Premenopause

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

Premenopause is the first stage of menopause. Thanks to the imbalance of progesterone and estrogen levels in your body, it's common to experience irregular periods, heavy menstrual bleeding, and less frequent ovulation. Fortunately, you can take certain supplements to regulate your female hormones and your periods. 

Soy isoflavones provide estrogen-like support to balance out fluctuating hormones, without the risks of conventional hormone replacement therapy. Take 50–100 mg daily.

Bioflavonoids also have estrogen-like effects in the body. When taken with vitamin C, they strengthen blood vessels, thereby reducing heavy menstrual bleeding. They also modulate estrogen levels. Take 1,500–3000 mg daily, along with 1,000–3,000 mg of vitamin C.

Vitex (Chaste tree berry) normalizes the secretion of female hormones and helps to bring estrogen levels and progesterone levels into balance. Take 40 mg daily. 

As we reach a certain age, it seems that more and more of our friends are being diagnosed with breast cancer. This can be disheartening and frightening. While we know women who are estrogen dominant or those who have eleveated estrogen levels are at greater risk for breast cancer, women in premenopause or even those experiencing menopause symptoms can be diagnosed with this awful disease.

However, cancer is not an inevitable part of growing older! Arming yourself with the right information on how you can prevent breast cancer from happening in the first place can help lessen your fears and improve your overall health. And a key piece of that information is an amazing nutrient that has been shown to significantly lower your risk of breast cancer: DIM.

DIM and Breast Cancer

DIM (diindolylmethane) is a compound found in Brassica vegetables such as broccoli, bok choy, cauliflower, cabbage, and Brussels sprouts. When you eat these vegetables, the chewing process releases plant enzymes, which in turn create a phytochemical known as indole-3-carbinol (I3C). DIM is formed directly from I3C in the acidic environment of the stomach. Best of all, DIM has also been found to be highly stable, requires no conversion, and promotes beneficial estrogen metabolism.

When we talk about estrogen or estrogen levels, we are actually referring to three different compounds: estradiol, estrone, and estriol. During estrogen metabolism, estradiol (the most potent of the three) is converted into estrone. Estrone then becomes either 2-hydroxyestrone (a “good” estrone metabolite) or 16-alpha-hydroxyestrone (a “bad” estrogen metabolite). The good metabolite (2-hydroxyestrone) is then converted into 2-methoxyestrone and 2-methoxyestrodial. These two estrogen metabolites have been shown to inhibit the growth of malignant tumors. Conversely, 16-alpha-hydroxyestrone has been strongly associated with cancer growth.

This is where DIM comes in. Research has shown that when DIM is ingested, it not only encourages its own metabolism, but that of estrogen. While it is not an estrogen or even an estrogen-mimic, its metabolic pathway exactly coincides with the metabolic pathway of estrogen. When these pathways intersect, DIM favorably adjusts the estrogen metabolic pathways by simultaneously increasing the good estrogen metabolites and decreasing the bad estrogen metabolites.

After many studies confirmed that the 2-hydroxyestrone to 16-alpha-hydroxyestrone ratio was a good predictor of breast cancer risk, researchers set out to determine if consumption of Brassica vegetables could influence this ratio. In 2000, American researchers took urine samples from 34 healthy postmenopausal women. They then added 10 grams of broccoli a day to the women’s diets. After taking another urine sample, researchers found that this dietary change significantly increased the 2-hydroxyestrone to 16-alpha-hydroxyestrone ratio.

A similar study conducted in 2001 looked at the dietary habits of postmenopausal Swedish women aged 50 to 74. When asked how often, on average, they consumed a wide variety of foods, including 19 different commonly eaten fruits and vegetables, researchers found that those women who ate 1 to 2 servings of Brassica foods a day had a 20 to 40 percent lower risk of breast cancer than those women who ate virtually none.

What’s a Girl to Do?

Clearly, we all need to eat more Brassica vegetables. Aim for at least two servings a day to help keep estrogen levels of estrogen metabolites in the right balance. You can also augment your diet with a good, high-quality DIM supplement. Dr. Lark suggests taking 30 mg of DIM a day.

If you are have healthy estrogen levels or are in early menopause or premenopause, then you should quickly make lycopene your close and personal friend. A fascinating study from the International Journal of Cancer found that high carotene intake, especially a diet high in lycopene, significantly reduced the risk of ovarian cancer in premenopausal women. Investigators suggested that consumption of fruits, vegetables, and food items high in carotene and lycopene, particularly raw carrots and tomato sauce, may reduce the risk of ovarian cancer.

To reap these benefits, aim for 10 servings of cooked tomatoes or tomato products every week. Just be sure to mix the tomatoes in an oil base, such as olive oil, to enhance lycopene absorption.

If you do not want to eat this much tomato-based food, or you simply dislike their taste, then lycopene supplements are a good alternative. Dr. Lark recommends taking 5–10 mg per day. Lycopene is available in most health food stores.

Unfortunately, lycopene does not confer the same protection against ovarian cancer in postmenopausal women that it does in younger women. Luckily, foods high in alpha-carotene and alpha-carotene supplements have been found to significantly reduce the risk of the disease in postmenopausal women.

And, animal studies have shown alpha-carotene is 10 times more effective than beta-carotene in suppressing lung, liver, and skin cancer, while other research has found that the nutrient is 38 percent stronger in antioxidant activity than beta-carotene.

Foods highest in alpha-carotene are carrots, corn, squash, watermelons, green peppers, potatoes, apples, peaches, and leafy green vegetables. If you prefer a supplement, Dr. Lark suggests taking 25,000 IU of mixed carotenoids that contain a blend of both alpha- and beta-carotene.

When it comes to ovarian cancer prevention, there are definitely categories of foods that you should avoid, namely caffeine, dairy products, and red meat. In the case of caffeine, several studies have shown a connection between regular caffeine intake and cancers of the reproductive system. For example, in one study from the September 2000 issue of the International Journal of Cancer, researchers compared the coffee intake of 549 women who had been newly diagnosed with ovarian cancer with that of 516 women without the disease. They found that the consumption of coffee, and caffeine in general, was linked to an increased risk of ovarian cancer in women in early menopause or premenopause.

Similarly, dairy products and red meat can also increase your risk for ovarian cancer. According to a 2003 study, also from the International Journal of Cancer, women who consumed more dairy products and red and white meat were at increased risk for ovarian cancer. Most likely, it is the saturated fats found in these two food groups that put women at high risk for the disease, as they elevate estrogen levels. And, as I wrote about earlier, elevated estrogen levels can lead to or contribute to one of the biggest risk factors for ovarian cancer—estrogen dominance.

In addition to avoiding certain foods, there are others you should strive to eat more often. These include cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.). In a study from the International Journal of Cancer, researchers looked at the frequency with which 609 ovarian cancer survivors in three Australian states ate certain foods and took certain supplements. They found a "survival advantage" in those women who consumed more vegetables in general, especially cruciferous vegetables. They also observed a significant advantage among those women in the upper third of vitamin E intake.

A second study found that vitamin E is not alone in its cancer-fighting benefits. In a 2001 study from Nutrition of Cancer, researchers asked 168 women with ovarian cancer and more than 200 cancer-free women to record their intake of specific foods and supplements. They found that women who took in more than 363 mg of vitamin C a day had a 40 percent lower risk for developing ovarian cancer, while women whose daily intake of vitamin E exceeded 75 mg had a 33 percent decreased risk for the disease.

A 2002 study from the same journal confirmed this conclusion. Researchers found that supplementing with vitamins C and E did indeed appear to significantly decrease the risk of ovarian cancer by about 50 percent.

The bottom line? To help avoid ovarian cancer, avoid caffeine, red meat, and dairy products. You can also increase your consumption of foods high in vitamins C and E, as well as cruciferous vegetables. These include: wheat germ oil, sunflower seeds, almonds and almond butter, and flaxseed and flaxseed oil (all high in vitamin E). For those high in vitamin C, aim for any fruit, tomatoes, red bell peppers, broccoli, cauliflower, spinach, celery, and avocado. Finally, your cruciferous veggies include broccoli, cauliflower, Brussels sprouts, kale, collard greens, bok choy, watercress, radish, and mustard seed.

Interestingly, with age, the human immune system undergoes something called immunosenescence—a decline in the number and function of immune cells in the bone marrow, blood, and tissues; and a decline in the ability of immune cells to communicate with each other and find the infection, and fight effectively once they get there.

Before menopause, when your female hormones are abundant, your immune system is stronger than a man’s at any age because estrogen is a natural immunostimulant. But as hormonal imbalances and premenopause/menopause occur, another change occurs in your body--your defenses take a hit that’s harder than an older man’s body ever has to deal with. So, along with menopause symptoms like night sweats and menopause hot flashes, another effect of menopause is your immune system's weakening.

These are just a few tips to help oost your immunity and protect yourself against illness this year:

Take zinc. Zinc levels, which are a critical competent for immune response, commonly decline with age, which accelerates immunosenescence. Take10–25 mg of zinc daily, plus 2 mg of copper (because zinc depletes copper). 

Take Propolis, a sticky compound bees produce to seal and protect honey-filled compartments, is rich in immune-modulating polyphenolic compounds. I recommend green Brazilian propolis from Uniflora Health Foods (http://store.uniflora.us).

 Vitamin D3, (the “sunshine” vitamin) is also critically important for immunity. It is critical for healthy mucosal barriers lining your respiratory tract, reproductive tract, eyes, and digestive system. Those barriers are your immune system’s first line of defense, keeping pathogens from getting past their guard. Take at least 2,000 IU of vitamin D3 daily.  

Wishing you the best of health this fall and winter!

I’m sure you don’t have to think too hard to name someone you know that has (or had) cancer. It simply seems to be a sad fact of life nowadays. And you can likely narrow that list down by type of cancer. For the next couple of weeks, I’d like to focus on one form of female cancer that has touched my family: ovarian cancer.

One of my mother’s closest friends is Connie. I grew up listening to them giggle and plot throughout my entire childhood. I ate dinners at Connie's house and had sleepovers with her daughters. In fact, I’m friends with them on Facebook to this day.

Several years ago, my mother called me with very distressing news—Connie had ovarian cancer. What a shot that was. This is one of the wittiest, life-loving, fun people I knew. How could this happen to her?

While I don’t know the exact reason in Connie’s particular case, I do know that estrogen dominance is a major risk factor for ovarian cancer. To fully understand why this is case, you have to look at what happens during a normal menstrual cycle and how that changes as you get older.

When you are in your teens, 20s, and even 30s, your normal reproductive cycle begins with signals from the hypothalamus and pituitary glands. These glands secrete a hormone (called FSH), which stimulates the follicle surrounding each egg in your ovaries and causes an egg to mature. During this process, your ovaries produce a powerful form of estrogen called estradiol, while your adrenal glands produce a lower-octane form of estrogen called estrone.

At mid-cycle, a second hormone called the luteinizing hormone (LH) is produced by the pituitary gland. LH triggers the egg to be released from the ovarian follicle. It also increases the synthesis of prostaglandins, short-lived hormones needed for ovulation. Once ovulation has occurred, the egg leaves the ovary and travels down the fallopian tube to the uterus.

Both estrogen and progesterone are produced during this second half of the cycle. If the released egg isn’t fertilized, both estrogen and progesterone production decline rapidly, triggering menstruation at the end of the monthly cycle. Thus, estrogen is produced during the entire menstrual cycle, while progesterone is only produced during the second half of the cycle.

As you approach menopause, this process is even more exaggerated. Although your ovaries and adrenal glands continue to produce a lower potency estrogen (estrone), and some estriol (a weaker form of estrogen) is produced by your liver, the amounts don’t support your systems the way your premenopause hormone production does. During this process, four things happen simultaneously:

• your ovaries age and shrink;
• they are less responsive to the hypothalmic-pituitary signals;
• you have fewer eggs to mature; and
• the eggs you have left are older and less healthy.

In an effort to bring your cycle back into balance, your brain’s triggering signals increase as much as ten-fold, trying to stimulate ovulation. During the early stages of menopause, this becomes more and more difficult to achieve. While estrogen production declines significantly, your progesterone levels decrease much more significantly, with production almost ceasing completely. This can lead to estrogen dominance, and consequently, put the health of all of your tissues—especially your reproductive organs—in jeopardy.

That’s because research has shown that unopposed estrogen levels may be carcinogenic to estrogen-sensitive tissues such as the ovaries, and may be a key cause of most female cancers.

If future blogs, I’ll discuss the nutritional and emotional steps you can take to keep estrogen levels in balance and reduce your risk for both estrogen dominance and ovarian cancer.

In the meantime, you can try using natural progesterone to balance your hormone levels. A typical dosage of natural progesterone cream is 1/4 to 1/2 teaspoon applied to any clean area of the skin once or twice a day.

If your menstrual periods are regular, Dr. Lark recommends using progesterone cream about 10 days before the expected start of your period. However, if you suffer from heavy or irregular menstrual periods, apply progesterone cream from day 12 to day 26 of your cycle.

If you are experiencing menopause symptoms and using some sort of estrogenic support, natural or otherwise, Dr. Lark suggesst using natural progesterone three weeks a month, with one week off.

As I indicated in my last blog, I believe that soy should be consumed only a couple of times a week by anyone with estrogen dominance, premenopause, or other conditions where estrogen levels are out of balance with progesterone levels. Additionally, I believe that women who are in menopause but who are taking tamoxifen for breast cancer or those who have a thyroid concern should also limit their soy intake.

That being said, I do feel it is okay for a woman who is experiencing menopause symptoms such as hot flashes, night sweats, and other menopause problems to consume soy. The key to soy for menopause relief is the natural isoflavones in soy. Therefore, the key is to eat the right amounts of soy foods in the right forms to help you ease the negative side effects of menopause.

I still maintain that you should limit your consumption of soy no more than one serving a day in a “pure” form such as edamame, tofu, or tempeh. On the isoflavone front, Dr. Lark recommends having 50-100 mg of soy isoflavones a day to effectively treat menopause symptoms. In relation to soy foods, this breaks down to one cup of tofu (70 mg isoflavones), 1 cup of tempeh (70 mg isoflavones), or ¼ cup edamame (75 mg isoflavomes) a day.

“Corby” asked a question related to my post about the use of melatonin for insomnia. The questions was does melatonin increase or cause depression. The short answer is…maybe, but not likely.

Several studies have confirmed that people who suffer from depression have low levels of melatonin (Lancet, 1979) (Biol Psychiatry, 1984). Other studies have linked depression to a delayed melatonin cycle (Psychoneuroendocrinology, 2004).

Melatonin is produced from serotonin and secreted by the pineal gland. Its secretion takes place at night and is inhibited by light. As such, it sets and regulates the timing of your body’s natural circadian rhythms, such as waking and sleeping. When this cycle is delayed, depression and depressive symptoms can occur.

This cycle is particularly affected during early menopause and, in fact, during all stages of menopause. As you get older, you produce less and less melatonin. Melatonin is produced from serotonin, and serotonin production is stimulated by estrogen. Low estrogen levels equates to low serotonin, which results in low melatonin.

As you can imagine, there is research to suggest that taking supplemental melatonin can help treat mild depression (Psychiatry Research, January 1998), including depression related to menopause and even premenopause. However, there are a few studies that have shown that melatonin can have a negative effect on depression (J Psychiatry, 1976).

Though the studies are small in scope and often include a small number of trial participants, it is always best to err on the side of caution. As the University of Maryland Medical Center advises, “Melatonin should be used with caution in people with depression and should be appropriately timed with…sleep-phase changes. Disruption of normal circadian rhythm by poorly timed melatonin administration may worsen depression."

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.

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.

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.

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.