Early Menopause

If you are have healthy estrogen levels or are in early menopause or premenopause, then you should quickly make lycopene your close and personal friend. A fascinating study from the International Journal of Cancer found that high carotene intake, especially a diet high in lycopene, significantly reduced the risk of ovarian cancer in premenopausal women. Investigators suggested that consumption of fruits, vegetables, and food items high in carotene and lycopene, particularly raw carrots and tomato sauce, may reduce the risk of ovarian cancer.

To reap these benefits, aim for 10 servings of cooked tomatoes or tomato products every week. Just be sure to mix the tomatoes in an oil base, such as olive oil, to enhance lycopene absorption.

If you do not want to eat this much tomato-based food, or you simply dislike their taste, then lycopene supplements are a good alternative. Dr. Lark recommends taking 5–10 mg per day. Lycopene is available in most health food stores.

Unfortunately, lycopene does not confer the same protection against ovarian cancer in postmenopausal women that it does in younger women. Luckily, foods high in alpha-carotene and alpha-carotene supplements have been found to significantly reduce the risk of the disease in postmenopausal women.

And, animal studies have shown alpha-carotene is 10 times more effective than beta-carotene in suppressing lung, liver, and skin cancer, while other research has found that the nutrient is 38 percent stronger in antioxidant activity than beta-carotene.

Foods highest in alpha-carotene are carrots, corn, squash, watermelons, green peppers, potatoes, apples, peaches, and leafy green vegetables. If you prefer a supplement, Dr. Lark suggests taking 25,000 IU of mixed carotenoids that contain a blend of both alpha- and beta-carotene.

When it comes to ovarian cancer prevention, there are definitely categories of foods that you should avoid, namely caffeine, dairy products, and red meat. In the case of caffeine, several studies have shown a connection between regular caffeine intake and cancers of the reproductive system. For example, in one study from the September 2000 issue of the International Journal of Cancer, researchers compared the coffee intake of 549 women who had been newly diagnosed with ovarian cancer with that of 516 women without the disease. They found that the consumption of coffee, and caffeine in general, was linked to an increased risk of ovarian cancer in women in early menopause or premenopause.

Similarly, dairy products and red meat can also increase your risk for ovarian cancer. According to a 2003 study, also from the International Journal of Cancer, women who consumed more dairy products and red and white meat were at increased risk for ovarian cancer. Most likely, it is the saturated fats found in these two food groups that put women at high risk for the disease, as they elevate estrogen levels. And, as I wrote about earlier, elevated estrogen levels can lead to or contribute to one of the biggest risk factors for ovarian cancer—estrogen dominance.

In addition to avoiding certain foods, there are others you should strive to eat more often. These include cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.). In a study from the International Journal of Cancer, researchers looked at the frequency with which 609 ovarian cancer survivors in three Australian states ate certain foods and took certain supplements. They found a "survival advantage" in those women who consumed more vegetables in general, especially cruciferous vegetables. They also observed a significant advantage among those women in the upper third of vitamin E intake.

A second study found that vitamin E is not alone in its cancer-fighting benefits. In a 2001 study from Nutrition of Cancer, researchers asked 168 women with ovarian cancer and more than 200 cancer-free women to record their intake of specific foods and supplements. They found that women who took in more than 363 mg of vitamin C a day had a 40 percent lower risk for developing ovarian cancer, while women whose daily intake of vitamin E exceeded 75 mg had a 33 percent decreased risk for the disease.

A 2002 study from the same journal confirmed this conclusion. Researchers found that supplementing with vitamins C and E did indeed appear to significantly decrease the risk of ovarian cancer by about 50 percent.

The bottom line? To help avoid ovarian cancer, avoid caffeine, red meat, and dairy products. You can also increase your consumption of foods high in vitamins C and E, as well as cruciferous vegetables. These include: wheat germ oil, sunflower seeds, almonds and almond butter, and flaxseed and flaxseed oil (all high in vitamin E). For those high in vitamin C, aim for any fruit, tomatoes, red bell peppers, broccoli, cauliflower, spinach, celery, and avocado. Finally, your cruciferous veggies include broccoli, cauliflower, Brussels sprouts, kale, collard greens, bok choy, watercress, radish, and mustard seed.

As I indicated in my last blog, I believe that soy should be consumed only a couple of times a week by anyone with estrogen dominance, premenopause, or other conditions where estrogen levels are out of balance with progesterone levels. Additionally, I believe that women who are in menopause but who are taking tamoxifen for breast cancer or those who have a thyroid concern should also limit their soy intake.

That being said, I do feel it is okay for a woman who is experiencing menopause symptoms such as hot flashes, night sweats, and other menopause problems to consume soy. The key to soy for menopause relief is the natural isoflavones in soy. Therefore, the key is to eat the right amounts of soy foods in the right forms to help you ease the negative side effects of menopause.

I still maintain that you should limit your consumption of soy no more than one serving a day in a “pure” form such as edamame, tofu, or tempeh. On the isoflavone front, Dr. Lark recommends having 50-100 mg of soy isoflavones a day to effectively treat menopause symptoms. In relation to soy foods, this breaks down to one cup of tofu (70 mg isoflavones), 1 cup of tempeh (70 mg isoflavones), or ¼ cup edamame (75 mg isoflavomes) a day.

I was upset to see news of a recent study conducted at the University of Illinois at Chicago and Northwestern University that concluded that placebo is better than black cohosh and red clover at reducing menopause symptoms like hot flashes. While I acknowledge that red clover has not been studied enough to conclude that it helps relieve certain effects of menopause, I completely disagree with their black cohosh findings. In fact, I have been recommending black cohosh for many years and my patients have experienced great relief from hot flashes, night sweats, and other effecs of menopause.

Black cohosh, native to North America, is derived from the dried rootstock and roots of Cimicifuga racemosa. Traditionally it was used to treat rheumatism, general malaise, kidney ailments, and malaria as well as to provide pain relief during menstruation and childbirth. Native Americans have used the herb throughout history to treat a wide variety of gynecological conditions.

Clinical studies have shown that black cohosh extract not only relieves menopause hot flashes, but also depression and vaginal atrophy. This research has prompted well-publicized studies on the standardized extract of black cohosh and its ability to treat menopause symptoms. 

In one of the largest studies on black cohosh, women with menopause symptoms received forty drops of liquid black cohosh extract twice a day for six to eight weeks. Within four weeks of treatment, a distinct improvement was seen in nearly 80 percent of the women. After six to eight weeks, all symptoms had completely disappeared in half of the women.

Another study found similar results. Scientists gave women with menopause symptoms either high- or low-dose black cohosh for a twelve week period. At the conclusion of the study, approximately 80 percent of both patients and physicians rated the treatment as "good to very good." The investigators reported no differences in either effectiveness or adverse reactions between the two groups.

The only good news that came from this newest study from the University of Illinois at Chicago and Northwestern University is that black cohosh won't hurt you and is considered safe. Well, this is GREAT news indeed, considering the only FDA-approved treatment for menopause symptoms--hormone replacement therapy--is dreadfully dangerous and increases your risk of heart disease, cancer (particularly breast cancer), stroke, and other serious problems. So if you have menopause hot flashes, night sweats, or other menopause symptoms, why not try a natural treatment that has been proven safe? I suggest taking 40 to 80 mg of a standardized extract of black cohosh twice a day. This dose should contain 2 to 4 mg of the active components (triterpenes, calculated as 27-deoxyacteine). 

“Corby” asked a question related to my post about the use of melatonin for insomnia. The questions was does melatonin increase or cause depression. The short answer is…maybe, but not likely.

Several studies have confirmed that people who suffer from depression have low levels of melatonin (Lancet, 1979) (Biol Psychiatry, 1984). Other studies have linked depression to a delayed melatonin cycle (Psychoneuroendocrinology, 2004).

Melatonin is produced from serotonin and secreted by the pineal gland. Its secretion takes place at night and is inhibited by light. As such, it sets and regulates the timing of your body’s natural circadian rhythms, such as waking and sleeping. When this cycle is delayed, depression and depressive symptoms can occur.

This cycle is particularly affected during early menopause and, in fact, during all stages of menopause. As you get older, you produce less and less melatonin. Melatonin is produced from serotonin, and serotonin production is stimulated by estrogen. Low estrogen levels equates to low serotonin, which results in low melatonin.

As you can imagine, there is research to suggest that taking supplemental melatonin can help treat mild depression (Psychiatry Research, January 1998), including depression related to menopause and even premenopause. However, there are a few studies that have shown that melatonin can have a negative effect on depression (J Psychiatry, 1976).

Though the studies are small in scope and often include a small number of trial participants, it is always best to err on the side of caution. As the University of Maryland Medical Center advises, “Melatonin should be used with caution in people with depression and should be appropriately timed with…sleep-phase changes. Disruption of normal circadian rhythm by poorly timed melatonin administration may worsen depression."

In the May 8, 2009 issue of Menopause, there were two powerful studies that looked at the use of intravaginal DHEA to treat vaginal atrophy.

The researchers explained that DHEA, the “exclusive source of sex steroids in postmenopausal women, is already decreased by 60 percent and continues to decline at the time of menopause.” For this reason, they wanted to determine if intravaginal DHEA could alleviate the symptoms of vaginal atrophy, just one of the effects of menopause.

After 12 weeks, researchers found that daily intravaginal DHEA at doses of 3.25–13 mg was able to “rapidly and efficiently achieve correction of all the signs and symptoms of vaginal atrophy and improve sexual function and caused no or minimal changes in serum sex steroid levels, which all remain within the normal postmenopausal range, thus avoiding the risks of all estrogen formulations.” In other words, DHEA did not raise estrogen levels, which is good news for women who are sensitive to estrogen, or whom have cancer or blood-clotting risks.

Natural Hormone Levels

This is all great news! DHEA has been referred to as the “fountain of youth hormone.” DHEA is one of the five major sex hormones. It is made from pregnenolone, a steroid hormone made from cholesterol that is the precursor to all the other sex hormones.

Pregnenolone converts to the other four sex hormones (DHEA included) via two different pathways. In the first, pregnenolone is converted into DHEA, which is then converted into testosterone and subsequently estrogen. In the second pathway, pregnenolone is converted into progesterone. The progesterone is then converted into testosterone and, finally, into estrogen. This pathway takes place during the first half of your menstrual cycle, when estrogen is the dominant hormone.

In the second pathway, pregnenolone is converted into progesterone. The progesterone is then converted into testosterone and, finally, into estrogen. This pathway occurs during the second half of the menstrual cycle, when progesterone and estrogen are both dominant.

When you are in your reproductive years, or even during premenopause, you experience both pregnenolone pathways. However, once you enter the later stages of menopause, you only go through only the DHEA pathway and not the progesterone pathway. This is one reason why estrogen levels are so much lower during menopause.

DHEA Eases Menopause Symptoms

Low serum (or blood) levels of DHEA have been associated with risk of heart disease, cancer, and immune-related conditions. Conversely, as the study shows, supplementing with DHEA helps with vaginal atrophy, as well as other menopause symptoms, including poor memory, joint pain, increased body fat, insomnia, and more.

According to Dr. Lark, women looking for menopause relief should take 15–25 mg of DHEA before bed. Be careful not to take more than this, as overdosing may result in increased levels of testosterone, which can lead to acne, increased facial hair, or deepened voice. It can also lead to increased estrogen levels, which can cause sleep disturbances, fatigue, anxiety, and irritability.

As is the case with any hormone replacement, you should have your hormone levels checked before you take DHEA. If your levels are low (below 130 ng/dl in blood; under 40 pg/ml in saliva) and you choose to take it in supplemental form, start with the lowest dose, and increase as needed, being careful not to exceed the abovementioned dosage.

Essential fatty acids (EFAs) are health-promoting nutrients that your body needs to perform a whole range of functions. Premenopause women or those in early menopause will find that proper amounts of EFAs will help to reduce the inflammation and pain seen in conditions such as endometriosis and menstrual cramps. 


Women who are in menopause need EFAs to prevent a wide range of health concerns, including heart disease and breast cancer. These incredible healthy fats also provide moisture to tissues of the skin, vagina, and bladder, as well as the hair.

 In fact, a study published in the British Medical Journal found that women who consumed foods rich in EFAs enjoyed greater vaginal lubrication and tissue thickness. Over a six-week period, researchers took smears from the vaginal wall every two weeks to see if the addition of these types of foods would cause a beneficial hormonal effect on the vagina. Typically, the vaginal mucosa thins out and becomes more prone to trauma and infections as the estrogen level drops with menopause. Interestingly, the vaginal mucosa responded significantly to the additional ingestion of flaxseed oil and soy flour, but returned to previous levels eight weeks after these foods were discontinued and the women went back to their usual diet.

If you are in early menopause or premenopause or suffer from menopause symptoms such as hot flashes and night sweats, you should definitely up your intake of EFAs.

There are several different types of EFAs, but the two main categories include omega-3 fatty acids—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—and omega-6 fatty acids (linoleic acid).

Omega-3 EFAs consist primarily of EPA and DHA. EPAs are your heart-healthy fats. They also promote beautiful, healthy skin, hormonal balance, and immune function. EPA also makes serotonin, the “happy” neurotransmitter. DHA, on the other hand, is a natural brain booster. Your brain needs DHA to create healthy nerve cell membranes. Your brain uses nerve cells for mood, attention, and memory. 

Two of the best sources of omega-3 EFAs are flaxseed and fish. (Other good sources include soybean, hemp powder, walnuts, canola oil, eggs, organ meats, and some forms of algae.) In the case of flaxseed, both the oil and the ground meal are rich in EFAs.

When it comes to fish, I recommend cold-water choices such as salmon, tuna, and mackerel. The colder the water a fish lives in, the more omega-3 its body requires and possesses, simply to keep it warm enough.

With omega-6 fatty acids, there are three main types: linoleic acid (LA), arachidonic acid (AA), and gamma linolenic acid (GLA). You only need to supplement with GLA, because you likely get enough of the other omega-6 fatty acids through your regular diet. However, the stress of daily life (as well as poor nutrition, alcohol, chemical carcinogens, cholesterol, saturated fats and low levels of some vitamins), may prevent your body from turning linoleic acid into GLA.

The reason GLA is particularly important for women is that it is converted into inflammation-fighting prostaglandins that help ease menopause symptoms such as depression and breast tenderness. They also help balance blood sugar and may also play a role in preventing certain cancers.

The best food sources of omega-6 fatty acids are whole grains, seeds, and vegetable oils. Other oils such as evening primrose, borage, and black currant are especially rich stores of GLA. If you would prefer to take a supplement, try 3,000–4,000 mg of evening primrose oil per day.

Ideally, you want to aim for a balance of omega-3 and omega-6 fatty acids, somewhere in the 4:1 and a 1:1 ratio of omega-6 to omega-3 fatty acids. To achieve this, up your intake of fish, nuts, and seeds (especially flaxseed), and decrease your consumption of red meat and dairy products, which are high in linoleic and arachidonic acids.

With all the discussion surrounding conventional hormone replacement therapy and bioidentical hormones, it’s no wonder that women are at a loss for ANY solution, natural or otherwise, to their menopause symptoms. If you are looking for a quick, easy, effective, and delicious option to ease the discomfort of night sweats, hot flashes, and other signs of menopause, then soy is for you.

Soy contains phytoestrogens, weak, estrogen-like plant compounds. The specific phytoestrogens found in soy are genistein and diadzein. They are also often referred to as isoflavones. These soy isoflavones have been shown ease menopausal symptoms in thousands of women.

Plus, eating soy-based foods has other long-term health benefits. For example, soy does not appear to have a carcinogenic effect on uterine cells or breast tissue. Plus, the EFAs in soy are good for heart health and supple skin.

To ensure you are getting adequate amounts of soy in your diet, Dr. Lark suggests aiming for 50–100 mg of soy isoflavones per day. This translates to two cups of soy milk (35–40 mg in one glass), ½ cup of edamame (150 mg in ½ cup), or one cup of tofu (35 mg in ½ cup). Just be sure to always, always choose organic soy products, as soy is one of the two most common genetically modified crops in the United States.

Here are a few easy and delectable ways to ensure you are getting enough soy in your diet:

• Make a smoothie for breakfast. Mix one cup soy milk with one banana, a handful of strawberries, one tablespoon of ground flaxseed, and a few cubes of ice. Blend well and enjoy your 70 to 80 mg of soy isoflavones.
• Enjoy a hormone-healthy salad for lunch. Mix 1 cup chopped romaine lettuce with one tomato (diced), ½ a cucumber (diced), ½ cup edamame (whole soybeans), and 2 tablespoons of pumpkin seeds. Toss with a bit of extra-virgin olive oil and balsamic vinegar and enjoy.
• Whip up an easy dessert. Place four ounces soft tofu, one cup mango, one cup papaya, and 1 teaspoon honey in a blender. Mix well and share with a friend. You’ll each get about 15 to 20 mg of soy isoflavones.
   

In a previous post, I discussed a common perimenopause symptom: fibroids. I also told you how to use diet to control this problem that’s so common in early menopause. Today, I am going to give you some supplements that can reduce fibroids and their symptoms.

Nutritional supplements can help balance hormones and reduce estrogen levels. When used properly, they can dramatically reduce bleeding, pain, and cramps that may accompany fibroids. In particular, I suggest using:

• B-Complex Vitamins—help regulate estrogen levels and reduce menstrual cramps. I recommend taking 50–100 mg of B-complex vitamins daily, with an additional dose of 50–100 mg of vitamin B6 (not more than 100 mg total of B6), which has been shown to be particularly helpful in reducing menstrual cramps, fluid retention, weight gain, and fatigue.

• Vitex (Chaste Tree Berry)—normalizes the secretion of hormones and helps bring estrogen and progesterone into balance. I recommend taking 40 mg once or twice a day.

• Vitamin C and bioflavonoids—work to build collagen and strengthen blood vessels, while promoting normal estrogen production and blocking its fibroid-stimulating effects. I suggest taking 1,000 to 5,000 mg of a mineral-buffered vitamin C and 750-2,000 mg bioflavonoids daily, in divided doses (choose a product with additional rutin, a potent bioflavonoid derived from alkaline buckwheat, rather than naringin, an acidic, grapefruit-derived bioflavonoid). With both nutrients, start at the low end of the dosage range and work your way up.

• Vitamin A—a study of 71 women found that those with excessive bleeding had significantly lower blood levels of vitamin A than the normal population. I suggest taking 5,500 IU of vitamin A, as beta-carotene, per day.
 

Wyeth Pharmaceuticals is the largest maker of hormone replacement therapy (HRT) drugs, including Prempro—which was found to be associated with an increased risk of breast cancer in the Women’s Health Initiative studies. However, that didn’t stop Wyeth from developing a new HRT formulation named Aprela for the relief of menopause symptoms such as menopause hot flashes and sleep disturbances, reportedly without increasing a woman’s risk of estrogen-related cancers.

 According to Wyeth, Aprela combines estrogen (Premarin) with a SERM (selective estrogen receptor modulator) called bazedoxifene. SERMs block the action of estrogen in certain tissues, including the breast, by occupying estrogen receptors so that estrogen cannot attach to the receptor sites. At the same time, SERMs reportedly stimulate estrogen receptors in other tissues, such as the liver, bone, and uterus (which increases your risk of uterine cancer!). But Wyeth’s studies suggest that bazedoxifene doesn’t have that uterine-stimulating effect, thereby making it a better SERM for a safer HRT drug. In clinical trials, women have been taking Aprela daily for two years while being monitored for breast cancer. However, the study is less than three years old, and it can take 10 years for breast cancer to develop!

If you need to take hormone replacement therapy to relieve menopause symptoms, I much prefer that you consider taking bioidentical hormones, which can provide menopause relief without increasing your risk of life-threatening cancer. Talk to your doctor about bioidentical hormones, a much safer and more effective option.
 

Progesterone's job in your body is to balance the effects of estrogen. Where estrogen is growth stimulating, progesterone is growth limiting. Estrogen is mood elevating; progesterone has a sedative effect on mood. One of progesterone's tasks is to prevent menstrual bleeding from becoming too profuse or long lasting (a symptom common with estrogen dominance). Often, progesterone is often combined with estrogen replacement therapy to control perimenopause symptoms and to provide menopause relief.

If you’re in early menopause (or premenopause), here's a checklist to help you find out if your body produces enough progesterone. If two of these symptoms apply to you, you may benefit from natural progesterone replacement.

o My sleep quality is poor.
o I am often unable to concentrate.
o I'm unable to remain calm under stress.
o I suffer from PMS.
o I'm over 50.
o I'm in perimenopause or early menopause.
o I have a decreased interest in sex.
o I have heavy, irregular bleeding.
o I have premenstrual bloating or swollen breasts.

Most of my patients tend to prefer natural progesterone cream, which is available without a prescription. A typical dosage of natural progesterone cream is 20 mg a day or one-quarter to one-half teaspoon amounts applied to any clean area of the skin twice a day. Look for a product that contains 400 – 600 mg of progesterone per ounce like Pro-Gest or Fem-Gest.

As I wrote in my blog back in early November, there are several spices that are particularly beneficial for women in early menopause or premenopause. These spices—namely ginger and cinnamon—can help to ease perimenopause symptoms. Not to mention, they taste fabulous!

The best way I know to stay in delicious hormonal balance is to incorporate these spices into your life. And what could be a tastier way to enjoy these spices than gingerbread!

Nothing says "Happy Holidays" to me quite like the smell of gingerbread baking. So, my gift to you this season, is a healthy version of my mother’s amazing gingerbread.

You can find this recipe and others like it (including several for women suffering from menopause symptoms such as hot flashes and night sweats) in Hormone Revolution.

Gingerbread
Serves 9

½ cup canola oil
½ cup erythritol
1 egg
½ cup light molasses
1 ½ cups Pamela’s wheat-free baking mix
¾ teaspoon salt
½ teaspoon baking soda
½ teaspoon ginger
½ teaspoon cinnamon
½ cup boiling water

1. Preheat oven to 350°F
2. Cream oil and erythritol for 30-45 seconds.
3. Add egg and molasses and beat thoroughly.
4. In a separate bowl, sift together baking mix, salt, baking soda, ginger, and cinnamon.
5. Add dry ingredients to egg mixture, alternating with boil water, until well blended.
6. Pour mixture into a lightly greased 8x8 pan and bake for 40 minutes, or until toothpick, comes out clean.
7. Serve warm or at room temperature.