Solutions for Seven Symptoms of Perimenopause

Since the sudden halt of the National Institutes of Health clinical study of the effects of the hormone Prempro, more women than ever are interested in how to create midlife health without the use of synthetic hormones. The Women's Health Initiative study was terminated in July 2002 because Prempro, which combines estrogen with progestin, appears to increase a woman's risk of breast cancer as well heart disease and stroke.

"The NIH finding was unexpected. It has been a real negative for women, driving them to consider options besides hormone-replacement therapy," says Susan Lark, M.D., one of the nation's leading authorities on the use of lifestyle and nutritional approaches to women's health.

Further fanning the flames was the release of a study in March 2003 (from the same Women's Health Initiative) showing that conventional hormone-replacement does not significantly improve mood, mental ability, sexual function or menopausal symptoms.

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Here's the good news, though. There are effective "do-it-yourself" alternatives to conventional-hormone formulations for easing the physical and emotional symptoms of perimenopause, the 10-15 years before menopause when a woman's monthly period comes to an end. Below is a "master plan" from which to create your own program for perimenopause relief.

Here, Discovery Health Online presents top solutions for seven common perimenopausal symptoms from three leading women's health experts: Susan Lark, M.D., nutritionist Ann Louise Gittleman, Ph.D., and Christiane Northrup, M.D.

Hot Flashes/Night Sweats

Hot Flashes/Night Sweats: Occur in 70 to 85 percent of women and are triggered by falling estrogen and above-normal FSH (follicle stimulating hormone) levels. Average age of onset = 48. Mainfests as intense heat over face, scalp and chest for 3-5 minutes.
Susan Lark, M.D. Ann Louise Gittleman (ALG) Christiane Northrup, M.D.
Vitamin E: Start with 800 I.U. daily with doctor's okay. Supplements containing soy isoflavones (50-100 mg*) or black cohosh also have shown strong results. All can be used together or separately. Vitamin E: 400 to 1200 I.U. Vitamin E may work by functioning like a weak estrogen in the body.
Bioflavonoids: 1,000 mg of hesperidin daily. Like vitamin E, bioflavonoids may work by having a structure similar to estrogen.
2 percent natural progesterone skin cream helps 85 percent of perimenopausal women; apply ¼ tsp. daily to skin. Soy foods like soy milk and tofu (aim for 45-160 mg of soy isoflavones daily) may provide relief, as do some herbs — black cohosh, dong quai or chaste berry.

Lower Libido

Lower Libido: Lower estrogen, progesterone and testosterone levels may dampen sexual desire. Relationship, stress, illness, life events are also contributing factors.
Susan Lark, M.D. Ann Louise Gittleman (ALG) Christiane Northrup, M.D.
L-arginine: Take 1,000 mg 1-2 times daily in combination with 250 mg of B-5 and 250-350 mg of choline once daily to promote better blood flow to the pelvic organs and tissue. See Dr. Lark below on vaginal dryness. She believes perimenopausal women may have lower libido because intercourse is painful. Topical testosterone cream can be "extremely effective." ALG advises getting a baseline salivary hormone ** test to determine hormonal deficiencies. Useful herbs: damiana, horny goat weed and maca, a Peruvian herb that may also help with hot flashes, night sweats and fatigue. Lower libido may result as a woman "reprioritizes her life and the manner in which she uses her energy" and redefines relationships to "serve the person" she is becoming. Women in love with their life tend to have high libido despite hormonal changes. Lack of libido may stem from low estradiol or testosterone. Check hormone levels with salivary hormone test. If one of these hormones is low, supplement with oral estradiol or patch; take testosterone as capsule or vaginal cream. In early perimenopause, ¼ teaspoon of natural progesterone cream twice daily may help.

Vaginal dryness/itching

Vaginal dryness/itching: As estrogen drops, vaginal and urethral tissues can become thinner, resulting in the production of less moisture and painful intercourse.
Susan Lark, M.D. Ann Louise Gittleman (ALG) Christiane Northrup, M.D.
Vaginal lubricants or moisturizers plump up the cells lining the vagina. Avoid antihistamines as they dry out mucus membranes. Regular sex relaxes the pelvic muscles & improves blood flow. Practice Kegel exercises for improved muscle tone and blood supply in pelvic area. Topical estriol (a natural estrogen that does not stimulate growth of breast or uterine tissue) "works wonders." You need a doctor's prescription for estriol, which you purchase at a formulary pharmacy. Use vaginal lubricant during intercourse. Topical estrogen cream, vitamin E suppositories, systemic estrogen therapy (low-dose Premarin or Estrace cream) or increased use of phytoestrogens such as soy.

Sleep Disturbances

Sleep Disturbances: Hot flashes or night sweats can cause sleep disturbances such as awakening in the middle of the night and early morning.
Susan Lark, M.D. Ann Louise Gittleman (ALG) Christiane Northrup, M.D.
Valerian root:150-300 mg about 45 minutes before bed has a mild sedative effect, but also dries out tissues.

Passionflower:Maintains blood levels of serotonin, the brain neurochemical that promotes sleep. Make a tea of 1 tsp. of dried passionflower leaves before bed.

5-HTP: (5-hydroxytryptophan) an amino acid and precursor to serotonin. Try 50-100 mg to help you sleep.

Chamomile: Reduces anxiety. Steep 2-3 heaping tsp. of chamomile flowers in 1 cup of boiling water.

Kava root: A potent sedative and anti-anxiety herb. Try 140 mg before bed.

Aromatherapy with lavender: Lavender increases the alpha brain waves associated with relaxation. Add lavender oil to a bedtime bath.

Melatonin:Produced by the pineal gland, the hormone that regulates the body's natural rhythms. Take 1 mg at bedtime.

Many symptoms of perimenopause are due to imbalances in blood sugar. To balance blood sugar, include protein, fats (olive oil and flaxseed oil) and low- glycemic carbohydrates at all meals. Breakfast could be a protein source (eggs, smoothie) and a slice of whole grain or sprouted grain toast with a pat of butter or drizzle of flaxseed oil. At lunch and dinner include at least 3-4 oz. of lean protein from fish, poultry, beef, lamb, seafood or tofu/tempeh and one tbsp. of olive or flaxseed oil or nuts or seeds such as almonds, sunflower seeds. Eat lots of steamed veggies of various colors (spinach, squash or sweet potato or peas, red peppers, cabbage, eggplant) and a leafy green salad. Dessert could be fresh fruit or a frozen fruit dish.
Low magnesium status has been linked to poor sleep. Take 400 mg in oxide form before bed.
Natural Progesterone: ¼-½ teaspoon at bedtime.

Kava Kava: 150-210 mg 1 hour before bedtime.

Valerian: If kava kava does not work add valerian in capsule form, 150-300 mg of a product standardized to 0.8 percent valerenic acid at bedtime.

Melatonin: 0.5-3.0 taken one hour before bedtime. Bedroom must be dark for melatonin to work.

5-HTP: Start with 100 mg 3 times daily and gradually increase over several months to 200 mg.

Northrup notes that even natural aids are not drugs and often take weeks to work. They also lose their efficacy over time, so use them sparingly and consider how diet, exercise, bedtime rituals and removing emotional stress may be contributing to poor sleep.

Weight Gain/Food Cravings

Weight Gain/Food Cravings: Brain chemicals like serotonin also fluctuate close to menopause. Diminished levels of serotonin may intensify food cravings, especially for carbohydrates & high-glycemic foods+ like baked potatoes, white bread & rice, pasta, raisins, pineapple. Low-glycemic foods include black beans, lentils, green veggies, peaches, strawberries, cottage cheese, sweet potatoes, mushrooms, multi-grain breads.
Susan Lark, M.D. Ann Louise Gittleman (ALG) Christiane Northrup, M.D.
Fight sweet cravings with snacks like whole grain bread with almond or sesame butter. Snacks that contain healthy oils and protein and complex carbohydrates cause blood sugar to rise, peak and drop slowly, thereby controlling cravings. Eating mildly salty food like miso also works. Take 50-100 mg 5-HTP with 25-100 mg of B-complex to stabilize blood sugar. Cravings often can stem from magnesium-calcium imbalance. Take both minerals in ratio of 2:1 in favor of magnesium. Amino acid L-glutamine, 500 mg 2 times a day may knock out sugar cravings. ALG's The Fat Flush Cookbook is a five-point lifestyle plan for weight loss: 1. Detoxify the liver with unsweetened cranberry juice; 2. Eliminate gluten-rich grains and dairy foods that promote water retention; 3. Eat fats that speed up fat burning; 4. Combat excess insulin with rainbow colored fruits & vegetables; 5. Balance blood sugar by eating every 3 hours before you are hungry. L-glutamine, 1,000 mg daily with lunch to stop sugar cravings. Stevia is a natural sweetener. Try a small bite of a Keto Bar, high in protein and healthy fat, for something sweet besides brownie or cake. Stabilize blood sugar by eating frequent, smaller meals with balance of protein & colorful fruits & vegetable. Aim for diet of 40 percent protein, 35 percent low-glycemic carbohydrates+, 25 percent healthy fats (flaxseed, pumpkin seeds, cold-water fish).

Irritability/Anxiety/Mood Swings

Irritability/Anxiety/Mood Swings: Symptoms can occur during perimenopause & menopause. Estrogen acts on the brain as a natural mood elevator while progesterone has a relaxant or sedative effect. As the production of these two hormones starts to diminish, mood imbalances can occur.
Susan Lark, M.D. Ann Louise Gittleman (ALG) Christiane Northrup, M.D.
Eliminate caffeine, dairy products, chocolate, alcohol. Ginger-root tea and magnesium (300 mg daily) help combat fatigue. High levels of estrogen can deplete vitamin B6 and cause depression. Take B6 as part of a B-complex containing 25-100 mg of B6. For anxiety take Evening primrose oil, 500 mg capsules, 2-4 per daily, vitamin C, 1,000-2000 mg, panthothenic acid 500-1,000 mg, or licorice root (follow instructions on the bottle.) Zinc, 35-50 mg daily, is helpful as is a topical progesterone cream like ProgestaKey, 1 pump daily during the last two weeks of the cycle. Dr. Northrup says natural foods, bioidentical hormones, vitamins & minerals, herbs, exercise, etc., are "powerful" tools that can help perimenopausal women "reestablish a physical and emotional comfort zone." But, reoccurring emotions may be a "wake-up call and an opportunity to implement much-needed change." Part of addressing perimenopausal symptoms, she writes, is acknowledging and listening to the inner wisdom and messages embodied in outward symptoms.

Dry Skin

Dry Skin: Production of collagen, the supportive fibrous structure that gives skin its strength, decreases after 40 and as estrogen levels fall. Skin feels and looks thinner, less elastic, and drier. The subcutaneous layer of fat also thins, thereby making the appearance of wrinkles more likely.
Susan Lark, M.D. Ann Louise Gittleman (ALG) Christiane Northrup, M.D.
Using the traditional Asian model, women are thought to become "yin deficient" when they reach menopause and their tissues become drier, hotter, or more yang. Healing substances that restore or rebuild yin include royal jelly. Take the liquid form of royal jelly, ¼ tsp. twice a day. Available at most health food stores or order from Glory Bee (800/456-7923.) Ensure you are getting essential fatty acids (EFAs) in your diet. Eat foods rich in omega-3 and omega-6 EFAs like flaxseed (1-2 Tbsp. per day), raw pumpkin seeds (2-3 oz. per serving as a snack) and cold-water fish (as salmon, trout, mackerel or halibut) three times weekly. Skin, hair and nails benefit from alpha-linolenic acid (omega-3) EFA. Flaxseed oil is the richest source of omega-3 EFA; take 2 Tbsp. daily as salad dressing or hide it in yogurt. 3-4 Tbsp. of flaxseeds = 1 Tbsp. of flaxseed oil. Flaxseeds can have a stabilizing effect on hormone-related mood disorders. Use borage oil, a source of gamma linoleic acid (GLA) in the omega-6 family, as a skin moisturizer. Borage oil is a natural anti-inflammatory. Dr. Northrup recommends two skin-care brands on her web site: the Trienelle line formulated by a physician (Aspen Benefits Group, 800/539.5195) and Sense from Usana Health Sciences (888/959.9595). She also recommends exfoliants like 5-12 percent alpha hydroxy acids and products with topical vitamin C ester or high-potency vitamin E for rejuvenation. For "inside" skin care, follow her insulin-normalizing diet by cutting out high-glycemic index foods+. Soy (100-160 mg of isoflavones daily) strengthens collagen. Midlife skin-boosting supplements: vitamins C and E, alpha-lipoc acid, proanthocyanidins (flavonoids extracted from grape seeds and maritime pine) and coenzyme Q10.


* One cup of soy milk, for example, has only 20 to 40 mg of isoflavones; one-half cup of tofu has 35 mg.
** Salivary home-test kits measure a panel of hormones, including estrogen, progesterone, testosterone, DHEA and cortisol. The technology is not widely accepted by the medical community and your doctor may seek a blood test to compare the results of salivary testing. Aeron Life Cycles Laboratory, San Leandro, Calif. and Great Smokies Diganostic Laboratory, Asheville, N.C., sell test kits.

+ High-glycemic foods rapidly raise blood sugar (glucose), which causes insulin production. Insulin transports sugars out of the blood stream and into fat cells and muscles. High-glycemic meals raise blood glucose so high that extra insulin is produced, quickly moving sugars into the body cells and causing blood-sugar levels to drop. Your body responds by producing hormones to increase appetite and balance blood sugar. Studies show that people are more successful at weight loss when they eat low-glycemic meals.

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