If like many women you are concerned about the side effects of HRT or hormone replacement therapy there are many natural options to consider. Listed below are alternatives that have solid research backing. In other words, they are solutions you can trust.

Dietary changes:

Whether you are in your 20s or your 50s it’s never too early to start preparing by making sure you have a good balance of nutrients. A healthy diet is the foundation stone of good health and is crucial during menopause for bone health and hormonal balance.

Coffee, sugar, alcohol and soft drinks should be avoided as they are known to increase the risk of osteoporosis. Instead of refined and processed food make sure you are eating plenty of fruit and vegetables, healthy protein and whole grains. You also need lots of nuts, seeds, oily fish like salmon and trout to ensure you’re getting essential fats.

Phytoestrogens are substances found in food that have a similar chemical structure to the oestrogen your body produces, and this may explain their hormone balancing effect. Studies show that they can not only take the place of natural oestrogens and increase oestrogen levels when they are too low but they can also reduce them when they are too high. As well as helping to balance hormones, phytoestrogens are also thought to have a protective effect on the heart. Research indicates that they can lower levels of bad cholesterol.

In addition, they may contain compounds that can inhibit breast and endometrial cancer (often due to excess oestrogen), fibroids, endometriosis and osteoporosis. Food sources of phytoestrogens include virtually all fruit, vegetables and cereals. However, ‘isoflavones’ — found in beans and lentils — are an even better source of phytoestrogens. Other excellent sources include: hummous, tofu, linseeds, lentils, garlic, kidney beans, mung and alfalfa bean sprouts, asparagus, plums and oats.

Food supplements:

If you suffer from dry skin and hair, aching joints, breast pain, vaginal dryness and have difficulty losing weight, you could be lacking in Essential Fatty Acids.

Food sources of essential fatty acids include oily fish, nuts and seeds but you could also supplement with fish oils to make sure you are getting enough Omega 3. The thinking nowadays is that we actually need more Omega 3 oils as we are not getting enough from our diet.

In addition to essential fats a good quality multivitamin and mineral should form the foundation of your supplement programme to make sure you have adequate nutrients for hormone balance and healthy bones, especially if you are over the age of 40 and already experiencing peri-menopausal symptoms. A good multivitamin and mineral I use in the clinic is Menoplus. You can then, if you feel you need an extra helping hand, add in other supplements which have suggested positive results in connection with the menopause; supplements like vitamin E, vitamin B, calcium and magnesium (or a combined calcium & magnesium supplement).

Vitamin E has been studied for many years for its ability to help reduce hot flushes. It is also beneficial for vaginal dryness and is a protective antioxidant that keeps skin healthy and supple. Good food sources of vitamin E include asparagus, avocados, brown rice, egg yolks, lima beans, peas, sweet potatoes, and vegetable oils.

The B vitamins (and vitamin B5 in particular) are renowned for their ability to relieve stress and support the adrenals. B vitamins also help to alleviate symptoms of anxiety, low energy levels and poor concentration that are often associated with the menopause. To boost your B vitamins go for a vitamin B complex (50mg a day of most of the B vitamins) and eat plenty of vitamin B rich food such as fish, eggs, nuts, seeds, soya beans, bananas, and leafy green vegetables.

Osteoporosis is usually a symptom of advancing age, but it can also be a consequence of the menopause. Oestrogen protects the bones by keeping calcium in the bones and thereby maintaining bone density. During and after the menopause when oestrogen levels are reduced, bone density decreases at a more rapid rate and studies have shown that supplementing with a combined calcium citrate and magnesium supplement can help maintain strong bones.

Herbs:

Agnus Castus is a great hormone balancer. It works best taken first thing in the morning, every morning and is especially for the premenopausal symptoms such as mood swings, irritability and depression which may start before the hot flushes and night sweats. Agnus Castus stimulates the pituitary gland which is in charge of producing and setting hormone levels.

Black Cohosh is the herb of choice for the menopause, hot flushes and night sweats and one of the medical journals in 2006 stated that black cohosh is ‘one of the most effective botanicals for vasomotor symptoms’. There have been concerns that black cohosh might have an oestrogenic effect and not be helpful for women with a history of breast cancer but a study showed that adding black cohosh to breast cancer cells actually slowed down the rate at which they multiplied.

There were also some suggestions that black cohosh might have a negative effect on the liver but the National Institutes of Health in America said there is no evidence of this.

Dong Quai is a herb which is often used in traditional Chinese Medicine as a tonic for the female reproductive system. During premenopausal phases, less active versions of female hormones are produced in the body e.g. oestrone instead of oestrogen. Dong Quai is believed to work by increasing the effects of these naturally produced hormones.

New research suggests that Dong Quai also contains phytoestrogens so it can work to boost oestrogen levels at the menopause and achieve a balance. The herb has proven to be most effective for relieving symptoms of the menopause, in particular hot flushes as well as vaginal dryness. (Call 0845 8800915 for details)

Milk thistle is also another useful herb around the menopause as it helps to improve liver function which is important for the detoxification of hormones.

I use a combination of organic herbs in the clinic called Black Cohosh Plus which are in vegetarian capsules.

Finally, herbs such as horsetail, nettle and alfalfa may also be used alongside dietary recommendations, supplements and exercise for the treatment of osteoporosis.

In a nutshell:

The menopause is a natural event in women’s lives and not an illness. There are many natural and effective alternatives to the drug approach of HRT, the most reliable of which have been detailed above, and these can really help to ease the emotional and physical discomfort associated with this time of life.

Eating well, exercising and using natural remedies around the menopause enables you to get on with your life and keep living it to the full.

Memory lapses and fuzzy thinking happen to everyone now and again but if you find that you always forget where you put your keys it is easy to think you might be losing it.

Studies show that fluctuating oestrogen levels at the menopause can cause poor concentration but the ageing process and specifically the menopause probably has little to do with your memory. Check what you are eating, your exercise level, what drugs you are taking and your ability to sleep. These factors are more important than the menopause or even ageing in your ability to remember.

What you eat could be affecting your memory
You are what you eat, and that includes your brain. Food powers your body and fuels your brain. Whatever you eat and drink will affect your body and your brain in some way. If it doesn’t get fed properly your brain begins to slow down, resulting in memory loss, foggy thinking and poor concentration.

B vitamins:
Studies have shown that deficiencies of B-vitamins can lead to poor memory during the menopause. Make sure that your diet is sufficient in B vitamins — especially vitamin B5 found in food such as whole grains, whole rice, whole meal bread, legumes, broccoli and tomatoes. Vitamin B5 is essential for optimum functioning of your nervous system.

If lack of co-ordination is a real problem you may also want to supplement with an additional 50 mg of vitamin B5 a day on top of your multivitamin and mineral. A multi-vitamin and mineral should never replace a healthy diet but it is a good insurance policy. Without the right nutrients, your brain can’t function right.

Having a breakfast of coffee and a sugary cereal or its equivalent is a prescription for memory loss and poor concentration. (Caffeine and sugar give you a boost for a few minutes, then both start leaching vital nutrients from your body that you need to think clearly and you either have to have another “fix” or you go into a fuzzy thinking period.)

Iron:
Make sure your diet is sufficient in iron as low iron levels can be associated with memory problems and poor coordination.

Alcohol and drugs:
Alcohol, wide swings in blood sugar (due to chocolate, sweets, cake and other sugary foods) and some drugs can cause memory loss. Some people are intolerant to wheat products (bread, pasta, cereals, cakes, biscuits and other processed foods) and that can lead to memory loss and fuzzy thinking, not to mention headaches and bloating. Eating an all carbohydrate meal, pasta with tomato sauce, for example, can dampen your memory. Add a protein such as tuna or beans to your pasta.

Cut down on sugar:
Refined sugars “turn off” the brain and that’s not a good idea when you want a clear mind and a good memory. Check labels of canned and frozen foods for added sugar and avoid those that list any type of sugar from fructose to cane or brown sugar.

Omega-3 fatty acids:
A diet rich in the omega-3 fatty acid docosahexaenioc acid (DHA) has been found to significantly reduce the risk of dementia and Alzheimer’s disease. In fact, a study published in the November 2006 issue of Archives of Neurology found that people with the highest levels of DHA in their blood were 47 per cent less likely to develop age-related cognitive diseases, compared to those people with lower levels of DHA.

The best food sources of DHA are omega-3 enriched eggs and seafood and fish, especially cold-water fish, such as mackerel, salmon and herring. A great way to enrich your diet with DHA is by eating a four- or five-ounce serving of fish two to three times a week. To give yourself a quick boost while you are sorting out your diet, you could add a good DHA/EPA supplement such as the BioCare EPA which I use in the clinic.

Fruit and vegetable juices:
Fruit and vegetable juices have also been found to protect against the onset of Alzheimer’s disease. Findings published in the September 2006 issue of the American Journal of Medicine found that a daily glass of juice is enough to make a difference. Study participants who drank fruit or vegetable juice a few times a week were 76 per cent less likely to develop the disease compared with individuals who drank less than one glass a week.

Drink up:
Water is vital for a healthy brain and that’s why you get headaches and can’t concentrate properly if you are dehydrated. The solution: make sure you drink around eight glasses of water a day (1 and a half litres or two and three quarter pints) to stay hydrated; more if you are exercising. One way to ensure you are drinking enough is to fill a bottle with your targeted amount and drink it throughout the day. If the container is empty by bedtime, you’ll know you have achieved your goal.

Don’t wait until you are thirsty to drink either as thirst is the first sign of dehydration. Herbal teas also count towards your target but ordinary black tea and coffee do not.

Fibre:
Putting the right food in helps, but it’s important to get it out too. Don’t you just feel better and think clearer once your system has had a good clear out? That’s why fibre should be nominated as the unsung brain food hero. Constipation causes toxins to be re-circulated into the bloodstream and triggers headaches, fatigue and low libido.

If you are eating at least five servings of fruit and vegetables a day you are well on your way towards your fibre intake. You can get the rest from complex carbohydrates such as wholegrain cereals, nuts and seeds. Do not add bran to food as this is a refined food and actually irritates the gut. It is better to eat bran in the form that nature intended — in other words, as part of the whole grain itself (wheat or oats, for example).

Meal timing:
It seems it’s not only the foods we eat that play a critical role in maintaining regular brain function, but also when we eat them. Skipping meals and eating at irregular times can affect short-term brain function. Going for long periods between meals deprives the brain of the nutrients and energy it needs to function properly. As a result, brain functions such as memory, concentration and mood can be affected. To optimize your brainpower, eat meals at regular times and have a healthy snack, such as a handful of nuts or piece of fruit, between meals to provide a steady supply of energy to the brain.

Importance of breakfast:
There is increasing evidence that breakfast may be the most important meal of the day for our brains. Studies have shown that when students are given a healthy breakfast, it has a positive effect on cognitive function related to memory, test grades, creative ideas and school attendance. Breakfast kick-starts our metabolism and brain function at the start of the day. Eat a breakfast to fuel brainpower by choosing foods that are high in fibre and are nutrient dense, such as whole grains and fruits.

In a nutshell
Memory loss is not an inevitable consequence of the menopause or ageing and, whatever age you are healthy eating combined with regular exercise and a good night’s sleep will not only help you manage your weight and protect against heart disease, cancer, and osteoporosis, it will also protect and improve your brain health.

(Food for thought concludes next month with my top 12 brain foods, herbs and supplements.)

The only thing predictable about the menopause is its unpredictability. Healthy eating combined with regular exercise is one of the best ways to protect yourself against the symptoms of the menopause but for those times when a hot flush or a low mood catches you unawares the on-the-spot solutions below are all designed to help you get on with your day.

Hot flushes: If you’re under stress this may make things a whole lot worse. For immediate relief try some deep abdominal breathing as it can help reduce hot flushes significantly if they are triggered by stress. It really helps to relax into your flushes, rather than panicking. Keep calm. It will be over before you know it. If it’s an emergency, excuse yourself, go to the bathroom and run some cold water over your inside wrists for a few minutes.

For the future invest in a good natural deodorant (or see page 7) wear clothes made from natural fibres — they allow your skin to breathe and cool down quicker than synthetics — and wear layers so you can disrobe at appropriate times when you feel yourself getting hotter. It’s also a good idea to drink plenty of water or calming camomile tea and take a black cohosh supplement as it’s proven to help hot flushes naturally. Stimulants like caffeine or nicotine or alcohol should be avoided.

Memory loss: Don’t panic if you are speaking to someone and have forgotten their name – or even what you are talking about – as this will make things worse. Listen to what they are saying and look for triggers you can pick up on. You could say something like, ‘Can we go over that point again so I can be clear in my mind?’ Don’t give yourself a hard time or tell yourself you are losing it because mental decline is not inevitable with age.

The secret to an agile brain is to keep using it every day and to feed it correctly as this avoids blood sugar swings which can stress the brain and cause confusion and memory loss. Studies show that kids who had fizzy soft drinks and sugary snacks for breakfast performed at the level of an average 70 year old in tests of memory and attention. To avoid blood sugar swings make sure you never skip breakfast, and eat fresh, natural unprocessed meals and snacks every two to three hours throughout the day. Research also shows that the herb gingko biloba can help boost brain power but consult your doctor before-hand if you are on any medication.

Mood swings: Fluctuating blood sugar levels can not only trigger memory loss they can also increase the risk of mood swings so eat small, low GI snacks throughout the day and avoid sugar and caffeine. Fruit, a handful of nuts, oatcakes or houmous is ideal when your mood takes a nose dive. A brisk walk or listening to energising music can also help as can acupressure. In Chinese medicine the skin between your thumb and forefinger is a good point for reducing stress. And don’t forget aromatherapy essential oils; sage is good for tearfulness and irritability while geranium is uplifting and balancing.

Insomnia: Rather than just lying there worrying about the fact that you can’t sleep — get up and try to relax a bit. Address any specific reasons for your insomnia — a snoring partner, room too hot or too cold and so on. Once you’ve removed any obvious causes work on your mind. Try self-hypnosis and breathing exercises. Get comfortable and without moving your head roll your eyes upwards slowly. Take a deep abdominal breath, hold for a moment and as you exhale close your eyes, relaxing the muscles around them. Breathe slowly and let the relaxed feeling spread from your head to your toes. If this doesn’t help try a simple repetitive task, such as ironing or folding laundry, and you’ll soon find that your eyes get heavy.

For future reference if you suffer from insomnia keep your last meal of the day light and during the day try to eat foods that contain tryptophan such as organic milk, egg whites and tuna. Tryptophan helps the body to produce melatonin, and melatonin is the hormone that promotes sleep. Some foods, however, are rich in another amino acid, tyramine. Tyramine causes the release of a substance that stimulates the brain and keeps you awake. Avoid eating bacon, cheese, sugar, ham or tomatoes. And always avoid other stimulants, like caffeine (and remember this comes in colas and chocolate as well as coffee) and alcohol.

Dry vagina: Low levels of oestrogen as you approach the menopause can make your vulval skin thinner and drier. In the long term think about including more hormone balancing skin lubricating foods rich in isoflavones (soya and legumes) and omega 3 (nuts, seeds and oily fish) in your diet and drink plenty of water.

You can also use a natural lubricant gel and one that many women have found effective is Sylk. Sometimes it may be that you are not aroused enough — most women need around twenty minutes to get turned on. Ask your partner to spend more time on foreplay — sensual touching and caressing — to help you feel closer. The saying if you don’t use it, you lose it doesn’t just apply to your brain it apples to sex too. Regular sex can keep your vagina healthy and happy. Although vaginal dryness is common during the menopause some women do still lubricate rapidly when aroused and the most likely reason for this is that these women continue to have sex once or twice a week.