Updated: 7/5/2019

Understanding Menopause

Menopause happens. Even with the best of health habits, menopause still happens.

It is a natural process, but has the potential to adversely affect all of the hormonal systems of the body. The hormonal changes that occur with the natural cessation of reproductive function often throw a monkey wrench into the body’s entire hormonal balance.

Though hot flashes and night sweats are classic, almost any symptom that occurs at this point in a woman’s life can be attributed to menopause.

Though these hormonal imbalances gradually equilibrate over time, natural herbal therapies, sometimes coupled with properly dosed bioidentical hormone therapy, can help to smoothen the transition.

Common Symptoms

  • Hot flashes, night sweats
  • Mood swings
  • Feelings of anxiety
  • Difficulty concentrating
  • Aching joints or muscles
  • Weight gain
  • Poor sleep
  • Bone loss
  • Headaches
  • Vaginal dryness
  • Loss of libido

What Causes Menopause?

In a nut shell, menopause occurs because the ovaries run out of eggs.

Prior to menopause, each normal menstrual cycle starts with recruitment of a cluster of eggs in the ovaries (at that point called follicles). These follicles produce estrogen. Estrogen production steadily increases until it reaches a peak mid-cycle. The peak in estrogen initiates a hormonal cascade, with the result of the largest follicle rupturing and releasing an egg.

Once the egg is released, estrogen production declines and the place in the ovary from where the egg was released (called a corpus luteum) begins producing progesterone. Progesterone prepares the body for pregnancy. If pregnancy does not occur (most of the time) progesterone declines, initiating a period. And then the cycle starts over.

In general, estrogen is stimulating, and progesterone is calming and relaxing.

Leading up to menopause (perimenopause), there are fewer follicles left, so estrogen production in the initial phase is erratic. Erratic production of estrogen, a very stimulating hormone, is what causes hot flashes, poor sleep, and many other symptoms. It is also the reason for irregular periods.

All this leads to poor development of a corpus luteum and inadequate progesterone production. Inadequate progesterone and abrupt progesterone withdrawal are responsible for moodiness and depression.

As menopause sets in, not enough follicles are present to cause ovulation and periods stop (though a period can show up out of the blue many months after the perceived final period). Decline of all hormones intensifies symptoms. This can go on for awhile until the body equilibrates into a new normal state.

The Three Stages of Menopause:


Perimenopause typically starts several years before the onset of menopause. As the ovaries run out of eggs, hormone fluctuations become more intense. Typical symptoms including mood changes, hot flashes, poor sleep, and highly variable menstrual cycles are associated with estrogen dominance and progesterone deficiency.


After periods have been absent for at least 6 months, it is defined as menopause. Estrogen is still being produced by the ovaries, but will gradually wane over several years. Classically, menopause is associated with hot flashes, night sweats, poor sleep, decreased mental focus, and feeling out of balance. Sometimes these symptoms intensify. Vaginal dryness is a key symptom indicating significant estrogen decline.

Another option is to talk to your healthcare provider about hormone replacement therapy (HRT).


In the phase after menopause, symptoms such as hot flashes and night sweats usually begin to ease up for most women. However, postmenopausal women are at a higher risk of bone loss than the general public and should be proactive about slowing bone loss.

Tips from Dr. Rawls

Take herbal supplements for balancing hormones

Herbal therapy is a safe and effective option by itself or in conjunction with hormone replacement therapy.

Practice a healthful lifestyle

In general, women who practice good health habits have a smoother transition through menopause. During menopause, it is recommended that you consume a diet high in fruits and vegetables and low in meat, processed foods, and sugar.

Do your best to exercise regularly, avoid toxins and manage stress levels. The focus and concentration required to practice yoga is excellent for focusing your mind and relieving symptoms.

Add progesterone

Progesterone is soothing and calming. Most over-the-counter progesterone products provide 20 mg of natural progesterone per pump. Take 1-2 doses (pumps) of progesterone cream daily for two weeks prior to the expected time of the menstrual period.

As periods decrease, progesterone cream can also be used throughout the cycle. Progesterone cream is safe and can be continued indefinitely in individuals choosing not to use estrogen. Progesterone does offer some bone protection. Avoid use of yam creams, which do not actually contain progesterone.

1. Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, Javadzadeh Y., Effects of Vitex agnus and Flaxseed on cyclic mastalgia: A randomized controlled trial, Complement Ther Med. 2016 Feb;24:90-5. doi: 10.1016/j.ctim.2015.12.009. Epub 2015 Dec 29.
2. Khalilzadeh E, Vafaei Saiah G, Hasannejad H, Ghaderi A, Ghaderi S, Hamidian G, Mahmoudi R, Eshgi D, Zangisheh M., Antinociceptive effects, acute toxicity and chemical composition of Vitex agnus-castus essential oil, Avicenna J Phytomed. 2015 May-Jun;5(3):218-30.
3. Arentz S, Abbott JA, Smith CA, Bensoussan A., Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings, BMC Complement Altern Med. 2014 Dec 18;14:511.
4. Jang SH, Kim D, Choi MS., Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review, BMC Complement Altern Med. 2014 Jan 10;14:11.
5. Depypere HT, Comhaire FH., Herbal preparations for the menopause: beyond isoflavones and black cohosh, Maturitas. 2014 Feb;77(2):191-4.
6. van Die MD, Burger HG, Teede HJ, Bone KM., Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials, Planta Med. 2013 May;79(7):562-75.
7. Schellenberg R, Zimmermann C, Drewe J, Hoexter G, Zahner C., Dose-dependent efficacy of the Vitex agnus castus extract Ze 440 in patients suffering from premenstrual syndrome, Phytomedicine. 2012 Nov 15;19(14):1325-31.
8. Ambrosini A, Di Lorenzo C, Coppola G, Pierelli F., Use of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observation, Acta Neurol Belg. 2013 Mar;113(1):25-9.
9. Zamani M, Neghab N, Torabian S., Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome, Acta Med Iran. 2012;50(2):101-6.
10. Garrison R, Chambliss WG, Effect of a proprietary Magnolia and Phellodendron extract on weight management: a pilot, double-blind, placebo-controlled clinical trial, PubMed. Altern Ther Health Med. 2006 Jan-Feb;12(1):50-4
11. Kalman DS, Feldman S, Feldman R, Schwartz HI, Krieger DR, Garrison R., Effect of a proprietary Magnolia and Phellodendron extract on stress levels in healthy women: a pilot, double-blind, placebo-controlled clinical trial, PubMed. Nutr J. 2008 Apr 21;7:11
12. Talbott SM1, Talbott JA, Pugh M., Effect of Magnolia officinalis and Phellodendron amurense (Relora®) on cortisol and psychological mood state in moderately stressed subjects, PubMed. J Int Soc Sports Nutr. 2013 Aug 7;10(1):37
13. Biswajit Auddy, Jayaram Hazara, Achintya Mitra, Bruce Abedon, Shibnath Ghosal, A Standardized Withania Somnifera Extract Significantly Reduces Stress-Related Parameters in Chronically Stressed Humans, JANA, Vol. II, No. I, 2008, pp. 50‐56.
14. Usharani Pingali, Raveendranath Pilli, Nishat Fatima, Effect of standardized aqueous extract of Withania somnifera on tests of cognitive and psychomotor performance in healthy human participants, Phamacognosy Research, January‐March 2014, Vol. 6, Issue 1, pp. 12‐18.
15. K.N.Roy Chengappa, Christopher Bowie, Patricia Schlicht, David Fleet, Jaspreet Brar, Ripu Jindal, Randomized Placebo-Controlled Adjunctive Study of an Extract of Withania somnifera for Cognitive Dysfunction in Bipolar Disorder, J Clin Psychiatry, 74:11, November 2013, pp.1076‐1083.
16. Usharani Pingali, Raveendranath Pilli, Nishat Fatima, Effect of Withania Somnifera Extract on Mental Stress Induced Changes in Hemodynamic Properties and Arterial Waveform Reflections in Healthy Subjects, Current Topics in Nutraceutical research, Vol. 11, No. 4, pp. 151‐158, 2013.
17. P.Nalini, K.Manjunath, N., K.Sunil Kumar Reddy, P.Usharani, Evaluation of the analgesic activity of standardized aqueous extract of Withania somnifera in healthy human volunteers using Hot Air Pain Model, Research Journal of Life Sciences (May 2013), Vol. 01, Issue 02, pp. 1‐6.
18. Pingali Usharani, Nishat Fatima, Chiranjeevi Uday Kumar, Evaluation of a highly standardized Withania somnifera extract on endothelial function and biomarkers of oxidative stress in patients with type 2 diabetes: A randomized, double‐blind, placebo‐controlled study, Int. J.Ayur. Pharma Research, 2014; 2(3): 22‐32.
19. P. Usharani, P.V. Kishan, Nishat Fatima and C. Uday Kumar, A comparative study to evaluate the effect of highly standardized extracts of Phyllanthus emblica, Withania somnifera and their combination on endothelial dysfunction and biomarkers in patients with type 2 diabetes mellitus, IJPSR, 2014; Vol. 5(7): 2687‐2697.
20. Nobre AC1, Rao A, Owen GN, L-theanine, a natural constituent in tea, and its effect on mental state, Asia Pac J Clin Nutr. 2008;17 Suppl 1:167-8.
21. Simon P. Kelly, Manuel Gomez-Ramirez, Jennifer L. Montesi, and John J. Foxe, L-Theanine and Caffeine in Combination Affect Human Cognition as Evidenced by Oscillatory alpha-Band Activity and Attention Task Performance, J. Nutr. 138: 1572S–1577S, 2008.
22. Tori Hudson, ND, Women’s Encyclopedia of Natural Medicine, Keats Publishing, Copyright 1999.
23. David Winston and Steven Maimes, Adaptogens, Herbs for Strength, Stamina, and Stress Relief, Healing Arts Press, Copyright 2007
24. Donald Yance, Jr., CN, MH, RH(AHG), Adaptogens in Medical Herbalism, Healing Arts Press, Copyright 2013
25. Sebastian Pole, Ayurvedic Medicine, The Principles and Traditional Practice, Churchill Livingstone/Elsevier, Copyright 2006
26. Merrily A. Kuhn and David Winston, Herbal Therapy & Supplements, second edition, Wolters Kluwer Health / Lippincott Williams & Wilkins, Copyright 2008
27. David Hoffmann, FNIMH, AHG, Medical Herbalism, the Science and Practice of Herbal Medicine, Healing Arts Press, Rochester, Vermont, Copyright 2003
28. Medicines from the Earth, Lecture notes, Conference May 31-June 4, 2013 Annual conference on herbal medicine, Black mountain, NC
29. Lisa Ganora, Herbal Constituents, Foundations of Phytochemistry, Herbalchem Press, Copyright 2009
30. Bone and Mills, Principles and Practice of Phytotherapy, 2nd ed., Churchill/Livingston, Copyright 2013
31. Sheldon Saul Hendler, Ph.D., M.D., FACP, FACN, FAIC, PDR for Nutritional Supplements, 2nd edition, Thomson Reuters, Copyright 2008
32. PDR for Herbal Medicines,4th edition, Medical Economics Company, Montvale, N.J., Copyright 2007
33. Mark Blumenthal, Editor, The ABC Clinical Guide to Herbs, American Botanical Council, Copyright 2003