Perimenopause Symptoms

Uterine fibroids affect 30–40 percent of women by age 50. However, fibroids rarely cause symptoms, so they’re often overlooked. Their growth is triggered by estrogen dominance, since estrogen is a growth-stimulating hormone. Estrogen dominance is a common hormonal imbalance during perimenopause, and fibroids often disappear on their own after menopause.

The problem with fibroids occurs when they get big enough or numerous enough to cause pain or increased bleeding during or between periods. Some women also experience more frequent urination or changes in bowel habits because of the enlarged fibroids pressing against the bladder or colon.

Many doctors recommend a hysterectomy to remove fibroids and prevent new ones from forming—after all, if you don’t have a uterus, you can’t have uterine fibroids. But hysterectomies can cause so many other problems in the long term, that I truly believe that they should be reserved only for extremely severe cases that cannot be resolved with any other treatments. Today and in the days to come, I am going to give you my top 5 recommendations for safely, naturally, and effectively dealing with uterine fibroids. 

#1: Eat for hormonal balance. One key to bringing estrogen levels back into balance is to avoid foods that stimulate estrogen production and raise estrogel levels, such as alcohol, sugar, and saturated fats. Let your meals revolve around phytoestrogens—substances that are chemically and functionally similar to a woman’s own natural estrogen, except that natural plant estrogens are much weaker and less potent. Phytoestrogens soften estrogen’s effects. Fibroid tissue is studded with estrogen receptors, and phytoestrogens bind to those receptors, displacing the more potent estrogen.

Colorful fruits and vegetables, whole grains such as buckwheat and ground flax meal are great phytoestrogen sources that are also rich in the vitamins and minerals needed to balance estrogen levels, strengthen capillaries, and reduce uterine bleeding. As for supplements, I recommend 4–6 tablespoons of ground flaxseed, or 700–3,000 mg of bioflavonoids taken in divided doses.

Between taking care of their kids and families, working, and handling various errands, women usually have to-do lists a mile long.

When you look at your to-do list, how many of those things involve doing something for yourself? For instance, when was the last time you had your hair cut, or your nails done, or--even more importantly--a physical exam? If you can't remember the last time you saw your doctor, it's time to add "yearly physical," complete with all the appropriate screenings and tests, to the very top of your to-do list. Since this is National Women's Health Week, now is as good a time as any to put yourself--and your health--first.

What tests and screenings you have done depend on your age and overall health. But, in general, you want to ask your doctor about:
 

• A blood pressure check
• A blood cholesterol screening
• A gynecological exam that includes a pap smear, pelvic and breast exam, and bone density testing
• Breast cancer screening using thermography, which I strongly prefer over mammography
• Thyroid hormone testing
• Diabetes testing
• A skin exam to look for signs of skin cancer

According to a nine-year study of 221 middle-aged women by researchers from the University of Pittsburgh Medical Center, women in perimenopause are more than twice as likely to develop depression compared to reproductive-age women. Also, women in postmenopause are more than three and a half times as likely.

It's well known that depression tends to happen in women more than men...but are female hormones to blame? The fact that depression is more common in postmenopausal versus perimenopausal women has confused researchers because, with every year into postmenopause, a woman’s estrogen levels become more stable, not less. Some researchers believe that maybe it's estrogen deficiency, rather than hormone fluctuation, that causes depression among postmenopausal women.

Clearly, more studies need to be conducted to really determine what role female hormones play in depression. But if you find that you are experiencing depression as an effect of menopause, try therapies such as T’ai chi, qigong, and meditation to help lift your spirits. Exercise is also an excellent way to improve your mood. And if you feel the need for extra help, I recommend talking to a professional counselor and/or trying a natural mood-lifting supplement like SAMe.

Yesterday, I wrote about how wonderful yoga is for reducing perimenopause symptoms, particulary hot flashes and night sweats. To follow up, I wanted to give you a few poses this week that are easy, even for beginners. This one is called "The Sponge."

This exercise relieves anxiety and stress due to emotional triggers or menopause-related tension, and other menopause problems. As an added bonus, it relieves lower back pain, and also reduces eye tension and facial swelling.

• Lie on your back with a rolled towel under your knees. Your arms should be at your sides, with your palms facing up.

• Close your eyes and relax your entire body.

• Inhale slowly, breathing from the diaphragm.

• As you inhale, visualize the energy in the air around you being drawn in through your entire body. Imagine your body is porous and open like a sponge, drawing in this energy and revitalizing every cell in your body.

• Exhale slowly and deeply, allowing all tension to drain from your body.

• Repeat 2-4 times.

To soy or not to soy…that is the question I am asked at least once a week. Unfortunately, there’s not a clear answer, even in the research. Part of the problem is lies in the underwriters of many studies. For example, many of the pro-soy studies are funded, in part, by John Deere and other companies that have a vested interest in soy production. On the flip side, some of the anti-soy studies are funded, in part, by the dairy lobby, which has an interest in less soy, more dairy. This makes the already murky waters a bit murkier.

For me, I tend to lean toward less soy less often. Here’s why.

For women with estrogen dominance or those suffering from perimenopause symptoms where estrogen levels are already a bit high, adding more estrogen (albeit phytoestrogen) to the mix doesn’t seem to make rational sense. Now, I’ve heard that the soy blocks the estrogen receptors and blocks you more potent estrogens from locking in and all that; but the reality is, you are adding an additional estrogen to a system that’s already overtaxed. That cannot be good.

For women looking for relief from their menopause symptoms, soy can be a Godsend for the exact same reason it’s questionable for estrogen dominant women. Meaning, you are providing additional estrogen where estrogen levels are low. Sounds good, right? Well, maybe, maybe not.

A study from the May 2002 issue of Cancer Research looked at the interactions between dietary genistein and tamoxifen (an estrogen antagonist used in the treatment of estrogen-dependent breast cancer). Researchers implanted estrogen-dependent breast cancer cells in mice who had had their ovaries and thymus removed. They found that genistein negated or overwhelmed the inhibitory effect of tamoxifen. Based on these findings, they urged postmenopausal women to exercise caution when consuming dietary genistein while taking tamoxifen.

Other studies that shown a correlation between dietary intake of isoflavones and thyroid disease for several species of animals. Additionally, some studies have found that animals fed soy isoflavones developed enlarged organs, particularly the pancreas and thyroid, as well as increased deposition of fat in the liver.

Additionally, Dr. Lark has written in the past that women who have inflammatory bowel disease, autoimmune thyroiditis, and/or a known allergy or sensitivity to soy should avoid soy. Finally, soy is one of the two most genetically modified (GMO) foods in the United States. That for me is a huge red flag.

My Suggestion

Given all the controversy, the GMO issue, the interaction with tamoxifen, and the possible thyroid concern, I personally err on the side of caution with soy. I limit myself to true soy foods only, meaning edamame (the beans themselves), tofu, and tempeh and always, always organic (eliminates the GMO concern). I also limit my soy consumption to no more than three times a week.

As I’m sure you’ve heard, the FDA issued a consumer advisory regarding several Hydroxycut products on May 1, 2009. (Hydroxycut products are supplements geared at promoting weight loss, fat burning, increased energy and metabolism, and decreased appetite.)

According to the FDA, they have received 23 reports over the course of seven years that people taking Hydroxycut products experienced serious liver-related problems. The FDA advisory goes on to state, “Although the liver damage appears to be relatively rare, FDA believes consumers should not be exposed to unnecessary risks.” As a result of the FDA advisory, Iovate Health Sciences (the manufacturer of Hydroxycut products) issued a voluntary recall of the products in question.

This recall shows, yet again, that the idea of “weight loss in a bottle” is a myth. As Dr. Lark has written about time and again and I have preached in seminar and retreats several times over, the “secret” to effective weight loss is (drum roll please!)…exercise and proper nutrition.

That being said, there are a few tricks laying right in your refrigerator or kitchen cabinet that can make your weight loss efforts, well, effortless, such as green tea and flaxseed. Then there are the things that should NOT be in your frig or cupboard…things like wheat and dairy. Let me explain.

Both wheat and dairy are common food allergens. For some, this can translate to very serious conditions such as celiac disease (wheat and gluten allergy) or lactose intolerance (dairy allergy). However, thousands of women have developed an intolerance to these foods. The result is often “false fat” due to inflammation of the digestive system.

When you think of inflammation, you most likely think of swelling around a knee or bruise. But the reality is that no matter where an injury occurs, the physical manifestations are the same—pain, stiffness, and swelling. Therefore, when certain foods irritate or “injure” your intestinal tract, the abdomen and midriff can swell, resulting in bloating and fluid retention in the abdomen—this is false fat. Simply avoiding foods that contain wheat and dairy can result in a flatter tummy for many women.

And if you are looking for delicious way to boost your metabolism and burn calories, skip the hype and just brew up a cup of green tea. Green tea contains polyphenols, which appear to block the enzyme that breaks down norepinephrine, a brain chemical that regulates your metabolism. The higher your levels of norepinephrine, the faster your metabolism, which in turn allows you to burn calories even more efficiently. To reap the full benefits of green tea for weight loss, aim for drinking three 8-ounce cups of green tea a day. This is enough to provide roughly 240 to 320 mg of polyphenols.

And if you are looking for an easy, healthy way to decrease your appetite, try flaxseed. Flaxseed is living proof that great things do come in small packages. Flax is a great source of fiber, which has been shown to enhance weight loss, help in weight management, and decrease feelings of hunger. It does this by increasing bulk and helping to reduce appetite, thereby producing feelings of satiety.

Plus, flax contains essential fatty acids (great for skin, hair, energy levels, and heart protection), as well as phytoestrogens, weakly estrogenic plant nutrients that bind with your body’s estrogen receptors, mimicking the effects of estrogen. This is good news for anyone suffering from menopause symptoms such as night sweats, hot flashes, or other signs of menopause. Aim for 4–6 tablespoons of ground flaxseed a day. Simply sprinkle on dairy-free yogurt or oatmeal in the morning, over a salad at lunch or dinner, or add to your favorite smoothie as a snack.
 

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.
   

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.

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.
 

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.

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.

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.

Growing up, my mother used to constantly remind me that “birds of a feather flock together.” Considering my group of friends, this was a good thing. I had (and still have) great friends in grade school, high school, college, and beyond…people I was proud to be associated with.

As it turns out, there is something to this “birds of a feather” theory. A study published last week in the British Medical Journal found that the people you surround yourself with can have a direct and profound effect on your happiness. According to researchers James Fowler and Nicholas Christakis, “People’s happiness depends on the happiness of others with whom they are connected.”

After mapping the social interactions of nearly 5,000 people aged 21 to 70, discovered that when someone expresses happiness, their friend experiences a 25 percent increased chance of catching the happiness bug. And that friend’s friend has a 9.8 percent chance of becoming happy. And even the friend of that second friend as a 5.6 percent chance of getting the happiness virus.

Pretty cool, right? But what, you may be asking, does this have to do with hormone health? I mean, how on earth can giggling help hot flashes or night sweats? The answer is that it actually can.

As Dr. Lark and I wrote in Hormone Revolution, there is a very large and very real connection between hormone health and positive emotions. Thousands of studies have shown that what you do with your mind and emotions has a powerful effect on your health. One study in particular has always resonated with me.

Researchers looked at the longevity of a group of Catholic nuns from Milwaukee. The sisters ate, lived, slept together for years. They had the same daily routine, taught in the same school, had the same financial situation, received the same medical care, etc. Given this unique set of circumstances, researchers decided to evaluate the connection between happiness and longevity.

They looked at writings the sisters did prior to taking their vows. They divided the writings and their respective authors into different classifications based on the levels of joy and satisfaction expressed in the letters. They found that 90 percent of those sisters whose writings fell into the “most happy” category were still alive at age 85 or older. Conversely, just 34 percent of those sisters who writings fell into the “least happy” category lived to be 85.

In the past, Dr. Lark has written about positive thinking and emotions helping women deal with menopause symptoms and ease the discomfort of many perimenopause symptoms, including fibroids and endometriosis. I can tell you firsthand that nothing eases cramps and PMS symptoms like my favorite comedy and a good laugh. And I have many, many friends that have brushed off concerns of early menopause with a self-deprecating joke or two. Come to think of it, there isn’t much that good friends and a good laugh can’t make better.

Clearly there is something to this happiness thing. Not only does happiness translate to a longer life span, but it seems to be viral, infecting those around you and those around them. It’s like an emotional flu!

Now that’s one virus I’d be glad to catch…and pass on.