Menopause – How to Manage This Phase?

The menopausal transition, conventionally observed between the ages of 45 and 55, represents a stage during which physiological signals of hormonal reorganization become most pronounced and perceptible to the body. Nevertheless, the initial—though often imperceptible—shifts in hormonal balance commence considerably earlier, specifically after the age of 30. Levels of critical sex hormones, including estrogen and progesterone, undergo a gradual yet persistent decline, only to experience a marked reduction around the fifth decade of life. A direct consequence of these alterations is the increased prevalence of anovulatory menstrual cycles, which diminishes fertility; however, conception remains biologically feasible until the complete cessation of the menopausal process. Notably, women with elevated adipose tissue levels (exceeding standard physiological ranges) may experience prolonged menstrual regularity and enhanced overall well-being. This phenomenon stems from the unique capacity of adipose tissue to synthesize estrogen, thereby partially offsetting hormonal deficiencies and delaying the onset of certain menopause-related symptoms.

Estrogens and progesterone serve as fundamental biological regulators that preserve youthful physiological characteristics by modulating tissue elasticity, cellular regeneration, and metabolic equilibrium. As their circulating levels decline—most prominently during the menopausal transition—a cascade of accelerated aging manifestations emerges across multiple systemic levels. The earliest and most visually apparent symptoms include diminished skin turgor, the formation of static and dynamic wrinkles, and progressive epidermal xerosis, all of which stem from reduced biosynthesis of type I and III collagen alongside hyaluronic acid—compounds whose production was previously estrogen-dependent. Concurrently, skeletal tissue undergoes progressive demineralization, substantially elevating susceptibility to osteoporotic fractures and structural degradation. Immune system responsiveness becomes attenuated, while inflammatory processes exhibit diminished regulatory control. Progesterone deficiency further disrupts cutaneous repair mechanisms, delays epidermal turnover, and may promote dysregulated cellular proliferation, thereby heightening long-term oncogenic risk. Cognitive domains also deteriorate, with observable declines in sustained attention, impaired acquisition of new information, and prolonged latency in processing external stimuli—phenomena linked to diminished prolactin secretion. Collectively, these multifaceted alterations exert a profound detrimental impact on quality of life, affecting both physical functionality and psychological well-being in menopausal and postmenopausal women.

In the context of alleviating menopausal symptoms, conventional hormone replacement therapy (HRT) remains the most frequently prescribed and medically endorsed intervention. However, a subset of patients—due to individual medical histories or contraindications—are unable to utilize this treatment modality. Furthermore, scientific literature documents potential adverse effects associated with prolonged synthetic hormone use (Szutnik-Fiedler et al., 2010), most notably a two- to threefold elevation in the risk of thromboembolic events. Patients with contraindications to HRT should consult their healthcare provider to explore alternative therapeutic avenues. Phytoestrogens—naturally occurring plant compounds with a chemical structure analogous to human estrogen—represent a promising substitute, particularly given the physiological decline in sex hormone levels during menopause. While their biological potency is lower compared to synthetic estrogens, their application may yield therapeutic benefits (Gryszczyńska et al., 2012; Szkutnik-Fiedler et al., 2010). The World Health Organization (WHO) actively advocates for the integration of traditional medicine, including preparations derived from licorice or red clover, into contemporary clinical practice. Phytoestrogens are categorized into three primary groups: isoflavones (found in legumes such as soy, sunflower seeds, red clover, and walnuts), coumestans (present in beans and soybean sprouts), and lignans (located in cereals, flaxseeds, and green/black tea). It is critical to note that the efficacy of phytoestrogen therapy is contingent upon multiple variables, including genetic predispositions, lifestyle factors, and the specific formulation of the supplement. Additionally, the bioavailability of these compounds depends on a healthy gut microbiota, as phytoestrogens exist in an inactive form and require activation by bacterial enzymes in the gastrointestinal tract. Consequently, a diet rich in dietary fiber and fermented dairy products is recommended to facilitate optimal metabolism of these compounds.

*Trifolium pratense*, commonly referred to as red clover, is a ubiquitous perennial herb found in meadows, woodlands, and uncultivated grasslands. Its longstanding use in herbal medicine stems from a rich phytochemical profile, most notably its isoflavone content—phytoestrogens demonstrated to exert vasomotor regulatory effects. Emerging evidence suggests that red clover extracts may substantially attenuate the frequency and severity of vasomotor symptoms, including hot flashes and nocturnal hyperhidrosis, which rank among the most disruptive manifestations of menopause. Furthermore, isoflavones exhibit anti-resorptive properties that help preserve bone mineral density, thereby mitigating the risk of postmenopausal osteoporosis. An additional benefit lies in their favorable modulation of lipid metabolism: supplementation has been associated with elevated high-density lipoprotein (HDL) concentrations alongside reduced triglyceride levels, collectively lowering cardiovascular risk (Szutnik-Fiedler et al., 2010). Of further clinical relevance is the potential anxiolytic and mood-stabilizing activity, which may enhance overall well-being during the climacteric transition.

To optimize therapeutic outcomes with red clover-based formulations, standardized extracts ensuring precise isoflavone dosing—ideally 40–80 mg daily—are essential. While herbal infusions offer an alternative, their bioactive absorption remains indeterminate. Licorice, renowned primarily for its intensely sweet profile (up to fifty times sweeter than sucrose), extends beyond culinary applications: its active metabolites demonstrate osteoprotective properties, particularly during the postmenopausal phase. Research (including Klasik-Ciszewska et al., 2016) confirms that the chemical structure of licorice glycosides mimics estradiol’s bone-preserving effects by inhibiting osteoclast activity. Additionally, the plant may alleviate climacteric symptoms such as hot flashes. For therapeutic use, 3–5 g of dried root per infusion is recommended (maximum 15 g/day), with critical contraindications including hypertension and potential interactions with diuretics, corticosteroids, or cardiac medications. Mandatory medical consultation is required prior to supplementation initiation.

Soybeans represent one of the richest dietary sources of bioactive phytoestrogens, a fact substantiated by extensive research, including studies by Gryszczyńska et al. (2012) and Prescha & Biernat (2008). Due to their high isoflavone content—compounds demonstrated to alleviate menopausal symptoms—soy and its derivatives are particularly recommended for women over the age of 45. Regular consumption of soy-based products has been shown to significantly diminish the severity of common complaints such as night sweats, sleep disturbances, and hot flashes by up to 40%, as documented in a 12-week controlled clinical trial where participants ingested 45 grams of soybean flour daily (Kołodziejczyk, Olas, & Wachowicz, 2012). Nutrition experts propose that the optimal daily intake of isoflavones from soy sources should approximate 60 milligrams—a target achievable through the consumption of roughly half a liter of soy milk or 120 grams of tofu (Kapliński, 2012). Beyond its phytoestrogenic properties, soy is distinguished by its exceptional nutritional profile, offering complete protein, vitamin K, folic acid, iron, omega-3 fatty acids, and lecithin, making it an invaluable dietary component, especially for individuals adhering to vegan or vegetarian lifestyles. While soy surpasses other legumes in terms of amino acid composition, alternatives such as chickpeas, lentils, and beans provide comparable health benefits. It is important to note, however, that soy is classified among the eight most allergenic foods; thus, in cases of adverse reactions, substituting it with other phytoestrogen-rich legumes is advisable.

The menopausal period is accompanied by numerous physiological changes, making it essential to adapt nutritional habits to the body’s evolving requirements. Due to the gradual decline in metabolic rate, a reduction in total caloric intake becomes necessary to prevent uncontrolled weight gain. An optimal dietary pattern should prioritize unprocessed foods, particularly fresh, seasonal, and locally sourced vegetables and fruits, which provide high concentrations of bioactive compounds. Their consistent inclusion in meals ensures an adequate supply of essential micronutrients—such as potassium, vitamin C, and folic acid—as well as dietary fiber, which promotes digestive regularity and enhances satiety. Highly processed foods with low nutritional density, including industrial sweets, fast food, and sugar-sweetened beverages that deliver only "empty" calories, should be eliminated. Equally critical is maintaining consistent hydration: mineral water, especially varieties rich in magnesium and calcium, plays a pivotal role in sustaining homeostasis and preventing dehydration, which may exacerbate menopausal symptoms.