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Once their periods stabilize in their late teens or early 20s, most women have regular menstrual cycles. They can expect to get their period at the same time every month and to bleed for the same number of days with the same intensity.
However, when a woman begins perimenopause, everything is subject to change. During this time, which can begin any time from your late 30s to early 50s, the reproductive system begins to age. The term perimenopause refers to the period in-between when your body begins to act erratically and your period actually stops. (The Latin root peri means around).
About 10 to 20 percent of women—the lucky ones—make the perimenopausal transition to true menopause with a minimum of discomfort and inconvenience. Their periods simply become fewer and fewer until, eventually, they stop. But the majority of women experience unpleasant symptoms, such as difficulty sleeping, decreased libido, hot flashes, worsening PMS, memory problems, and breast tenderness. For months (or even years), a woman can feel as though her life has been turned upside down.
During this time, hormone levels can fluctuate considerably, leaving you in an almost constant state of imbalance. Your body’s natural response is to try to restore this balance, but it can only do so much. Estrogen dominance, a hormonal imbalance, is responsible for most of the symptoms women experience. This occurs when estrogen levels are too high in relationship to progesterone. Low levels of progesterone, common during perimenopause, can also contribute to a number of health issues.
As you approach menopause, your periods get farther and farther apart, leaving you wondering after each one, “Is this it?” Doctors usually say, “Yes, that’s it,” once you have gone 6 months without menstruating.
- I have heavy, irregular periods.
- I’m retaining fluids.
- I’ve gained more than 10 pounds.
- I’m experiencing problems sleeping.
- I’m having headaches.
- I have bouts of brain-fog—like forgetting names, where I put my car keys, or the point of a text I’ve just been reading.
- I recently discovered cysts in my breasts.
- I have fibroid tumors.
- My endometriosis symptoms have gotten worse.
- I’m over age 35.
- I suffer from premenstrual anxiety, irritability, and mood swings.
- My interest in sex has declined.
- I’ve started to have hot flashes and night sweats.
If these symptoms don’t match yours, perhaps you’re in menopause.
- My last period was 12 months ago or longer.
- My periods are lighter, less frequent, and of shorter duration.
- I’m in my early to mid-40s or older.
- I’m having hot flashes.
- Intercourse is painful.
- My desire for sex has faded.
- I have difficulty achieving orgasm.
- I have frequent vaginal infections.
- I leak urine when I laugh, cough, sneeze, exercise, or wait too long to void.
- I have difficulty sleeping through the night.
- I’m frequently tired.
- I’m anxious and irritable.
- I forget small details.
- My skin is drier, thinner, and more wrinkled.
- My muscles are losing their tone.
- I’m gaining weight.
- My joints and/or muscles ache.
- I have itchy, crawly skin.
- I sometimes feel as if electric shocks were going through my body.
If you have 5 or more of these symptoms, it is likely that your are menopausal. If these symptoms don’t match yours, perhaps you’re perimenopausal.
Chances are, you’ve never heard of estrogen dominance before today. But if you’re among the millions of women in the 35 to 55 age bracket who are experiencing irregular menstrual cycles, headaches, sleep difficulties, fluid retention, anxiety, irritability, mood swings, weight gain, lowered sex drive, brain fog, and heavy bleeding, you’re likely to be affected by estrogen dominance.
Estrogen dominance is the most frequent problem in perimenopause. Even though estrogen levels are fluctuating during perimenopause (sometimes they rise too high and sometimes they drop too low), progesterone levels are also declining. In our 40s and early 50s, progesterone production drops or ceases entirely during many menstrual cycles.
I have treated thousands of women for these issues, and hardly a day goes by that I don’t get calls from women all over the country looking for relief. The good news is that relief is possible.
To bring estrogen back into balance, you have to reduce estrogen production and block the hormone’s ability to bind to tissue receptors. You also have to support the breakdown and detoxification of estrogen by your liver, as well as its elimination from your body. All these steps need to occur in order to regulate estrogen and bring your symptoms under control. Luckily, with a program of diet, nutritional supplements, stress reduction and natural hormone support, you can put your hormones back in balance.
These dietary guidelines are a natural and easy way to improve perimenopause symptoms.
- Eat soy foods, buckwheat, citrus fruit rind and pulp (not the juice) and flax in shakes and cereals. They help to reduce estrogen production and prevent the hormone from binding to tissue receptors.
- Avoid potato chips, caffeine, alcohol, sugar, soft drinks, fruit juices, fried or fatty foods, and salt, all of which hamper the process that metabolizes estrogens and eliminates them from your body.
- Eat a low-fat, high-fiber diet to help your intestines eliminate estrogens so they are not reabsorbed into your body. Include plenty of fresh fruits, vegetables, whole grains and legumes (beans, peas).
- Reduce or eliminate red meats because they elevate estrogen levels. This can cause menstrual cramps. Instead, eat fish such as salmon, mackerel, sardines, trout, and tuna, which are high in beneficial omega-3 fatty acids that reduce the pain of menstrual cramps and endometriosis.
- Avoid dairy products, as they have a negative effect on reproductive health similar to that of red meat. Use soy or rice substitutes, including soy and rice milk, cream cheese, sour cream, and soy yogurt.
- Avoid wheat products since they can make PMS symptoms worse. Instead of wheat, use rice, quinoa, corn, or soy-based breads, crackers, pasta, and whole grains.
For a healthy economical lunch, take rice cakes, soy yogurt, tuna fish, almond butter and whole fruit to work.
If your symptoms are mild to moderate, you can be a little less rigid occasionally, but be sure to follow the diet most of the time. If your symptoms are severe, or you’re facing a hysterectomy or repeated use of heavy-duty drugs, I urge you to dedicate yourself to the diet until you begin to get significant symptom relief.
In addition to your dietary program, the following supplements can help to maintain normal estrogen levels.
- Soy isoflavones — 50 to 100 mg of soy isoflavones as food and in pill form.
- Bioflavonoids — 750 to 2,000 mg per day.
- Flaxseed oil or flax — 1 to 2 tbsp of flaxseed oil; or 4 to 6 tbsp ground flax meal mixed into cereals and shakes.
- Vitamin B-complex — 25 to 100 mg daily assists the liver in detoxifying estrogen.
- Herbs such as turmeric (400-500 mg two to three times a day), or dandelion (150-500 mg daily) or milk thistle standardized extract (150-175 mg one to three times a day) and amino acids like L-methionine (200-1,000 mg) or L-cysteine (200 mg twice a day) also promote healthy liver detoxification.
- Oat or rice bran for fiber (1-2 tbsp per day in 8-12 oz water).
Soy isoflavones have estrogen-like effects similar to your own estrogen, but in a much weaker and less toxic form. According to a 1992 study published in Lancet, women in Japan, who regularly eat a more soy-based diet than American women, are rarely troubled by such menopausal symptoms as hot flashes. Soy isoflavones interfere with estrogen production and prevent the hormone from binding to tissue receptors.
Bioflavonoids, found in the peel and pulp of citrus fruits and buckwheat, are weakly estrogenic and can be used as a safe, nontoxic substitute for estrogen. Many studies have shown that bioflavonoids and vitamin C in combination also strengthen blood vessels and thereby reduce heavy menstrual bleeding.
Essential fatty acids, I believe, are critical for reproductive health and must be supplied by diet. They can be found in fish, nuts and seeds, but the most effective source of fatty acids I’ve found are flaxseeds.
Flax and cold-pressed organic, rich, golden flaxseed oil are also excellent sources of the two essential oils, linoleic acid (omega-6 fatty acids) and linolenic acid (omega-3 fatty acids). Flax oil is weakly estrogenic. Flaxseeds are rich in lignans—part of the seed’s cellular structure. When ingested, these lignans are broken down by intestinal bacteria to weakly estrogenic substances. Flaxseeds are 100 times richer in lignans than any other plants. (Caution: the seeds must be ground into flax meal to release the fatty acids and lignans that deliver the health benefits.) Click here for great-tasting flax recipes.
Flax lignans help to both reduce your production of estrogen and compete with your own more potent estrogen for tissue receptors. In addition, flax oil is a rich source of omega-6 and omega-3 fatty acids that your body converts to the series 1 and 3 prostaglandins.
Nutritional Supplements to Promote Progesterone Production
For best results during perimenopause, it is not enough to maintain normal estrogen levels in your body. You also have to promote more frequent ovulation. This will move you from estrogen dominance back to hormonal balance.
- Flaxseed oil or flax help to promote more frequent ovulation and therefore more frequent progesterone production. They may also help relieve pain due to menstrual cramps and reduce common PMS symptoms.
- You need enough B-3 (25-100 mg), B-6 (50 mg twice a day), zinc (15-30 mg), vitamin C (600-2,000 mg), and magnesium (350-500 mg) to help convert flax oil into series 1 and series 3 prostaglandins in your body. If you’re taking a high quality multinutrient such as Daily Answer Multinutrient for Women, I believe you’ll be covered.
- Vitex, or Chaste tree extract, (225 mg daily) may help increase the production of the luteinizing hormone that triggers ovulation at midcycle, promoting progesterone production. It may also help inhibit release of the follicle-stimulating hormone that stimulates estrogen production in the first half of the menstrual cycle. So it supports the normal secretion of hormones and helps to balance estrogen and progesterone during perimenopause.
If you’re between 46 and 53 years old, it’s likely that your monthly periods occur less frequently and that bleeding is becoming lighter (late perimenopause) or has stopped altogether (menopause). Simply put, menopause is a change in your hormone production.
By the time your periods have stopped, you will have experienced a 75 to 90 percent drop in your estrogen production. Estrogen is one of the two critical female hormones essential for conception and pregnancy. But estrogen has many other functions, as well, such as being a natural mood elevator and a great skin conditioner.
Meanwhile, your progesterone production has ceased almost entirely at menopause. Progesterone also has some very critical tasks. It helps your body burn fat for energy, it’s a natural diuretic, and it acts as a sedative, helping you sleep. Knowing this, you can see why many women gain weight at menopause even if they go on stringent diets and serious exercise regimens. The huge decrease in progesterone is also one of the causes for sleep disturbances at menopause.
There’s also a 50 percent decrease in androgen production, the male hormones that stimulate your sex drive. They used to be produced during the middle of your monthly menstrual cycle, but when you stop ovulating, the amount of those important hormones circulating in your body is also substantially diminished.
This normal drop in hormone production at mid-life is because your ovaries and the follicles containing your eggs are aging. It’s the end of your reproductive years, but not a vibrant life. For many women, it’s just the beginning of a whole new adventure.
Although your ovaries and adrenal glands continue to produce a lower potency estrogen (estrone) and some estriol (an estrogen metabolite) is produced by your liver, the amounts don’t support bone, breast, brain, heart, and vaginal tissues the way your pre-menopause hormone production does.
The symptoms that come with this hormone reduction—hot flashes, insomnia, painful intercourse, loss of libido, vaginal infections, loss of muscle and skin tone, achy joints and brittle bones, fatigue and mental confusion—are unpleasant and distressing. Yet with the proper nutrition—including herbs and nutrients—you can help your body combat some of the negative effects of the drop in hormone levels.
And while many doctors push synthetic supplemental estrogen in the form of hormone replacement therapy (HRT), I believe you can get many of the same benefits of HRT without running the risk of its side effects. It can be difficult to decide what to do. No matter what you decide, you’ll still need good nutritional foundation.
I believe that taking a wide variety of beneficial nutrients to keep you in vibrant health provides a much broader level of protection than taking only a hormone pill. Always start with the lowest dose and work your way up.
Vitamin A (as beta-carotene)
Recommended postmenopausal dosage: 5,000-15,000 IU daily
Helps support your: cell membranes, DNA, immune system, and promotes healthy skin.
Recommended postmenopausal dosage: 1,000-3,000 mg daily
Helps support your: joints, tissues, bones, blood vessels, and immune system.
Recommended postmenopausal dosage: 400-2,000 IU daily as d-alpha tocopherol
Helps support your: cardiovascular system, immune system, and cellular health.
Recommended postmenopausal dosage: If you aren’t taking HRT, take 1,000-2,000 mg daily.
Best for: They work with vitamin C to help relieve hot flashes and maintain strong bone.
Recommended postmenopausal dosage: 80-160 mg of standardized extract a day
Has been clinically shown to: reduce menopause symptoms by up to 70%.
Recommended postmenopausal dosage: 4-6 tbsp. flax or 1-2 tbsp. flaxseed oil daily.
Helps promote: heart health with essential fatty acids, maintains normal cholesterol levels, supports healthy joints and strong bones, as well as breast tissue, and may assist in weight loss, as it creates a feeling of “fullness.”
Recommended postmenopausal dosage: If you don’t regularly consume soy foods, try 50-100 mg daily.
Best for: Their estrogenic activity helps combat hot flashes, as well as support breast and bone health.
Premenstrual syndrome (PMS) is one of the most common problems affecting women. One-third to one-half of all American women between the ages of 20 to 50 (as many as 10-14 million women) experience PMS. The symptoms can begin 10 to 14 days prior to the onset of the menstrual period and become progressively worse until menstruation begins.
The symptoms of premenstrual syndrome are numerous, affecting almost every organ system of the body. More than 150 symptoms have been documented. Some of the most common ones are:
- Mood swings
- Abdominal bloating
- Weight gain
- Breast tenderness and swelling
- Less frequent urination
- Sore throat
- Joint pain and swelling
- Sugar craving
It is common for women to experience more than one of these symptoms each month. In fact, many of my patients have reported 10 to 12. PMS seems to touch every aspect of their lives—from their relationships with family and friends, to their work productivity, to their ability to take pleasure in their own bodies.
It’s impossible to exaggerate the importance of good nutrition in controlling PMS. No medication can entirely overcome the effects of a poor diet. Eating the right foods for your body type is the most important thing you can do to prevent PMS.
Make sure you’re eating a wide variety of complex carbohydrates:
Whole grains stabilize blood sugar and help eliminate premenstrual sugar cravings, as well as provide excellent sources of protein, fiber, and various vitamins and minerals critical to premenstrual health. Avoid, if possible, wheat and gluten products, which may worsen PMS bloating, weight gain, and gas.
Legumes help regulate blood sugar levels, thus stabilizing mood swings, anxiety, and energy levels.
Soybeans help relieve PMS symptoms by competing with your own levels of estrogen for receptor sites on cells when your estrogen levels are too high.
Seeds and Nuts. Choose raw and unsalted; roasted and salted will only make your symptoms worse. If you have acne, or are subject to premenstrual weight gain, eat only very small amounts.
Vegetables. Stick with leafy green vegetables such as kale, collards, and mustard greens; root vegetables such as carrots, turnips, and parsnips. Plus, cruciferous green vegetables such as broccoli and Brussels sprouts are high in the vitamins and nutrients that help relieve PMS symptoms. Red, orange, and yellow vegetables also help reduce PMS-related blood sugar and mood swings, while their high vitamin A content helps regulate heavy menstrual bleeding and premenstrual acne.
Fruits. The best fruits for PMS are seasonal, grown in temperate climates, such as apples and pears, which have more fiber and less sugar.
Poly- and monounsaturated oils such as corn, sesame, olive, and safflower.
Plus, make sure you rotate your foods to minimize symptoms of food allergies, which can be worse just before your period; eat heavier meals early in the day and lighter meals in the evening; chew thoroughly; and make changes in your diet slowly, typically one at a time.
Living with premenstrual symptoms can be frustrating/a challenge. While proper diet and exercise can combat them, I recommend that patients suffering with PMS take a combination of targeted vitamins, minerals and herbs in addition to a powerful multi-vitamin/mineral formula.
Here are a few of the nutrients you should consider using:
Calcium (1,000-1,200 mg daily)
Helps reduce moodiness, water retention, food cravings, and pain. Be sure to take a 10:4 or 2:1 ratio of calcium to magnesium. That is, if you take 1,000 mg of calcium, take 500 mg of magnesium.
Magnesium (500-600 mg daily)
Women with PMS are often magnesium-deficient. Magnesium supplementation may improve common premenstrual mood changes, help reduce pain and inflammation, and stabilize mood swings.
Chaste tree or vitex (225 mg daily of standardized extract)
May help to relieve cramping and breast tenderness.
Vitamin E (400-1,600 IU daily)
Although it is widely unclear exactly how vitamin E works to help relieve common PMS symptoms, it is widely believed that either its antioxidant properties or its modulation of prostaglandin production are involved.
Essential fatty acids from flaxseed (1-2 Tbsp. of cold-pressed flaxseed oil or 4-6 Tbsp. of flax daily)
Helps reduce common PMS symptoms such as menstrual cramps, breast tenderness, and bloating. Although other foods and supplements provide EFAs, I believe that flaxseed is by far the finest source.
These are the recommendations that work for most women. But remember, we’re all unique and what works for one woman may not work for you. If after trying these nutrients for 3 months, you’re still suffering each month, don’t give up. There’s more you can try! In fact, PMS is such a common problem for my patients that I frequently discuss alternative solutions in my monthly newsletter, Women’s Wellness Today.