Perimenopause, the entire hormonal transition through and beyond menopause

Paul Reller, L.Ac.

Perimenopausal Syndromes: Premenopause, Menopause and Post-Menopause considerations of symptoms, health risks and associated health problems

The term menopause comes from a French medical term that is derived from the Greek words menos and pausis, meaning “month” and “pause or cease”, and from pauein, meaning “to cause to cease”, and refers to the cessation of the monthly cycle of fertility mechanisms and bleeding. More importantly, though, is the subject of the normal hormonal changes that occur with this ending of the monthly menstrual cycle, or the cause of these changes. An unhealthy focus on menopause instead of the whole process, or perimenopause, in standard medicine reflects the typical allopathic view. Instead of helping the patient experiencing problematic symptoms and considering risks of associated health problems with a holistic understanding of their physiological changes, a narrow focus on the cessation of the menstrual cycle and subsequent treatment with hormone replacement occurred. At one point, it was suggested that all women should perhaps replace their natural hormone estradiol with a synthetic version. This proved profitable for the industry, but disastrous for the women, as the Women’s Health Initiative study discovered. Today, most women, and a growing number of medical doctors, are finally considering the whole period of hormonal transition and the health concerns associated. In fact, we now know that men experience a similar transition hormonally at about the same age, and we term this andropause, usually occurring at about age 56. The ancient Taoist Chinese physicians stated that women experience a cyclical change every 7 years, and men every 8 years. Since the vasomotor symptoms are not so dramatic for men, men are allowed the luxury of ignoring this change and hoping for the best. Since about 80 percent of women in the United States now experience some degree of vasomotor episodes, or hot flush and abnormal sweating, during perimenopausal changes, most women are having a hard time ignoring the problem.

The term menopause should be replaced with the term perimenopause, or perhaps simply called the transition. Perhaps we could just say that “I’m going through my Peri”. It was enticing for women to try to ignore the hot flush and sweating episodes and take a pill, hope for the best, and pretend that you weren’t aging. The smart woman, though, will take a look at this perimenopausal stage of 2 to 9 years, understand it, and make the smart and healthy moves to insure that the rest of their lovely life is of the best quality possible. Helping your body to achieve the most physiologically normal balance of hormones during the transition will prevent hot flush, abnormal sweating, sleep disturbance, and an array of potential symptoms that disrupt your life. More importantly, it will help prevent breast cancer, osteoporosis, cardiovascular problems, memory and attention span problems, and syndromes of anxiety and depression, and may even help prevent neurodegenerative disorders, such as Alzheimer’s and Parkinson’s disease.

As women approach age 50 there are normal hormonal changes that can become problematic, and an array of therapeutic measures that may make this transition from the normal hormonal production, stimulated by the breakdown of hormonally rich ova and endometrial linings each month, to a hormonal production and regulation that is not dependent on the menstrual cycle. This transition is called menopause because it is a pause in the menstrual production of hormones and a period of adaptation to new type of hormonal balance and regulation. By understanding the physiology of this transition, women may choose sensible ways to insure that the transition is smooth and relatively free of symptoms. Historically, cultures across the planet have adapted with dietary changes and herbal regimens to make this transition smooth and healthy. In modern times, women have been given the impression that they could ignore these changes and depend upon synthetic hormone replacement when alarming symptoms occurred. We now know that this was a tragic mistake, as increased cancers, cardiovascular problems and osteoporosis resulted, and many women did not achieve a significant control of post-menopausal symptoms and found that their general health and quality of life had deteriorated with chronic use of the synthetic hormones.

Menopause transition, or perimenopause, may vary considerably from one woman to another. Fluctuating ovarian function may start to occur from 2 to 8 years before menopause, and may continue for up to 1 year after full cessation of the menstrual periods. This entire time of hormonal change is called the perimenopause by the World Health Organization. This is a confusing subject for most women, who have been given the impression that the perimenopausal state ends with premenopause and menopause. In reality, the term perimenopause defines the entire course of transition hormonally through the premenopausal changes, to menopause, and for up to a year post-menopausally. This entire perimenopausal time should be addressed when the woman and her physicians try to decrease health risks and symptoms, and make the hormonal transition as smooth as possible.

Many systems are affected by the hormonal imbalances that occur during this variable perimenopausal period, including the neuroendocrine, cardiovascular, musculoskeletal, and genitourinary systems, and even the system regulating the health of the skin and hair. The perimenopausal changes are still poorly understood in medicine, but we have accumulated much data concerning the pathology of adverse perimenopausal syndromes. Up to 1% of women in the United States may experience premature ovarian insufficiency before the age of 40, resulting in ovulatory failure and amenorrhea (no menstrual period of bleeding). A much larger percentage may experience subclinical ovarian insufficiency or dysfunction, which may account for the large percentage of women having difficulty with normal fertility and pregnancy. In recent years, certain demographic sets of women under the age of 40 have shown signs of polycystic ovarian syndrome at alarming rates, up to about 20 percent of women studied. Understanding the physiology of the healthy ovarian function is integral to solving and preventing the problems of perimenopause, premenopausal states, and menopause. Ovarian problems may even contribute to problems in post-menopause for some time after the last menstrual period is experienced. Ignoring this important issue of healthy ovarian function is not an option for the women wishing to take a proactive approach to better health and quality of life in their 40s.

Complementary Medicine offers women the chance to achieve a smooth menopausal transition that is healthy and reduces risks of this wide array of associated health problems, most of which are not associated with the menstrual period and the premenopausal changes by the patient. A complete and thorough approach in Complemetary Medicine works with the woman to achieve a physiologically normal hormonal balance with herbs, nutrient medicine, dietary changes and acupuncture. Even deep tissue, or soft tissue physiotherapy has been found to be beneficial in this hormonal modulation and regulation (see the related article on this website). Understanding the physiological issues and goals of therapy is the key to success. Finding a knowledgeable Licensed Acupuncturist and herbalist to assist with these goals may be the most important step.

Understanding the physiology of menopause

At birth, a woman may have up to two million oocytes, or immature eggs. These are germ cells called gametocytes, and the process of maturation of the ova to the viable egg takes about 13 months in the ovaries. Many immature eggs are lost in the process, and fail to mature. At menopause, the process of atresia (monthly degeneration and resorption of immature avarian follicles) reduces these viable immature eggs to just a few hundred. An ovarian follicle is a complex organ that contains one egg, or ova. A matured, or dominant ovarian follicle produces a quantity of the most potent natural estrogen, estradiol (E2). During menopause the most dominant form of estrogen is estrone (E1), which is still produced by the ovaries as well as the adrenal glands. Estrone is also produced in quantity by the fat cells and derived from the natural conversion of andrestenedione to estrone. Acquisition of increased midsection adipose tissue, or as we could call it, voluptuous curves, is important for the woman in her 40s. In an earlier time, such icons of beauty as Marilyn Monroe went from a skinny freckled girl to a curvy voluptuous model of female sexuality in her 40s and everyone admired this. In more recent decades, the woman is more likely to go on starvation diets to lose weight and look skinny again in midlife. This does not bode well for the production of estrone from adipose cells. A healthy amount of midsection fat appears to be important for the production of estrone during the transition of perimenopause through menopause.

As the perimenopausal woman transitions from an estradiol dominant hormonal mechanism to a more estrone dominant one, the production of androstenedione, a precursor to estrone, becomes more important. Androstenedione is synthesized in two ways in the body. The primary pathway of synthesis involves conversion or pregnenelone to dehydroepiandrosterone (DHEA) with the aid of the enzyme lyase, and the conversion of the DHEA to androstenedione with the aid of the enzyme dehydrogenase. DHEA is the most abundant hormone produced by the adrenal glands, and usually declines with age. The second pathway involves conversion of progesterone to androstenedione with the aid of lyase. The specific progesterone metabolite needed is 17-hydroxyprogesterone, a precursor to cortisol, and thus cortisol imbalances may deplete the 17-hydroxyprogesterone, and thus the androstenedione and estrone. When this happens, estradiol may become dominant in the balance of steroid hormones, and create symptoms. Stimulating increased production of pregnenelone and achieving a better cortisol balance and adrenal function is thus the emphasis in modern Complementary Medicine, as well as maintaining a pphysiological normal level of progesterone and a healthy PG/E2 ratio of active metabolism (progesterone to estradiol). Active hormonal metabolites measured with a saliva sample will produce a laboratory assessment of these key hormonal parameters and guide therapy for the perimenopausal woman in Complementary Medicine.

Progesterone is a steroid hormone produced by the non-selected egg follicle casing, or corpus luteum, that promotes a healthy thickening of the endometrium (uterine lining) . Progesterone is also produced in other tissues as needed, in both males and females, but the large production of progesterone in the unused egg follicles of the ovary is crucial to the menstrual cycle and viable pregnancy. This corpus luteum develops into a structure that is typically very large relative to the size of the ovary, resulting in the indistinct feeling of pressure, called “Mittelschmerz”, or middle pain. A typical ovary at rest is about 3 cm wide, and a typical developed corpus luteum is about 2-5 cm in diameter. If the viable egg is not fertilized, the corpus luteum of the unused egg stops secreting progesterone and decays during the menstrual bleeding. The uterine lining, or endometrium, which grows in relation to the amount of progesterone, also decays, producing menstrual bleeding. The health of the ovary and corpus luteum is thus important during the menstrual cycle, and is important during the perimenopausal period. Progesterone balances with estrogen to maintain the normal healthy hormonal balance that is crucial to so many processes in the body.

A number of factors may contribute to lowered progesterone production during the menstrual cycle. Usually, this lowered progesterone will manifest itself as premenstrual symptoms. If premenstrual syndrome (PMS) occurs in the menstrual cycle, the perimenopausal woman should try to correct this condition to better insure a healthy perimenopausal, premenopause and menopause states. Some factors that may contribute to poor production of progesterone from the corpus luteum include polycystic ovary syndrome (unused egg follicles creating cysts), and other factors affecting the healthy formation of the corpus luteum in the ovary. The yellow color of the corpus luteum is due to its concentration of carotenoids, especially lutein, and deficiency of these nutrients may play a part in less than healthy corpus luteum. Studies have shown that the human corpus luteum concentrates carotenoids from the diet, and are probably not synthesized by the ovary. Carotenoids from the diet mainly come from fruits and vegetables, and are considered antioxidants, but a number of nutritional supplements are popular today that contain key carotenoids, as well as herbal medicines. Beta-carotene is the most well known carotenoid, but alpha-carotene, lycopene and lutein are also now much studied. Carotenoids containing oxygen include lutein and zeaxanthin, while carotenoids without oxygen include beta-carotene, alpha-carotene, and lycopene. Carrots and apricots (orange foods) contain much carotene, but unprocessed palm oil is considered the richest food source. Wikipedia lists 86 chemicals in their list of naturally occurring carotenoids, though, and many healthy foods, especially fresh dark leafy green vegetables, as well as many herbs, contain valuable carotenoids that may contribute to healthy corpus luteum. This is just one example of how the diet is very important in the overall treatment strategy for health problems related to the perimenopause through menopause states.

Since overall progesterone is created from the decay of the endometrial lining in menstruation as well, endometriosis or abnormalities of menstrual bleeding could signal a problem with progesterone creation during the menstrual years as well. Since progesterone promotes thickening of the endometrial lining in the uterus, ovarian dysfunction may lead to a precipitous drop in progesterone, both from the lack of progesterone from the corpus luteum, and also from the subsequent lack of progesterone from the thin endometrium. This is exactly what happens in perimenopause and premenopausal states. As the ovaries age and health imbalance creates problems with the healthy formation of the corpus luteum, the menstrual flow may be decreased, menstrual bleeding may be skipped, and the result is a large drop in the production of progesterone.

When progesterone is deficient, greater levels of unopposed estrogens occur, and this may create a number of health problems and risks, especially concerning breast, ovarian and uterine cancers. Progesterone inhibits the actions of estrogens, especially the most active and potent estrogen, estradiol, on certain tissues. The balance of progesterone to estrogens is thus important not only to the healthy function of the menstrual cycle and smooth transition during the perimenopause through menopausal time, but to a wide array of health issues, including cancerous cell mutation regulation, calcium regulation, bone health, fertility problems,

Estrogens must be balanced with progesterones in the physiology. The menopausal state occurs when the ovary no longer produces estradiol or inhibin, and the failure to create the corpus luteum in the ovary, and subsequently the endometrial lining of the uterus, results in a precipitous drop in progesterone, as well as estradiol. Since the hormonal system is a feedback system, the production of FSH (follical stimulating hormone) and LH (luteinizing hormone) in the hypothalamic pituitary axis, is also affected. The loss of natural estrogen inhbition of FSH and LH may also result in a number of hormonal symptoms. While standard medicine has insisted that the emphasis be put on the loss of estrogen as the cause of menopausal problems, the loss of progesterone may be even more important, and the changes from an estradiol dominant estrogen system to an estrone dominant system are also obviously important. The array of hormonal problems caused by imbalances between a number of hormones are what are of concern, not just the loss of estradiol from the cessation of the lack of secretion of the viable egg. Standard medicine has stubbornly refused to address this broader issue, mainly because the focus of pharmaceutical treatment is the replacement of the natural estrogens with a synthetic estradiol. The treatment and prevention of symptoms, health risks, and hormonal imbalance should begin early in perimenopause, not when the menopause occur.

A wide array of symptoms may occur due to hormonal imbalances in the perimenopausal, premenopausal and menopausal states

Most of the focus in menopause has been on the menopausal symptoms, but recognizing the symptoms in the perimenopausal and premenopausal states and understanding what they mean physiologically and how to correct the underlying causes may be the most important issue. The perimenopausal period from premenopausal changes through one year after cessation of the last menstrual period is a highly variable time period. Early signs of perimenopause include a mild shortening of the menstrual cycle, typically from 29 days to 26. There is then a 50% incidence of anovulation, sometimes resulting in a missed menstrual cycle of bleeding. This is normal. Vasomotor symptoms related to heat flush and abnormal sweating may occur in erratic periods around these changes. Prolonged or heavy bleeding may occur, and symptoms that are less obvious, such as nervous tension and lack of energy, are also common and erratic as the perimenopausal hormonal fluctuations start to occur. A long term study entitled the Massachusett’s Women’s Health Study, started in 1981, found that perimenopausal women tended to have an increased incidence of musculoskeletal problems, sleep disturbances, and gastrointestinal concerns as well.

In menopause, a precipitous drop in estradiol may accompany the already precipitous drop in progesterone as ovulation fully stops. Since many cells throughout the body have hundreds of estradiol receptors, changes in the circulating estrogens may have a lot of cellular effects. The cells and local tissues may have to convert to a dependence on higher levels of circulating estrone and estiol, and a more efficient conversion in local tissues of one hormone into another. The fat cells may have to be stimulated to produce more local estrogens as well. This makes for a very complex mechanism. There is no one physiological or chemical action that needs to take place, but rather a complex array of homeostatic restructuring. As stated, the ovaries in the menopausal state continue to function, but now produce estrone more than estradiol. Testosterone may also convert to estradiol in local tissues with the aid of aromatase enzymes. These changes in local hormonal receptors and conversions increase the chance that cell mutations and cell apoptosis (normal programmed cell death) will be insufficiently regulated, increasing the risks of breast and uterine cancers. The key to health in this state is aid the body as it achieves a new type of homeostasis through a complex rebalancing, and the symptoms tell us what is going on, and what needs to work better to achieve this new homeostasis.

In full menopause, sudden loss of estradiol dominance creates symptoms of hot flush episodes, other vasomotor symptoms, mood disturbances, sleep disturbances, and urogenital symptoms, such as dry vaginal membranes and urinary urgency. Signs of the loss of estradiol dominance include osteopenia (loss of bone mineralization), hair loss or thinning, and thinning of the vaginal wall, with unusual bleeding and discomfort with sexual intercourse. Hot flush, or hot flashes, are the most well-known symptom, and may occur either due to neuroendocrine dysregulation (hypothalamic control of temperature) or to vasomotor changes. Other vasomotor signs include sweating, nausea, cephalalgia (headache), dizziness, heart palpitations, and “skin crawling” sensations. Some women may experience dryness in the eyes, nose and mouth as well, contributing to increased allergy symptoms. Decreased estrogens are also associated with a relative excess of androgen effects, and anxiety, hair loss on the scalp, and increased hair growth on the body may result. The body tries to respond by creating more estrone and estriol, and increasing conversion of testosterone to estradiol. Estriol is the most abundant circulating estrogen, but the least active at estrogen receptors. A large amount of estriol converts as needed to estrone, and the estrone converts to active estradiol in local tissues, where the estradiol finally converts to an active form to stimulate many key receptor types. In these local tissues, the balance in the number of progesterone receptors to estrogen receptors keys modulating celluar mechanisms that maintain healthy cells and function, and more importantly regulate the normal cell cycle of life and death, called apoptosis. The number of estrogen receptors on the outside of the cell versus the inside of the cell (estrogen receptor type 1 vs 3, or ER1 vs ER2), also plays a significant role in the regulation of cell apoptosis, and this is often altered by receptor expression changes with menopausal hormonal change and adaptation. Of course, if the cell cycle is prolonged, the chance of cellular dysfunction and mutations increase, which is the main cause of cancer. A smooth transition from the menstruationg estadiol dominant metabolism to the menopausal estrone dominant metabolism is important to decrease the number of cell mutations and receptor changes that stimulate cancerous growth.

Although the predominant symptoms of menopause, hot flush and sweating, are the result of loss of estrogen dominance (imbalance of estrogen versus progesterone), the exact mechanism involves a narrowing of the thermoneutral zone in the hypothalamus (increased reactivity to changes in body temperature), involving a balance of neurotransmitters (and neurotransmitter receptors) affected by the loss of estrogen dominance. These hormonal changes of perimenopause put much stress on this complex feedback mechanism, and restoration of homeostatic controls often require a holistic and thorough treatment protocol that addresses not only hormonal balance and production of steroid hormones by a variety of tissues in the body, but also the improved function of the hypothalamus (re: adrenal-pituitary/hypothalamus axis), and a bioavailability and balance of neurotransmitters. In other words, health of the brain as well as the ovaries and adrenals, is important. In 2011, researchers at University medical schools in the U.S., United Kingdom, Australia, France, Israel, South Africa, Spain, Italy and Chile, led by the Departments of Gynecology and Obstetrics at Columbia University in New York, published the results of a broad review of menopausal symptoms entitled Menopausal hot flushes and night sweats: where are we now?, for Informa Healthcare, acknowledging that “Vasomotor symptoms, specifically hot flushes, are caused by a narrowing of the thermoneutral zone in the brain. This effect, although related to estrogen withdrawal, is most likely related to changes in central nervous system neurotransmitters. Peripheral vascular reactivity is also altered in symptomatic women.” (D.F. Archer et al). To correct this health problem, rather than simply decrease it with synthetic hormone replacement forever, which comes with a wide array of adverse effects and health risks, stimulation of renewed hormone production with bioidentical hormone therapy, as well as stimulation of hypothalamic function and neurotransmitter homeostasis, and restoration of peripheral vascular health and reactivity, may be needed. While this is a more complex course of therapy, the achievement of restoration will not require chronic use of medication, and will result in an array of health improvements and decreased risk of related comorbid conditions. Quality of life will be improved along with symptom relief, and risk of hormonal cancers and cardiovascular problems will be dec

With menopause, symptoms may be decreased by supplementing with a topical estriol cream of low dosage, as well as a temporary prescription of estrone by the medical doctor when necessary. The most desirable scenario is to avoid the estrone pill, but sometimes this is temporarily needed when menopausal symptoms are extreme. An array of dietary, nutrient and herbal aids may also help with symptoms as well, and acupuncture is now well studied and proven to be able to help with true menopausal symptoms. The use of estriol topically is very safe, but always should be balanced with the use of progesterone stimulating creams. Balance between the estradiol and progesterone is very important, and simple monitoring via saliva tests is now affordable and accurate. Such testing also helps guide the physician to prescribe the right amounts of topical creams and guide the patient in monitoring the symptoms to adjust the dosage as needed. A good understanding of the symptoms guides the patient in the daily choices of dosage of the topical creams, and utilizing the lowest effective dose is very important to achieve a quick reestablishment of the new homeostatic health and hormonal balance in the menopausal and post-menopausal state.

What may be most important to the woman as she enters the perimenopausal year or years, is the recognition of symptoms and signs of progesterone deficiency, though. Progesterone is the first of these hormones to precipitously drop in circulation during premenopausal changes, and a prior progesterone deficiency is often seen that could contribute as well. This progesterone deficiency in the years preceding perimenopause usually, but not always, manifests as premenstrual symptoms of bloating, breast tenderness, fibrocystic breasts, moodiness, menstrual migraines, and low back pain. One, all, or none of these premenstrual symptoms may occur and signal a progesterone deficiency. Skipped, late or insufficient menses may also be a sign, as well as poor blood flow, excessive clotting, and menstrual cramping. Correcting this progesterone deficiency will not only insure a less problematic PMS and menstruation, but may help to prevent symptoms and health problems in the perimenopausal through menopausal states as well.

Use of a progesterone stimulating topical cream of low dosage is very helpful to correct the progesterone metabolism, but should be combined with a holistic regimen to restore normal homeostasis and quickly end the dependence on external progesterone stimulation. The phytochemicals currently in use to achieve progesterone stimulation include a type of wild yam extract (Dioscorea villosa) containing the active diosgenin, and a specific set of phytohormonal chemicals from the soybean. While none of these chemicals are progesterone, they do stimulate increased progesterone production by acting on the progesterone receptors. Other species of Dioscorea are also well used in herbal medicine around the world, and some of these have chemicals that also are shown in studies to exert phytohormonal effects. A number of clinical studies have been designed with the mistaken notion that these extracts exert phytoestrogen effects, which they do not. Some studies have demonstrated that the wild yam based topical creams do not significantly reduce hot flush in the menopausal woman, and this is true when used alone. A balance must be reestablished in menopause, and use of the estriol and progesterone creams together is needed to correct imbalances and speed the healthy transition. Such published studies appear to be designed to discourage use. These studies do consistently show that the topical progesterone stimulating and estriol creams are safe and without significant side effects. The premenopausal woman must be aware that the improper timing and dosage of the progesterone stimulating cream will alter the changing hormonal balance within the cycle and when taken improperly may cause anovulation and amenorrhea. Professional guidance is highly recommended, and monitoring hormonal levels with saliva tests is beneficial as well.

The precursor to progesterone in the body is DHEAS (dehydroepiandosterone-S) and the precursor to this hormone is pregnenelone. We also know that pregnenelone, an abundant and beneficial hormone in the body, is available as a phytohormonal bioidentical plant chemical, and use of the pregnenelone topical cream may also increase the bioavailability of progesterone in the body. Adrenal insufficiency may be involved, and for some women, stimulating of adrenal function may eventually help the body to achieve a better hormonal homeostasis and progesterone and estrogen normalization.

Understanding the hot flash, night sweats, and other vasomotor symptoms

Numerous studies show that over 80 percent of women in the United States experience vasomotor symptoms of hot flush and abnormal sweating at various stages of the perimenopausal course. Symptoms may be mild or severe, temporary, recurrent or persistent. If these problems are not addressed properly they may continue for years postmenopausally. Each woman must make the choices concerning the need for treatment. The gonadal hormones all play a part in the regulation of the vasomotor system, and an intelligent approach assesses the abnormalities from physiologically normal levels of the three estrogens, progesterone, testosterone, DHEAS, and cortisol levels. The help of a knowledgeable TCM physician makes this often complex and confusing task much simpler.

While typical vasomotor symptoms in perimenopause are hot flush and heavy sweating, a wide array of variable symptoms may occur. Some studies have reported that over 50 percent of women with hot flashes experience chill after the episode, and such symptoms as headache with the sensation of pressure throughout the head, sensation of pressure in the chest, anxiety, changes in the heart rate and breathing, and mood disturbances are not uncommon. The reasons for these vasomotor responses center on the hypothalamic control of core body temperature, which normally oscillates in a circadian rhythm controlled mainly by cortisol levels and melatonin. Disruption of this tightly controlled hypothalamic thermostat results in exaggerated heat-loss responses of flush and sweat, and may involve changes in core circulation, such as heart rate and breathing pattern. While estrogens, especially estradiol, are potent modulators of this system, a number o hormones, neurotransmitters and even immune cytokines play important roles in the overall regulation.

Typically, hot flush and night sweats occur with a low progesterone relative to estradiol, but low testosterone, high FSH, surges of LH, increased cortisol at night, increased adrenalin (epinephrine), and low beta-endorphin levels have all been associated with hot flush and night sweat. Some studies have indicated that low levels of antioxidants with high levels of reactive oxygen species may also contribute to hot flush and night sweats. Hormonal imbalance is thought to create a potential for exagerrated emotional responses and emotional triggers that may more easily set off episodes of hot flush and sweating. The exact physiological mechanism is still not completely understood, but prominent theories state that these hormonal imbalances affect neurotransmitters and neurotransmitter receptors to trigger the episodes. A thorough treatment protocol may thus need to be established for some time before normalization of all of these parameters occurs.

Cortisol is an adrenal steroid hormone, or glucocorticoid, that is secreted in a complex feedback control in the hypothalamus-pituitary-adrenal axis, and fluctuates normally in a diurnal pattern, meaning that the levels during the day should vary against the levels at night. Frequently, in the perimenopausal syndrome, cortisol imbalance due to adrenal stress or deficiency will occur, and usually an excess cortisol at night with a dificient cortisol during the day results from a sluggish adrenal-hypothalamus feedback response. This may cause a restless sleep and contribute to night sweats and flush. Vascular effects related to cortisol include blood pressure changes, vasodilation, and sodium regulation. Chronic cortisol imbalances may have a depleting effect on the hypothalamic function. Poor regulation of temperature and exagerrated responses of vasodilation may contribute to night sweats, hot flush and other vasomotor responses.

Much is being made about the role of FSH, or follicle-stimulating hormone, rises in the perimenopausal and menopausal state. Some supposedly more alternative medical doctors state that this is due to a last-minute attempt by the body to stimulate fertility in the older woman. This is of course a fairy tale, but may sell the course of therapy for some women, which often includes some herbs and nutrient medicines, but still pushes synthetic estradiol. The truth is that the rise in FSH is due to a protein hormone called inhibin, which normally balances with activin in the ovary to help regulate FSH secretion from the pituitary. Inhibin normally inhibits FSH, and a stopping of the ovulation creates a lack of inhibin. A decrease in the number of viable egg follicles may also results in less inhibin as well, and consequently an increase in FSH. This inhibin effect is accomplished by affecting the aromatase enzymes. Inhibin levels, like FSH, vary considerably from day to day in the menstrual cycle, and even perhaps hour to hour due to the pulsatile release of the LH. Levels of FSH have little direct effect on the creation of perimenopausal symptoms, but do tell us that a complex balance of hormones is necessary to achieve a healthy hormonal homeostasis. Inhibin secretion from the ovary is not only diminished by a drop in FSH, anovulation, and decreased estrogens, but also by diminished GnRH (gonadotropin releasing hormone), and inhibin may be increased by insulin-like growth factor-1. Hypothalamic dsyfunction may play a significant role. FSH levels may be more of a marker for hormonal problems in perimenopause than a cause. In addition, low FSH levels are associated with polycystic ovary syndrome, hypothalamic insufficiency, hyperprolactinemia, and gonadotropin deficiency.

Hormonal deficiencies in Menopause, Infertility, Pre-Menstrual Syndromes, Anovulation, and related health problems

These last years have brought great clarity to the treatment of hormonal problems. The amount of knowledge from research in response to the failure of the synthetic hormone replacement therapy (HRT) has finally brought these problems and the effective restoration of hormonal balance, or homestasis, into focus. In addition, we now see exactly how the hormonal deficiencies affect a wide variety of disorders. Estrogen deficiencies are a primary cause for problems with short term memory and attention problems, poor tissue healing, inflammatory disorders related to tissue calcification, and a variety of calcium related problems, including osteopenia and osteoporosis. Progesterone deficiencies create a relative estrogen excess even in estrogen deficient states, and are responsible for most menopausal and premenstrual (PMS) symptoms, and many cases of infertility, as well as the possibility of cancerous growth. Hormone dysfunction is a prime contributor to metabolic disorders and creates an added stress that contributes greatly to insulin resistance, diabetes and weight gain.

What do we do with this wealth of medical knowledge? Has it resulted in simple herbal cures? The answer is no. The endocrine system is the most complex system in the body, and most hormonal problems are multifactorial. The endocrine system also acts in a feedback manner to achieve a constant complex regulation, and affecting just one aspect of this system with a single herb is usually not enough to restore your normal physiological homeostasis. Fortunately, there are medical practitioners, such as Licensed Acupuncturists and herbalists, with the knowledge and skills to utilize a holistic and individualized approach to these problems. The integration of simple laboratory saliva and veinous blood tests, topical herbal creams, supplements and herbal formulas, with acupuncture, and guidance in your dietary regimen and lifestyle, has created a package of care that is phenomenally effective and tailored to the individual case. Finally, the knowledge and treatment options have accumulated over time to give Complementary Medicine physicians a treatment plan with a great chance of success when integrating with standard care to correct hormonal imbalances and deficiencies. This safe and conservative approach may be tried before resorting to synthetic hormonal therapies that come with side effects and risks. Restoration of the endocrine balance when going off of synthetic hormonal therapies may also be achieved with Complemetary Medicine.

Use of strong hormonally altering drugs in fertility treatment is now commonplace. These medications do come with risks of adverse effects and even fetal mutations. Use of these strong hormone altering medications may have implications for future hormonal health and balance in perimenopause, especially if this drug therapy is prescribed after the age of 35. For this reason, and because statistics show poor success rates for the older woman, many fertility clinics have quit accepting women over the age of 40 for these fertility drug regimens. Before resorting to these drug therapies, many women are now trying to correct underlying problems inhibiting fertility with a holistic approach. A wealth of research guides this therapeutic protocol, and many fertility experts are incorporating acupuncture, herbal and nutrient medicine into their practice, even medical doctors and clinical nursing specialists. Most problems in younger women may involve subfertility issues, and a normal, safe and healthy pregnancy will occur for most of these women when a few simple health issues are resolved. Taking a more natural approach to subfertility and fertility issues creates greater assurance that your baby will be born healthy and avoid many of the health problems associated with multiparity, ART, and drug therapies.

In 2007, a large women’s health survey was published in the medical journal Menopause: The Journal of the North American Menopause Society (vol. 14 (3) 397-403) concerning the use and success of Complementary Medicine by symptomatic women transitioning through perimenopause in Sydney, Australia. The study followed 1,296 women from three Sydney menopause clinics, general practice clinics and government agencies. Of these women recruited in standard medical clinics and programs, 53.8 percent had acknowledged visiting a Complementary Medicine practitioner, such as a Licensed Acupuncturist and herbalist, or simply used a CAM product during the past year to treat perimenopausal symptoms. Unfortunately, only 5 percent of these women consulted a practitioner (Naturopath or Licensed Acupunturist) only when utilizing these medicines, and only 46 percent of the women utilized professional guidance at all. Most of the women simply bought products via commercial advertisement with a professional assessment. Most of these products were thus very simple and mild, such as soy isoflavones and evening primrose oil. Nevertheless, the conclusions from the study stated that the report of effectiveness from users was high, and a significant number of women taking prescription hormone replacement also utilized these herbal and nutrient medicines, as well as professional treatment in Complementary Medicine. While this shows the patient satisfaction with these therapies, the overall success could obviously be much higher if Complementary Medicine was more professionally utilized and integrated with standard medical protocol. The lack of support in standard medicine was noted (only about a fourth of these women reported even a inquiry about CAM utilization by their MD), and of course, the failure of insurance and government health organizations to provide financial support was also a significant hurdle to increased professional utilization. The burden of choosing an effective treatment for perimenopausal syndromes within the realm of Complementary Medicine is still largely the responsibility of the woman herself, who must take a proactive role, both in seeking professional care, and often, in paying for it. Perhaps this will change in the near future as more of these large studies are published.

What do you do to correct your hormonal problems with integrative Complementary Medicine? You need to spend the time for a thorough history and consult with a knowledgeable practitioner, such as a Licensed Acupuncturist and herbalist. You may try to find an endocrinologist that is open to integrative approaches. When you and your health providers are on the same page you can expect to get great results. In Complementary Medicine you need to take a proactive approach to the therapeutic course and the adjustments in therapy that are needed. You need to gain an understanding and work with your physicians to insure that lasting success is obtained. A number of articles are provided on this website to help you gain a thorough understanding. You’ll be glad you did in the long run.

Problems with utilizing HRT (hormone replacement therapy with synthetic hormones such as estradiol sulfate) alone in the treatment of menopause

While some women with severe symptoms are going to utilize HRT to decrease symptoms, a number of choices in this protocol is sensible, not just the binary question of pharmaceuticals versus alternatives. When taking these HRT chemicals, reducing the need of dosage, using the least problematic course of therapy, and integrating Complementary Medicine into the treatment protocol presents many benefits, both in the short and long terms.

Decreasing the number of years that the synthetic estradiol or natural estrone pharmaceuticals are taken is important for the overall health. The Harvard Nurses’ Health Study found that women that took estrogen medications after menopause for ten years or more were 50 percent more likely to develop asthma than women who never took the HRT medications. The risks increased with dosage and time of use. A total of 121,701 women were followed from age 33 on in this study. Declining estrogen levels in studies were associated with asthma risks as well, presenting a dilemma for medical doctors who only prescribe pharmaceuticals. The answer, of course, is to integrate effective Complementary Medicine into the protocol to help normalize hormonal balance and metabolism. This is still rarely inititated by the MD, though, and the wise patient will request this integration of specialties.

While the asthma example is just one health aspect, it is revealing in its scope. Of course, the Women’s Health Initiative is now well known and the results of long term study show many health risks and adverse effects related to HRT, especially with long term use. To read more about the negatives of HRT, go to the article entitled Hormone Replacement / Contraception on this website.

Dietary considerations in Perimenopause transition

A variety of dietary considerations are important with optimizing perimenopausal homeostasis and resolving symptoms. Health studies have shown that a more plant-based diet rich in healthy essential fatty acids and balanced omega 3 and 6 are proven to benefit women in perimenopause. Whole grains, beans and legumes, green leafy vegetables, healthy oils, fresh nuts and seeds, and an array of healthy fruits is recommended. As always, the proper balance of these foods in the diet is most important, not just eating a single food that is advertised as the supposed miracle cure. The choices are complex, but this is not a bad thing when considering your diet, as complexity may equal enjoyment when eating and experimenting with healthy foods and recipes. When the symptoms and health problems underlying imbalance become complex, it may be best to consult a knowledgeable Complementary Medicine physician, such as a Licensed Acupuncturist and herbalist, or a Naturopathic doctor. Below are just some of the researched considerations and explanations for why specific dietary changes may be chosen. As always, this is an individualized consideration, and while some dietary principles may be universal, each woman has some degree of individual needs.

1. Carotenoids: carotenoids are a family of fat-soluble nutrients that are categorized as either xanthophylls or carotenes. These yellow to orange pigments are widespread in plants, and when the green chlorophyll declines in the fruits and roots of these plants, foods rich in carotenoids will develop a strong yellow to orange color from carotenoid pigments. As stated, carotenoids from the diet are important to the healthy development of the corpus luteum of the egg follicle that matures in the menstrual cycle but is not released. This corpus luteum provides the needed shot of progesterone that is needed to maintain the menstrual homeostasis. Since progesterone in the premenopausal stages is often dropping precipitously, carotenoids may be a valuable food in the early perimenopausal changes. The most studied carotenoids are beta carotene, lutein, lycopene, and zeaxanthin. The oxygen containing carotenoids include lutein and zeaxanthin, while the non-oxygen containing carotenoids include beta-carotene, alpha-carotene, and lycopene. Some nutritional supplement formulas deliver these key phytochemicals, but a number of nutritious food sources should also be considered. Beta-carotene is abundant in carrot juice, but also in any bright yellow to orange fruit or vegetable. Lutein is found in high concentrations in many dark leafy greens. Lycopene is found in high concentration in many red colored fruits and vegetables, such as red grapes, pink grapefruit, red bell pepper, and watermelon. Lycopene also gives the reddish tint to unprocessed palm oil, purported to be the richest source of carotenoids. The Chinese herb seabuckthorn (Sha ji, or Hippophae rhamnoides) contains a high concentration of carotenoids, which explains its medicinal use. The pulp oil of sea buckthorn contains the highest concentration by far, whereas the seed oil contains a relatively low concentration (beware of commercial products). Retinols (carotenes and cryptoxanthin derived) are also found in high concentration in dark leafy green vegetables (especially collards and turnip greens) and apricots (dried or fresh), as well as cantaloupe. Bananas and orange juice contain a small concentration. Red berries, mangos, papayas, kumquats, persimmons, and a host of tasty red, yellow and orange fruits are full of carotenoids. The foods and herbs with the highest concentration of beta-carotene include noni, chrysanthemum, sorrel, jujube, spinach, carrot, barleygrass, comfrey, gotu kola, watercress, papaya, and artemesia absinthia, in that order. Alpha-carotene is also found in carrot, and small concentrations in corn, tangerine, orange, avocado, raspberry and plantain. Lutein is found in rhubarb, bilberry, plum, black currant, avocado, pear, kiwi, grape, raspberry and watermelon, in that order of concentration. Lycopene is found in watermelon and carrot. Eat and enjoy.
2. Lignans: in 2006, Italian researchers at the University of Insubria, in Varese, found that the concentration of plant lignans in the Norway spruce, mainly hydroxymetairesinol, converts to a significant amount of the human hormones enterolactone and enterodiol, which are produced by normal intestinal bacteria, and produce a significant estrogen effect at receptors while also inhibiting estrogen dominance in a modulatory manner. This was a significant finding, and subsequent studies showed that a percentage of women with perimenopausal and postmenopausal hot flushes benefited from the supplement. Of course, establishing a healthy intestinal flora and fauna, or microbial colony, is thus also important when consuming lignans. If there are intestinal problems, clearing these and then using a professional probiotic regimen will help allow these dietary lignans to help with perimenopausal hormone balance. The supplement medicinal NuLignan may also be very helpful. Various lignans are found in sesame seeds, flax seeds, rye, steel cut oats, barley, barleygrass, pumpkin seeds, beans, broccoli and berries. Lignans may also be applicable for prevention or treatment of breast cancer, colon cancer, liver cancer, prostate cancer, osteoporosis, cardiovascular disease, and hyperlipidemia, as well as obesity and insulin resistance. Herbs containing lignans include Siberian ginseng (Ci wu jia), Du zhong, Luo shi teng, Hong hua, Pa jiao lian, Zanthoxylium, and various medicinal berries. Many herbs have chemicals related to lignans in Chinese medicine, though, and the artemesias, cinnamons, magnolias, salvias, and Chai hu are examples of commonly used herbs that have effects related to lignans.
3. Isoflavanoids and bioflavonoids: isoflavones, lignans and coumestans are the 3 major classes of phyotestrogens, which exert modulatory effects on the steroid hormone metabolism via evolved metabolic processes. Isoflavonoids, found in soy and many other healthy foods, are polyphenic compounds that are related closely to isoflavones. They exert significant antioxidant benefits as well. Soy isoflavone supplements have been well researched and many beneficial effects have been found, but are not an effective treatment for perimenopausal symptoms and osteoporosis on their own. Eating of soy is problematic as the soy bean contains a number of chemicals that make it hard to digest. Heavily promoted soy milk and poorly formed soy food products do present some adverse chemistry. This is why Asian civilizations created fermented soy products such as tempe, and utilized a number of elaborate steps and herbal chemicals in creating a healthy tofu. Commercial tofu in the United States may not always be a healthy product. The isoflavones genistein and daidzein, though, are found in a variety of supplement formulas, and in various foods and herbs besides soy. Green beans, mung bean sprouts, alfalfa sprouts, cowpea and kudzu contain significant concentrations. Fermented soy miso has a more concentrated isoflavone profile than other soy products. Chick pea (garbanzo), lima bean, and peanut are good sources. Herbal sources include Red Clover (trifolium), which explains why this tincture works so well for many women with perimenopausal symptoms. Other bioflavonoids (flavonoids) include quercetin, epicatechin, kaempferol, apigenin, anthocyandidins, and myricetin. These too are found in a significant number of foods and herbs. Red Clover (Trifolium pratense) is highly touted as a source of isoflavonoids that benefits many women with perimenopausal symptoms. Red Clover contains a balanced array of flavonoids, coumarins and coumestol, which may explain why it works so well for many women. Separating these chemicals from their naturally evolved balance may have much reduced effect. A quality Red Clover tincture is recommended to capture the most esssential chemicals in extraction. While isoflavones are not a panacea for perimenopausal pathology, they are a healthy addition to the diet, and provide a number of benefits. Studies do show that higher doses of these phytohormonal nutrients do not appear to increase benefits, though, and a daily small dose, mainly from the diet, is the recommended course of therapy. Eating a variety of beans may be the most essential component to this protocol, but a wide variety of vegetables, nuts, seeds, legumes and oils provide these three phytohormonal nutrient classes, isoflavones, lignans and coumestans. Research, enjoy, experiment and cook.
4. Essential fatty acids: depending on the diet that one has been eating, an essential fatty acid imbalance may occur, and now numerous studies point to the healthy outcomes when these imbalances are corrected. Unfortunately, the public is not paying attention to the word balance, and instead relies on commercial marketing to make the choices of what essential fatty acid sources to purchase. The most well known and studied of these are the class of omega 3 essential fatty acids, because the typical modern diet in the United States has been very imbalanced with excess meat and simple starches, creating a deficiency of omega 3 fatty acids. On the other hand, vegan diets may create an omega 6 deficiency. The two most well prescribed sources of this in pill form are krill oil, with a balance of the main essential omega 3s, and GLA, an omega 6 from seed oil. Taking both could not hurt if deficiency is suspect. Many health problems, but especially chronic inflammatory states, and chronic health problems with the intestinal tract, create essential fatty acid deficiencies as well as the poor diet. While fish oil supplements and salmon consumption have exploded in popularity, this comes with some serious negatives. Most salmon, and in fact, many ocean fish today, now come from unhealthy fish farms in the ocean that create diseased conditions that require a huge amount of antibiotics and other chemicals to keep the fish healthy and promote fast growth. Disease from these fish farms is spreading to the wild fish populations, decimating them in many areas, and the oils from these fish are proven to have reduced concentrations of key beneficial chemicals. The public needs to demand healthy practices of fishing and raising fish if this is to change. The governments of the world are doing almost nothing to stop this bad practice.
5. Alkilinizing foods: many problems in perimenopause may be related to chronic acidity, which inhibits a number of physiological processes. Of course, restoring gastric function may lie at the heart of this problem, but dysfunction in the calcium metabolism (calcium is the main alkilizer utilized in the body), excess consumption of acidic foods (red meat, orange juice, and simple carbohydrates such as brekfast cereals and sugary foods), liver stress (excess alcohol, cigarettes, fatty foods), and kidney stress (excess carbonated beverages) may also play important roles in chronic acidic states. Eating alkilinizing foods may help over time. Most alkilinizing foods are fresh vegetables, and the percentage of fresh vegetables in the diet should be increased. Raw vegetable juices are alkilinizing, but too much may be difficult for your digestive system to deal with, and this is perhaps not sensible for all persons, especially if gastric hypofunction issues exist. Dark leafy green vegetables are especially alkilinizing, as well as sprouts, and most of these have no drawbacks, although some may produce an excess of chemicals that may lead to gallstones and kidney stones in particular individuals, such as beet greens and kale. Collard green, mustard greens, brussell sprouts, cabbage, celery, cucumber, dandelion greens, parsley and spinach are good foods to alkilinize. Onions, shallots, garlic, asparagus and beets are also recommended. Seaweeds, such as kelp, dulce, sheets of toasted nori, and kombu are not only alkilinizing, but supply iodine and minerals. Spirulina, barley grass powder, and chlorella are also alkilinizing and provide a host of beneficial nutrients. Whole grains such as amaranth cooked as a breakfast porridge with steel cut oats, buckwheat, quinoa, lentils, lima beans, and a variety of dried beans easily cooked in soups or as bean salads, also provide alkalinization with a host of other beneficial nutrients. Coconut, almonds, flax, pumpkin and sesame seeds are alkalinizing. Cantaloupe, apricot, banana, berries, dried figs, currants, pears and avocado are alkalinizing fruits.

Dietary Supplements that may be beneficial in perimenopause

Each individual may have different needs and nutritional deficiencies in perimenopause, and some of these are measurable. The hormone called Vitamin D is a good example. Many perimenopausal women have a Vitamin D deficiency, and this hormone (not really a vitamin) is important in the regulation of calcium metabolism and many other cellular processes. Dietary deficiency is not the most important concern, or cause, of D3 deficiency, though. Most of our D3 (cholecalciferol, the prohormone that creates the prehormone calcidiol that creates the ability to synthesize actual hormone vitamin D) comes from health cholesterol converting to the cholecalciferol in the layers of the skin that are exposed to midday sun. Even sun exposure (without sun block) may not be the crucial issue, though, as the regulation of the D hormone and calcium metabolism is complex. A holistic approach to hormonal restoration is recommended to restore the body’s ability to produce D hormone as needed. Taking a high dose liquid supplement, though, does help the deficiency and may reduce related symptoms and risks temporarily. Since the body has a rate limiting mechanisms where about 25,000 IUs can be synthesized per day, taking more than 5000 IUs per day may be counterproductive. We want our bodies to synthesize D3. Correcting the underlying problems is the key, though, and generating healthy cholesterols, achieving a fatty acid balance, and promoting improved liver and kidney/adrenal health is important. A simple veinous blood stick test can be used to monitor the levels of circulating hormone vitamin D and guide therapy.

Since calcium is perhaps the most highly regulated molecule in the body, taking any old calcium supplement in perimenopause is not a good idea to correct problems related to calcium metabolism. In fact, numerous studies have shown that many types of calcium supplement not only do little good, but have the potential to creat tissue calcifications, joint inflammation, kidney stones, and gallstones. The chemical attached to the calcium is the most important consideration when taking supplements, and a professional Complementary Medicine physician can supply the right type of calcium for specific needs, as well as design an individualized treatment protocol to restore a healthy calcium and hormonal metabolism. A number of common medication protocols may also play roles in preventing absorption of calcium, especially the gastric inhibitors so often prescribed for any complaint of heartburn whatsoever without a proper diagnostic workup. In a majority of these cases, gastric hypofunction may be the problem, not simple excess production of stomach acids. Antidepressants have now been shown to play negative roles in calcium regulation since serotonin is the key neurotransmitter in the gut regulating the absorption of calcium from the diet, and the utilization of calcium. Since more and more medications that affect serotonin metabolism are being prescribed for a wide variety of health problems, this subject and the array of health warnings is becoming complex. Certain antibiotics, pain medications, and other drugs have received warnings concerning creation of serotonin imbalances. In certain areas of the United States a large percentage of women over the age of 40 have been shown to have a hormone vitamin D deficiency as well. Since this D hormone is produced in the kidneys as needed, and plays a vital role in all calcium metabolism, absorption from the diet to deposition and withdrawal from the bone stores, restoring hormone vitamin D metabolism may be very important. The way to do this is to assess the levels, take a high dose of the prohormone D3 cholecalciferol as needed, obtain adequated midday sun exposure, and correct kidney and adrenal dysfunction. Looking at the whole picture of calcium in the body may be necessary to correct problems with calcium metabolism.

Essential minerals besides calcium may play a large role in many neurohormonal processes, and may easily become deficient when the hormonal regulation is stressed in perimenopause. An essential mineral supplement of quality may help restore this essential metabolism. This subject may best be addressed with the help of a professional, though, that performs a thoughtful assessment and prescribes individually, rather than adopting a one-size-fits-all approach.

DIM (diindolylmethane) is a well-studies nutritional chemical that the body produces from I3C (indole-3-carbinol), which in turn is derived from the breakdown of glucobrassicin, a compound in cruciferous vegetables, that is found in such foods as broccoli, but is most concentrated in cauliflower. Cauliflower and broccoli are actually the same plant with different flowers, and now the broccoflower, or green cauliflower is available as well. Getting the body to produce a lot of DIM from eating cruciferous vegetables, which includes Brussel sprouts and cabbages as well, is difficult, though, and a professional DIM supplement is recommended. ProDIM affects the estrogen metabolism in a beneficial way, helping the body to balance the 3 types of estrogens in the body, and acts on the aromatization of the estrogen at the receptors, and the aromatization of testosterone to estrone in local tissues. The more beneficial local estrogens, 2-hydroxy estradiol and 2-hydroxy estrone may be increased with DIM use, while the local tissue metabolites 16-hydroxy estrone and 4-hydroxy estrone may be decreased. Originally researched for its benefits in preventing breast cancer, a number of studies and human clinical trials have demonstrated the benefits of DIM in the treatment of perimenopausal estrogen dominance. In perimenopause, slow or dysfunction estrogen metabolism may create an excess of the more active estradiol, and an excess of estrogen metabolites that act as reactive oxygen species. While DIM may not be a miracle cure, it is proven to exert valuable effects to help the woman experiencing perimenopause maintain a balanced hormonal homeostasis and prevent breast cancer.

NuLignan is a concentrated patented form of lignan supplement that is derived from the Norway spruce and proven in clinical trials to benefit hormonal balance for a high percentage of women experiencing perimenopausal changes. Once again, while this supplement may not have an immediate and dramatic effect, the chemical effects are well studied and proven, and the woman can be assured that the benefits are being derived, and that she will be healthier in the long run taking this nutritional supplement.

Quality sources of omega-3 and omega-6 essential fatty acids should be utilized periodically. As stated, if the diet has been focused on red meat and simple carbohydrates, omega-3 fatty acids in the form of krill oil is recommended. If the diet has been predominantly vegan, GLA, an important omega-6, is recommended. For all patients, periodic supplementation of both of these may be beneficial as the hormonal changes create increased demands.

What to avoid in the diet during perimenopause

Unhealthy fats and a diet centered on a high percentage of meat and simple carbohydrates should be avoided in perimenopause. The Nurses’ Health Study, began in 1976, and associated with such institutions as Harvard University School of Public Health, is the gold standard for long term studies in this regard. In 2003, a large study showed a high association of increased breast cancer risk during perimenopause for women with high intake of red meat and butterfat, with a 75% increased risk. The researchers studied nearly 100,000 women over decades, and concluded that a more plant-based diet, and healthier fats in the form of unprocessed vegetable, nut and seed oils should be promoted. This is just one example of the numerous studies finding association with a typical American diet and menopausal pathologies.

Information Resources

A large and increasing number of research studies of perimenopause, premenopause, menopause and post-menopausal states is avaible to physicians and patients today. An array of confusing advice and information has been presented, though, mostly to increase sales of particular pharmaceutical medicines, but also to promote specific herbal and nutrient products with sometimes inaccurate claims. Below is a set of links to studies and information resources that seem sound and accurate.

1. A 1998 article in the medical journal Endocrine Reviews by researchers at the University of British Columbia and Vancouver Hospital and Health Sciences Center in Vancouver, British Columbia, Canada, clearly outlines the history of misinformation concerning the complex physiology of the perimenopausal state, and how this physiology was largely ignored in studies to promote menopausal drug therapy: http://edrv.endojournals.org/content/19/4/397.full

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.