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The treatment usually prescribed by doctors, hormone therapy (HT), is controversial and not appropriate for some women. I won’t get into the HT debate here—Mark did a great job covering the pros and cons recently. Suffice it to say that HT isn’t the answer for everyone, and it’s not a panacea by any means.
Whether or not they choose to go the HT route, many women desire additional support during perimenopause and beyond. For the sake of keeping this post from becoming a novella, I’m going to focus on mind-body therapies today.
This is not meant to be an exhaustive list of nonhormonal options, nor is it meant to try to dissuade you from trying HT. That’s a decision you have to make for yourself with your doctor. The approaches below can be used alone or in combination with other modalities, including HT.
As with any medical-adjacent tools, if you are considering any of the options here, take the time to educate yourself, talk to your doctor, and find qualified practitioners to help you implement these practices.
A Note Regarding Research Evidence…
Because so many women are interested in complementary or alternative approaches, there’s a fair amount of research into nonhormonal treatments. There are also important limitations.
A lot of the randomized control trials—experiments that are best for establishing causal effects—are small. There is considerable variability in research design, so it’s difficult to generalize across studies.
Participants in these studies tend to be white and well-educated. Since there are cross-cultural differences in the experience of menopause, we shouldn’t assume that the findings apply to all women. Likewise, a lot of the research focuses on women with a history of breast cancer because HT is generally contraindicated in this population. While the results of these studies probably generalize to other women, it would be great to have more data.
Finally, vasomotor symptoms—hot flushes and night sweats—are studied more than other types of symptoms. Though they are the most common complaint, many women do not experience debilitating vasomotor symptoms. They might, however, experience mood fluctuations, depression, sexual issues, memory problems, and more. We know less about how these approaches might help those women.
Nevertheless, I’ll highlight some of the potentially fruitful avenues you might explore. When possible, I’ll focus on systematic reviews and meta-analyses. They pool the results of multiple smaller studies to help a more reliable picture emerge.
Cognitive Behavioral Therapy (CBT)
In CBT, individuals are encouraged to explore how their thoughts (cognitions) affect feelings, behaviors, and physical symptoms. With help, they change their thoughts or beliefs about a situation to help manage their responses and improve coping skills.
Although there isn’t a ton of research on CBT for menopause, available studies are very promising. Whether or not CBT reduces the actual number of hot flushes—and the data here are mixed—CBT should work by changing women’s perceptions of their hot flushes. Multiple studies do find that after CBT women view their hot flushes as interfering less with daily life. As expected, they are also less bothered by them.
Women who see themselves as having less control over their hot flushes also tend to experience more distress. Changing their perceived control could be an effective intervention for improving quality of life. Indeed, in one study, 95 women received either group-based or self-help CBT. After therapy they reported feeling greater control over hot flushes and having better coping skills compared to women in a no-CBT control condition. Further analyses showed that women’s beliefs about control and coping predicted how problematic they found their hot flushes to be. (Having more positive beliefs about how hot flushes affect sleep also helped.)
Women who participated in CBT also experienced fewer sleep issues and insomnia as well as fewer depressive symptoms and sexual concerns. They also noticed less impairment at work. Positive results were found with in-person therapy, self-help programs, and telephone-based therapy. When studies included a follow-up assessment, the beneficial effects of CBT persisted for at least six months.
Mindfulness, Meditation and Relaxation Training
A cross-sectional study of 1744 women found that women with higher scores on a mindfulness assessment tended to report less severe menopausal symptoms. For women with higher life stress, this association was especially strong. The idea here is that when women are able to be present-focused and observe their symptoms without judgment, they are protected against some of the distress, and possibly the physical symptoms, associated with menopause.
Although some of the women in that survey are probably mindful by nature—lucky them—mindfulness is also a skill that can be learned and cultivated. Among the many reasons to do so, mindfulness and meditation training can apparently lessen menopausal symptoms.
For example, researchers assigned 110 women to either an intensive eight-week mindfulness-based stress reduction program or a control group. The women who received mindfulness training reported having less bothersome hot flushes, better sleep quality, less anxiety and stress, and greater overall quality of life compared to the control group. When the researchers followed participants over the next 11 weeks, these results persisted or became even stronger.
A few other studies found that women who receive mindfulness or meditation training report fewer and less bothersome hot flushes, improved sleep, and better psychological functioning, though the results have not consistently endured over time. However, when looking at more general relaxation training and paced breathing techniques, effects are minimal, at least for hot flushes.
An ethnographic study of nine female yogi masters concluded that they tend to skate fairly easily through menopause. The authors concluded that menopausal women should be encouraged to practice yoga. Of course, in addition to yoga, these yogi masters’ lifestyles included “healthy food habits, adequate sleep, and the use of nature cure techniques (i.e., fasting, detoxification, selection of suitable food products, and living in well-ventilated houses) that facilitated the art of living in tune with nature.” This sounds pretty great, but can we give really yoga all the credit here?
Probably not. However, two recent meta-analyses did conclude that yoga offers small but significant relief from symptoms of all types: vasomotor, psychological (including depression), somatic (including fatigue and sleep disturbances), and urogenital. Women also report better overall well-being and quality of life after receiving yoga training.
In one study, a group of breast cancer survivors received twelve weeks of yoga and meditation instruction, and they were encouraged to practice daily at home. Compared to women in a control group (no instruction), they reported fewer symptoms and improved quality of life at the end of the twelve weeks and again when asked three months later. A later analysis found that many of the effects were mediated by improved self-esteem in the yoga group.
Note that most of the individual studies are small, and they employ different types of yoga practices. This might be considered a strength insofar as different practices have been shown to work, or a weakness in that it’s not clear if one approach is particularly effective.
Cross-cultural surveys find that women who are more active tend to have an easier time with menopause. For example, two large surveys of Swedish women found that women who exercised at least once per week reported less intrusive symptoms than women who never exercised, and women who exercised more than three hours per week were significantly less likely to experience severe symptoms than their less active counterparts. Sedentary women in this Finnish study experienced more vasomotor, psychological, and somatic/pain symptoms than women who were at least somewhat active.
While promising, experimental studies have not yielded such favorable results. When women were assigned to “physical activity” conditions (often walking), some studies report improvements, but others find no improvements or even worsening symptoms (perhaps depending on women’s baseline fitness). Multiple reviews have concluded that there is no systematic effect of exercise, particularly not for vasomotor symptoms.
Does that mean menopausal women shouldn’t exercise? Obviously no. It’s clear that being active—or at least not being sedentary—is important for overall health, and it probably helps menopausal women through the transition. However, there isn’t enough research to know what types of exercise are most effective and when. Do the types of movement you enjoy and that make your body feel good.
A recent review concluded that acupuncture is effective for reducing vasomotor symptoms, both frequency and severity, as well as for improving quality of life. However, the reviewers also found that acupuncture was not reliably better than sham acupuncture where needles are inserted at points other than the prescribed pressure points and at a shallower depth—a placebo condition.
A handful of studies have shown that clinical hypnosis can reduce hot flush frequency and distress among breast cancer patients. Another study of 187 women without breast cancer found that women who received hypnotherapy had fewer, less severe, and less bothersome hot flashes, as well as improved sleep. These results were evident at the end of the five-week treatment protocol, and they remained or got stronger in the six-week follow-up period.
The Experts Weigh In…
In 2015, the North American Menopause Society released a position statement on nonhormonal management of vasomotor symptoms. Of the approaches discussed here, the only ones NAMS recommended based on the strength of the available evidence were CBT and hypnosis. Mindfulness-based stress reduction earned a “recommend with caution,” which means, “We think it might work, but the evidence isn’t conclusive.”
The others—yoga, exercise, relaxation and paced breathing techniques, and acupuncture—were not recommended. This does not mean they are not worth trying! It simply means that based on their standards, the evidence was not strong enough for the committee to conclude that they are likely to be effective treatments for vasomotor symptoms specifically. This says nothing about other types of symptoms, nor about general well-being or quality of life.
Mind-Body Therapy Pros and Cons
So where does this leave us? Each of these therapies shows promise for alleviating at least some symptoms of menopause. Moreover, all these therapies have the potential to improve overall quality of life, sleep, stress, and general health. While reading these studies, I did wonder whether some of the women felt better simply because they were investing time and energy in taking care of themselves. If so, is that a problem? I don’t think so. They are low-risk interventions with a lot of potential upside.
That said, these aren’t quick solutions. The effective mindfulness/mediation trainings included six to eight weeks of classes and multiple hours per week. Women practiced yoga for two to four months during the study periods. Hypnotherapy was five weeks or longer. It’s not clear what the minimum time frame is for each of these therapies to be useful, but they’ll certainly involve a time commitment that might not be practical for all women. However, yoga, mindfulness/meditation, exercise, and even CBT can all be practiced at home once you know the proper technique.
As I said at the beginning, this is not an exhaustive list of nonhormonal therapies. There are also various supplements that might help, as well as lifestyle modifications that most of you Primal-savvy readers are probably already implementing: eating a variety of nutrient-dense foods, getting plenty of sunlight, practicing good sleep hygiene, and nurturing social connections.
Whatever you choose, be patient. Don’t just focus on one symptom; focus on the big picture. Pay attention to how you’re feeling more globally. Consider that while an intervention might not hit its desired mark, it might help you in ways you didn’t expect.
Have you used mind-body techniques (these or others)? What’s been your experience? Share your insights and questions below, and have a great week, everyone.
Atapattu PM. Vasomotor symptoms: What is the impact of physical exercise? J SAFOMS. 2105 Jan-Jun;3(1):15-19.
Goldstein KM, et al. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric. 2017 Apr;20(2):178-182.
McMillan TL, Mark S. Complementary and alternative medicine and physical activity for menopausal symptoms. J Am Med Womens Assoc (1972). 2004 Fall;59(4):270-7.
Molefi-Youri W. Is there a role for mindfulness-based interventions (here defined as MBCT and MBSR) in facilitating optimal psychological adjustment in the menopause? Post Reprod Health. 2019 Sep;25(3):143-149
Moore TR, Franks RB, Fox C. Review of Efficacy of Complementary and Alternative Medicine Treatments for Menopausal Symptoms. J Midwifery Womens Health. 2017 May;62(3):286-297.
Sliwinski JR, Johnson AK, Elkins GR. Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind-Body Medicine to Improve Cognitive Performance. Integr Med Insights. 2014;9:17–23.
van Driel CM, Stuursma A, Schroevers MJ, Mourits MJ, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG. 2019;126(3):330–339.
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I know we missed Valentine’s Day, but I’ve always said love cannot be contained. Besides: People are always going on dates. People are always searching for new ways to break out of the regular mold, which is completely understandable. Dates are try-outs. You’re spending time with another person to determine how they fit into your life. Unconventional dates that branch out from “dinner, movie, drinks” into more adventurous, creative realms provide excellent feedback for making that determination.
Dates are also a way for established couples to keep things fresh and exciting, to keep the relationship moving. There’s no better way than to try something new.
As it happens, most work for friends, too.
Now, some of these dates are silly or out-of-left field. Some are more serious. And one is a Primal Costanza date—what not to do. But regardless, they are all worth exploring. And—as always—I’d love to hear what you’d add.
1) Watch a Movie and Fill In the Dialogue
You know that scene in Eternal Sunshine of the Spotless Mind where Jim Carrey and Kate Winslet are watching a drive-in movie without sound and filling in the dialogue themselves? Do the same thing, only make all the dialogue health and fitness-related. For example, The Empire Strikes Back would work great.
Just before Han is frozen in carbonite, Leia speaks. “I love cold therapy, so many benefits. I can send you the PubMed links.” Han replies. “I know.”
Vader gives Luke the bad news. “Luke, I am a vegan.” “Nooooooooo!”
Pick your favorite movie, and try it out yourselves. Drive-ins aren’t necessary (do they even still have those?); you could just put the T.V. on mute.
2) Couples’ Spa Day
A couple hundreds years ago, you didn’t really go to the doctor. You’d go to a spa. Spas were healing centers erected around natural springs of mineral-rich water. People would bathe in it (many were hot springs), drink it, and engage in other healthy pursuits. Many of today’s most popular bottled mineral waters come from springs that doubled as health spas back in earlier days.
The average person may think of a spa as a pleasure center, a superficial luxury. But getting a massage, soaking in hot mineral water, smearing yourself with mud and/or clay, exposing yourself to extreme temperatures in the sauna, steam room, and cold water pool? These are all objectively healthy and pleasurable experiences with measurable benefits.
Go for a hot soak, followed by a cold plunge. Do the mud bath thing. Get a deep tissue massage. Soak in the salty mineral-rich brine. And do it with your date, as your date.
3) Get Physical
Intense physical exertion—performed together—increases bonding. You’re sweating, you’re touching, you’re working hard toward a goal. You’re a team. Make it a little dangerous and the juices really flow. For the same reason, going to see a scary movie helps couples get closer.
4) Go Dancing or Take Dance Lessons
Dance is the prelude to closer, more intimate physical contact. And it’s incredibly healthy learning to move with cohesion and fluidity and precision through constantly varying ranges of motion. Dancers are some of the most athletic folks around—think b-boys, ballet dancers, practitioners of modern dance. I’m not a follower of the show, but seriously just look at an episode of “So You Think You Can Dance” for plain evidence of their athleticism.
Go dance, or take dance lessons if you can’t dance yet. If the latter, don’t make this a one-off. Keep the lessons going. Build that skill together. Move together.
Dancing together in your living room to music on your smartphone is completely valid, too.
5) Cook the Farmer’s Market
This is a fun little date to try. Carrie and I used to do this at the Malibu farmer’s market every once in awhile.
Go to every stand, ask the farmer what’s best today, and then buy that item. If your market is huge, you don’t need to buy from every single stand. Try to stick to a dozen stands or so just to keep things manageable.
Be reasonable with the quantities. Otherwise it’ll add up fast. If, say, the farmer recommends the leeks, buy a couple leeks. If it’s cauliflower, buy a head. If it’s strawberries, buy a basket.
Go home and create a meal together using only the things you purchased from the market. Use things like oil/cooking fat, salt, pepper, and spices from home (unless you bought them at the market, in which case you get extra points). If your market doesn’t offer any meat, feel free to incorporate store-bought meat. But do your best to use only things from the market.
Prep and cook it together. There you go, that’s your date.
6) Ten-Mile Date
Walk ten miles, at least. It can be through the city, the suburbs, or the forest. You can stop at stores, cafes, museums along the way—it doesn’t have to be ten miles straight without stopping. But get those ten miles in however you can.
Roughhousing is universal. It’s also great fun. You roughhouse. You wrestle, jostle, poke, prod, but you don’t (ever) hurt each other. You keep things light, engaged, dancing on the edge of intensity. I really like Rafe Kelley’s approach. Check out the one where he and his partner act like their wrists are glued together as they move around, roll, push, and pull. Or where they stand on a large log, clasp hands, and try to pull each other off balance. That stuff is really fun. I’d try any of the videos from that link.
Another is one-legged tug of war. You each stand on one leg, clasp the other’s hand, and attempt to pull the other off balance. If there’s a big weight or strength disparity, have the stronger person stay on one foot and the weaker person use both. Put pillows and other soft landing spaces around your perimeter.
If you’re a man and she’s a woman, there will probably be some strength disparities. Use your better judgement. Keep things fair and competitive and fun.
8) Picnic and a Hike
Think back to all the hikes you’ve done, all the wilderness areas you’ve explored. Were there any perfect picnic spots that jumped out at you? Maybe a dry pebbly shore next to a gurgling creek. Maybe a ring of redwoods. Maybe a grassy meadow. Maybe a beach that only locals know about. If nothing comes to mind, Google one.
Then pack a lunch and get moving.
9) Stand-Up Paddling
I’m extremely biased. Stand-up paddling is probably my favorite activity. It’s training, meditation, adventure, and a fantastic core and rear delt/lat workout all in one. I’ve seen dolphins, manatees, whales, and any number of marine life on my board. I’ve hit the flow state on my board. I’ve finally figured out meditation being on my board. I’ve woken up with some of the most intense DOMS after a long day on my board. My transverse abdominals and obliques have never been stronger. It’s an all-around great time—and it makes a great date. We’re no longer youngsters in love, but Carrie and I have had a lot of good times when I can get her out on a board.
Not everyone has access to a paddle-worthy body of water, although more than you’d think—rivers, lakes, and reservoirs all work with a paddle board, not just the ocean. If you can’t paddle, something similar like kayaking or even cross-country skiing will work well.
10) Lecture Your Date At Dinner
Make sure your date knows exactly how unhealthy everything he or she is putting in her mouth.
When he orders pasta, make a face.
When she fails to confirm that the salad dressing was made with extra virgin olive oil, pull the waiter aside and do it for her.
When he orders the fish, let him know the Monterey Bay rating.
If she gets anything deep-fried, tell her all about how restaurants reuse cooking oil, which (by the way) is most likely very high in unstable polyunsaturated fats.
This will ensure a second date.
That’s it for today, folks. If you try any of these date ideas, let me know how it goes. If you have any other ideas, write them in down below!
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We’re almost halfway through 2018. History is accelerating. New advances, technology, scientific findings, and social changes are occurring faster than ever before. There’s never any time like the present, but these days it feels like the present is slipping away at an exponential rate. This is no time to be resting on your laurels, biding your time, or waiting to see what happens. It’s time to act. It’s time to make the changes you’ve been mulling over, the ones you know in your heart are the right moves to make.
To help you on your way, I’ve put together a 30-day action plan for the month of June. No one has to follow this to the letter, or even at all, but use it as a template or inspiration. Wake up on June 12 swelling with energy and unsure how to direct it? Check out the action plan. Feeling a bit lazy on June 19? See what the action plan recommends; it may resonate.
Let’s get right to it:
June 1st: Plan your month. Set a goal or two, aiming as high as you realistically can attain.
June 2nd: Track what you eat, how much you move, how long you sit or stand, what you do in the gym, how much you procrastinate or waste time, how much time you spend in flow or being productive. Get specific, get precise—it’s just one day, and you can handle it. Get a good baseline, so you know what you’re working with. Then try to improve on it every day forward.
June 3rd: Try the fitness or movement pursuit you’ve been thinking about for a long time. That thing you know you should be doing, like foam rolling at night or doing a light mobility session in the morning, but keep putting off. Just do it. Feels good, right?
June 4th: Take a cold shower.
June 6th: Reflect on your approach to competition. Who are you competing against? Who should you be competing against? Consider that it might be a better idea to compete against your former self, because besting your former self is a reliable path to self-improvement.
June 7th: Take three walks. One in the morning, one at lunchtime, and one after dinner.
June 8th: Meditate, if you’ve never tried it before. If you have and it doesn’t work for you, try an alternative method for reaching a similar headspace. My favorite way as of late is just sitting quietly at the beach, watching the waves go in and out across the horizon.
June 10th: Don’t just go to the farmer’s market. Make friends with your favorite farmer’s market vendors.
June 11th: Pickle something. It’s really easier than you think to make your own fermented food. Mix 50 grams salt with a liter of quality water, pour over garlic/hot peppers/shallots/pretty much anything you can stuff in a jar until submerged, place something on top to keep everything submerged (a roof of carrots wedged against the sides of the jar works well), lightly cover, and wait for the bubbles to start. When you like the taste, you’re done and can refrigerate the jar.
June 12th: Plan a camping trip for later during the month. Get your family and/or friends together, throw your gear in the car, and make a weekend of it somewhere nice and secluded. Leave electronics behind if you can, or at least limit artificial light after dark (red LED on the headlamp is a must when camping).
June 13th: Wake up and write down ten ideas. About anything at all. They don’t even have to be good. They just have to be on paper.
June 14th: Go for a PR in something. Pick a physical activity, and try to beat your personal best.
June 15th: Fast (if your personal context permits). Men, aim for the full 24 hours. Women, shorter will probably work better—somewhere in the realm of 12-16 hours (less if you’ve never tried).
June 16th: Grill something over open flame. At least one animal and one plant.
June 18th: Try a new recipe. Or just cook something new freestyle, using no recipe at all.
June 20th: Read for two hours. Books, not blogs or social media feeds (present blog excluded).
June 21st: Try to assemble the least expensive, most nutritious day of meals you can.
June 22nd: Have a glass of good wine with someone close to you. Friend, spouse, child (if of age).
June 23rd: Meal prep for the week ahead. Take an hour and get all the basics you need for the rest of the week ready to go. Roast veggies, start something in the Instant Pot, boil some eggs, prep Big Ass Salad makings. What you can cook ahead of time, cook ahead of time.
June 24th: Climb a tree. Be safe, just not too safe. Try to get the blood pumping.
June 25th: If you have any nagging health concerns you’ve been worrying about, make an appointment with a medical professional to get them checked out. Eating, exercising, and living well can transform our health, but we’re not invincible.
June 26th: Dance. Preferably with someone watched (and joining).
June 27th: Dream big. What’s your biggest, most ultimate dream that still has a chance of happening? Write it down, and figure out what you have to do to make it a reality.
June 28th: Forage for something in your yard, neighborhood, local park, or forest. Edible plants are everywhere.
June 29th: Grill some fruit in cast iron over open flame. The best fruit of the year is in season—peaches, cherries, nectarines, berries of all kinds—and yet most people don’t know that you can grill them over open flame and improve the flavor. Top with unsweetened whipped cream (you don’t need the sugar).
June 30th: Show gratitude for the awesome month you just experienced.
I’ll also have more on June’s staff-led 21-Day Challenge next week, so stay tuned. Have a great end to the week, everybody. Thanks for stopping by.
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