They say the only certain things in life are death and taxes, but if you’re a woman, there’s one other thing you can be sure of: at some point, you’re going to go through menopause.

Typically, most women start to experience a drop in estrogen levels by their late 40s, a few years before they completely stop having their period. And with that comes many uncomfortable symptoms — hot flashes, night sweats, sleep problems, mood changes, vaginal dryness and more. The average length of perimenopause is four years, but for some women this stage may last only a few months or continue for up to 10 years. Perimenopause ends when a woman has gone 12 months without having her period.

Many women turn to synthetic hormone replacement therapy for help. However, recent studies have shown that traditional hormone replacement therapy can caused increased risk of heart disease, breast cancer and stroke, leading many to seek more natural alternatives.

Earlier this month, we talked about the benefits of bioidentical hormone replacement therapy, which uses estrogen derived from plants and is tailor-made to address your specific hormone levels.

Fortunately there are additional natural approaches to mitigate your symptoms, too. Here are nine great ways to manage menopause that keep you feeling more like yourself: 

1. Put down the coffee
   Coffee lovers, you’re not going to like this, but it turns out that caffeine can make your hot flashes worse. The same goes for alcohol and foods that are high in carbs or sugar. If you need to boost your energy, Patricia DeAngelis, MS, APRN, a family nurse practitioner and functional medicine practitioner at the Center for Holistic Medicine, suggests switching to green tea, which contains phytoestrogens (which is estrogen made by plants).
   
2. Eat foods that contain phytoestrogens
   As the body stops producing its own estrogen eating phytoestrogenic foods can help balance symptoms associated with changing hormones. Phytoestrogenic foods can have an estrogen-like effect on symptoms.  Consider adding soybeans, tempeh, edamame, oats, whole gluten-free grains, and flaxseeds to your diet. DeAngelis recommends eating only non-GMO and organic products and seeking further advice from your healthcare provider or nutritionist.
   
3. Don’t forget your omega 3s
   Are you starting to forget where you put your keys? To help reduce forgetfulness and irritability common in menopause, you can promote brain health by eating foods high in omega 3 fatty acids, such as salmon, mackerel, sardines and fresh tuna. DeAngelis recommends eating small, wild-caught, cold-water, low-mercury fish.
   
4. Eat your broccoli
   Changes in bone density can occur in menopause and lead to brittle bones or osteoporosis. Calcium and vitamin D are important micronutrients needed to maintain bone health. DeAngelis recommends that calcium be gained through diet and having your vitamin D level checked by your healthcare provider. Cruciferous vegetables like broccoli, brussel sprouts, cabbage, kale, and cauliflower are good food sources for calcium, magnesium and folic acid.

• Manage your stress
  During menopause changes in hormones and the brain’s ability to regulate body temperature can lead to hot flashes, which may disrupt sleep, leading to mood instability and stress. To combat stress, try yoga, meditation or even just deep breathing exercises. You can also try muscle relaxation techniques (tense each part of your body one at a time and then relax it, moving all the way from your head down to your toes), to help relieve tension in your body.
  
• Get help with your sleep
  The sleep problems you experience during menopause can not only be annoying, but can also lead to other problems such as weight gain, brain fog, forgetfulness and depression. Try to get as good a night’s sleep as possible by following good sleep habits, such as avoiding screens before bed, going to bed the same time every night, and making sure your room is a cool temperature and very dark and quiet. DeAngelis says you can also talk to your health care provider about which minerals and supplements you can take to aid in sleep. 
  
• Set emotional boundaries
  Irritability is especially common during menopause, which is why Nora Aisenberg, a psychologist at the Center for Holistic Medicine, recommends making self-care a priority. This can be especially challenging if you have teenagers or college-aged children, as well as aging parents. “Women are really good at caring for other people, but they need to give themselves permission to find that space for themselves,” Aisenberg says. “This is a time for women to be there for themselves emotionally.”
  
• Increase blue space exposure
  Another way to reduce stress and relieve the effects of hot flashes is to spend time looking at the water, also known as blue space. “When you are exposed to environmental things like water, rivers, fountains, etc. it creates a cooler, more relaxed feeling,” Aisenberg says. She says even looking at pictures of water or listening to the sound of water or rain can work wonders.
  
  
• Seek out counseling
  Just because your mood swings, irritability, anger and depression may be partially related to hormone changes doesn’t mean you have to suffer through them alone. Aisenberg says a professional therapist or counselor can help you tease out what is really related to menopause and what isn’t, and can help give you some tools to deal with your emotions. “Some women may, for the first time ever, go on antidepressants during menopause, and a professional can discuss the pros and cons of these approaches with you,” she says.