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.

Progesterone has many benefits in the body, especially for women who have menopause hot flashes, night sweats, and other, menopause symptoms. Some of the benefits of progesterone include:

• Improved sleep patterns
• Enhanced mental clarity and acuity
• Balanced mood
• Increased ability to remain calm under pressure
• Control of irregular and excessive bleeding
• Prevention of endometrial hyperplasia and growth of uterine fibroids
• Reduced menopause hot flashes
• Prevention osteoporosis
• Increased libido

I recommend natural forms of progesterone creams, such as Pro-Gest or Fem-Gest, or a transdermal spray such as Progest-Ease.

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).

Who would have thought that you can ease menopause symptoms with what you eat! Normally, I tell my patients to avoid spicy or hot foods that an increase the incidence of menopause hot flashes. But there is one spice that can actually decrease symptoms: saffron. This bright yellow Indian spice has 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. (Higher amounts can be toxic, so be sure not to use more than this amount.)

As my patients and newsletter readers know, I recommend many different types of herbs and nutrients for the relief of menopause hot flashes and other menopause symptoms. But there’s one herb that often doesn’t get the attention it deserves: red clover. Red clover contains four phytoestrogens (estrogen-like plant compounds thought to have an effect on menopause symptoms such as hot flashes) called genistein, daidzein, biochanin A, and formononetin, and has become increasingly popular among menopausal women here in the United States.

Many studies have been done on red clover, and according to a review of five studies published in the American Journal of Medicine, red clover helps to significantly reduce the frequency of menopause hot flashes. Other research has shown that the herb is also beneficial for cardiovascular health. In one placebo-controlled study reported in the Journal of Clinical Endocrinology and Metabolism, red clover improved arterial compliance. Other known potential cardiovascular benefits of red clover isoflavones include the inhibition of platelet clumping or aggregation, which can clog arteries, and the herb’s action as a potent antioxidant, which also helps reduce buildup of “bad” low-density lipoprotein (LDL) cholesterol in arteries.

I recommend taking a standardized extract that contains 40 mg of total isoflavones.

Acupressure is an ancient Chinese treatment that involves the stimulation of certain points on your body. Unlike acupuncture, which uses needles to stimulate these points, acupressure uses finger pressure. The following acupressure exercise can help to relieve a wide variety of menopause symptoms, including menopause hot flashes, night sweats, fatigue, and emotional tension.

• Locate the points on the back of your neck, in the hollows about a finger-width to the right and left of the base of your skull. Hold these points simultaneously for one to three minutes.

• With the thumb and index finger of your right hand, press the point located in the webbing between the base of your thumb and pointer finger of your left hand, directly above the muscle. Hold for one to three minutes, then switch hands.

• With the index and middle fingers of your right hand, press the point directly between your eyebrows, where the bridge of your nose meets your forehead. With the index and middle fingers of your left hand, press the point at the top of your head. (There should be a slight indentation.) Hold for one to three minutes.

• Press the fingers of your right hand on the point three finger-widths above the bottom of your breastbone, in the center of your breastbone, directly over your heart. Hold for one to three minutes.

Linoleic acid (omega-6) and linolenic acid (omega-3) are particularly important for menopause relief. The body converts fatty acids into substances called prostaglandins that bolster the immune system, reduce inflammation and risk of heart attack and stroke, and help keep body tissues, including skin, vaginal, and bladder mucosa, moist and plump.

Walnuts and raw seeds such as flax, pumpkin, sesame, and sunflower seeds are wonderful sources of omega-6 fatty acids. Fish—especially wild salmon, trout, and tuna—as well as flaxseed; soy foods; and leafy, green vegetables, are excellent sources of omega-3 fatty acids.

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.

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.

Soy milk…soy yogurt…tofu…what’s the deal with soy?

Well, not only are soy foods very nutritious and a great alternative to dairy, but soy is also an excellent way to get some much-needed menopause relief. The estrogen-like components (phytoestrogens) in soy replace your natural estrogen, providing the hormone support you need, but at lower potencies that are not likely to produce unwanted side effects.

Some of the benefits of consuming soy include the reduction in the severity of menopause hot flashes and the thickening of vaginal cells that thin after menopause. Not to mention, soy can also lower your cholesterol and even possibly help protect you from breast cancer and osteoporosis. In fact, studies have found that Asian women whose traditional diet is high in soy foods are four- to six-fold less likely to develop breast cancer compared to women in the U.S., where this disease is much more common.

So what are the best ways to add soy to your diet?
You can forgo dairy milk and drink soy milk (such as Silk brand), and you can replace dairy ice cream, yogurt, and cheese with the soy varieties. You can easily find these in health food stores and most grocery stores. Other good soy foods include soy burgers and tofu. If you choose to supplement, you can take soy isoflavones in capsule form—50 mg–150 mg each day.

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.

Do you know if you really are post-menopausal? Or are you in early menopause? Or is that wave of heat you experienced really a menopause hot flash or just a passing flush?

Here is a wonderful checklist you can use to determine if you are in menopause, and if the symptoms you are experiencing really are menopause symptoms. The more statements you check off as being true, the more likely it is that you are, in fact, entering this stage of life.

Potential Signs of Early Menopause

• My last period was six months ago or longer (true menopause).
• My periods are lighter, less frequent, and of shorter duration (late perimenopause).
• I’m in my early to mid-40s or older.
• I’m having hot flashes.
• Intercourse is painful.
• My desire for sex has faded.
• I have difficulty achieving orgasm.
• I have frequent vaginal or bladder infections.
• I have difficulty sleeping through the night.
• I’m frequently tired.
• I’m anxious and irritable.
• I forget small details.
• My skin is drier, thinner, and more wrinkled.
• My muscles are losing their tone.
• I leak urine when I laugh, cough, or sneeze.
• I’m gaining weight.
• My joints and/or muscles ache.
• I have itchy, crawly skin.
• I sometimes feel as if electric shocks were going through my body

As women, we always hear about menopause-this, menopause-that. But there’s another stage in the menopausal process that you may not be familiar with: perimenopause. Perimenopause refers to the time period preceding menopause, when your periods completely stop. Perimenopause can last one to two years, or as long as seven to ten years. During this time, progesterone levels are declining. In fact, if you’re in your 40s or early 50s, you may be experiencing a decrease or even cessation in progesterone production during many menstrual cycles, due to a lack of regular ovulation and aging ovaries.

Let me give you a little “biology lesson” to explain what happens. As ovaries age, they actually undergo physical and structural changes. They begin to shrink and become less responsive to signals from your hypothalamus and pituitary glands. Additionally, you have fewer eggs available to mature, and the eggs that are left are older and less functional. This situation often prevents a follicle from maturing enough to expel an egg. When this happens, the second-half of the menstrual cycle never kicks in, so progesterone isn’t produced. Meanwhile, fluctuating estrogen levels may range from unusually high to unusually low. The result is an almost constant state of imbalance known as estrogen dominance, which is often the cause of perimenopause symptoms. These include irregular menstrual cycles, breast cysts or breast tenderness, sleep difficulties, fluid retention, anxiety, weight gain, lowered sex drive, brain fog, endometriosis, fibroid tumors, and heavy, irregular menstrual bleeding.

Some of the nutrients I recommend to bring perimenopause symptom relief include:

• Chaste tree berry or Vitex (175–275 mg daily of a standardized extract) appears to have a progesterone-like effect on the body during perimenopause. It is useful in treating periods that are either too frequent or too heavy and helps normalize and regulate the menstrual cycle.
• Citrus bioflavonoids (750–2,000 mg daily) put a damper on overall estrogen activity by binding to estrogen receptor sites and blocking the body’s own high-octane estrogen. Many studies have shown that the combination of bioflavonoids and vitamin C reduces heavy menstrual bleeding by strengthening blood vessels.
• Quercetin (50–300 mg a day), a potent antioxidant, reduces the inflammation of endometriosis. It also helps reduce excessive estrogen levels, while helping maintain healthy cholesterol levels, good blood circulation, and proper digestion.