Nitric Oxide and Menopause: Could Low Nitric Oxide Be Making Your Symptoms Worse?
If you’re in your 40s, 50s or beyond and struggling with hot flushes, brain fog, fatigue or poor exercise tolerance, it’s easy to assume hormones are the whole story.
But what if there was another piece of the puzzle?
One that most women have never heard about.
Nitric oxide.
By your 40s, your body’s production of nitric oxide (NO) is just 50% of what it was in your 20s. This can result in vascular changes that cause hot flushes, deplete energy levels, cause brain fog, and more. Yet, how many women know about NO, or how simple lifestyle adjustments can help restore balance and alleviate these symptoms.
Understanding how nitric oxide affects your body in menopause and how to support its production naturally, could be key to managing some of your symptoms, reclaiming your energy and wellbeing and protecting your future health.
Key Takeaways
✔ Nitric oxide naturally declines with age and hormonal changes.
✔ Low nitric oxide may contribute to symptoms like fatigue, brain fog and hot flushes.
✔ Food, movement and lifestyle can help support nitric oxide production.
✔ Nitric oxide is one piece of the puzzle, not the whole story.
What is Nitric Oxide and Why Does It Matter?
Nitric oxide is a gas produced by cells in your body, especially the endothelial cells lining your blood vessels. It relaxes blood vessels to improve blood flow and regulate blood pressure, supports thermoregulation to help control body temperature, facilitates communication between cells, influences brain, muscle, and organ function, and provides immune support with anti-inflammatory benefits.
The Impact of Perimenopause and Menopause on Nitric Oxide Production
As you transition through perimenopause and into menopause, oestrogen levels eventually decline, which directly affects your body’s ability to produce NO. This decline can contribute to many common symptoms, including hot flushes, fatigue, and brain fog. NO is important to consider even if you have chosen hormone therapy though as hormones are only part of the picture when it comes to declining NO production.
This Goes Much Deeper Than Perimenopause Symptoms too
This is not to downplay the difficult time some women have with perimenopause but I need to also bring this to your attention – Lower nitric oxide levels are linked to stiffer blood vessels and impaired circulation, increasing the risk of cardiovascular issues, including high blood pressure and even cardiac arrest.
In New Zealand, heart disease is the leading cause of death among women. With nitric oxide playing a crucial role in maintaining flexible blood vessels and regulating blood flow, addressing its decline is really important.
Perimenopausal Symptoms that may be Linked to Low Nitric Oxide Levels
Hot Flushes and Night Sweats
Declining nitric oxide levels make it harder for blood vessels to regulate heat, contributing to sudden temperature changes and excessive sweating.
Exercise Intolerance and Poor Recovery
Nitric oxide enhances oxygen delivery and circulation, which are vital for stamina and muscle recovery. Reduced levels can lead to fatigue and soreness after exercise.
Low Energy and Fatigue
Your cells rely on optimal blood flow and nutrient delivery to produce energy. Insufficient nitric oxide can leave you feeling drained, even after a good night’s sleep.
Brain Fog and Cognitive Decline
Nitric oxide supports blood flow to the brain, which is crucial for focus, memory, and overall cognitive function. Low levels may contribute to the dreaded “meno brain.”
Joint Pain and Stiffness
Nitric oxide’s anti-inflammatory properties help protect joints. Without it, inflammation can increase, exacerbating stiffness and discomfort.
Headaches and Migraines
Nitric oxide plays a role in vascular tone. When levels fluctuate, it can trigger migraines or worsen existing headache patterns.
Poor Sleep Quality
Sleep disruptions are common in menopause, and low nitric oxide can contribute by impairing blood flow and increasing inflammation, making it harder to relax and recover overnight.
Cardiovascular Changes
Menopause is a pivotal time for heart health. Nitric oxide helps keep blood vessels flexible and regulates blood pressure. Its decline may increase the risk of high blood pressure, palpitations, and other cardiovascular issues.
Decreased Sexual Function
Nitric oxide improves blood flow, which is essential for arousal and sexual response. Its decline can lead to reduced libido and physical discomfort during intimacy.
Mood Swings and Anxiety
Nitric oxide influences neurotransmitter activity, including serotonin and dopamine. Lower levels can impact mood stability, contributing to irritability, anxiety, or even depressive symptoms.
Weak Immune Function
Nitric oxide helps regulate immune responses and fights inflammation. Low levels may leave your body more susceptible to infections and slower to recover from illnesses.
What I see in clinic
Nitric oxide is one piece of the puzzle. While nitric oxide plays a vital role in supporting many different bodily functions it is important to remember that not everyone’s symptoms may be solely due to low NO levels. In my work as well as looking at hormones I also commonly assess things like blood sugar, gut health, stress resilience, sleep quality and histamine, because these can all influence how women experience perimenopause.
Symptoms Potentially Linked to Low Nitric Oxide
| Symptom | How Nitric Oxide May Be Involved |
|---|---|
| Hot flushes | Reduced blood vessel flexibility |
| Fatigue | Reduced oxygen and nutrient delivery |
| Brain fog | Reduced circulation to the brain |
| Exercise intolerance | Reduced oxygen delivery to muscles |
| Poor sleep | Reduced recovery and increased inflammation |
How to Support Nitric Oxide Levels Naturally
The good news is there are simple, effective strategies to boost your nitric oxide production. This is why I always say – How you ate and your lifestyle in your 20’s may no longer work for you in your 40’s and beyond. Now we may have to make a more intentional effort. You can start here:
Eat Nitrate-Rich Foods
Incorporate foods like beetroot, spinach, silverbeet, arugula, and celery. These are natural precursors to nitric oxide.
Stay Active
Regular exercise, particularly cardiovascular activities, stimulates nitric oxide production and supports overall vascular health.
Stay Hydrated
Proper hydration ensures optimal blood flow and helps nitric oxide function effectively.
Manage Stress
Chronic stress can reduce nitric oxide levels. Mindfulness practices like meditation, yoga, or breathing exercises can help.
Sunlight
Sunlight is another natural way to boost nitric oxide levels! When UV rays hit your skin, they stimulate the release of nitric oxide from stores in your body, helping to improve blood flow and regulate blood pressure. Spending time outdoors, especially in the morning, not only supports NO production but also promotes better mood, sleep, and vitamin D synthesis. It’s yet another reason to prioritise time in nature as part of your wellness routine.
Supplement Smartly
Yes, there are absolutely supplements that can help support nitric oxide production. I personally treat the person in front of me so this will look different with each client. Some supplements contain aminos like L-arginine, or L-citrulline, nutrients and whole food powders like beetroot or black garlic. The right supplement can make a huge difference to your symptoms and quality of life. I see it daily in my practice.
Wondering if low nitric oxide is one of your root causes?
Low nitric oxide isn’t a diagnosis. It’s one possible contributor to symptoms.
Nitric oxide is just one of many factors that can influence how you feel during perimenopause.
When women come to see me, we don’t just look at hormones.
We explore:
✔ nutrition
✔ stress
✔ sleep
✔ inflammation
✔ gut health
✔ blood sugar
✔ lifestyle
And check for any other individual drivers.
Because it’s often the combination of these factors that shapes your experience.
Book an online consultation if you’d like personalised support uncovering what may be contributing to your symptoms.
FAQ'S About Nitric Oxide
Nitric oxide is a naturally occurring molecule produced by your body that helps blood vessels relax and widen, improving circulation. It also plays important roles in brain function, exercise performance, immune health, temperature regulation and cardiovascular health. As we age, and particularly during perimenopause and menopause, our ability to produce nitric oxide naturally declines.
Oestrogen helps stimulate nitric oxide production. As oestrogen levels fluctuate during perimenopause and eventually decline after menopause, your body produces less nitric oxide. Ageing, chronic stress, poor diet and inactivity can also contribute to lower nitric oxide levels.
Supporting healthy nitric oxide production may help some women improve circulation, energy levels, exercise tolerance and overall wellbeing. However, every woman is different, and symptoms are often influenced by multiple factors including hormones, sleep, stress, nutrition and metabolic health.
Some people may benefit from supplements that support nitric oxide production, such as beetroot, L-citrulline or L-arginine. However, the best approach depends on your individual health picture. I prefer to assess the whole person before recommending supplements rather than using a one-size-fits-all approach
Low nitric oxide may contribute to symptoms such as hot flushes, poor exercise tolerance, fatigue, brain fog, headaches, joint pain, poor sleep, cardiovascular changes and reduced sexual function.
These symptoms are common during perimenopause, but it’s important to remember that nitric oxide is just one possible contributor.
Not necessarily.
While declining nitric oxide may contribute to symptoms during perimenopause and menopause, it’s rarely the whole story.
Hormonal changes, chronic stress, poor sleep, blood sugar imbalance, inflammation, nutrient deficiencies and other health factors can all influence how you feel. Looking at the bigger picture often provides the best opportunity for lasting improvements.
Foods naturally rich in nitrates include beetroot, spinach, rocket (arugula), silverbeet, celery and leafy green vegetables. These foods provide the building blocks your body uses to produce nitric oxide. Regular exercise, sunlight exposure and good oral health also support nitric oxide production.
Nitric oxide itself isn’t commonly measured in routine clinical practice. Instead, I look at your symptoms, health history, nutrition, lifestyle and other factors that may influence nitric oxide production and overall health before making recommendations. I can also offer nitric oxide saliva test strips to clients.
References
Lundberg JO, Weitzberg E, Gladwin MT. (2008). The nitrate–nitrite–nitric oxide pathway in physiology and therapeutics. Nature Reviews Drug Discovery, 7, 156–167.
Carlström M, Montenegro MF. (2019). Therapeutic value of stimulating the nitrate–nitrite–nitric oxide pathway to attenuate oxidative stress and restore nitric oxide bioavailability in cardiometabolic disease. Journal of Internal Medicine, 285, 2–18.
Förstermann U, Sessa WC. (2012). Nitric oxide synthases: Regulation and function. European Heart Journal, 33(7), 829–837.
Rossman MJ, et al. (2021). Research on reduced nitric oxide bioavailability and vascular function during the menopause transition
Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. (2018). Symptoms of menopause—global prevalence, physiology and implications for cardiovascular health.
