In this guide, we discuss the hormonal changes that characterise perimenopause from an innovative, rigorous and up-to-date perspective. We also present the latest findings from the scientific literature and data from available studies in our area of expertise, with over 25 years’ experience in research and development: medicinal mushrooms used in traditional medicine such as Lion’s Mane (Hericium), Reishi, Cordyceps, Chaga, etc.
WHAT IS PERIMENOPAUSE? PREMENOPAUSE, PERIMENOPAUSE AND POSTMENOPAUSE
Perimenopause is the transitional stage that precedes the menopause. It is a natural stage in a woman’s life that involves significant hormonal, immunological and inflammatory changes. Modern science is currently investigating how to address all these changes in an integrative way, and the evidence is growing by the day. Among other natural ingredients and active compounds, research is also focusing on mushrooms used in Traditional Medicine, as their centuries-long use—particularly in relation to inflammation, balance and the immune system—is now supported by scientific evidence derived from studies of their constituents, notably beta-glucans, terpenes, mycosterols, ganoderic acids, hericenones, etc.
HOW LONG EACH PHASE LASTS AND HOW TO KNOW WHICH ONE YOU ARE IN
According to the World Health Organisation (WHO), menopause is the permanent cessation of menstruation as a result of the loss of ovarian function. A woman is said to be in this phase after 12 consecutive months without a period, provided there is no other medical cause. The menopausal transition includes the changes that occur before the last period, whilst perimenopause encompasses this transition and the twelve months that follow. After that, postmenopause begins, which lasts for the rest of a woman’s life.
WHY CAN SUPPLEMENTATION HELP AT THIS STAGE?
In recent years, research into women’s health has increased significantly, particularly that relating to the different hormonal stages, how they function and how they can be managed using new strategies. Until now, there has been an overwhelming silence and a lack of understanding about everything these changes entail, beyond each woman’s personal experience.
In other words, every day we learn more about how to look after ourselves, how to eat healthily and which sports suit us best. In the field of supplementation, progress has also been remarkable. Creatine, ashwagandha, collagen, magnesium, etc. are no longer unfamiliar terms in our daily lives. In this regard, adaptogenic mushrooms from traditional medicine occupy a privileged position, as modern science is now following the leads provided by traditional uses to offer a scientific explanation that validates and elaborates on them, thereby providing a new strategy for women’s health care at different stages of life.
Supplements made from extracts of these mushrooms and containing active quantities of substances such as hericenones, mycosterols, beta-glucans, terpenes, etc., are a suitable option for those who choose to use supplements to look after their health and complement their treatment plan.
However, given the wide range of options available, it is advisable to consult specialists who can develop a personalised plan tailored to each individual’s needs.
THE SYMPTOMS OF PERIMENOPAUSE AND WHY CERTAIN FUNGI FROM TRADITIONAL MEDICINE ARE BEING RESEARCHED
Some medical societies highlight menstrual irregularities as one of the earliest associated symptoms, followed by mood swings and sleep disturbances. However, we will analyse all the changes reported by those going through this new stage or those researching and treating it.
HOT FLASHES AND NIGHT SWEATS
What are known as vasomotor symptoms —which include the familiar sensation of heat, night sweats and facial flushing— are the most common manifestation during this stage. They can appear very early on, even up to 15 years before menstruation ceases, significantly impacting quality of life, sleep and self-esteem, particularly in social or work settings.
Although their pathophysiology is complex and not yet fully understood (Gatenby and Simpson, 2024), these hot flushes stem from a hormonal dysregulation that disrupts the functioning of our internal thermoregulatory centre.
In light of this disruption to the ‘internal thermometer’, the use of natural compounds presents a promising field of study:
- Reishi (Ganoderma lucidum): Research is being conducted into the role of its natural active compounds in alleviating hot flushes, thanks to their potential to influence hormonal balance.
- Green tea: Its catechins — particularly epigallocatechin gallate (EGCG) — are noted for their antioxidant activity and their effects on various cellular pathways, and are being studied for their potential modulatory action on the thermoregulatory centre involved in these symptoms.
INSOMNIA
Some adaptogenic mushrooms such as Reishi, Cordyceps and Lion’s Mane are being studied for their effects on the central nervous system and stress. Hence, traditionally—especially Reishi—it is known as ‘the mushroom of eternal youth and calm’. Its main bioactive compounds, such as polysaccharides and triterpenoids, have been investigated for their potential immunomodulatory and antioxidant properties, amongst others.
STRESS AND CORTISOL
Changes in oestrogen levels can alter the functioning of neurotransmitters such as serotonin and GABA, whose main role is to control anxiety. Furthermore, a lack of these hormones can also increase emotional sensitivity and lead to mood swings.
Adaptogens are natural substances studied for their ability to help the body respond to stress and promote the balance of its functions. These include Reishi, Siberian ginseng, Rhodiola and Ashwagandha, as well as traditional mushrooms such as Cordyceps, Lion’s Mane (Hericium) and Chaga. Their triterpenes and polysaccharides are being investigated for their potential influence on mood, fatigue and longevity. Thus, during the menopause, these could contribute to relaxation and stress management through compounds linked to the activity of neurotransmitters and endorphins, although these effects are currently based on studies using animal models.
WEIGHT GAIN
A study published in Cell Metabolism in 2018 noted that disruptions to biological rhythms can throw hormonal release out of balance and promote the accumulation of fat in cells, which could contribute to obesity during stages characterised by hormonal changes. Furthermore, various medical societies point out that the menopause, due to a lack of oestrogen, promotes the redistribution of fat towards the abdomen.
In this regard, some research into the Maitake mushroom has evaluated the effect of its compounds—some of which are common to other mushrooms such as Reishi—on fat metabolism and cardiovascular health.
FATIGUE AND LACK OF ENERGY
Cordyceps sinensis, traditionally used to combat fatigue, contains active compounds such as cordycepin, adenosine, ergosterol and beta-glucans. Preliminary studies suggest possible anti-fatigue and anti-inflammatory effects, whilst a 2019 review found improvements in lung function, exercise endurance, quality of life and certain respiratory symptoms, although further clinical trials are needed to confirm these preliminary findings.
Other adaptogenic species such as Reishi and Lion’s Mane have also shown evidence of beneficial effects on the central nervous system. Further studies are also needed in this area to help us better understand how these species can serve as a natural source of support.
VAGINAL DRYNESS AND INTIMATE HEALTH
Vaginal dryness is undoubtedly a discomfort that can result from a lack of oestrogen and a loss of elasticity in the mucous membranes. Many women experience changes in their pH levels and even a higher risk of infections during hormonal changes; therefore, natural moisturisation and protection – whether applied topically or taken orally via vaginal prebiotics and probiotics – can be of great help in preventing discomfort and restoring intimate comfort. Thus, certain probiotics – particularly those of the Lactobacillus genus – combined with other ingredients that regulate the microbiota, can be effective in combating vaginal dryness, a condition defined as Genitourinary Syndrome of Menopause (GSM), which includes: dryness, itching or a sensation of vaginal irritation, incontinence, frequent urination, nocturia or dysuria.
SKIN
The skin is one of the body’s largest organs, and both its elasticity and firmness are affected by the loss of certain hormones. In this regard, recent studies highlight the moisturising and antioxidant properties of adaptogenic species such as Lion’s Mane; this is complemented by other ingredients such as Reishi, known as the ‘mushroom of eternal youth’.
HAIR LOSS
A certain increase in hair loss during perimenopause is considered a normal physiological response to hormonal changes. Although mushrooms used in Traditional Medicine are not in themselves a treatment for hair loss, there is growing evidence to suggest that they may contribute to the functioning of various biological systems related to healthy hair growth. These include Reishi, Cordyceps, Lion’s Mane and Shiitake.
HORMONAL BALANCE
This aspect could be defined as the starting point of pre-menopause and the origin of the symptoms or conditions associated with perimenopause and menopause. Addressing this hormonal imbalance may therefore be essential for mitigating the effects on appetite, emotions, fat metabolism, cardiovascular health, etc. If we focus on the evidence and the proposed treatments, exogenous substances are currently used to alleviate the deficiency of certain hormones, always under strict medical supervision and not without side effects. At an individual level, strategies can be adopted based on routines, foods and supplements that also serve this purpose and have fewer associated side effects. In this case, it is also recommended to consult a professional, especially if there are other medical conditions and pharmacological treatments.
When it comes to hormonal balance, the evidence regarding mushrooms in Traditional Medicine continues to point to Reishi, Lion’s Mane and Cordyceps. This makes sense, as these are the species whose compounds have been most extensively documented in the literature. There are as yet no studies confirming hormonal regulation, but research is being conducted into their effects on oestrogen signalling and their immunomodulatory, anti-inflammatory and antioxidant properties; these could have an impact on hormonal balance. In the field of botany, other substances derived from Ashwagandha and green tea, for example, are also being studied on similar grounds.
IRREGULAR MENSTRUAL CYCLE
Given the changes involved in the transition to perimenopause and menopause, as explained in the previous sections, it is worth helping the body adapt to these physiological changes through strategies advised by professionals and adjustments to daily routines and habits. If you decide to support this transition with supplements, a formula based on ingredients that balance different areas may be beneficial. These are the key areas of action: stress, sleep, cognitive wellbeing and vitality.
JOINT PAIN AND INFLAMMATION
The decline in oestrogen has in some cases been linked to joint discomfort, but it is not the only cause. Some women have reported pain, stiffness or tenderness in their knees, hands, hips and shoulders during the transition to the menopause. Specifically, these changes are also linked to inflammatory regulation, in which oestrogens play an important role.
However, these changes are not universal and do not depend solely on hormonal changes. Age, metabolic health and other related conditions influence how women experience this new hormonal phase.
Species such as Reishi, Cordyceps and Lion’s Mane have the longest history of use in traditional medicine and are the subject of the most scientific studies currently being carried out. Although each contains distinct compounds, they all possess beta-glucans, whose impact on the immune system is attracting a great deal of research due to their potential. Research is also being carried out into how other compounds present in these mushrooms (such as terpenes) may influence inflammatory signalling pathways.
MEMORY AND CONCENTRATION, MICROBIOTA, IMMUNE SYSTEM, BONES, THYROID
Brain fog is one of the effects most frequently mentioned by women during hormonal transition. Linked to fatigue and lack of sleep, forgetfulness and a lack of mental clarity are among the main concerns affecting the central nervous system.
One of the most widely studied effects of the Lion’s Mane mushroom (Hericium erinaceus) is neuroprotection, which is being investigated due to the presence of compounds such as hericenones and erinacins and their role in neuronal growth and communication pathways.
In this regard, at Hifas da Terra we led a collaborative study entitled ‘Development of new functional foods and nutritional supplements aimed at healthy neurocognitive development’. It culminated in an observational study in humans, the findings of which included statistically significant improvements in attention, memory, concentration, processing speed and visuospatial skills following the intake of Lion’s Mane.
HOW TO TAKE TRADITIONAL MEDICINAL MUSHROOM-BASED SUPPLEMENTS: A GENERAL GUIDE TO USE
These recommendations may be useful when starting a supplementation programme:
You may wish to consult a specialist to draw up an appropriate supplementation plan; this would form the basis on which to build your specific programme, detailing which supplement or supplements to take, when and how much, and for how long to follow the protocol. These queries can also be resolved by checking the labelling, which should include the recommended daily dose, dosage instructions and warnings, as well as relevant information on potential allergens.
Once these general issues have been clarified, it is worth checking the quality certifications the product holds. There are essential factors such as the product being properly registered as a food supplement with the country’s health authority (in Spain’s case, this would be the Spanish Food Safety Agency, AESAN) and the quality seals the product carries, including, for example, the European seal for certified organic production, the country of origin, the detailed composition of the ingredients and the nutritional content per recommended daily dose… At this stage, it is important to check the qualitative and quantitative specifications of the supplement’s ingredients. This is not merely an exercise in transparency; it also provides clear information that enables you to research and find out more about the supplement.
As for how to take the supplement, there are general guidelines such as taking it on an empty stomach, before main meals or, if the supplement is designed to promote relaxation, after the last meal, accompanied by a slightly warm drink to aid absorption in the gut.
AN EXAMPLE THAT MEETS ALL THESE CRITERIA: HIFAS-MENOPAUSE
If you’ve reached this point, you understand what to look for in a supplement. HIFAS-Menopause is an example that meets all these criteria:
SCIENTIFIC COMPOSITION
- Reishi, Cordyceps, Lion’s Mane, Ashwagandha, green tea, probiotics, vitamins and minerals.
QUALITY CERTIFICATIONS
- ✓ AESAN registration
- ✓ Eco-label
- ✓ Detailed composition
- ✓ Clear origin
SCIENTIFIC BACKING
Clinical studies showing improvements in general menopausal symptoms.
Note: Consult your healthcare professional if you are undergoing drug treatment.
HOW LONG DOES IT TAKE TO NOTICE THE EFFECT (APPROX. 90 DAYS OF CONTINUOUS USE)
The minimum recommended duration to notice the effects of supplements is estimated at three months of daily intake of the active ingredient, based on a standard average weight. At Hifas da Terra, we include the recommended daily dose (usually two capsules a day) based on this desired effect and specify a minimum course of three months. Effects may be noticeable from the very first days, but prolonged use is required for the active ingredients to be fully incorporated into the cell cycles.
Note: If you have looked at HIFAS-Menopause, you will see that this is precisely what it specifies: a clear dosage (2 capsules daily) and a recommended minimum duration of 3 months.
WHAT TO TAKE IT WITH (VITAMIN C FOR THE BIOAVAILABILITY OF B-GLUCANS) AND THE BEST TIME OF DAY
Some of the bioactive compounds found in mushrooms have been shown to be better absorbed in the gut when combined with vitamin C. This is why many mushroom-based supplements already include a sufficient amount of this vitamin in the same capsule to ensure its full absorption and effectiveness. The choice of vitamin C source is also important. This may be standard vitamin C or a naturally sourced form such as acerola, whose scientific name is Malpighia glabra, which has a much higher vitamin C content than that found in common citrus fruits.
Note: HIFAS-Menopause is an example of a supplement that already includes high-quality vitamin C in its formula, ensuring optimal bioavailability of its active ingredients.
PRECAUTIONS AND CONTRAINDICATIONS
The general recommendations when taking supplements are as follows: Furthermore, if the person is undergoing pharmacological treatment, it is advisable to check for any warnings regarding the use of the supplement in question. These considerations should also be borne in mind when starting to take a supplement during the menopause or earlier, during the perimenopause.
- If you have any doubts, consult your healthcare professional.
- Food supplements should not be used as a substitute for a varied and balanced diet or a healthy lifestyle.
- Do not exceed the recommended daily dose.
- Keep out of reach of young children.
- If you are pregnant or breastfeeding, consult your doctor. Store in the original packaging at a temperature below 25 ºC.
- Do not use if the seal is damaged or broken.
- Once opened, use within the period indicated on the label.
INTERACTION WITH ANTICOAGULANTS AND PRIOR TO SURGERY
In some cases, for safety reasons and when taking anticoagulants or prior to surgery, specific recommendations or warnings regarding a possible interaction are included.