Menopause: symptoms, causes and hormone-free solutions

Around the age of 50, something changes. Periods become irregular, nights get shorter, and hot flashes appear without warning.

For many women, this transition period comes with symptoms that can significantly disrupt daily life and are still too often underestimated.

Yet behind every hot flash, every restless night and every bout of unexplained fatigue are specific biological mechanisms that are now well documented. Understanding them is the first step toward taking effective action.

What is menopause?

Menopause refers to the permanent and natural cessation of menstruation, resulting from the progressive loss of ovarian follicular function [1].

It is diagnosed retrospectively after twelve consecutive months without a period.

In Europe, the median age of menopause is between 50 and 51.5 years, but around 10 to 15% of women experience menopause before the age of 45 [2]. This is known as early menopause or premature ovarian insufficiency.

What are the 3 stages of menopause?

The menopausal transition is not a single event. It extends over several years and occurs in three distinct stages.

Perimenopause is the first stage. It precedes the permanent cessation of periods and can last from two to ten years. Menstrual cycles become irregular, shorter or longer, and the first symptoms appear:

• Hot flashes
• Mood swings
• Sleep disturbances.

Hormone levels fluctuate unpredictably, which explains why these symptoms can sometimes be surprisingly intense.

Menopause itself is confirmed retrospectively after twelve consecutive months without menstruation. At this stage, the decline in estrogen production is most pronounced and symptoms often reach their peak intensity.

Postmenopause refers to the entire period that follows. While hot flashes tend to gradually subside, other long-term effects involving bone, cardiovascular and genitourinary health can develop and require particular attention.

What happens in your body: the biological mechanisms

Biologically, menopause is characterized by a progressive decline in ovarian secretion of estradiol: the main and most active form of estrogen.

The brain detects this decline and attempts to compensate by sending emergency signals in the form of hormones (FSH and LH) to stimulate ovaries that no longer respond [3].

This disrupted communication between the brain and the ovaries is responsible for the range of symptoms.

Why does the decline in estrogen cause so many different changes?

Because estradiol is not a hormone limited to reproduction.

Its receptors are found in the brain, bones, heart, skin and mucous membranes [4]. In other words, when estradiol levels decline, the entire body feels the imbalance.

Two secondary mechanisms then make these symptoms worse:

1. On the one hand, cortisol levels — the stress hormone — increase: deprived of one of its natural regulators, the body shifts into a state of chronic alert that intensifies hot flashes.

2. On the other hand, melatonin, which is essential for restorative sleep, decreases. These two disruptions reinforce each other: more stress, less sleep, and symptoms that intensify as the body becomes increasingly exhausted.

What are the symptoms of menopause?

Menopause symptoms are varied and differ considerably from one woman to another in their nature, intensity and duration.

Some women go through this period with little discomfort, while others experience a significant decline in quality of life for several years.

Hot flashes and night sweats

Hot flashes are the hallmark symptom of menopause.

They affect between 60 and 80% of women during perimenopause and can persist for 6 to 7 years on average, or even up to 10 years for some women [5] [6].

Their mechanism is now well understood. The decline in estrogen disrupts the activity of KNDy neurons (kisspeptin/neurokinin B/dynorphin), located in the hypothalamus and involved in thermoregulation.

These neurons are normally inhibited by estrogen. Without this inhibition, they become hypertrophied and disrupt the hypothalamic thermoregulatory center [7], causing sudden cutaneous vasodilation that is experienced as an intense wave of heat, often followed by heavy sweating and chills.

At night, the same mechanism results in night sweats that cause repeated awakenings and disrupt sleep.

Sleep disturbances

Sleep disturbances affect a large majority of menopausal women and have two main causes.

First, night sweats cause frequent awakenings that prevent women from reaching the deep stages of restorative sleep.

Second, the decline in progesterone (a hormone with natural sedative properties) deprives the body of important support for falling asleep. This is compounded by the increase in cortisol mentioned above, which keeps the nervous system in a state of hypervigilance even in the evening.

Psychological symptoms: anxiety, irritability and brain fog

Irritability, anxiety, difficulty concentrating and depressive episodes are frequently reported during perimenopause.

These symptoms are not simply emotional reactions to change: they have a specific neurobiological basis.

Estradiol has a direct modulating effect on the brain's serotonergic and dopaminergic pathways [4].

Its decline destabilizes these mood-regulating systems, while lack of sleep further intensifies emotional instability.

"Brain fog" — a feeling of slowed thinking, difficulty finding words or concentrating — is also directly linked to the effects of estradiol on hippocampal neurons involved in memory and attention.

Genitourinary symptoms

Vaginal dryness, pain during sexual intercourse (dyspareunia) and urinary symptoms (urinary urgency, recurrent infections) are collectively known as genitourinary syndrome of menopause (GSM).

Unlike hot flashes, which tend to subside over time, these symptoms tend to progressively worsen without appropriate management [1].

The vaginal and urethral mucous membranes, which are highly sensitive to estrogen, become thinner and lose tone without this stimulation.

Effects on bones and the cardiovascular system

The decline in estradiol significantly accelerates bone resorption: up to 20% of bone mineral density may be lost within the first five years after menopause [1].

This decline significantly increases the risk of osteoporotic fractures, particularly of the hip, wrist and vertebrae.

How can you relieve menopause symptoms in the long term?

With such a wide range of symptoms, there is no single solution.

The options available today — medical, psychological, behavioral and nutritional — can be combined and adapted to each woman's individual needs.

Hormone replacement therapy: significant limitations

Menopausal hormone therapy (MHT) — often referred to as hormone replacement therapy (HRT) — remains the most effective approach for relieving vasomotor symptoms and preventing bone loss.

It involves the use of estrogen, either alone or combined with progesterone or a synthetic progestogen depending on whether or not the woman still has her uterus.

Its effectiveness is well established. So are its limitations.

MHT is contraindicated in women with a personal history of hormone-dependent cancers (breast, uterine, ovarian), deep vein thrombosis, stroke or cardiovascular disease [1].

It is also declined or avoided by some women who wish to avoid synthetic hormones.

According to an international survey cited by the CBIP, 54% of American women and 56% of European women prefer not to use it [6].

Phytoestrogens: between potential benefits and precautions

Phytoestrogens are plant compounds with a chemical structure similar to 17-β-estradiol.

The most widely studied are soy isoflavones (genistein, daidzein) and lignans (found in flaxseeds).

However, their use requires an important precaution: phytoestrogens are contraindicated in women with a personal or family history of hormone-dependent cancers (breast, uterine, ovarian).

ANSES recommends not exceeding 1 mg/kg of body weight per day. Although their action is weaker than that of synthetic hormones, it remains a hormonal action that warrants caution and medical advice.

Other documented natural approaches: exercise and CBT

Several non-pharmacological approaches have been the subject of rigorous studies and can naturally be incorporated into a comprehensive approach.

Cognitive behavioral therapy (CBT) adapted to menopause has demonstrated effectiveness in randomized controlled trials, including the MENOS 1 and MENOS 2 studies published in The Lancet Oncology (2012).

Clinical hypnosis was compared with CBT in a study presented at the 2024 annual meeting of The Menopause Society. The results suggest that hypnosis may be more effective at reducing hot flashes [11], particularly through modulation of the autonomic nervous system and improved regulation of thermal perception.

Regular physical activity is one of the most widely recommended approaches. Brisk walking, swimming, yoga or strength training can help reduce hot flashes in some women, improve sleep quality, support cardiovascular health and slow the loss of bone mass.

Supplements without phytoestrogens: a targeted alternative

For women looking for a natural approach but without phytoestrogens, there are formulas designed to work differently.

Rather than attempting to mimic estrogen, they target the mechanisms downstream of hormonal imbalance: stress, sleep, the nervous system and bone metabolism.

Several of the best-documented ingredients used in this approach stand out.

Saffron, an ally during menopause:

Saffron (Crocus sativus), particularly standardized extracts such as Activ'Inside®, primarily acts on mood and sleep quality by modulating serotonergic and dopaminergic pathways.

Its main active compounds — crocin, safranal and picrocrocin — have a documented neuroprotective and anxiolytic effect.

More specifically, regarding Safr'Inside™ extract (Activ'Inside), a randomized, placebo-controlled clinical trial involving 165 adults with moderate insomnia showed a significant improvement in sleep quality. The study was published in 2025 in Sleep Medicine: X [15].

It also has a very favorable tolerance profile, with no documented hormonal effects — clearly distinguishing it from phytoestrogens.

The benefits of fenugreek for menopausal women

Fenugreek extract (Trigonella foenum-graecum) comes from a plant that has been traditionally used for thousands of years and whose seeds are rich in steroidal saponins.

These compounds act on the hormonal axis without behaving as phytoestrogens in the strict sense: instead, they may indirectly modulate the availability of certain endogenous hormones through interactions with enzymes involved in their metabolism [8].

In terms of symptoms, anti-inflammatory, antispasmodic and anxiolytic properties have also been described, which could help improve overall comfort during menopause, particularly for musculoskeletal pain and nervous tension, two symptoms often associated with the hormonal transition.

L-theanine for nervous system balance during menopause

L-theanine is an amino acid naturally found in green tea. It acts on the brain by promoting the production of calming compounds, including:

• GABA
• Serotonin
• Dopamine [11]

These three compounds help the body switch into "rest" mode without causing drowsiness.

More specifically, it stimulates alpha brain waves, which are observed during a state of deep relaxation, such as just before falling asleep.

A systematic review published in 2025 confirms a positive and well-tolerated effect on sleep quality, making it a particularly relevant option for menopausal women whose sleep is disrupted by night sweats and an overactive nervous system.

What you need to know about managing menopause

Menopause is a profound biological transition that temporarily disrupts balances that have been finely regulated for decades.

Its vasomotor, psychological, bone and genitourinary symptoms have specific mechanisms that require appropriate responses.

There are several ways to manage symptoms over the long term. At Argalys, we have formulated a supplement without phytohormones to provide women with safe and effective supplementation throughout every stage of menopause.

Thanks to targeted active ingredients, it gradually supports nervous system balance and reduces the most uncomfortable everyday symptoms.

This approach can also be complemented by behavioral methods (CBT, hypnosis), regular physical activity and an appropriate diet.

If you are unsure which supplementation approach is best suited to your needs, seeking guidance from a healthcare professional should remain the priority.

References

[1] MSD Manuals Professional. Ménopause. Revised July 2023, modified January 2024. doi:10.1097/GME.0000000000002187

[2] Urofrance / Collège Français d'Urologie. Item 124 — Ménopause, insuffisance ovarienne prématurée, andropause. Référentiel, April 2024.

[3] Société Française d'Endocrinologie. Item 124 — Ménopause, Insuffisance ovarienne prématurée. Available at: sfendocrino.org

[4] Davezac M et al. The different natural estrogens promote endothelial healing through distinct cell targets. JCI Insight. 2023;8:e161284. doi:10.1172/jci.insight.161284

[5] Study of Women's Health Across the Nation (SWAN). Longitudinal study conducted since 1994, US universities.

[6] CBIP. Le fézolinétant, une alternative à l'hormonothérapie pendant la ménopause ? June 2024. Ref.: Nappi RE, Kroll R, Siddiqui E, et al. (2021 global survey)

[7] Rance NE, et al. Neurokinin B signalling and the regulation of body temperature. Prog Brain Res. 2010;182:301-17.

[8] Akhtari E, et al. Fenugreek (Trigonella foenum-graecum L.) in women's health: A review of clinical evidence and traditional use. Journal of Herbal Medicine. 2024;43:100816. doi:10.1016/j.hermed.2023.100816

[9] Mann E, Smith MJ, Hellier J, et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1). Lancet Oncol. 2012;13(3):309-318. doi:10.1016/S1470-2045(11)70364-3

[10] The Menopause Society Annual Meeting 2024. Clinical Hypnosis vs. Cognitive Behavioral Therapy for Managing Hot Flashes. Baylor University, Texas. September 2024.

[11] Moshfeghinia R, et al. Efficacy of L-theanine in various neuropsychiatric conditions: a systematic review of randomized controlled trials. Neuropsychiatr Dis Treat. 2024.

[12] Lopresti AL, Smith SJ. The effects of a saffron extract (affron®) on menopausal symptoms in women during perimenopause: a randomised, double-blind, placebo-controlled study. Journal of Menopausal Medicine. 2021;27(2):66-78. doi:10.6118/jmm.21002

[13] Razzaque MS. Magnesium: Are We Consuming Enough? Nutrients. 2018;10(12):1863. doi:10.3390/nu10121863

[14] Rosen CJ. Vitamin D Insufficiency. New England Journal of Medicine. 2011. — data consolidated in Endocrine Reviews, 2019.

[15] Schuster J, Mundhenke C, Nordsieck H, Pouchieu C, Pourtau L, Hahn A. Effect of a saffron extract on sleep quality in adults with moderate insomnia: A decentralized, randomized, double-blind, placebo-controlled trial. Sleep Medicine: X. 2025;10:100147. doi:10.1016/j.sleepx.2025.100147