Menopause is a natural developmental transition in every woman’s life. It refers to the discontinuation of the function of the ovaries and is associated with the cessation of menstruation, which explains the name. While the average age of menopause is 51, many women may begin menopause in their 40’s. Menopause is artificially triggered when a woman has her ovaries surgically removed. The impact on hormones associated with menopause can affect mood and mental health as well as cardiovascular risk, cancer risk, and the risk of bone loss.
Depression in menopause is linked both to the psychological effect of the loss of fertility and the hormonal changes associated with menopause, but there may be additional factors to consider.  Menopause may increase systemic inflammation.  This may be the result of the changes in body fat distribution and insulin receptivity associated with menopause.  Oxidative stress may increase with estradiol depletion through menopause.  As you know, inflammation and oxidative stress are factors involved in depression and dementia as well as other mental health concerns.
Acute anxiety triggered by menopause has been reported [5-8], as has bipolar disorder [9, 10]. Schizophrenia may worsen in menopausal women. This has been associated with the protective effects of estrogenic hormones as well as structural changes in the brain that occur during menopause.
Oophorectomy (ovary removal) before menopause has been associated with an increased risk of age related cognitive decline and dementia , and early menopause may be a risk factor for eventual development of dementia in women with Down Syndrome. Insulin resistance and changes in the immune system are also linked to menopause and a variety of conditions from metabolic syndrome to depression. I have explored the link between metabolic syndrome and depression in a previous paper. So what evidence is there that nutritional interventions may be useful to address menopausal mental health?
The link between inflammation and oxidative stress suggests that an anti-inflammatory diet may be a safe and appropriate intervention. While pharmaceutical anti-inflammatory medications may present serious side effect risk, anti-inflammatory botanicals may be a safe and effective consideration.
The literature has reported Vitamin E to address vasomotor effects (hot flashes) of menopause since the late 1940’s.[16-18] Vitamin D has also been explored. Calcium and Vitamin D help to reduce bone loss secondary to menopause. [19, 20] Additionally there are numerous herbs and botanicals historically used for menopausal symptoms.
Black Cohosh may be one of the most widely used herbs for this purpose in the US. This native North American plant has been widely used over the past 100 years for women’s health issues, including its ancient use by Native Americans for menopausal symptoms. Many studies report it to be safe and effective.[21-23] However, other studies suggest it may be no more effective than placebo. And there is controversy about whether it can cause liver damage. One study suggests that pure standardized Black Cohosh may be safe but that adulterants found in many preparations may be hepatotoxic.  Other studies conclude that reports of liver damage may have erroneously concluded that the liver problems were caused by Black Cohosh. At this point, it appears that while people with risk factors for liver disease may be wise to avoid Black Cohosh, it is likely to be effective and safe for the vast majority of people if sourced from a reliable supplier in a standardized and pure form. 
Other herbs such as Dong Quai and Chaste tree berries have been used for menopausal symptoms. Dong Quai addresses hot flashes, sleep quality and fatigue. Chaste berry may have an effect on the dopaminergic nervous system, which can assist in menopausal symptom reduction. 
Soy isoflavones have also been widely used to reduce symptoms associated with menopause. However, the mechanism of action and efficacy remain unclear.[29, 30] Some suggest that phytoestrogens can replace estrogen function without increasing the risk of estrogenic cancers, while other research suggests that this is not correct. Other approaches to sidestep estrogen such as DIM (Diindolylmethane), a component found in cruciferous vegetables, may activate estrogen receptor sites rather than provide estrogen alternatives. 
Magnolia extract and magnesium have been reported to be helpful for the psychological symptoms of menopause, while soy isoflavones have been more linked to the vasomotor symptoms.  Soy isoflavones have been reported in a single study to be helpful for cognitive issues of menopause including memory and learning, but these have not been replicated. 
As is often the case in the natural product arena, the science lags the application in the area of menopausal relief. It is wise to avoid products that do not have clear quality assurance throughout the chain of custody and to look for products that have good scientific support of their formulation. That said, natural products may offer considerable relief for both the vasomotor and psychological symptoms of menopause.
Dr. Richard A. Wyckoff, PhD
Founder, The Alliance for nutrition and Mental Health
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