Hot-flash help (and more) New natural treatments ease perimenopause symptoms, including insomnia, moodiness, and more

It has been just eight days since I blew out the candles on my 40th-birthday cake, yet I already have a nagging sense that something’s changing. A few times a month, I wake Are bioidentical hormones safer? up in a pool of sweat, where I lie wide-eyed for hours. In BY lisa marshall When the Women’s Health Initiative (WHI) study concluded in 2002 that the days before my period, a sink full of dirty dishes can Insomnia and mood swings postmenopausal women using synthetic estrogen-progestin had higher make me weep. And menses itself is often earlier, and But because of the government’s bombshell 15-year ❋These are among the earliest signs of perimenopause, rates of heart disease and breast cancer, “people stopped cold-turkey heavier, than I expect. Surely, I’m too young for meno- Women’s Health Initiative (WHI) study released in 2002— caused when your ovaries cut back on production of overnight and were scared to death,” says Christiane Northrup, MD. “Many pause. Right? Not necessarily. which linked synthetic estrogen (Premarin) and progestin progesterone, a natural sedative. were left with insomnia, intolerable hot flashes, and a decreased quality of “We’ve learned that women can actually start expe- (Provera) to an increased risk of heart disease and breast life.” But, she points out, the study focused on women ten years past their riencing perimenopausal symptoms up to 10 years prior cancer in older, postmenopausal women—the one-size- { Natural remedies } to menopause,” says Laurie Steelsmith, ND, author of fits-all pharmaceutical approach has been replaced by one To boost progesterone, Northrup recommends rub- last period, and only looked at Premarin (an artificial estrogen made from 1 Natural Choices for Women’s Health (ThreeR ivers, 2005). that emphasizes more natural interventions, undertaken bing ⁄4 teaspoon of 2 percent bioidentical progesterone pregnant mares’ urine) and Provera (a synthetic progestin). “Bioidentical “Fortunately, I see a lot more focus today on helping earlier. A 2008 study found that 80 percent of women now cream (available by prescription or over-the-counter) hormones were not studied at all,” she says. women through this hormonal roller coaster using nat- use complementary and alternative medicine to lessen onto your arms, thighs, or stomach nightly for at least Bioidentical hormones are typically plant-based (from sterols ural methods.” perimenopausal symptoms. And a growing number of two to three weeks each month. Or, try the herb chaste- found in yams, soybeans, and other plants) and are manufactured in For decades, conventional medical advice went like physicians are recommending bioidentical hormones berry (Vitex agnus castus), a plant with progesterone- labs to be chemically identical to those produced in the body. Some this: Tough it out as long as possible, then go on synthetic (which more closely resemble women’s own), contending like properties that is believed to bind to progesterone hormone replacement therapy (HRT) that was believed to they may be safer. receptors in the body. A 2010 study of 67 Chinese are standardized and approved by the FDA; others are custom-compounded reduce risk for heart disease and osteoporosis. “Doctors “For some women, using hormone therapy as a bridge women found that those who took standardized vitex in a pharmacy, based on an individual woman’s hormonal needs. Although basically gave the same hormones at the same dose to can still be a helpful intervention,” says Shelley Wroth, MD, daily for three cycles reported far more improvements the medical community is far from convinced, some studies suggest every woman,” says Christiane Northrup, MD, author of an assistant professor of obstetrics and gynecology at Duke in hormone-related symptoms, especially insomnia bioidenticals may be safer. One study followed 80,000 newly postmeno- The Wisdom of Menopause (Bantam, 2006). “Many women University Medical Center. “For others, there are great and moodiness, than the placebo group. Steelsmith pausal women in France for eight years and found that those taking went on hormones when they started skipping periods, studies that show just how much of an impact relaxation recommends 175 mg of standardized powdered extract, bioidentical estrogen had significantly less risk of breast cancer than those and they stayed on them forever.” strategies, acupuncture, exercise, and diet can have.” Con- or 40 drops of liquid daily. Other milder progesterone- sider these remedies for the most common symptoms. mimicking herbs include turmeric, thyme, and oreg- on synthetic estrogen. Large multicenter trials are underway to further ano. All are available in capsule or tincture form. ➤ investigate bioidenticals’ impact on other health risks.

34 Delicious Living october 10 deliciousliving.com 35 Hot-flash help (and more)

Is it perimenopause? Although every woman’s experience is different, studies show about 15 percent of women sail through “the change” with no symptoms. For others, mild symptoms start as early as 40 and persist for years during perimenopause, the stage Fatigue ❋Hot flashes leading up to the last menstrual Your adrenals (two energizing glands atop Women’s health experts say hot flashes are period. First come dipping ❋your kidneys) may be fried from years of probably caused by radical dips in estro- progesterone levels, which can churning out cortisol and adrenaline, the gen. But supplemental estrogen—still body’s main stress hormones. Adrenal fatigue considered the gold standard for treat- lead to insomnia, tender breasts, is particularly problematic in perimenopause ment—is associated with increased breast and irritability. Then, as ovaries because these glands also produce estrogen, cancer risk. produce less estrogen—typically progesterone, and testosterone as your ovaries around the mid-to-late 40s— slack off. When overtaxed, adrenals will pref- { Natural remedies } 70 percent of women experience erentially produce stress hormones over sex By far the most studied natural remedy is hot flashes. Around age 51, as hormones, which can worsen perimenopause black cohosh, a phytoestrogen (a plant with symptoms. estrogenlike properties). Although overall you approach true menopause data is mixed, one 2006 study of 301 women (defined as the day you’ve gone a { Natural remedies } found that those who took black cohosh for full year without menstruating), To check adrenal health, ask your doctor for an 16 weeks saw hot flashes drop 50 percent estrogen, progesterone, and Adrenal Stress Index, a saliva test. Then take a while the placebo group saw a 20 percent testosterone plummet, often good look at your diet. “One of the most drop. Try 20–80 mg twice a day of stan- leading to vaginal dryness, brain important things you can do to support your dardized extract, says Wroth. adrenals is stabilize your blood sugar,” says Soy is another promising phytoestro- fog, and a crescendo of discom- Steelsmith. Erratic blood sugar levels prompt gen. Researchers have long suspected that fort before hormones level off even more cortisol production, so go easy on one reason Japanese women have fewer hot and symptoms subside in sweets and other refined carbohydrates, stop flashes is because of their high soy intake, postmenopause. skipping meals, and eat plenty of protein, and a growing body of evidence bolsters a natural blood-glucose stabilizer. Also, con- this hypothesis. sider taking 500 mg of pantothenic acid (B5) Twelve weekly acupuncture sessions— and 1,000 mg of vitamin C twice a day. These or a twice-daily, 20-minute deep-breathing building blocks for adrenal hormones tend to practice—also can cut hot flashes signifi- be flushed out under stress. cantly, according to recent studies. ➤

36 Delicious Living october 10 Hot-flash help (and more) Brain fog Life after menopause ❋A 2009 University of California study of Perhaps the most intimidating symptom Vaginal dryness 2,362 women ages 42 to 52 found that 60 facing women entering perimenopause is ❋Because vaginal tissue depends on estrogen percent suffered memory and mental- fear—a fear “they are going to come out of it to remain moist and elastic, the hormonal processing problems. The good news: Top 5 supplements for menopause-symptom relief old and wrinkled and lacking vitality,” nosedive at menopause often leads to a According to the study, cognitive function says Steelsmith. That’s far from reality. try benefits Dose HRT and age: thinning and drying of tissue, making tends to return to premenopausal levels Symptoms typically subside within three Is younger better? women more prone to yeast and urinary after menopause. Black A 2010 meta-analysis found that in six out of nine 20 mg of extract years of the last period. The emotional highs cohosh trials, products containing black cohosh worked better standardized A growing body of research suggests infections and painful sex. than a placebo to relieve hot flashes. to 1 mg of total and lows and discomforts that accompanied { Natural remedies } saponins per dose, menstrual cycles are replaced by a more that when synthetic or bioidentical { Natural remedies } Try 2,000 mg of omega-3 fatty acids daily, twice daily even keel. And thanks to shifts in wiring in hormones are used in younger Steelsmith recommends vitamin E vaginal including both docosahexaenoic acid Chasteberry One 2007 study of 50 women ages 44 to 65 found 20–120 mg daily the temporal lobe (associated with intuition) women (ages 49 to 59) during perimeno- suppositories (available over-the-counter (DHA) and eicosapentaenoic acid (EPA). (vitex) those who took a product containing vitex saw a and permanently elevated levels of follicle- pause or shortly after, they tend to at most pharmacies), Kegel pelvic-floor DHA is believed to promote production of 69 percent decrease in night sweats. stimulating hormone and luteinizing hor- work better—particularly for boosting exercises to bring blood flow to the area, brain-derived neurotrophic factor, a hor- Maca Shown in some small studies to enhance sex drive and 300 mg daily mone—which previously spiked only at and plenty of sex to restore elasticity. “If you mone that helps neurons function better and boost memory. ovulation—many postmenopausal women memory—and they seem to carry less risk. don’t use it, you lose it,” she says. TheA sian fuels brain-cell growth. One 2009 study of report a renewed mental clarity. In March 2010, the North American Pueraria An Asian herb used for centuries to combat vaginal 50–80 mg of botanical Pueraria mirifica, also known as 485 healthy adults found those who took mirifica dryness, insomnia, and hot flashes. a standardized So enjoy the ride, advises Northrup. Menopause Society (NAMS) actually Thai kudzu, also has been shown to relieve 900 mg per day of DHA for six months made (PM) extract with “What we have to lose is not nearly so valu- miroestrol daily revised its position statement on hormone vaginal dryness, in some cases better than “significantly fewer errors” on memory tests able as what we have to gain.” ■ Premarin. Look for a product with the stan- than at the study’s onset. Another 2009 study therapy, saying the benefits may outweigh Soy Compounds in soy are believed to behave like estrogen 30–90 grams Health writer Lisa Marshall is a frequent contribu- dardized active ingredient miroestrol. Typ- found that perimenopausal women who in the body; shown in numerous studies support soy’s powdered soy the risks for younger women. “It appears ability to lessen hot flashes, improve sexual health, isoflavone extract tor to Delicious Living. ical dose is 50–80 mg daily. Northrup rec- took 1,000 mg of EPA daily for eight weeks that the risk of heart disease in and curb bone loss. daily. Stick to ommends applying 0.5 mg of the topical saw psychological distress and mild depres- 20 grams daily if women using hormones is largely bioidentical estrogen, estriol, to the vagina; sion lift. Finally, get moving. R “ esearch you have a history For more natural approaches to of breast cancer. menopause, go to deliciousliving. confined to older women,” says NAMS talk with your health care provider before shows the more people exercise, the better com/oct10. president Cynthia Stuenkel, MD. starting treatment. their brains function,” says Wroth. Sources: Hyla Cass, MD; Christiane Northrup, MD.

38 Delicious Living october 10 deliciousliving.com 39