|Natural Management of Menopause|
By: Serafina Corsello, MD
Before reaching menopause, a potentially liberating stage of life, women go through perimenopause—the transition time between regular menstrual cycles and their complete cessation. On the average, women move into menopause around ages 50 to 52. If all is well, perimenopause should not exceed one year. Over the course of my lengthy clinical practice, however, I have witnessed a dramatic increase in both the length and intensity of this transitional phase.
In my practice, I use natural remedies and stress management to facilitate smooth sailing through this tumultuous period. I think that women, by nature, have a tremendous amount of creative energy. For many, a good portion of that energy is channeled into birthing and raising children during the reproductive years. When reproductive capability ceases, and perimenopause and menopause begin, women have the opportunity to redirect their creative energy.
Perimenopause is marked by a disruption of the hormonal feedback loop (the relationship between ovarian hormones and the brain signals), which inevitably increases as we age. The ovaries begin to receive confusing messages and go through bouts of estrogen overproduction. Concurrently, progesterone rapidly declines as the frequency of anovulatory (without ovulation) periods increases. Follicle stimulating hormone (FSH), one of the hormones responsible for ovulation, spikes irregularly, as if a whirling dervish is trying to awaken the last few eggs to their final hurrah.
One of the earliest symptoms of perimenopause is a change in the character of the menses (monthly periods). Subtle emotional shifts may begin to occur. Family, work, and other stressors that were previously manageable now trigger irritable responses. Some women begin to have insidious recall or short-term memory difficulties that threaten their livelihood. Sleeping patterns may be disrupted, the sex drive may dwindle, and vaginal dryness can lead to painful intercourse. Unexpected weight gain while maintaining the same eating habits may add to the distress of this often unrecognized early transitional stage.
These bursts of estrogen in response to the FSH spikes can cause unpleasant premenstrual-syndrome-like symptoms—mood swings, anxiety, irritability, depression, acne, and carbohydrate craving. An overproduction of estrogen leads to excessive insulin production, which in turn is responsible for inexplicable weight gain. If uncontrolled, this hyperinsulinism can lead to type 2 diabetes. With falling progesterone levels unable to balance the estrogen bursts, the result is further estrogen dominance. Estrogen dominance can lead to increased incidence of breast, uterine, and ovarian cancer.
When we stop ovulating, we no longer form a corpus luteum—the site of progesterone production. The corpus luteum is the cholesterol accumulation that occupies the space left by the exiting egg. It is from cholesterol that all hormones are produced. As ovulation becomes less and less regular, progesterone levels decline rapidly.
Since progesterone plays a role in many important body functions, including glucose metabolism, mineral balance, cell division, good thyroid function, mood stability and bone metabolism, inadequate levels can have many consequences in midlife. Symptoms can be very surprising—such as midlife asthma. Since progesterone is an involuntary muscle relaxant, declining levels of the hormone can result in constricted breathing in women who either have allergies or an inherent lung weakness.
Testosterone is most often associated with men, but women do produce a small measure of testosterone, and their testosterone levels begin to decline in midlife. Low testosterone levels play a major role in osteoporosis, decreased libido, and loss of initiative and drive. Fifty percent of postmenopausal women have substantially decreased testosterone levels.
The thyroid gland is to the body what the starter is to the car. By midlife, the thyroid has been subject to much wear and tear, becomes less efficient, especially because progesterone, the thyroid’s hormonal assistant, is low.
A sluggish thyroid worsens both the weight gain and fatigue associated with menopause, and fat distribution begins to takes on more of a male pattern, with accumulation of fat at and above the waistline (apple shape). Besides the loss of the appealing feminine waistline, an apple shape is associated with a greater risk of heart disease.
Treatment for Perimenopause
In my practice, I approach the midlife transition in two phases:
Phase One is usually sufficient for women who are generally in good health and have mild to moderate symptoms. Treatment includes bowel and liver detoxification, lifestyle modifications, some hormone-mimicking herbs and foods, bone nutrients, and an over-the-counter hormonal cream. Additional nutrients are recommended for specific concerns, such as “brain fog,” insomnia, and urinary problems.
Bowel and liver health
A healthy bowel and liver is essential for overall body health. It is particularly important during perimenopause. Nourishing and keeping the liver clean enables the organ to efficiently process and release excessive estrogens from the body. In my practice, I use a three-step process called the Bowel Healing Program to remove toxic estrogen species (xenoestrogens).
Diet and phytonutrients
Although it is always wise to eat a highly nutritious and balanced diet, it is particularly important during this major hormonal transition.
If you are not already doing so, you should include soy products in your diet. Soy products (soybeans, soy milk, tofu, tempeh, soy protein powder, etc.) are rich in phytoestrogens—good plant estrogens. Soy is high in a type of phytoestrogen called isoflavones (primarily genestein and diadzein). Intestinal bacteria convert isoflavones into hormone-like substances that have weak, but protective, estrogenic activity. These phytoestrogens have been shown to bump toxic forms of estrogen out of the receptor site (receptor sites are the portals through which various hormones enter the cell) and thus counteract their harmful effects. Researchers have found that soy offers benefits for mature women, such as decreasing perimenopausal symptoms, lowering the risk of a wide range of cancers, and preventing osteoporosis and heart disease.
Another food I have recommended for years, and that should have a preeminent place in the diets of mature women, is flaxseed. Flaxseed contains a type of phytoestrogen known as lignans. Lignans, like soy isoflavones, are acted upon by colonic bacteria to produce more weak, but protective, estrogenic-like substances. Lignans have been shown to offer protection against both cancer and heart disease.
Researchers have confirmed that eating one serving of soy (45 milligrams) a day decreases cancer risk and helps mitigate hot flashes. It appears, however, that larger quantities are necessary to reduce the risk of heart disease and osteoporosis. A cup of soy milk has about 20 to 30 milligrams of isoflavones, while a half cup of tempeh or tofu have about 35 milligrams. A tablespoon of flaxseed is roughly equivalent to one serving of soy.
Limit or avoid harmful foods
Refined carbohydrates and sugars should be limited or avoided, as they can increase hot flashes. And as you already know, they have a tendency to be turned into fat when they are not utilized for energy production. Limit red meats and sodas. Besides being acidic, they are also high in phosphorus, which is an element that depletes skeletal calcium.
Natural hormonal supplements
Since consistently consuming large amounts of phytoestrogen-containing foods is difficult for some women, I recommend combining dietary phytoestrogens (20 to 45 milligrams) with the phytoestrogens and hormone precursors found in herbal members of the plant kingdom. Herbs, such as black cohosh, licorice, chaste berry, wild yam, dong quai and ginseng have been found to relieve menopausal symptoms and promote overall health and vitality. I recommend you supplement your diet with these powerful healers.
In my practice I also use an over-the-counter natural hormone cream that contains progesterone, a small amount of pregnenolone (a precursor hormone to DHEA, or dehydroepiandrosterone), and a small amount of DHEA, which is included to modulate the shunting of progesterone into testosterone. My perimenopausal patients have found using one teaspoon a day helpful in relieving a variety of symptoms. Progesterone also prevents osteoporosis. To this end, we also recommend supplementing the diet with calcium and other nutrients essential to bone health.
Stress management and exercise
Managing stress during perimenopause is crucial. Your progesterone is already waning, and stress accelerates its decline.
Exercise is an essential longevity strategy, especially important during the female hormonal wind-down as stress-releaser, energizer, and heart-protector. Its role in the prevention of osteoporosis is well documented.
Yoga is one of the best exercises for the prevention of osteoporosis. The slow, deep stretching of the muscles facilitates bone rebuilding by improving re-absorption of calcium.
Phase Two is for women who are experiencing a more challenging transition. We add pharmaceutical-grade, individually prescribed natural hormonal combinations that are based on clinical symptoms and tests.
Phase two interventions
When the combined Phase One interventions don’t relieve perimenopausal symptoms, we move into Phase Two. In Phase Two, we do complete hormonal testing that includes total estrogen, estrone (E1), estradiol (E2), progesterone, testosterone, pregnenolone, and DHEA levels. If I am unsure as to whether the ovaries have stopped producing hormones, I add FSH and LH levels to the tests (high levels indicate menopause). We then use the information from the tests, in conjunction with the patient’s symptoms and general history, to design a prescription-grade, natural-hormone-replacement therapy.
Pharmaceutical Grade Natural Hormonal Replacement Therapy
About 90 percent of our patients who need Phase Two intervention choose pharmaceutical grade natural hormonal replacement therapy rather than synthetic pharmaceutical hormones. The source of these natural hormones is from either wild yam (diascorea) or soy, usually in the form of transdermal creams or gels. This is a very individualized strategy, and the ingredients and their proportions vary from patient to patient. This aspect of the treatment needs a trained physician familiar with natural hormones.
Other Menopausal Symptoms
If you suffer from symptoms such as forgetfulness, fogginess, depression, or impaired creativity, I recommend that you add phosphatidylserine (100 milligrams, two times a day). Phosphatidylserine is the main lipid (fat) in the brain. It is essential for maintaining the integrity and fluidity of brain cell membranes and facilitates the smooth working of the neurotransmitters.
Gingko biloba extract is also useful for improving brain clarity (40 milligrams, three times a day). Gingko biloba is extracted from the leaves of the gingko tree and has been used in China for thousands of years. Gingko increases the brain’s blood circulation and the brain utilization of glucose for mental activity.
Insomnia can have many causes. The overall drop in estrogen that causes hot flashes or other heat symptoms in the middle of the night is also frequently responsible for menopausal frequent awakenings. Decreased melatonin, characteristic of this transitional phase, also plays a role in insomnia. One of the many functions of this pineal gland, which is found in the brain, is the promotion of deep, restorative sleep. Taking three to six milligrams of sublingual melatonin at bedtime, four to five times a week is extremely efficacious in managing menopausal insomnia. Combined with soy, flaxseeds, and calcium, it relieves most of my menopausal patients’ sleep disturbances.
The menopausal transition is sometimes accompanied by the embarrassing loss of urinary control and frequent urinary infections. Decreased vaginal mucus, which traps and expels bacteria, and thinner vaginal walls and lining, make us more vulnerable to infections.
Early signs of a low-grade urinary tract infection (UTI) are increased urgency and frequency of urination. When the UTI is more advanced, it can cause a burning sensation and chills and malaise when the bacteria move into the bloodstream.
At the first sign of a possible infection, I recommend two capsules of the urinary protective herb, uva ursi (one capsule, two times a day on an empty stomach) and cranberry capsules (two capsules, two times a day with meals).
The good news about moving into the postmenopausal stage is that the body has now adjusted to different levels of hormones. Some perimenopausal symptoms, such as urinary incontinence and vaginal dryness, may, however, appear for the first time postmenopausally. Preventing heart disease and osteoporosis are the most important concerns.
Risk factors for heart disease include high levels of triglycerides and total cholesterol, high LDL ("bad" cholesterol) and low HDL ("good" cholesterol) levels, obesity (particularly apple shape), smoking, diabetes, chronic stress, and lack of exercise. Healthy eating habits, regular exercise, and managing stress are the most effective strategies for decreasing the risk of heart disease at any age—and they are a must at this stage in a woman’s life.
Food and nutritional supplements
Since foods and nutritional supplements high in phytoestrogens have been demonstrated to be cardioprotective, they should be part of any postmenopausal woman’s diet. Vitamin E, the premier lipid antioxidant, is a well-documented heart protector, as is coenzyme Q-10 (ubiquinone), another powerful antioxidant. As a preventive measure for postmenopausal women, I recommend 400 international units of vitamin E and 50 milligrams of coenzyme Q-10 two times a day with meals. (The lipoidal form of Coenzyme-Q10 is much more powerful).
Some osteoporosis risk factors include:
• Refined carbohydrates
• Caffeinated Tea
• Lack of exercise
• Soda pop
• High animal protein intake
• Low ovarian hormones, especially
• Low calcium intake
Diet as an osteoporosis prevention tool
To prevent osteoporosis, avoid calcium-depleting foods, such as excessive animal protein. While animal protein has an acidifying effect on the body that leaches calcium from the bones, vegetables and fruits are alkalinizing. Italian researchers, who evaluated the effects of diet on bone health, recently recommended that the daily intake of animal protein should not exceed 20 grams a day. I believe that this is particularly important for postmenopausal women. Coffee, black tea, alcohol, sugar, and sodas are also calcium depleting and should be limited or avoided. Adding calcium rich foods to your diet, such as dark green, leafy vegetables, soy foods, salmon, and sardines is a wise move.
Proper supplementation of calcium can significantly reduce bone loss. Since it is usually impossible to obtain the amount of calcium necessary for prevention (1,000 to 1,500 milligrams a day) solely from dairy intake, I recommend that you add a calcium supplement. Not all calcium supplements are equally beneficial. Some are difficult to absorb and incorporate into the bony structure. The supplement that has emerged as the most advantageous is microcrystalline hydroxapatite (MHCH), which has a similar structure to our bones.
Other nutrients that insure optimal bone health include the mineral boron, which increases calcium uptake and has mild estrogenic properties, vitamin D, also needed for calcium uptake, and vitamin K, which improves calcium binding. However, check with your doctor before taking any vitamin or herbal supplements, as they may have potentially harmful effects if mixed with other medications.
Ipriflavone: The amazing bone-builder
Fosamax and other bisphosphonates are pharmaceuticals that bind and neutralize the osteoclasts—the cells responsible for rapid bone remodeling.
A more promising alternative is Ipriflavone, synthesized from isoflavones, the bioflavinoids primarily found in soy. Ipriflavone is a registered medication for the treatment of osteoporosis in Japan, Argentina, and Italy. It inhibits bone thinning and stimulates bone-building osteoblasts. Researchers have found Ipriflavone to be a safe and effective treatment for established osteoporosis in post-menopausal women. Most researchers recommend 200 milligrams, three times a day. In combination with other bone-building substances, 50 to 100 milligrams, three times a day is equally effective.
While it is true that modern life has made menopause more difficult, we now have enough knowledge of natural nontoxic strategies to make it easy. These same strategies make us stronger, more intelligent and able to enjoy the “wise woman” stage, unencumbered by the responsibilities of child-rearing.