For her, medication was a good decision at the time, helping to smooth over the transition. Hilary took no other measures, in nutritional or lifestyle terms. “We simply didn't know about that back then,” she says. But the impacts of a lifestyle change shouldn’t be underestimated.

Bestselling author and breast cancer survivor Bernadette Bohan was sent into sudden menopause by her chemotherapy treatment at the age of 46. She wasn't keen on taking any kind of drug, so HRT was never an option. Her symptoms were relatively severe.

“The worrying palpitations and unbearable, massive hot flushes were the worst,” she says. But then she embarked on a healthy eating plan. Bernadette's diet focuses on vegetables and wholefoods, largely raw and organic, and as little sugar as possible. The addition of omega oils and supplements agnus castus and dong quai gave further relief. She believes her change in diet quite literally saved her life.

“My symptoms simply disappeared,” she says. Facing the fear Sabina Jennings, a medical herbalist, has noticed this sea change in women’s approach to the menopause.

“We are seeing an increasing number of women who are reluctant to take HRT and seek a more natural form of symptom control.” Like many practitioners, Sabina believes that there is a powerful emotional element involved.

“A lot of women feel that they have come to a crossroad in their lives, which can be frightening,” she says.

Bernadette agrees. Even though her family was already happily completed she admits there was “a wrench” when she was told that her fertile years were over. This is part of the problem says Sabina. Rather than focusing on what is lost, women should see the menopause as a new and positive stage of life, which in turn can help control the symptoms.

“What middle-aged women need to realise,” she says, “is that they're beautiful and wise. They should see the future as a time for fulfilment.”

Going natural Besides a positive mental outlook, there are many other natural means of coping. John Garvey, a nutritionist based in Leap, Co Cork, believes that the body's adverse reactions during this transitional period are not really necessary. He takes a holistic approach, involving plenty of relaxation and a diet of foods that are as close to their natural state as possible.

This means more wholefoods and plant proteins, and fewer animal products, which can adversely effect hormonal and pH balance in the body. The single most important step in dealing with menopause is to eat a diet high in phytoestrogens, which mimic the action of oestrogen in the body.

These occur naturally in foods such as nuts and seeds, grains, vegetables, pulses and soya products. Phytoestrogens can have a profoundly harmonising effect on hormones, and endless numbers of women swear by them.

Wild greens such as nettles, dandelion leaves, parsley, watercress and seaweeds might be an acquired taste, but they are potent powerhouses full of all the nutrients the body needs at this time.

It can be no accident that in countries like Japan, where the diet revolves around seafoods, soya, vegetables and rice, there is no word for hot flush. Oily fish provides not only the hormone-balancing, moisturising, mood and brainenhancing omega oils, which the body is unable to produce itself, but precious vitamins B, D and E and calcium too, all vital for skin, emotional, heart and bone health.

Exercise is a must on several levels. It helps control weight, builds bone mass, and releases feel-good endorphins which aid sleep and ease stress. Bernadette says that thanks to the changes in her lifestyle, she can view what was potentially a very difficult stage in positive terms. “This is a normal part of a woman's life – not a catastrophe – with the potential to be hugely liberating,” she says. Hilary agrees.

As a writer, one of her concerns was that her creativity would disappear with her periods. She had always noticed that she felt domesticated in the two weeks before her period, as the body prepares for possible motherhood, and creatively inspired in the weeks after. But there hasn't been a problem. Hilary radiates health and says that she has more energy now than she ever had.

“In retrospect, menopause was nothing to fear,” she says. “It is an ending, but it's a beginning too.”

● SabinaJennings,Hayward ClinicOfNaturalMedicine, Bandon,CoCork,02342873, info@whatsthealternative.ie

● JohnGarvey,Leap,CoCork, 02834055,johngavey526@hotmail. com

● BernadetteBohan'sDVD,The Choice,isoutonSeptember2, availableinhealthstoresoremail b@changesimply.com

Take action top tips

● Go easy on red meat and saturated fats but include plenty of vegetable protein and oily fish and nuts and seeds.

● Avoid processed foods, smoking, sugar and caffeine, and excess salt and alcohol.

● One or two glasses of red wine carry benefits, however, as does regular sex!

● Exercise gently but regularly.

● Try to get enough sleep and relaxation. Yoga, meditation, tai chi, aromatherapy, acupuncture and homeopathy have shown excellent results.

Best supplements

● A good multivitamin and mineral

● An antioxidant combination, including vitamins A, C and E vitamin B complex

● A bone/heart health supplement

● Calcium and magnesium

● Vitamin D

● Vitamin K and boron

● Omega oils

● Agnus castus

● Don quai

● Black cohosh

● Wild yam

● Red clover