Menopause

Menopause is a normal biological process, often referred to as “change of life” for women when there are no longer any eggs left in their ovaries.

This “burning out” of the ovaries reflects a natural course of events and is often characterized by hot flashes, vaginal dryness, night sweats, headaches, mood swings, and fatigue. With menopause, the absence of active follicles results in a significant drop-off in estrogen and progesterone levels. Menopause is often treated like a disease by American physicians, and though it is certainly not a disease, it can signal a woman’s increased risk for diseases, including osteopenia, osteoporosis, coronary-artery disease, Alzheimer’s, or even cancer.

Never before has the American public been so bewildered and confused over the terms menopause and estrogen. The medical world will never be the same after the news broke on July 9, 2002 that a long-term study has shown that estrogen (Premarin) and the combination of estrogen and progestin (Prempro) might pose a significant health risk to women who take them to prevent menopausal-like symptoms. This study was indeed a revelation and reinforced what qualified alternative health-care practitioners have been saying for years—that not all women automatically need hormone-replacement therapy (HRT) when they turn menopausal age, and most women do not need to assume the increased risk of taking HRT. 

So what’s a woman to do?  With the widely reported risks of conventional therapies for hot flashes, many women are exploring as an alternative the use of botanical medicines and dietary supplements. They hear about the risks of synthetic estrogens, but their OB-GYNs insist that the advantages outweigh the risks. They read about the benefits and safety of phytoestrogens, but they aren’t sure what they are, if they are safe, and how they work. They are apprehensive about the ravages of osteoporosis, or weakened bones, and yet they are convinced they don’t want “chemicals” in their bodies. And they worry about their sex appeal and loss of libido. Does menopause mean the end of female sexuality?

When considering HRT, it is important for women to ask questions and seek professional counseling. They should explore the pros and the cons, the facts and the fiction, the natural and the synthetic approaches. They should obtain information from a doctor, an OB-GYN, a pharmacist, a naturopath, a nurse, a magazine, a book, and from whatever other sources are available to them. Ultimately, women must decide for themselves what is best for their bodies. But before deciding, they should get educated and garner as much information as possible.

Symptoms

The most common complaints and symptoms summarized in a menopausal index include hot flashes, sweating, sleep disturbances, night sweats, nervousness, depression, fatigue, vertigo, arthritis symptoms, low libido, and vaginal dryness. 

The Hormones

Estrogens (Estradiol, Estrone, Estriol)

Following menopause, a woman’s total estrogen production declines 70 to 80 percent. This is nature’s way of telling her she can no longer get her monthly period or have children. This sudden decline in estrogen produces a rash of irritating effects, including hot flashes, painful intercourse, vaginal dryness and burning, night sweats, and bladder infections. Decreased sexual pleasure and activity may ensue because of painful intercourse. Estrogen replacement (HRT) can be a double-edged sword. On occasion, HRT can definitely alleviate hot flashes, lubricate the vagina, improve sleep, help maintain bone mass, and improve a sense of well being. The side effects, however, of HRT include increased cancer risk, possible heart problems, weight gain, depression, and blood clots. Estradiol is the most potent estrogen hormone in a woman’s body, triggering female reproductive organs and secondary female sex characteristics. In pre-menopausal women, low estradiol is unusual unless they are on birth control pills, but post-menopausal women, estradiol can influence a female’s skeletal mass and stimulate the deposition of fat in subcutaneous tissue, particularly breasts, buttocks, and thighs. Low levels occur in women who have had a hysterectomy and/or ovaries surgically removed.  It is assumed that high estradiol levels in post-menopausal women is usually due to insufficient progesterone levels.

Testosterone

In the adult female, testosterone plays an important role in maintaining lean body mass, bone density, skin elasticity, and blood-cell production. Although testosterone is the main male hormone, it can be just as important for a woman’s sexual satisfaction as it is for a man’s. Testosterone is responsible for the intensity of orgasm, the ability to achieve climax, the sensitivity of the clitoris, and sexual interest. Women experiencing severely decreased libido (sex drive) may benefit from a small amount of testosterone. For low levels of testosterone, DHEA can be used and progesterone may help. For high levels of testosterone, Dr. John Lee has suggested supplementing with chaste tree berry extract. Women should consult a qualified health practitioner for recommendations regarding supplementation.

Progesterone

Progesterone is the weakest of the hormones, but it is the temperate (balancing) hormone in the body. Progesterone is as significant as estradiol in maintaining female function. Like estrogen, it is important that progesterone levels stay within their proper range. When progesterone is low (due mainly to high estrogen levels, estrogen dominance from HRT use, a diet heavy in meats and dairy products and light in green foods, chemicals, pesticides, stress, and anxiety), symptoms appear quite readily. Low progesterone symptoms include fatigue, weight gain around the mid-section, low libido, cravings for sweets, depression, irritability, cold feelings in extremities, loss of hair, fibroids, and headaches. Progesterone more indirectly affects a woman’s sexuality. During menopause, when the ovarian levels of the sex hormones (estrogen, DHEA, and testosterone) decline, adrenal gland conversion of progesterone to these hormones increases. For many women this may be enough to help them regain their sex drive. Low progesterone levels are generally found in pre-menopausal women with little or no ovulation, luteal insufficiency, or the use of birth control pills containing synthetic progestins.  Low levels can be found in post-menopausal women who have had their ovaries removed, or still have high estrogen levels (pushing down progesterone). High progesterone can occur with over-supplementation and/or sluggish metabolism. Supplementation with bio-identical progesterone is becoming a common practice for American women. Natural progesterone is safe, without risk, and often very effective.

Pregnenolone

Also known as “preg,” pregnenolone is a natural hormone which has recently emerged as an overlooked steroidal compound with various therapeutic properties. Studies conducted with pregnenolone strongly suggest that it has impressive physiological merits that should be further investigated. These studies reveal the hormone’s impressive ability to stimulate healing and enhance brain function. There is probability that pregnenolone can be used to treat various conditions, including lupus, psoriasis, prostate disease, MS and scleroderma. Pregnenolone plays a profound role in the body as a hormone precursor from which steroid hormones are synthesized in accordance with individual physiological requirements. 

Dhea

DHEA is a hormone produced by the adrenal glands and quantitatively the most abundant hormone in humans and mammals. It is responsible for a wide variety of physiological effects, including regulatory effects upon the immune system. DHEA plays a primary role as a precursor (building block) for steroid hormones, including estrogen and testosterone. It is sometimes known as the “youth” hormone because of its ability to enhance energy, vitality and sexuality. Since DHEA is known to convert to testosterone, supplementation often results in a dramatic increase in libido.

Two of the most striking aspects of DHEA are its steady decline in a woman’s tissue levels with age and its marked deficiency in patients with serious diseases, including cancer, Alzheimer’s, and atherosclerosis. DHEA supplementation also shows promise in enhancing mental function in the elderly, as well as increasing muscle strength and lean body mass. Because there is little known regarding the effects and side effects of supplementing with DHEA (it can raise both estrogen and testosterone levels), it is best not to self-medicate. Always seek the supervision of a qualified health-care practitioner. While there are many reasons to be excited about DHEA, too much DHEA is linked to prostate cancer in men and breast cancer in women.

What is Natural and What Isn’t? 

There are only three natural human estrogens: estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the most potent form of estrogen and the main estrogen influencing the menstrual cycle. Estrone is the principal hormone present in women after menopause. Estriol, the weakest of the three, is most active on the vagina, cervix and vulva, and theoretically the safest and most effective estrogen to use in treating vaginal dryness and atrophy (tissue breakdown).

What is ‘Estrogen Dominance?’ 

Estrogen dominance is a term coined by Dr. John Lee in his first book on natural progesterone. It described a condition where a woman can have deficient, normal, or excessive estrogen but little or no progesterone to balance its effects in the body. Even a woman with low estrogen can have estrogen-dominance symptoms if she doesn’t have progesterone. The symptoms and conditions associated with estrogen dominance are: sluggish metabolism (weight gain without eating more), PMS, low libido, tiredness and fatigue, hair loss, foggy thinking, cancer, thyroid dysfunction, water retention, irritability, depression and headaches.

What are the causes of ‘Estrogen Dominance?’ 

Unfortunately, the causes of estrogen dominance are prevalent in our society today, not only among women, but also with men and children. The reason that just about every woman is suffering from a little estrogen dominance is because there is so much in the environment. Excess estrogen (from chemicals that mimic estrogen in the human body) come from pesticides, plastics, industrial waste, exhausts, meat, dairy foods, soaps, furniture, carpeting, petroleum  products, lawn chemicals, cosmetic products and poultry (eat free-range poultry). Various group sources are:

Diet. Sugars and refined starches, meat, dairy foods, poultry, and lack of green foods (good phytoestrogens.)

 

Stress. Increased ‘stressors’ in our lives will stress the adrenal glands, affecting cortisol release that negatively affect thyroid function, anovulatory cycles, and the pancreas.

Iatrogenic. Due to the intake of drugs, including birth control pills and hormone replacement therapy.

Environmental. Excess chemical exposure, along with estrogen fed to cattle, steers, and poultry in the U.S. Xenoestrogens –“synthetic estrogens”–exposure during embryo phase of life.

Other Nutritional Factors. This category includes excessive caloric intake, impaired liver function, and deficiencies that impair the ovaries or mitochondria (energy part of the cell).

Treatment for ‘Estrogen Dominance’ 

From a dietary standpoint, it is always better to eat organic foods whenever possible. Keep in mind that nearly all poultry, beef, eggs, and dairy products in America have excessive and unsafe levels of pesticides and hormones (that mimic estrogen) and antibiotics. Decrease your intake of refined and simple sugars and carbohydrates, including refined starches. Eat a low glycemic diet and one that is primarily alkaline in pH (see pH balance). Eat high fiber foods (more fruits, vegetables, whole grains, legumes), add some organic soy into the diet, along with healthy unsaturated fats (flaxseed and other lignans).

Exercise on a regular basis, especially do more “stress management” exercises including prayer, yoga, Tai Chi, bath with soft music, gardening, meditation, or a walk in nature. Supplement with magnesium, B complex, phytoestrogens, and additional antioxidants (alpha-lipoic acid, vitamins C, E, A, CoQ10, green tea). Also milk thistle, chaste tree berry, and progesterone cream can be utilized for estrogen dominance treatment. See a qualified health care practitioner.

What are Plant Estrogens and are they Effective? 

Plant estrogens are biologically weak, naturally-occurring phyto or plant-based estrogens that can be effective in reducing the bothersome effects of menopause. Soy (genistein, daidzein) is a common phytoestrogen that has a moderate effect in reducing hot flashes, night sweats, and other symptoms. Eating a diet rich in natural, organic soy (tofu or tempeh) is a healthier choice than taking soy tablets or capsules, although over consumption of soy has been associated with increasing controversy and caution. Other phytoestrogens include black cohosh, dong quai, wild yam, ginkgo, St. John’s wort, ginseng, and chaste tree berry.

Diet

 

Diet is thought to play a major role in the different ways women experience menopausal symptoms. For instance, Asian women eat considerably more plant estrogens than their western counterparts and have significantly fewer menopausal symptoms. In addition, vegetarians are noted to experience little or no symptoms of menopause. To minimize menopausal symptoms, women should maintain a diet adequate in proteins, complex carbohydrates, ground flaxseeds, green and yellow vegetables, whole grains, nuts and seeds, olive oil, cold-water fish, free-range eggs, and legumes (beans). They should add more dietary fiber and soy protein (tofu, tempeh, soy milk), and eliminate or greatly reduce refined carbohydrates and flours, refined sugar, salt, animal and saturated fats, processed and canned foods, caffeine and alcohol (all will excrete extra calcium). In addition to maintaining a healthy diet, women should exercise regularly. 

Consuming soy foods may help middle-aged women protect themselves against bone fractures.  Recent studies examined the relationship between the amount of soy foods in the customary diet and instances of bone fracture.  Results showed that eating soy foods may reduce post-menopausal women’s risk of sustaining fractures, especially the first few years after menopause.

Risks

Risk factors that contribute to menopausal symptoms (which may include extreme hot flashes) include a maternal history of acute symptoms, a history of irregular periods, periods beginning before age twelve, menopause occurring before age fifty, and cigarette smoking. Low levels of estradiol and high levels of follicle-stimulating hormone (FSH) have been related to hot flashes during menopause. Triggers of menopausal symptoms include spicy foods, exercise, hot or humid weather, stress, pain, and confined spaces. Symptoms can also be exacerbated by decreased thyroid activity.

Menopausal symptoms are sometimes associated with low zinc levels and higher copper levels. Zinc is associated with progesterone activity, and copper with estrogen activity. A low ratio of zinc to copper indicates a progesterone/estrogen imbalance (confirmed by a saliva hormone test). If going off HRT (Premarin, Estrace), do it very slowly to minimize the chances of rebounding and intensified hot flashes (skip one dose per week for 7 weeks). Extra iron may be necessary during this time. High levels of testosterone and DHEA after menopause appear to be protective against excessive hot flashes, while high-fiber diets, Vitamin C, and beta-carotene decrease the risk of post-menopausal breast cancer. 

Supplement Protocol For All Post-menopausal Women

1. MULTIVITAMIN/MINERAL SUPPLEMENT
   Women of menopausal age should take an optimal multivitamin/mineral supplement geared toward women over 45 years old. This supplement should contain additional nutrients needed to prepare for menopausal symptoms. Dosage: as directed on package.
2. CALCIUM, MAGNESIUM, with VITAMIN D
   Every woman past her mid-30’s starts losing one percent of her bone density per year. It is vital to supplement with calcium and magnesium in approximately a 2:1 ratio to maintain good bone density and protect against osteoporosis. Dosage: 1,000–1,500 mg calcium (citrate form, not carbonate) daily; 500-750 mg magnesium daily; 400-1,200 IU of vitamin D daily.
3. VITAMIN E
   Research on vitamin E concludes that supplementation helps to decrease hot flashes and reduce mood swings. Vitamin E taken orally or in a suppository form can help minimize vaginal dryness. Vitamin E is a potent antioxidant that has heart-healthy characteristics and will decrease a body’s exposure to damaging free radicals. Dosage: 200-1,200 IU daily.
4. VITAMIN C and BIOFLAVONOIDS (HESPERIDIN, QUERCETIN)
   Vitamin C is a stable and important antioxidant that boosts the immune system and helps stabilize the adrenal glands (the stress glands). In recent years scientific research has touted the health benefits of flavonoids, owing to their antioxidant effects and free-radical scavenging activities. Some flavonoids demonstrate weak estrogenic effects, which may be why regular use can alleviate some symptoms associated with menopause. The flavonoid hesperidin, derived from citrus fruit, has been known to improve vascular integrity and decrease capillary permeability. Dosage: Vitamin C 1,000-5,000 mg daily; Hesperidin or Quercetin 1,000 mg a day.
5. ANTIOXIDANTS
   Woman of menopausal age should supplement with extra antioxidants, including SELENIUM (100-200 mcg daily), BETA-CAROTENE (up to 10,000 IU daily), ZINC (25-50 mg daily), GRAPE SEED EXTRACT (50-100 mg daily), GREEN TEA, and COENZYME Q10 (50-100 mg daily).
6. ESSENTIAL FATTY ACIDS
   Essential fatty acids consist of high-lingan FLAXSEED OIL, FISH OIL, and omega-6 fats, including PRIMROSE and BORAGE oils. These good fats help to normalize hormones, burn fat, lower cholesterol, lubricate joints, and decrease inflammation. Flaxseed is a rich source of lignans and isoflavones, both considered phytoestrogens that are similar to the structure of a woman’s endogenous estrogen. Dosage: 1,000-4,000 mg daily.
7. SOY ISOFLAVONES
   Soy isoflavones are phytoestrogens that are present in soy foods such as tofu, tempeh, soy nuts, and soybeans. Although best from a food source (always get organic) supplements may be utilized.  Flaxseed would alter estrogen metabolism in postmenopausal women to a greater extent than equal amounts of soy. Dosage: 50 mg 1-3 times a day.
8. VITAMIN B COMPLEX
   B complex vitamins help to increase energy, improve circulation, build red blood cells, aid in liver and stomach function, and are necessary for normal cell division and function. Dosage: 25-100 mg 1-3 times daily.

Supplement Protocol For Women With Symptoms

1. BLACK COHOSH (CIMICIFUGA RACEMOSA)
   Black cohosh is advocated as an alternative to HRT and widely used by European women (and recommended by Western doctors) for moderate hot flashes and night sweats. Scientific studies have proven the effectiveness of this herb, which contains isoflavones, beta-carotene, ascorbic acid, calcium, zinc, B complex, and selenium. A combination of essential fatty acids, phytosterols (plant fats), proteins, vitamins, and minerals may result in numerous positive physiological effects. Dosage: 20 mg of root and rhizome once or twice a day. Black cohosh can safely be used for up to six months. NOTE: Recent studies have confirmed that black cohosh can safely be taken to manage hot flashes in women with a history of ER-positive breast cancer taking Tamoxifen or Irimidex. NOTE: If a patient has unusual fatigue, weakness, loss of appetite, dark urine, abdominal pain or yellowing of the skin, discontinue use immediately.
2. NATURAL PROGESTERONE CREAM
   Natural progesterone cream is valuable in managing post-menopausal symptoms of estrogen-dominance, while improving bone density and reducing fibrocystic breast condition. Progesterone has a number of important roles relative to menopause. It naturally balances estrogen and facilitates optimum estrogen utilization. NOTE: Synthetic progestins [Provera] can produce such side effects as facial hair growth, depression, heart and liver disorders, fatigue, and acne. Dosage: See a qualified practitioner.
3. ISOFLAVONES (SOY or IPRIFLAVONES)
   Isoflavones are natural phytoestrogens that improve the quality of life and decrease hot flashes. Many women prefer taking a natural hormonal therapy over conventional HRT. Dosage: 50 mg 1-3 times a day.
4. RED CLOVER
   Red clover is a legume containing four principle isoflavones similar in chemical structure to estradiol (a female hormone). It contains coumarins and is contraindicated with drugs that thin the blood (i.e. warfarin, coumadin). It has been shown to improve systemic arterial elasticity in post-menopausal women, potentially decreasing the risk of cardiovascular disease. Red clover shows little affinity to the estrogen receptors of the breast and uterus, so it can be safely supplemented with anti-cancer drugs like Tamoxifen and Irimidex. Dosage: 400 mg 1-2 times a day.
5. CHASTE BERRY (VITEX AGNUS CASTUS)
   This herb is often used in combination with black cohosh. However, supplementation with chaste tree berry has not been well studied in terms of alleviating hot flashes, and its use is controversial in treating women who have had their uterus surgically removed. Dosage: take as directed by a qualified practitioner.
6. WILD YAM PLANT
   Wild yam root is applied topically or taken sublingually to decrease sweats and hot flashes. Frequently wild yam is mixed with progesterone. However, wild yam alone does not increase progesterone levels. Slight improvements in common menstrual symptoms are usually noted. Dosage: take as directed on package.
7. DHEA
   DHEA relieves hot flashes and other symptoms usually attributed to estrogen deficiency. DHEA has been used for a range of health problems since natural DHEA declines with age. Little is known about the long-term safety of DHEA, and there are fears that it can raise estrogen levels in women who have already had cancer. A combination of DHEA and progesterone (topical cream) may be more effective against hot flashes than either treatment alone. Dosage: 5-25 mg a day. Check hormone levels before initiating therapy and see a qualified practitioner before using.
8. PREGNENOLONE
   Pregnenolone, an important sex-hormone precursor (along with DHEA), regulates female sex-hormone balance. It counteracts the potential masculinizing effects of DHEA, and can be used by women who are also supplementing with progesterone. Dosage: see a qualified practitioner.
9. EVENING PRIMROSE OIL
   Evening primrose oil is derived from the seeds of the yellow primrose wildflower. Studies have shown that it is effective in alleviating some mild to moderate menopausal symptoms. The seeds contain oils rich in gamma-linolenic acid (GLA) and other omega 6 fatty acids. EPO is also effective in relieving pre-menopausal symptoms and PMS. Dosage: 1,000 mg 1-3 times a day.
10. ST. JOHN’S WORT
    St. John’s wort can be successfully used to relieve the psychological and depression-like symptoms of menopause. Of note, sexual well being also improves after treatment with St. John’s wort extract. Dosage: 300mg 3 times a day.
11. DON QUAI (ANGELICA SINENSIS)
    Don quai is a phytoestrogen that can be taken in combination with other herbs. It is known as “female ginseng” and is the second best-selling herb (next to black cohosh) for relieving menopausal symptoms. Don quai seems to decrease hot flashes by eliciting a mild estrogenic effect and acting to stabilize blood vessels. Dosage: take as directed on package.
12. 5-HYDROXYTRYPTOPHAN (5-HTP)
    5-HTP may be an alternative for hot flashes, especially in the at-risk breast cancer populations where hormone replacement therapy is too risky or contraindicated.  Women who are also experiencing depression with hot flashes may consider supplementation with 5-HTP. Dosage: 25-100 mg daily.
13. MELATONIN
    When supplemented for a few months, perimenopausal women were found to have significant improvement in thyroid function, better sleep, and abrogation of menopausal-related depression.  Dosage: 3-10 mg at bedtime.
14. L-ARGININE and L-LYSINE
    L-arginine is an amino-acid/herbal formula that may improve sex drive and satisfaction. Both L-arginine and L-lysine help to detoxify the liver and aid in liver function. Dosage: 500 mg of each twice a day.
15. L-THEANINE
    L-theanine is an amino acid derived from green tea that is effective in relieving acute stress and anxiety associated with menopause. Dosage: 100-300 mg daily.
16. VITAMIN B COMPLEX with extra VITAMIN B6, B12, and FOLIC ACID
    These B vitamins will help to calm a woman from the stress of menopausal symptoms. They also help improve circulation and cellular function. Dosage: 50-100 mg daily.

Peri-menopausal Symptoms

1. Irregular periods; periods can be heavy or light
2. Hot flashes
3. Problems with sleep patterns
4. Exacerbated PMS symptoms
5. Anxiety, forgetfulness, and difficulty concentrating
6. Headaches, dizziness, and heart palpitations
7. Breast pain or enlargement
8. Weight gain
9. Fluctuations in sexual desire
10. Fatigue that may be associated with low thyroid function

Possible Causes: Age-related hormone fluctuations that occur as a woman winds down from her reproductive years. Frequently, these symptoms are caused by estrogen dominance (see Dr. John Lee’s What Your Doctor Never Told You About PreMenopause).

Suggested Protocol

1. ADJUST DIET
   Bring diet into balance with more whole foods, grains, vegetables, and fruit.
2. MULTIPLE VITAMIN/MINERAL FORMULA
3. EXERCISE
   Exercise helps bone density, prevents cardiovascular disease, and alleviates menopausal symptoms.
4. PROGESTERONE CREAM
   Apply progesterone cream on days 14-25 of the monthly cycle to areas on palms, above breasts, inside thighs, on wrists, and neck. 
5. SOY
   Soy from soy foods or supplements may reduce early symptoms.
6. VITAMIN E
   Vitamin E may reduce pre-menopausal symptoms. Dosage: 400-800 IU daily.
7. ADRENAL and THYROID SUPPORT
   Supplement with adrenal and thyroid support if symptoms of adrenal stress and low thyroid are evident. Dosage: see a qualified practitioner.

 

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