Supplements and Menopause: Phytotherapeutic and Nutritional Strategies During Climacteric

The transition from the fertile years to menopause represents a phase of profound physiological and psychological restructuring in a woman's life. While the onset of reproductive age coincides with puberty and is met with enthusiasm, the approach of menopause often generates anticipatory anxiety. The phenomenon, marked by the definitive cessation of ovarian activity and the menstrual cycle, is sometimes perceived as an early sign of aging, prompting many women to seek immediate solutions to preserve their quality of life.

Menopause is not a disease, but a physiological condition (when primary) characterized by the depletion of the follicular reserve. It can also occur secondary to surgical procedures, iatrogenic treatments (radiotherapy, chemotherapy), or autoimmune and genetic dysfunctions. The diagnosis is clinical and retrospective, confirmed by at least 12 consecutive months of amenorrhea and specific hematochemical parameters: elevated levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), accompanied by a marked reduction in estradiol and undetectable concentrations of progesterone.

Physiopathology of climacteric and clinical picture

The climacteric encompasses premenopause (the phase characterized by menstrual irregularities, anovulatory cycles, and an initial decline in estrogen) and postmenopause (a state of permanent hypoestrogenism). The clinical manifestations related to hormonal deficiency are divided into several symptomatic areas:

• Vasomotor disorders: They affect approximately 75% of women. Hot flashes (hot flashes) and profuse sweating are caused by an alteration of the hypothalamic thermoregulatory centers, influenced by peaks of LH, noradrenaline, and dopamine, together with the reduction of endogenous opioids. Smoking accentuates their intensity due to its stimulating effect on vagal tone.
• Genitourinary syndrome: It affects 30-45% of women and is characterized by the thinning of the vaginal epithelium, reduced secretions, increased pH with greater susceptibility to coliform infections, as well as dryness, itching, dyspareunia, dysuria, and urgency incontinence.
• Neuropsychological profile: Estrogen deficiency promotes an increase in monoamine oxidase activity, reducing the availability of serotonin and melatonin. This mechanism, associated with frequent nighttime awakenings caused by sweating, contributes to the onset of insomnia, irritability, concentration deficits, and a decline in mood.
• Metabolic and cardiovascular risks: The loss of estrogenic protection causes an atherogenic lipid profile (increased LDL and reduced HDL), increasing the incidence of metabolic syndrome, type 2 diabetes mellitus, hypertension, myocardial infarction, and stroke.
• Bone tissue: Hormonal deprivation accelerates bone resorption at the expense of osteogenesis, significantly increasing the risk of osteopenia and osteoporosis.

The integrated and non-pharmacological therapeutic approach

Although Hormone Replacement Therapy (HRT) represents the conventional treatment — whose use is limited by international guidelines such as those of the FDA and AACE to minimum doses and specific contexts due to potential thromboembolic and oncological risks — scientific interest has focused on non-pharmacological strategies. The use of functional foods, phytotherapeutics, and micronutrients allows for the reduction of vasomotor symptoms and the prevention of metabolic complications, offering high compliance and a favorable emotional impact.

Functional foods and phytocomplexes for support

• Common oat (Avena sativa): Rich in proteins, soluble fibers (beta-glucans), minerals (calcium, magnesium, silicon, iron), and alkaloids such as avenulin and avenalumina. Avenulin acts on the GABA receptor, while avenalumina modulates catecholamine metabolism. Triterpene saponins (avenacosides A and B) and avenanthramides exert an anti-lipolytic and antioxidant action, countering LDL oxidation. According to EU Regulation 432/2012, a daily intake of 3 g of beta-glucan contributes to the maintenance of normal blood cholesterol levels.
• Green tea (Camellia sinensis): Source of polyphenols and catechins, particularly epigallocatechin gallate (EGCG), which has marked antioxidant and anti-lipolytic properties. The presence of L-theanine stimulates the production of alpha brain waves, promoting relaxation without inducing drowsiness. Green tea polyphenols also modulate oxidative stress, which is implicated in the pathogenesis of postmenopausal osteoporosis.
• Watermelon (Citrullus lanatus): Natural source of L-citrulline and lycopene. Clinical evidence shows that watermelon extract can reduce arterial stiffness and central aortic pressure in postmenopausal women with hypertension and obesity.
• Soy isoflavones: Genistein and daidzein are phytoestrogens with structural affinity for estrogen receptors (particularly ER-β). They act as selective modulators: in the presence of hypoestrogenism, they partially substitute for hormonal activity; in the presence of endogenous estrogens, they compete with them, acting as weak anti-estrogens. Their active metabolite, (S)-equol, demonstrates high efficacy in reducing the intensity and frequency of vasomotor events.
• Nuts (Almonds, Walnuts, Hazelnuts): They provide a highly bioavailable supply of calcium and magnesium, representing an essential nutritional alternative in cases of lactose intolerance or dairy-free dietary choices.

Bibliographic References

1. AACE Menopause Guidelines Revision Task Force. (2011). American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice, 17(Suppl 1), 1-25.
2. Utian, W. H. (2005). Psychosocial and socioeconomic burden of vasomotor symptoms in menopause. The American Journal of Medicine, 118(12), 74-77.
3. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). (2010). Scientific Opinion on the substantiation of a health claim related to oat beta glucan and lowering blood cholesterol pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA Journal, 8(12), 1885.
4. Zhang, J. X., et al. (2002). Effects of oat bran, soy protein isolate, and apple fiber on lipid profile and cardiovascular risk factors in postmenopausal women. European Journal of Clinical Nutrition, 56(1), 86-91.
5. Samman, S., et al. (2003). A green tea extract lowers plasma concentrations of total cholesterol and LDL cholesterol in postmenopausal women. Journal of Nutrition, 133(10), 3298-3302.
6. Shen, C. L., et al. (2012). Green tea polyphenols and mitigation of oxidative stress in postmenopausal women with osteopenia. Journal of Nutritional Biochemistry, 23(9), 1152-1157.
7. Figueroa, A., et al. (2013). Watermelon extract supplementation reduces ankle blood pressure and carotid augmentation index in postmenopausal women with hypertension. American Journal of Hypertension, 26(2), 291-299.
8. Jackson, R. L., et al. (2011). Designs for s-equol clinical trials in postmenopausal women with vasomotor symptoms. Frontiers in Endocrinology, 2, 45.
9. Setchell, K. D., & Clerici, C. (2010). Equol: history, chemistry, and formation. The Journal of Nutrition, 140(7), 1355S-1362S.