Menopause Relief

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.

Ever since the Journal of the American Medical Association (JAMA) reported on the dangers of conventional hormone replacement therapy (HRT) in the July 17, 2002 issue of the journal, women have been scrambling to find a safer, yet still effective treatment for menopause symptoms.

In case you are not familiar with the study, JAMA reported on the findings from one part of the Women’s Health Initiative, an 8.5 year project funded by the National Institutes of Health. According to the findings, menopausal women taking estrogen/progestin for five years or more had an increased risk for blood clots, coronary heart disease, strokes, and breast cancer. In fact, researchers felt so strongly about the negative implications of long-term combined HRT, especially the unacceptably high risk for breast cancer, that they ended the study three years early! Participants were contacted and instructed to stop taking the drug—immediately.

As you can imagine, the pharmaceutical companies have been in a panic ever since, as hundreds of thousands of women have stopped taking their medication and look to natural medicine for answers…answers that many have found in bioidentical hormones.

Dr. Lark has written about and prescribed bioidentical hormones for more than 20 years. In fact, in our book Hormone Revolution, we have devoted several pages to the topic. And when it comes to using bioidentical hormones to treat menopause symptoms such as night sweats, hot flashes, and other signs of menopause, the most commonly prescribed hormone is estriol.

Given the sudden drought in conventional HRT usage (and therefore loss of money to pharmaceutical companies), as well as the increased interest and media attention surrounding the usage and efficacy of bioidentical hormones—namely estriol—it shouldn’t come as a surprise that the FDA is now cracking down on these natural options.

According to the FDA’s Web site, the “use of ‘bio-identical’ as a marketing term implying a benefit for the drug, for which there is no medical or scientific basis.” They even go so far as to state that estriol “is not a component of an FDA-approved drug and has not been proven safe and effective for any use.”

This is simply ridiculous and just plain outrageous. Estriol is the weakest, and therefore safest, of your three main types of estrogen. It has been studied in various animal and human studies and has been shown to be less likely to promote excessive tissue growth, and even helps prevent breast and endometrial cancers.

To me, that seems to contradict the “not been proven safe” part of the FDA’s statement. And, as for the “not been proven effective for any use,” I cannot help but wonder if the FDA is familiar with the JAMA study that found that estriol was particularly effective in treating vaginal atrophy, mood swings, and hot flashes. Or, how about study from Alternative Medicine Review, which found that estriol provided the protection of conventional hormone replacement therapy without the risks. Plus, estriol was found to ease menopause symptoms, including hot flashes, insomnia, vaginal dryness, and urinary tract infections.

Don’t be fooled by the FDA’s “concerns.” Sadly, in this arena, their main concern seems to be with the pharmaceutical company’s checkbooks, not your health. Keep yourself informed by reading blogs, newsletters, and informative emails from trusted sources and doing research for yourself. And fight for your right to natural alternatives to all your health concerns.

So many of my friends and patients who are in menopause mention to me how much they would love to have the boundless energy that they witness in their grandchildren, and even adult kids. Along with night sweats, menopause hot flashes, and weight gain, it’s perfectly normal to experience fatigue and a lack of energy during premenopause and menopause.

To feel like a kid again (at least energy-wise):

Eating the right way gives you the raw material you need to produce lots of energy, and eating the wrong way can cause fatigue. If you are fatigued and just dragging yourself through the days, you can turn this situation around, even if you're 100 years old. It’s best to eat for your body type. For the best diet recommendation, see my previous entries on eating for your body type (Diet for the Estrogen Deficient-Fast Processor and Diet for the Estrogen Deficient-Slow Processor). Most menopausal women fall into one of these two categories. Once you figure out where you fall, follow those diet recommendations.
Avoid caffeine. While it's true that caffeine will give you an immediate boost, ultimately it lets you down, and hard. Used in excess, caffeine increases anxiety, and depletes energy and physical reserves by stressing your nervous system and exhausting the adrenal glands.

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 Dr. Lark and I wrote in Hormone Revolution, women with varying hormonal types need to eat very different categories of foods. For example, a woman with menopause symptoms or someone looking for menopause relief (an estrogen deficient-fast processor) would want to steer toward foods with a higher pH and avoid foods that are spicy or acidic.

Conversely, a woman who is in early menopause or premenopause and may be experiencing perimenopause symptoms (estrogen dominant or an estrogen deficient-slow processor) would aim for the exact opposite. She would want to choose foods that are more acidic, spicier, and those high in fiber.

An easy way to work beneficial foods into your specific hormonal program is to start with profile-appropriate spices. Here are three spices that are perfect for each hormonal type and a variety of ways to incorporate those spices into your diet.

Spices to Relieve Menopause Symptoms

Basil: Use basil in your scrambled eggs in the morning, mixed into a salad at lunch or dinner, or layered with eggplant and goat cheese as a delicious side dish.

Peppermint: Mint adds a surprising flavor to quinoa. Mix with dried apples and serve warm. Also makes a perfect after dinner tea.

Herbes de Provence:  This delightful blend of rosemary, basil, marjoram, bay leaf, thyme, and lavender is the perfect mixture for topping chicken or fish. I also like to add it to pureed cauliflower for a quick and easy side dish. If you are really adventurous, try it over a roasted pear for a savory dessert. Yum!

Spices for Estrogen Dominance and Premenopause/Early Menopause

Ginger: Mix ginger into your wheat-free pancake batter for a little kick in the morning. Top with sautéed apples and you are set for the day. Another easy trick is to add sauté shallots and sliced ginger in a little olive oil and serve over chicken.

Turmeric (curry): One of my husband’s favorite sauces is made with two teaspoons of curry paste, a 14-ounce can of coconut milk, ½ a cup of chopped onions and one tablespoon of tamari sauce. Bring to a boil and serve over any mild white fish.

Cinnamon: You can go wild with cinnamon at any meal. Add to oatmeal or a smoothie in the morning. Mix with balsamic vinegar and olive oil for an easy salad dressing. Mix into quinoa or rice and dried fruit for an easy side dish. Or sprinkle on an apple, pear, or even berries for an easy, yet delicious dessert.

During the Today Show’s 9:00 hour, they have a segment on the five health habits to skip. They included: eating breakfast every day, doing a monthly breast exam, taking a daily multivitamin, staying inside when it’s cold out, and not eating after 7:00 pm. While some have value (the staying inside and not eating after 7:00 pm), two are completely irresponsible—telling women that they don’t have to do a monthly breast exam and that they can skip their multinutrient.

I was so floored my toothbrush literally fell out of my mouth. No monthly breast exam? The expert explained that research has indicated that by the time a woman feels a lump in her breast, it is already pretty advanced. Instead, she should opt for yearly mammograms. Also, they indicated that self-exams often have a high rate of false positives, and that women who did them had double the rate of biopsies as women who did not. And the vast majority of those lumps ended up being benign.

Okay, now I get it. Once again, big medicine is telling us to “pay” for prevention rather than showing us free or inexpensive ways to prevent disease on our own. Most interesting is the fact that everything they have said about self-exams is true for mammography!

As Dr. Lark wrote back in August 2002, there are several inherent risks with mammograms. According to a 2000 study from the Journal of the National Cancer Institute, “the cumulative risk of having false positive mammograms is quite significant in many women.” On the flip side, a research article that appeared in the June 27, 2002 issue of The New York Times reported that mammograms don’t detect breast cancer in 30 to 40 percent of women who have the disease. But most telling is a 2000 study from the Journal of the National Cancer Institute, which found that in women between the ages of 50 and 59, mammograms were no more effective in reducing death from breast cancer than self-exams!

So, sorry Today Show, you are very wrong on this one. All women, especially those in early menopause or premenopause, and those women experiencing perimenopause symptoms should absolutely continue to perform monthly breast self-exams. All three of these scenarios are closely tied to excess estrogen, which is a risk factor for breast cancer.

Also, to advise people who “eat a healthy diet” to not take their multivitamins is downright absurd. First of all, how many people can agree on what is a healthy diet? This has been an ongoing debate for decades! Just look at the diet industry!

But even if we can all agree that a healthy diet includes at least five servings of vegetables, four servings of fruit, and four to six servings of whole grains, how many people are really, truly eating this way? According the Johns Hopkins Bloomberg School for Public Health, only 11 percent of Americans are eating five servings of fruits and vegetables a day. That’s one out of every 10 people eating a healthy diet.

And even if you are in that 11 percent, what’s the likelihood you are eating mostly vegetables and mostly organic? I’d wager that the number would start to shrink down to the lower single digits. Plus, the people claiming that you can get all the nutrients you need from the food you eat are delusional. Sure, about 20,000 years ago, the diet of our Neanderthal ancestors supplied all of their major minerals, and the vast majority of their trace minerals. Even in my great-grandparents and grandparents time, farmers used practices that returned minerals and other nutrients back into the soil, such as crop rotation, mulching, and relying on manure as fertilizer. But today’s conventional and large-scale farming practices are not what they used to be.

Now we are finding phosphates and nitrates in the soil, thanks to the widely used conventional NPK fertilizers, which has been shown to deplete the soil of its mineral content. The result has been far fewer micronutrients, especially the minerals selenium, iron, and zinc. So, even if you are eating your fruits and veggies, they are likely not providing you with the nutritional foundation you need for optimal health.

My advice? Watch the Today Show for their take on the news and the latest celebrity gossip, but leave the health and nutrition advice to those less swayed by advertising dollars. And take your multivitamin every day. Your body will thank you.

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.

What are green foods? No, they’re not broccoli, spinach, and green beans(although these veggies are extremely nutritious). Instead, green foods encompass foods like spirulina, chlorella, barley green, and wild blue-green algae.

These “super foods” are exceptionally rich sources of vital nutrients, digestible protein, essential minerals, and vitamin A. Algae, like spirulina, also contain omega-3 and omega-6 fatty acids. “Green foods” may not sound appetizing, but trust me—they are! And on top of that, green foods can be especially helpful for menopause relief—including increased energy and improved mood.

So many of my patients have told me that when they add 1 to 2 Tbsp. of these green foods to their diet (either by mixing the powdered form with 8 to 12 ounces of water or using it in shakes and smoothies), they’ve experienced significant symptom relief.
 
If you are in menopause and suffer from fatigue or depression (which frequently occur as side effects of certain types of hormone replacement therapy), then I urge you to give greens a try.

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

So many women come to me looking for relief from such common menopause symptoms as night sweats, hot flashes, vaginal dryness, and insomnia. I tell all these women the same thing: One of my top solutions for menopause relief is an herb called black cohosh.

Right now in Germany, a special extract of black cohosh is the most thoroughly studied and widely used natural alternative to hormone replacement therapy. Clinical studies have shown that black cohosh extract not only relieves menopause hot flashes, but also depression and vaginal atrophy.

In one of the largest studies on black cohosh, women with menopause symptoms received 40 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.

If you have signs of menopause or menopause symptoms, I suggest taking 80–160 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). Black cohosh is available in most health food stores, nutrition centers, and even some pharmacies.