Stages of Menopause

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. 

Anyone with rosacea knows that the tell-tale signs of the skin condition are ruddy cheeks and small pimples. Although it is unknown why people develop rosacea, we do know that the redness and breakouts are due in part to enlarged, dilated blood vessels. We also know that, for many women, rosacea is one of the side effects of menopause.

Iinitial rosacea symptoms include a flushed appearance on the cheeks, forehead, and nose. If left untreated, symptoms can also develop on the neck, back, ears, scalp, and inside and around the eyes. In an advanced stage, a person may develop a bulbous nose or thickened, distorted patches of skin. Aside from being unsightly, rosacea can be extremely painful. Many women describe it as a stinging or sunburn sensation, due in part from inflammation that occurs during flare-ups.

Avoid Breakouts

The best strategy for treating rosacea is a preemptive one. First and foremost, get diagnosed to be sure you truly have the condition. Next, make a few lifestyle changes that can greatly reduce flare-ups:

• Avoid things that trigger your face to become flushed. These include highly acidic foods, spicy and fried foods, sugar, caffeine, dairy products, trans fatty acids, and alcoholic beverages. The National Rosacea Society has also identified Mexican food; hot sausage; hot peppers; black, red, and white pepper; paprika; vinegar; and garlic as triggers.
• Determine whether any of your cosmetic products are aggravating your condition. Ask your dermatologist to recommend skin-care products that are non-irritating.
• Protect your skin with a sunscreen containing SPF 15 or higher.
• You also need to be careful not to scrub or rub your face roughly. You don’t want to be the cause of your own redness.

Two Treatment Options

• Take a good, high quality multinutrient that contains 25–100 mg of the B-complex vitamins—especially riboflavin (B2), which has been shown to be effective in treatment of rosacea.
• Glycolic acid peels have been used effectively to treat rosacea. Known for their ability to reduce fine lines and wrinkles, the fruit acids used in glycolic acid peel treatments will significantly improve your skin’s texture, reducing redness and ridding your skin of break-outs.

While I ususally focus my blog on alleviating menopause symptoms like hot flashes and night sweats, today, I'd like to address new mammography guidelines that the U.S. Preventive Services Task Force proposed yesterday. Essentially, the recommendations now state that women between the ages of 40 to 49 should not get annual mammograms unless they are high-risk (i.e., strong family history and/or positive for the breast cancer genes BRCA-1 or -2) because the risks outweigh the benefits. The new guidelines also state that women over the age of 50 should get mammograms, but every two years instead of yearly. Finally, they state that self-breast exams are no longer necessary.

There are aspects of these new guidelines with which I agree, and others that, quite frankly, anger me.

First and foremost, I have been speaking out against mammograms for decades because I, too, believe that the risks outweigh the benefits. As I stated in my February 2008 issue of Women’s Wellness Today:

A routine mammogram’s sensitivity (how good it is at detecting suspicious tissue) varies. If a woman is still menstruating, her breast tissue is denser, which drops the sensitivity of routine mammograms to below 70 percent. That means that as many as 30 percent of existing breast cancers are missed, which is troubling because cancers in younger women tend to grow faster. After menopause, a mammogram’s sensitivity is better, but still not great. Routine mammograms are hamstrung by the fact that any tumor smaller than about four-tenths of an inch across is less likely to show up, so a tumor might be just small enough to escape detection, and then have lots of time to grow and spread before the next mammogram. On top of all this, human error in reading the films is also a very real possibility.

Here’s another problem with mammography. Five out of six “suspicious” routine mammograms turn out not to be cancer. Those five women are undoubtedly relieved, but they also got the scare of their lives, underwent more tests, maybe got biopsies, and possibly even had surgery they didn’t need.

The latest studies show that for every 2,000 women who get a routine mammogram, one life is prolonged. If that seems mediocre, you should know that protecting any individual woman against breast cancer was never the goal of routine mammograms—it’s well known that they miss too many cancers in the early, most treatable stage. As a routine screening tool, their purpose is simply to reduce the percentage of women who die from breast cancer.

For these exact reasons, I recommend a breast imaging test called thermography over mammography. In short, mammography looks at the structure of a woman’s breast tissue, while thermography looks at its behavior--which is a much more accurate indicator of potential future problems.

Keep Up with Those Self-Exams
The Task Force’s belief that self-exams are no longer important really frustrates me. I strongly believe that becoming familiar with your breasts, and how they look and feel, can help you determine if any scars, dents, lumps, or bumps are normal for you. Plus, you'll be more sensitive to any little changes that might indicate the need for further testing.

In a nutshell, I recommend that you look into getting breast thermography done, and I strongly encourage you to keep up with your breast self-exams. To learn more about thermography, visit the International Academy of Clinical Thermology or Infrared Sciences Corp.

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.

“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.

Ah, the humble flaxseed. Who knew that such a small seed could have such a profound impact on your hormonal health?

As Dr. Lark and I wrote in Hormone Revolution, flaxseed helps women at every stage of hormonal development. For women in the throes of estrogen dominance, premenopause, early menopause, and even perimenopause, flaxseed helps to increase progesterone production while simultaneously flushing excess estrogen from your system. This keeps perimenopause symptoms such as heavy menstrual bleeding at bay.

For women suffering from signs of menopause like dry skin or a flaky scalp, flaxseed helps to keep skin and tissues soft and supple. Plus, it helps to lubricate those creaky joints that seem to show up out of nowhere.

Given all the amazing things that flaxseed can do for women of all ages, the question remains: How do I manage to get the four to six tablespoons a day I need for optimum hormonal health? The answer is deliciously easy.

I find that breakfast is a great time to get flaxseed. I’ve included my three favorite breakfast ideas for you, as well as an easy lunch and dessert option.

1. Add four tablespoons to a smoothie. My favorite is to take half a banana, 1 cup of berries, 1 cup almond milk, 1 cup fresh spinach, a handful of ice, and your flaxseed. Blend until smooth and drink immediately. The fruit “hides” the spinach, yet you are still getting 2+ servings of fruits and veggies!
2. Add four tablespoons to oatmeal. I like to “steam microwave” half an apple (diced) and add to a cup of cooked oatmeal. Sprinkle on some cinnamon and your flax and you have a hot meal that just sings of autumn.
3. Add four tablespoons to scrambled eggs. Yes, to eggs. You’ll have to trust me on this way. It is delicious! Scramble two eggs and add a little goat cheese and dill. Add the flax and mix well. It adds a nutty taste that goes beautifully with the goat cheese and dill.
4. Add two to three tablespoons to your salad. Start with mixed greens of your choice. Add chopped veggies (I like cucumbers, celery, carrots, and mushrooms). Top with four ounces of chicken or salmon and sprinkle on the flax. Dress with two tablespoons of olive oil and one tablespoon of tamari sauce (a wheat-free soy sauce). Presto! A delicious, Asian-inspired salad you’re sure to love.
5. Sprinkle two tablespoons into plain soy yogurt. Add a dropperful of chocolate raspberry liquid stevia to the yogurt, a handful of raspberries, and top with the flax. It’s reminiscent of a sundae…without the unwanted sugar and excess calories.

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?

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

• 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.