Another common perimenopause symptom is uterine fibroids. Approximately 40 percent of women have fibroids by mid-life, and usually, they don’t cause problems. However, fibroid removal accounts for nearly one-third of all hysterectomies performed annually in the United States, many of which are completely unnecessary. The fact is, many fibroids will likely shrink and may even disappear with menopause.
As with estrogen dominance, another premenopause symptom, fibroids can be largely controlled through diet. You need a wide range of nutrients to help balance your hormones and reduce your estrogen levels, decrease cramping and inflammation, and generally improve your physical and mental well-being. Increasing your intake of the foods listed below will provide the necessary nutrients to produce these effects.
1. Whole grains are excellent sources of B vitamins, as well as vitamin E, magnesium, calcium, and potassium. Fiber in whole grains absorbs estrogen, helps remove it from the body, and normalizes bowel function.
2. Legumes contain fiber and are high in calcium, magnesium, and potassium. I am especially fond of soybeans, which help regulate estrogen levels.
3. Fruits and vegetables contain a wide range of nutrients that can relieve menstrual cramps, including vitamin C and bioflavonoids.
4. Seeds and nuts, especially flaxseed and pumpkin seeds, are wonderful sources of essential fatty acids (EFAs), the raw materials necessary for the production of prostaglandins.
5. Fish contains linolenic acid and is an excellent source of minerals, especially iodine and potassium. Salmon, tuna, mackerel, and trout are especially good for women with menstrual cramps.
6. Oils containing vitamin E help to balance mood, and ease fatigue and cramps that occur at the onset of menstruation for women with fibroids. Good oil sources include sesame seeds and wheat germ.
7. Avoid saturated fats; dairy products such as yogurt, milk, cheese, and cottage cheese; salt; refined sugar; caffeine; and alcohol.
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.
In response to my recent blog post on "Are You in Perimenopause?," Lisa B. asked if there was a pill available to help relieve perimenopause symptoms. Because this is an issue that touches so many women, I've decided to devote this post to its answer.
Estrogen dominance is the most frequent cause of unpleasant symptoms during perimenopause and bringing it back into balance is key to finding relief. While there are many products on the market that claim to provide relief from perimenopause symptoms, I urge you to do your research and pick the product that best fits your unique symptoms. Some women find relief from their symptoms with just one or two supplements, while others may need to take several in combination. The specific supplements I recommend for estrogen balancing are:
- Soy isoflavones — 50 to 100 mg of soy isoflavones as food and in pill form.
- Bioflavonoids — 750 to 2,000 mg per day.
- 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.
- Vitamin B-complex — 25 to 100 mg daily assists the liver in detoxifying 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).
On my website, www.DrLark.com, you’ll find many products that meet the specific needs of women, along with valuable information to help you identify a natural solution that will work best for you.
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.
It's not uncommon for physicians to prescribe birth control pills to control perimenopause symptoms—especially heavy menstrual flow and irregular periods. This is a trend that I find quite disturbing, particularly when there are so many safer ways to control symptoms of premenopause.
Common side effects of birth control pills closely resemble PMS symptoms: anxiety, nausea, bloating, breast tenderness, and depression. And long-term use has been associated with increased risk of blood clots, liver disease, and breast cancer.
If your doctor prescribes birth control pills to control your perimenopause symptoms, consider trying some of the more natural approaches I’ve discussed throughout my blog. Early menopause is a natural part of life—and there are safe, effective ways to control its symptoms!
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).
Estrogen dominance is often the cause of the perimenopause symptoms many women experience. Estrogen dominance is when your hormones are imbalanced and your body produces too much estrogen and not enough progesterone. My perimenopause program corrects estrogen dominance by reducing estrogen levels and promoting progesterone production. In this post, I will give you my diet recommendations to reduce your perimenopause symptoms, including estrogen dominance:
- Eat soy foods, buckwheat, citrus fruit rind and pulp (not the juice), and ground flax meal in shakes and cereals. They help to reduce estrogen production and prevent the hormone from binding to tissue receptors.
- Avoid caffeine, alcohol, chocolate, sugar, soft drinks, fruit juices, fried or fatty foods, and salt—all of which hamper the process that metabolizes estrogens and eliminates them from your body.
- Eat a low-fat, high-fiber diet to help your intestines eliminate estrogens so they are not reabsorbed into your body. Include plenty of fresh fruits, vegetables, whole grains and legumes (beans, peas).
- Reduce or eliminate red meats. They not only elevate estrogen levels but they also contain the type of fats that cause menstrual cramps and worsen the inflammation of endometriosis. Instead, eat fish such as salmon, mackerel, sardines, trout, and tuna which are high in beneficial omega-3 fatty acids that reduce the pain of menstrual cramps and endometriosis. Range-fed chicken or poultry are also good dietary options. In addition, instead of hamburgers and hotdogs, buy vegetarian Gardenburgers or Boca Burgers to prepare at home.
- Avoid dairy products since they have a negative effect on reproductive health similar to that of red meat. Use soy or rice substitutes, including soy and rice milk, cream cheese, sour cream and soy yogurt.
Perimenopause (otherwise known as early menopause or premenopause) is the name given to the seven to 10 years preceding menopause. Here is a checklist to help you determine if you are in this stage of life. If you answer yes to two or more of these questions, you may be in early menopause.
• Do you have heavy, irregular periods?
• Are you retaining fluids?
• Have you gained more than 10 pounds?
• Are you experiencing sleep difficulties?
• Are you having headaches?
• Do you have bouts of brain fog—forgetting your friend's first name, where you put your car keys, or the point of a text you recently studied?
• Have you recently discovered cysts in your breasts?
• Have you been told you have fibroid tumors?
• Have symptoms from endometriosis worsened?
• Are you over age 35?
• Do you suffer from premenstrual anxiety, irritability, and mood swings?
• Do you have a decreased interest in sex?
These hormone substitutes provide a safe, estrogen-like effect, and using a combination of them every day can improve your hormone status:
• Royal jelly has been used for centuries to promote reproductive health and ease menopause symptoms. Doctors from France have reported that women who ate royal jelly during menopause had a complete remission of symptoms! Take 1/4 teaspoon of the liquid form of organic royal jelly twice a day.
• Dong quai has been used for thousands of years as a female health tonic to prevent or treat menopause symptoms and provide menopause relief—especially from menopause hot flashes, night sweats, and irregular menstruation. I recommend that you take dong quai in powdered form in a 500 mg capsule. Take two capsules two to three times per day. (However, you should avoid it if you are on a blood thinner.)
• Saffron is a spice that has also been used traditionally to reduce menopause symptoms, enhance calmness, and reduce irritability. To preserve its medicinal properties, stir saffron into hot, cooked food. Use 1/10 of a teaspoon or less per day, as higher amounts may be toxic.
Estrogen deficient–fast processors have more acidic body compositions and can’t handle the acidic foods that estrogen deficient–slow processors thrive on. A 53-year-old patient of mine, Lorraine, is a perfect example of this hormone type.
Lorraine, who had recently entered menopause, came to me complaining of pain, stiffness, and immobility. She also told me that she was feeling more nervous and agitated than ever. On top of that, her skin and hair had become very dry, and she was experiencing unbearable menopause hot flashes, night sweats, insomnia, and vaginal dryness. With all of these severe symptoms, it was clear to me that Lorraine was a typical estrogen deficient–fast processor.
I suggested that she completely eliminate all acidic foods, such as red meat, citrus fruits, and hot spices, and instead follow a vegetarian diet that had greater emphasis on cooked grains, beans, salads, and vegetables. I also recommended that she trade in the hot spices she loved so much for cooler spices like lemon balm, cilantro, basil, marjoram, and chamomile. Almost immediately, Lorraine noticed an improvement in her pain and immobility. A few months later, her menopause symptoms had calmed significantly, and she started to feel much more comfortable in general.
If you are an estrogen deficient–fast processor, you, like Lorraine, need to avoid all acidic and spicy foods and eat a mostly vegetarian, nutrient- and mineral-rich alkaline diet that will help restore you to a naturally healthy state of alkalinity. This includes:
• Most vegetables
• Gluten-free whole grains
• Legumes (beans and peas)
• Small amounts of raw seeds and nuts
• Organic eggs
• Wild fish such as salmon, mackerel, trout, and tuna
• Sea vegetables such as kelp
• Fruits like bananas, melons, and papayas
• Free-range poultry in moderation
Eating a diet rich in these types of foods will help will increase your energy, stamina, and resistance to disease. Plus, you’ll notice a dramatic decrease in troubling menopause symptoms like menopause hot flashes, night sweats, and vaginal dryness.
Women who are estrogen deficient–slow processors tend to have greater reserves of alkaline minerals such as calcium, magnesium, potassium, and zinc within their cells, tissues, and bones. They have the body and hormonal makeup to be able to handle an acidic diet that is rich in red meat and dairy, but these foods lack the essential nutrients that all women need to maintain optimal health. For this reason, estrogen deficient–slow processors are best served by following a diet that is both highly acidic and nutrient-rich. This includes the following foods:
• High-fiber foods such as buckwheat and flaxseed
• Citrus fruits (oranges, limes, lemons, and grapefruit), berries, and pineapple
• All vegetables, especially sauerkraut, spinach, cucumbers, tomatoes, asparagus, and broccoli
• Free-range poultry
• Wild fish such as salmon, mackerel, trout, and tuna
• Free-range beef and lamb, as well as game meats like venison and buffalo
• Soy and soy-based foods
• Vinegar
• Raw nuts (almonds, walnuts)
• Heating spices such as turmeric (curry), ginger, cayenne pepper, chili powder and pepper, cumin, cloves, and cinnamon
By following this diet, estrogen deficient–slow processors are able to regain their energy and zest for life, reduce joint pain, and stabilize their hormone levels. Not to mention, eating a healthy diet provides menopause relief from symptoms like menopause hot flashes and night sweats.
This exercise helps to relieve menopause hot flashes and ease emotional tension. It also improves concentration and relieves headaches. (Click here to read more about acupressure
http://blog.drlark.com/blog/dr-lark/0/0/acupressure-relieves-a-variety-of-menopause-symptoms.)
1. Sit upright in a straight-backed chair.
2. With the second and third fingers of your right hand, press the point directly between your eyebrows, where the bridge of your nose meets your forehead.
3. With the second and third fingers of your left hand, press the point directly at the top of your head. (There should be a slight indentation.)
4. Hold these two points for one to three minutes.
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.
During menopause, I’ve found that things aren’t as simple as just too much or too little of any given hormone. Instead, my patients tended to experience a total shift in their entire physical and chemical makeup that manifested as one of two patterns. Their body and brain chemistry tended toward becoming either too fast or too slow. For this reason, I call the first pattern estrogen deficiency–fast processor. The second is its mirror image: estrogen deficiency–slow processor.
An estrogen deficiency–fast processor woman is in menopause with too little estrogen. Characteristics include:
• Anxiety
• Thin, dry skin and tissues
• Menopause hot flashes
• Night sweats
• Insomnia
• Vaginal dryness
• Sore joints
• Increased risk for heart disease and osteoporosis
An estrogen deficiency–slow processor woman is also in menopause, but she has the opposite body type and temperament. Characteristics include:
• Plumper/difficult time losing weight
• Fluid retention
• Stronger bones and connective tissue
• Thicker skin and hair
• Placid temperament
In future entries, I’ll tell you how to balance your hormones, depending on which of these categories you fall into.
I had a patient named Mary Ellen, who was 57 years old when she came to me to get help with her insomnia (the menopause symptom that was causing her the most distress). She was always somewhat of a light sleeper—she’d have her good nights of deep restful sleep, but when she was under stress, she had more disturbed sleep. And as she got older, she began noticing a shift in her sleep cycle.
During the day, Mary Ellen was groggy and sleepy, which made it hard for her to function at work, and her quality of work was affected. But as the night came, she became more agitated and couldn’t settle down. Over-the-counter products didn’t work, and she didn’t want to get hooked on prescription medications.
I worked with Mary Ellen on some key sleep-inducing exercises. Specifically, a couple of hours before bed, she did some quieting exercises, meditation, peaceful visualization, and prayer, which was compatible with her belief system. In addition, I also recommended that she take low-dose melatonin (300 mcg–1 mg) and 5-HTP (50–100 mg) each evening before bed. She was happy to report a few weeks later that she really achieved great success from this program.
If you’re having similar sleep issues because of night sweats or other menopause symptoms, I urge you to try these two supplements!
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.
Many women call them “their own personal summer”—and for good reason. Menopause hot flashes—sudden, intense episodes of warmth and heat—are one of the most uncomfortable symptoms that menopausal women complain about. While the frequency, intensity, and duration of hot flashes vary greatly, they usually involve sweating—mild in some women and profuse in others. These episodes are the result of increased blood flow to the brain and other organs.
Menopause hot flashes are physically draining since the body loses fluids and minerals in the process of perspiring. When they take the form of night sweats, hot flashes may disrupt sleep, soak sheets, and leave a woman exhausted and cranky. If they occur at work or during a social function, they can be embarrassing.
There are several natural remedies for menopause hot flashes, including:
• 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);
• 400–1,000 IU vitamin E; and
• 50–100 mg of soy isoflavones daily.
These nutrients are available in most health food stores, nutrition centers, and some pharmacies.
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