In addition to the diet recommendations I gave in my last post for undoing estrogen dominance (the most common perimenopause symptom) http://blog.drlark.com/blog/dr-lark/0/0/undoing-estrogen-dominance-with-diet, I urge you to take the following supplements to help to reduce estrogen levels.

• Soy isoflavones—50 to 100 mg as food and in pill form. Soy isoflavones have estrogen-like effects similar to your own estrogen, but in a much weaker and less toxic form.
• Bioflavonoids—750 to 2,000 mg. Bioflavonoids are found in the peel and pulp of citrus fruits and buckwheat and are weakly estrogenic.
• Flaxseed oil or ground flax meal—1 to 2 tbsp of flaxseed oil; or 4 to 6 tbsp ground flax meal mixed into cereals and shakes. Essential fatty acids, such as flax, are critical for reproductive health.
• Vitamin B-complex—25 to 100 mg daily are necessary for the liver to detoxify estrogen.
• Herbs such as turmeric (400–500 mg two to three times a day), or dandelion (150–500 mg daily) or milk thistle standardized extract (150–175 mg one to three times a day) and amino acids like L-methionine (200–1,000 mg) or L-cysteine (200 mg twice a day) also promote healthy liver detoxification.
• Oat or rice bran for fiber (1–2 tbsp per day in 8–12 oz water).

In addition to reducing estrogen levels in your body, you also have to promote progesterone production. This will move you from estrogen dominance back to hormonal balance.

• Take vitamin B-3 (25-100 mg), B-6 (50 mg twice a day), zinc (15-30 mg), vitamin C (1,000-5,000 mg), and magnesium (400-600 mg)
• Vitex, or Chaste tree berry, (40 mg daily) increases the production of the luteinizing hormone that triggers ovulation at midcycle, promoting progesterone production. It also inhibits release of the follicle-stimulating hormone that stimulates estrogen production in the first half of the menstrual cycle. So it normalizes the secretion of hormones and helps to bring estrogen and progesterone into balance during perimenopause (premenopause).

I follow an exercise program for estrogen deficient–fast processors (click here to see my previous blog entry that describes what this is http://blog.drlark.com/blog/dr-lark/0/0/exercise-for-estrogen-deficient-slow-processors). Even though my hormones are healthy and well-balanced, I fall more into this category than any other because I am a petite and slender woman, and I have a fast-paced day-to-day life. To help maintain my hormonal balance, I slow down by following an exercise program that calms me.

Estrogen deficient–fast processors don’t want to heat up their bodies and sweat. It is more important to engage in slower, more expansive and relaxing aerobic activities that are moderately strenuous and can be done in a relaxed and leisurely way. For this reason, the best activities for women in this category include golf, gardening, swimming, and moderately-paced walking and bicycling. You can also try ballroom dancing—in particular, slower dances like the waltz.

In terms of stretching, the best types for this hormonal category include tai chi and hatha yoga, which are slower and more meditative. With these slower-paced exercises, you will tend to breathe more deeply and slowly. Moderate aerobic exercise relaxes, dilates, and expands the network of blood vessels in your body, and enables your heart to work more efficiently. Better circulation and oxygenation, in turn, improve the health of all of your organs, including your ovaries and uterus.

Personally, I am an avid walker. I walk almost every day at a moderate pace, breathing slowly and deeply to maximize the alkalinizing benefits. Walking keeps me limber and has helped me to maintain almost the same weight as when I was in medical school! And another benefit to this and all exercise is the reduction of menopause symptoms like menopause hot flashes and night sweats!

If you are an estrogen deficient–slow processor (see my previous blog entry to determine if you are http://blog.drlark.com/blog/dr-lark/0/0/strong-nails-and-smooth-skin), I recommend keeping your hormones balanced with high-intensity activities such as power walking, cycling, running, triathlons, racquetball, tennis, and fast-paced styles of ballroom dance like the tango, foxtrot, and swing. Women with these hormone profiles tend to be instinctively drawn to strenuous types of exercise that are more contracting and acidifying to counter their natural tendency toward alkalinity. I’ve seen women with these hormonal profiles maintain this level of intense physical activity well into their later years. In fact, it is not unusual to see slow processors participating in triathlons and bodybuilding well into their 70s and beyond!

Stretching and flexibility exercises are also important parts of your workout routine. Stretching keeps you limber and helps your muscles and tendons function well into your older years. The best stretching exercise is Pilates, as it tends to include more intense and faster-paced movements. In addition, yoga is beneficial for these women—particularly the high-energy Bikram (hot), ashtanga, and power yoga.

Another benefit of these exercises? They help reduce menopause symptoms like menopause hot flashes and night sweats!

One of my patients had a hysterectomy in her late 30s for endometriosis, and her doctor at the time put her on low-dose hormone replacement therapy. She was on hormone replacement therapy for seven years, but found that when she hit her early 50s, her body began to change. Her nails began to crack and split and her skin became incredibly dry. Lotions and other solutions didn’t work.

She came to me to see what we could do about this problem. I looked at her diet and made some changes that would support estrogen production in her body. First and foremost, she cut out caffeine and alcohol. I started her on wheat germ oil and flaxseed (a great omega-3–based food) to moisturize her skin from within. She also started eating wild salmon, butterfish, and other fish high in omega-3s. In addition, I recommended that she up her B-vitamin and silica intake.

Within months, her nails went from being really soft to strong and firm. Her skin also became much more moist and supple. We also noticed a slight increase in her estrogen levels, which helped to ease her other menopause symptoms, such as hot flashes and night sweats.

If you have found that natural hormone replacement therapy isn’t strong enough to relieve your menopause symptoms, an herb called maca is a perfect option. By some estimates I’ve read about in research studies, approximately 80 percent of menopausal women find menopause relief with maca. 

Maca is most commonly used in traditional medicine to increase libido, promote fertility, and balance hormone levels. An added bonus is that it increases vaginal lubrication, which obviously can improve sexual activity and satisfaction. Because it increases energy, it helps create more vigor for sexual activity, which is why Peruvians have used it for centuries to increase sexual desire.

Dosages are unique to each woman, so you will need to determine the dosage that works for you. You can take it indefinitely—there have been no acute toxic effects, even at very high doses. If you are sensitive to herbs, start with the low end of the recommended dosage, as too much can cause increased menopause hot flashes, breast tenderness, or headaches. Also avoid maca if you have a hormone-related cancer, liver disease, or are pregnant or nursing.

I like the Whole World Botanicals’ Royal Maca brand, which is available at www.wholeworldbotanicals.com.

For my patients whose menopause symptoms do not respond to the various herbs and nutrients I recommend, I have frequently prescribed natural hormone replacement therapy using estriol and natural progesterone. 

Estriol (2–4 mg daily) is prescribed in capsule or cream form to reduce menopause hot flashes, vaginal dryness, and mood swings. Estriol is the weakest and safest type of estrogen and is less likely to promote tissue growth. Unlike conventional estrogen replacement therapy (replacement therapy using estrogen alone) that may cause fluid retention, headaches, nausea, and the buildup of uterine tissue, estriol has few, if any, side effects. You’ll need a prescription and then you or your doctor can contact the Women’s International Pharmacy (www.womensinternational.com) to fill the prescription. If used directly on vaginal tissues, not only will estriol cream rebuild vaginal cells, it can also help restore clitoral sensitivity and orgasmic intensity, and reduce bladder infections.

If you are already taking hormone replacement therapy but want to transition to some of the natural therapies I’ve discussed throughout my blog, discuss your decision and alternative therapies with your doctor before you make any changes. A good physician will work with you to come up with a plan specific to your needs.

One of the first things you should talk to your physician about is weaning yourself off your current hormone replacement therapy dose. You should do this slowly, because stopping abruptly can increase the severity of the symptoms for which you began taking hormone replacement therapy, such as night sweats and menopause hot flashes.

Begin by cutting the dose of estrogen by one-half each month for one or two months. Then cut back to every other day for a month, then to twice each week, and then once a week each month. Continue to take the progesterone regularly until you have stopped all estrogen, so that you stay in balance.

Flaxseed contains the entire range of essential amino acids in an easily assimilated form. It also contains calcium, potassium, magnesium, and zinc; is an excellent source of phytoestrogens; and is high in fiber, which promotes healthy bowel function. In addition, flaxseed is 100 times richer in lignans (part of the seed’s cellular structure) than any other plant. Lignans reduce production of estrogen before menopause and help balance your hormones during and after menopause. This, in turn, can provide menopause relief.

A study published in the Journal of the American Nutraceutical Association showed that taking 38 grams (about four tablespoons) of ground flaxseed daily significantly reduced the rate of bone loss in post-menopausal women not on hormone replacement therapy.

An added bonus is that the fatty acids in such products as flax and pumpkinseed oil make hair shiny. So with flaxseed, you’ll not only feel better, you’ll look better, too! Take 4 to 6 tablespoons of ground flaxseed daily. If you prefer flaxseed oil, take 1 to 3 tablespoons daily.

With so much attention given to estrogen, many women don’t know what role progesteron plays in the body. In short, progesterone balances 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 and prevent the uterine lining from becoming too thick, which may lead to uterine cancer. This is the reason progesterone is often a part of hormone replacement therapy.

I suggest looking into progesterone supplementation if you have menopause symptoms or signs of menopause.  There are natural forms of progesterone, which has no known side effects at the usual dose of 20–40 mg daily. Be sure to consult a physician who is knowledgeable about natural progesterone before beginning treatment with it.

Although it's available in pill form, many women prefer natural progesterone in a skin cream base, which you can get without a prescription. Topically applied creams are absorbed into body tissues immediately. Oral progesterone is first metabolized by your liver and converted into three different compounds. You can also use a transdermal spray such as Progest-Ease, that can be applied to the skin and absorbed into the blood stream without going through the liver.

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.

Perimenopausal women can apply the cream from day 12 to day 26 of their menstrual cycle. Menopausal women not taking estrogen may use progesterone for two to three weeks each month. And don't buy products that list wild yam on the label. Unprocessed, wild yam can't be converted to progesterone in your body. This conversion from the plants can only be done in a laboratory. And don't buy progesterone products that are made with mineral oil, which blocks the progesterone from entering your body. You can find a good natural progesterone cream at the Women's International Pharmacy (www.womensinternational.com).

Tired?

You’re not alone! I can’t even begin to tell you how common insomnia can be during menopause. And menopause symptoms such as hot flashes and night sweats are some of the major reasons for insomnia, as well as stress, anxiety, and thyroid disorder, just to name a few.

If you are menopausal, I urge you to use a natural form of hormone replacement therapy to treat your symptoms. Acupressure is also a great remedy. The two acupressure points traditionally used to relieve insomnia are the Spirit Gate and the Inner Gate. The Inner Gate is located in the middle of the inner side of the forearm, two and one-half finger widths from your wrist. The Spirit Gate is located on the inside of the wrist crease, in line with the little finger. To promote sleep, apply pressure to one point and then the other. You’ll soon learn whether you get the most benefit from pressing both points or one in particular.

In my 30-plus years of practice, I've found that most women eventually see an end to menopause hot flashes and night sweats—even if it takes a few years. But unfortunately, some women never become completely immune to these symptoms, regardless of their age.

About half of menopausal women suffering from hot flashes see them disappear within a year, even without hormone replacement therapy, while another 30 percent experience these symptoms for up to three years. The last 20 percent of women endure menopause hot flashes for five to ten years or longer. I've worked with women in their 60s, 70s, and even early 80s who continue to have menopause hot flashes if they're not on some form of hormone replacement therapy. Luckily, safe, natural therapies for menopause such as vitamin E, black cohosh, and soy isoflavones (which I’ve talked about in other posts) are useful in eliminating menopause hot flashes, no matter what your age.

This combination not only eliminates menopause hot flashes, but also provides additional support to the cardiovascular system and bones. As a rule, I recommend taking the following daily dosages for menopause relief: 400–1,000 IU vitamin E; 80–160 mg black cohosh; and 50 mg–150 mg soy isoflavones.

Women always ask me if they should take hormone replacement therapy to alleviate their menopause symptoms. My answer is always the same, no matter what the situation: Choose bioidentical hormone replacement therapy over conventional.

Conventional hormone replacement therapy has been shown to have a wide range of risks, including increased risk of breast cancer and heart disease. Why take this risk? Instead, choose more natural forms of hormone replacement therapy, including estriol.

Estriol is produced in the lab from active steroid molecules found in soy. The resulting molecules are structurally the same as those produced in your body. Of the three types of estrogen produced within your body, estriol is the weakest and least potent. Several research studies have found that it is as effective as the stronger, more potent estrogens for treating menopause symptoms. And unlike conventional hormone replacement therapy that may cause fluid retention, headaches, nausea, and the buildup of uterine tissue, estriol has few, if any, side effects.

One study published in JAMA found that estriol was particularly effective in treating vaginal atrophy, mood swings, and hot flashes. Researchers selected 52 symptomatic, postmenopausal women and separated them into four groups, giving each group either 2 mg, 4 mg, 6 mg, or 8 mg of estriol per day for six months. On average, women in every group experienced a decrease in their menopausal symptoms after one month of treatment. Plus, in three of the four groups, women who had ranked their symptoms as severe now felt that their symptoms were very mild.

Talk to your doctor about this safe and effective option for menopause relief