As you’re probably aware, menopause is that phase of a woman’s life when her ovaries no longer produce the sex hormones estrogen and progesterone. Well before then, however, a woman’s hormones begin to fluctuate from month to month, often causing many unpleasant symptoms. This process may take from five to 10 years. This is perimenopause. During this time, even though periods are still occurring, symptoms associated with menopause, including hot flashes, mood swings, brain fog, and sleep disturbances begin. Yet with periods persisting, most doctors are reluctant to start prescription hormones that would stop these symptoms in days. Furthermore, since her hormonal status fluctuates, she may not need prescription hormones every month. So what’s a person to do?
At WholeHealth Chicago, we recommend an integrative approach that delays having to start taking prescription medication and instead relies on nutritional remedies and other self-care measures. Then, as long as you’re feeling well, you’ll have time to consider if hormone replacement therapy (HRT) is right for you.
What is Perimenopause?
Menopause is that phase of a woman’s life when her ovaries no longer are releasing eggs for fertilization or producing the female hormones estrogen and progesterone. During perimenopause, she still releases eggs, or ovulates, during some cycles. But during others, she may not ovulate at all and therefore may not produce as much progesterone. This causes wild fluctuations and imbalances in her hormone levels. As these hormones decline, menstrual periods first become irregular, then finally stop. When a woman has had no periods for 12 months or if a blood test shows her ovaries are not responding anymore, she is said to be in menopause. This phasing out of menstrual periods is a gradual process, however, and the decrease in hormones can take several years. If a woman is beginning to experience symptoms from her declining hormones, but still having menstrual periods, she is considered to be in perimenopause.
Of course, neither perimenopause nor menopause is a disease, but simply names for natural phases in a woman’s life. Perimenopause can take from five to 10 years and begin as young as age 40 or even 35. Most women are in menopause by the time they reach their early to mid fifties.
Three health issues emerge during perimenopause that affect some, but certainly not all women. Each is caused by fluctuating levels of estrogen and the imbalance that occurs between estrogen and progesterone levels. The first medical concern is a familiar group of symptoms, including hot flashes, night sweats, mood swings, fatigue, and menstrual irregularities. The second is an increased risk of developing heart disease because of changes in cholesterol and blood pressure. And the third is an increased risk of osteoporosis (brittle bones) as the bones themselves lose calcium into the urine.
Key Symptoms
- Menstrual irregularities, including spotting
- Hot flashes
- Night sweats
- Sleep problems
- Irritability or mild depression
- Lack of focus or concentration
- Vaginal dryness with painful or uncomfortable intercourse
- Aches and pains in fingers, shoulders, and other joints
What Causes Perimenopause?
During the years leading up to menopause, called perimenopause, the ovaries’ production of the hormones estrogen and progesterone dwindles gradually, a shift experts believe may begin as early as a woman’s thirties. Perimenopausal symptoms become more noticeable as menopause approaches and are due not only to the lower levels of hormones being produced but also to unpredictable hormonal fluctuations. In addition, women who have had total hysterectomies in which the uterus and both ovaries have been surgically removed develop immediate and usually severe menopausal symptoms. This is because their female hormone levels fall so abruptly and completely–and not gradually as in perimenopause.
Treatment and Prevention
Perimenopause is a natural stage of life and may not necessarily require any treatment at all. However, if your symptoms are severe enough to interfere with your life, you should talk to your doctor about different treatment options.
One immediate option for women with truly troublesome symptoms is hormone replacement therapy (HRT)–although some doctors advise against HRT until after menopause when it is used to reduce the risk of heart disease and osteoporosis. However, no matter the age when HRT is given, there are possibilities of unpleasant side effects (bloating, breast tenderness, menstrual cramps, headache, and weight gain) or even health risks (blood clots, gall bladder and liver disease). In fact, of all women placed on HRT, one in three discontinues it after one year due to side effects.
On the other hand, there are a number of complementary approaches to perimenopause that have proved to be very helpful at easing symptoms. These range from gentle herbs for hot flashes and mood swings to a variety of alternative therapies including dietary changes, vitamins, yoga, meditation, acupuncture, Chinese herbs, aromatherapy, and homeopathy for all the troubling symptoms of perimenopause.
A number of herbs have been used for centuries to control perimenopause symptoms. Although these herbs can work singly, for some women combinations of certain herbs seem more effective.
Just a reminder: If you have a serious health condition, always talk to your doctor before beginning a supplement program.
How Supplements Can Help
Black cohosh, a relative of the buttercup, appears to reduce levels of LH (luteinizing hormone), a pituitary hormone that may contribute to hot flashes.
Chasteberry, the fruit of the chaste tree also called vitex, is often recommended by European doctors to help with PMS symptoms and may also help with hot flashes. Chasteberry causes the pituitary gland, which directs the interplay of female hormones, to signal the release of progesterone, bringing it into better balance with estrogen already circulating in the system.
Siberian ginseng has been used as a tonic for both men and women for centuries in China. Recent evidence indicates that this all-purpose herb relieves stress, boosts mood, and increases mental alertness; it also seems to stimulate the immune system and lower blood pressure.
Dong quai has been referred to as “female ginseng.” As such, it seems to act as an adaptogenbalancing a variety of functions throughout the body to increase energy, counter the physical effects of stress, and enhance physical and intellectual performance.
Vitamin E improves the stability of blood vessels and seems to block the erratic dilation of the blood vessels just beneath the skin that are responsible for hot flashes when estrogen levels fall. Research as early as from the 1940s confirmed that vitamin E can prevent hot flashes. However, sometimes rather high doses are required (up to 1,200 I.U. per day), so you might want to discuss this therapy with your physician.
Vitamin C and flavonoids may slow the heavy menstrual bleeding that often appears in perimenopause. These substances strengthen capillary walls that normally weaken before and during the menstrual period. Flavonoids may also relieve hot flashes and moodiness.
Women who live in countries where soy is a staple also suffer fewer hot flashes and other perimenopausal symptoms as well. An alternative to soy foods are supplements containing soy isoflavones, natural chemicals that scientists believe to be the protective ingredients in soy.
Used either either as a cream (available over the counter) or taken orally (doctor’s prescription required), natural progesterone acts to restore the hormonal imbalance between estrogen and progesterone that can happen at perimenopause. Progesterone, when used either continuously or during the second half of the menstrual cycle if these are predictable, can improve many symptoms of perimenopause.
The essential fatty acids found in flaxseed oil and in evening primrose or borage oils help regulate naturally occuring hormonelike chemicals called prostagalins. They will help control the irregular menstrual bleeding so common during perimenopause, including heavy or scant flow and cramping.
Get supplement dosages and tips in our WholeHealth Chicago Supplement Recommendations for Perimenopause.
Self-Care Remedies
Reduce stress with techniques such as meditation, yoga, or aeorbic exercise. This can reduce hot flashes and improve mood during this time of reduced reserves against stress.
Avoid food triggers, such as alcohol, coffee, chocolate, and spicy foods, which can add to the stresses on your system and aggravate hot flashes.
Wear your clothing in layers. When hot flashes arrive, layers can come off until the amount of clothing is comfortable.
Use cotton clothing, sheets and blankets. Cotton allows heat to escape quickly.
Relaxing in a tepid bath for 20 minutes each morning can help prevent hot flashes.
When to Call a Doctor
- If you begin to bleed heavily and for prolonged periods of time
- If your period changes are associated with chronic gastrointestinal symptoms and increasing abdominal girth. These symptoms may have a cause other than perimenopause.
- If your nightsweats are associated with weight loss, weakness, and general illness
- If your flashes are associated with severe headache and elevated blood pressure
- If your mood swings are more than mild-to-moderate irritability and occasional “blues”
- If natural remedies don’t relieve severe symptoms
Supplement Recommendations
From David Edelberg, M.D. at WholeHealth Chicago: If you’re troubled by hot flashes or other perimenopausal symptoms, and HRT isn’t on your (or your doctor’s) agenda, try taking some of the supplements suggested here. All are safe as recommended, but they do have hormonelike effects. So while they’re effective at quelling perimenopausal symptoms, supplements shouldn’t be used when hormones aren’t appropriate, such as when breast cancer is a concern.
How to Take the Supplements
Start with black cohosh, a reliable herbal hormone stabilizer. If your symptoms are especially uncomfortable, add either chasteberry or a women’s herbal combination product, which includes small amounts of a number of herbs (dong quai, soy isoflavones, chasteberry) and other nutrients. Alternatively, if your symptoms are mild and you only need minimal doses of the various herbs, an herbal combination product alone may be all you need.
You can also add other herbs, such as Siberian ginseng,dong quai, which seems to enhance the effects of other herbs. Both are considered “female tonics” and are used worldwide for menopausal symptoms. If your symptoms don’t respond to these herbs, move on to the topically applied natural progesterone cream, which can be very beneficial.
There’s also recourse if you’re having menstrual problems associated with perimenopause. The essential fatty acids in flaxseed oil and evening primrose oil or borage oil can help to regulate sudden hormonal shifts that can lead to irregular bleeding or cramping.
Eating plenty of soy can also reduce your symptoms, improve your cholesterol, and lower your blood pressure. Soy isoflavone capsules are a good option if you don’t want to consume soy foods or beverages.
Recent studies have shown that antioxidant vitamins can be beneficial for perimenopause as well. Vitamin E in particular helped reduce the risk of heart by keeping LDL (“bad”) cholesterol from adhering to artery walls.
Two other herbs have also proved beneficial for certain symptoms. Ginkgo biloba can aid women with menopausal-related concentration or memory problems. And St. John’s wort has a long track record as a safe, effective remedy for the melancholy that plagues some women as their estrogen supply declines.
Of special note:
Adding a calcium and magnesium product (800-1,200 mg calcium and 400-800 mg magnesium twice a day) can be a protective step against osteoporosis-induced fractures, and it’s particularly important during perimenopausal years.
If you’re suffering from mood shifts, anxiety, and nervous tension, kava (250-500 mg 2 or 3 times a day) can be an herbal miracle. It works quickly, doesn’t make you drowsy, and improves your concentration.
Sleep disturbances during perimenopause are extremely common. Melatonin (1-3 mg at bedtime) can be a real lifeline–a safe, effective sleeping aid that’s not addictive. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions. The Healing Path for Perimenopause provides more extensive therapeutic information about this condition.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
Be well,
David Edelberg, MD