Editor's Note: This article is a part of an Op-Ed series, "Second Opinion," where patient experts and health writers share their take on current research, news, and trends in health and medicine. The views expressed in this article do not reflect the opinions or views of HealthCentral.com.
Let’s face it — when you’re going through perimenopause or menopause, the symptoms can be downright frustrating. You probably know about the hot flashes and night sweats, but other common symptoms include erratic periods, insomnia, fatigue, depression, anxiety, and low sex drive.
The conventional treatment for these symptoms is hormone replacement therapy (HRT): conjugated estrogen and progesterone drugs like Premarin and Prempro, or bioidentical estrogen and progesterone creams, pills, pellets, or patches. There are, however, risks associated with any type of HRT. These risks are even greater if you have a family history of breast or ovarian cancer, or you’re post-menopausal.
If, like me, you'd prefer a low-risk, natural, and non-prescription approach to managing menopause symptoms, not all hope is lost. Let me tell you about two supplements — melatonin and maca — that helped me sail through my perimenopause and menopause.
My Melatonin Story
I first discovered the hormonal effects of melatonin when I began having insomnia for the first time during perimenopause in my mid-40s. I started taking 3 mg of melatonin nightly to help with sleep. The melatonin significantly improved my sleep, but its benefits didn’t stop there.
For the past few years, I had been experiencing another classic perimenopause symptom: irregular menstrual periods. My periods lasted anywhere from two days to two weeks, and they were heavy, painful, and filled with clots. They were also coming anywhere from two to six weeks apart. But now, after several months of melatonin use, I noticed my periods had returned to normal. They were pain-free, coming every 28 days, lasted five days, and were a normal flow and color.
I couldn’t help but wonder whether the melatonin might have something to do with my cycle returning to normal.
Can melatonin Reduce Symptoms of Menopause?
At that time, I was writing my book, “The Menopause Thyroid Solution,” and I wanted to explore my theory — so I reached out to Walter Pierpaoli, M.D. This Italian physician and researcher is the author of the bestselling 1985 book “The Melatonin Miracle” and is one of the world’s leading researchers on melatonin. He’s actually credited with making the public widely aware of the benefits of melatonin for sleep problems and jet lag.
In an extensive phone interview, Dr. Pierpaoli told me the story of how he discovered the hormonal effects of melatonin. He conducted melatonin research with groups of perimenopausal and menopausal women, and After several months of low-dose melatonin use, many of the women saw their menstrual cycles return to normal and had relief of some of their perimenopausal and menopausal symptoms.
While some researchers have shown that melatonin has benefits on several aspects of menopause, others question the majority of studies evaluating the effects of alternative drugs to treat vasomotor symptoms (hot flashes, night sweats, palpitations).
He also discovered that in perimenopausal women, daily low-dose melatonin supplementation helped increase estrogen levels and reduced levels of two hormones characteristic of perimenopause: luteinizing hormone and follicle-stimulating hormone. Melatonin was extending normal menstrual cycles and even fertility in some women. Surprisingly, some of the women he studied whose periods had stopped even started menstruating again and became pregnant! Dr. Pierpaoli also found that melatonin was effective at alleviating several key perimenopausal and menopausal symptoms such as morning fatigue, anxiety, depression, and sleep problems.
How Does Melatonin Work?
What was going on? To understand, it helps to learn a bit about melatonin. Your pineal gland, located in the brain, produces melatonin naturally in response to nighttime darkness to regulate your daily sleep/wake cycle. As we age, melatonin levels drop, and there’s an even steeper drop in melatonin around perimenopause.
Dr. Pierpaoli’s research showed that melatonin had another vital function: master hormonal conductor and scheduler. Melatonin had positive effects on the thyroid gland, adrenal glands, and reproductive hormones. And, a significant decrease in melatonin was a signal to the reproductive system to reduce sex hormone production and start perimenopause — and, ultimately, menopause.
Nightly use of melatonin could prevent the deterioration of the pineal gland, synchronize hormones, and push back the start of perimenopause and menopause, according to Dr. Pierpaoli’s published research.
Other research has confirmed Dr. Pierpaoli’s findings. One study found a clear cause-effect relationship between the decline of nightly melatonin levels and the onset of perimenopause and menopause. That same study found that melatonin supplementation normalized menstrual cycles and restored fertility in some perimenopausal or menopausal women. Finally, the study reported that melatonin supplementation resulted in “highly significant improvements” in thyroid function, and reduced menopause-related depression. Other studies have shown that melatonin helps with sleep for women in perimenopause and menopause.
How Much Melatonin Should You Take?
Time-released, synthetic melatonin is the best form to take, according to Dr. Pierpaoli. He recommended taking 3 mg of melatonin an hour before bedtime, or around 10 p.m., but no later. This allows the time-released melatonin to peak in your bloodstream at the most effective time.
Low-dose melatonin is considered very safe, with minimal toxicity. The main side effects of melatonin are vivid dreams or morning grogginess. Dr. Pierpaoli recommends that if you have side effects, you should drop your dosage below 3 mg.
Maca: A Natural Way to Manage Hot Flashes?
I was several years further along in my perimenopause, and while melatonin had resolved my menstrual and sleep problems, a new symptom — multiple hot flashes each day — appeared. My mother had hormone-receptor-positive breast cancer, so I was not a good candidate for estrogen therapy. So my friend and colleague, anthropologist Viana Muller, urged me to try maca.
Viana had learned about maca root, a cruciferous vegetable that is grown at high altitudes in the Andean mountains of Peru and South America, through her research. Native Peruvians have a long history of using maca as food for energy and stamina. They also use maca as a remedy to enhance fertility and sex drive in men and women, support erectile function, and alleviate PMS and menopausal symptoms. Viana spent years researching maca’s botany, the history of its use, how it was grown, and how it is used today by native peoples and doctors practicing in Peru.
Then Viana set up a company — Whole World Botanicals — to empower local maca growers in Peru by providing a market for their organic, traditionally prepared maca, which her company trademarked as “Royal Maca.” Viana is largely credited with introducing maca — now a popular supplement and “superfood” in the natural products world — to the American market.
Armed with information and detailed instructions from Viana, I started taking maca. It comes in both capsules and powder, and I used the powder form. It has a slightly nutty taste, and I mixed it in a smoothie.
The Power of Maca: How It Works
Maca does not contain plant hormones. It has adaptogenic properties, meaning that it helps to adjust the body’s response according to what is needed. One extensive review of 17 studies on maca for menopausal symptoms found that maca appears to help the body produce its own estrogen and progesterone while helping lower stress hormones like cortisol. Researchers theorize that maca stimulates and helps maintain hormonal balance in your hypothalamus, pituitary, pineal gland, adrenal glands, ovaries, and thyroid gland. The result: measurable improvements in sleep, mood, energy, fertility, and hot flashes.
Other studies have shown that in addition to increasing estrogen and progesterone production, maca can significantly reduce follicle-stimulating hormone levels, which helps alleviate many menopausal symptoms. Maca has also been shown to be especially effective at relieving other symptoms such as anxiety, depression, and sexual dysfunction.
Emory University-trained OB-GYN, hormonal health educator, and bestselling author Anna Cabeca, M.D., uses maca extensively in her practice.
"In my decades as a physician and researcher, and in working with thousands of women as well as with my personal health journey, I have found maca … to be beneficial in addressing a variety of peri-menopausal symptoms, including hot flashes, fatigue, mood swings, PMS, and weight gain,” Dr. Cabeca tells us. “Women I've treated typically experience better mood, more energy, less hot flashes, and improved appetite control." (Disclaimer: Dr. Cabeca sells a product called MightyMaca Plus.)
Disclaimer: According to the American Menopause Society, there is not yet enough scientific evidence that maca works for menopausal symptoms, or if it's related to cancer, so they do not currently recommend its use.
How Do You Take Maca?
Maca is considered safe and does not appear to have any serious adverse effects.
Viana Muller cautions, however, that not all maca is created equal: “Most maca available in the U.S. today is grown in China, at altitudes too low to produce the most potent maca, from seeds smuggled out of Peru.” Some maca is also genetically modified or exposed to pesticides. As a result, Viana recommends choosing only organic, pesticide-free maca grown in Peru.
Another issue is how the maca is prepared. Maca is never eaten raw in Peru, Viana says. Many maca products on the market are, however, raw. As a cruciferous vegetable, raw maca is a goitrogen, meaning that uncooked maca can slow down your thyroid gland and contribute to hypothyroidism. Viana recommends you choose gelatinized maca, as this unique heating process reduces the goitrogenic properties and eliminates toxins. (Her company’s Royal Maca is gelatinized using traditional methods used by generations of Peruvian maca growers.)
And how much maca should you take? Too low a dose — or using a sub-potent, inferior maca — may be ineffective against menopausal symptoms. Too high a dose can cause some gastrointestinal discomfort or a worsening of your menopausal symptoms. Viana recommends starting with a low dose and very gradually working up to an effective dose.
Remember that if you decide to try maca, most of the products on the market are non-organic, raw, Chinese maca. For safety and effectiveness, I recommend the maca I use — Whole World Botanicals Royal Maca — or Dr. Anna Cabeca's MightyMaca Plus, as both are organic, gelatinized, and sourced from Peru.
I have now been post-menopausal for several years. I still take melatonin and maca and have no symptoms of menopause. I’ve recommended my “melatonin/maca menopause miracle” to many friends and health coaching clients, who then found relief through menopause as I did.
But remember: These remedies may not work the same for everyone. And you should always be sure to consult your health care provider to find out if these supplements are right for you.