Menopause and pre-menopause are two very different but interconnected subjects. The pre-menopause or the peri-menopause is that time leading up to menopause, when your hormones are fluctuating in a kind of a hormonal chaos. You don’t feel like yourself; you feel different than you have ever felt before with mood swings, irritability and brain fog.
Your estrogen levels overall are higher than they have ever been in your life, but they are fluctuating up and down, and the progesterone levels are low. This is a clear case of progesterone deficiency. The worst thing you can do is go to your doctor and get an estrogen patch, and that is exactly what most people do. That will make all your symptoms worse.
The Push For Hormone Replacement Therapy
The modern medical model supports a full-scale menopause industry that is profit-driven, and that is the key to understanding the push for Hormone Replacement Therapy (HRT). All continuing education to doctors is sponsored by hormone companies and direct advertising. The industry identifies menopause as a disease in order to induce a whole population of women over 50 to take hormones for the rest of their lives.
At present only 11 to 15% of Canadian women are taking hormones; whereas about 40 to 50% of American women are taking hormones. I think that Canadian women read more and are more aware of their choices and I am hoping that this situation will change for American women as well. The basic dilemma in menopause is whether all women should take hormones, or only women with high risk of bone loss or heart disease.
Only 25% of women will develop osteoporosis. Fifty percent will develop heart disease, but of course, heart disease is entirely preventable through diet, lifestyle, anti-oxidant vitamins and even the use of chelation therapy, which has recently been legalized in this province.
The Medical Model Vs. Other Models Of Menopause
Although the medical model of menopause is depressing, focussing on deterioration, sagging skin and estrogen deficiency (which is not at all true), there are other traditions in which post-menopausal women are considered to be the wise women of the tribe who have extra privileges.
In our society, when you reach your 50th and 60th birthdays, you certainly don’t get extra privileges. Usually there are fewer job opportunities and more discrimination. Menopause is a radical transition that occurs on the physical, mental, emotional and spiritual planes, a transition from the childbearing years to the non-childbearing years and also a transition in which women can be more themselves and contribute to the larger community.
The Saliva Test
The blood test for hormones is not that accurate, although it can be used to determine the level of your hormones when you go into menopause, and whether or not you are extremely estrogen deficient. The saliva test, however, is a more accurate test than the blood test; it is a very, very accurate way to measure hormones, and you can do it yourself.
You may call Aeron Lifecycles Clinical Laboratories for information at 1-800-631-7900. You send a sample of spit, and they will measure your estrogen, progesterone, free testosterone and DHEA. Their website is www.aeron.com.
You can also have your DHEA measured. DHEA is a screen test which will give you an indication of your adrenal function. If your DHEA is rock bottom, then you know that your adrenal glands are functioning very low. DHEA is low in most women who are approaching menopause. DHEA is a mother hormone and it can convert either to estrogen or testosterone.
It is a useful supplement and women can take anywhere from 10 to 20 mg a day. Unfortunately, it is not legal in this country at the present time. I do not recommend DHEA for women who have breast cancer, or men who have prostate cancer because it can increase your hormone levels and we really don’t know what it does.
Diagnosis And Treatment For Bone Loss
If you are going into menopause and you don’t know your bone density, you can get a heel bone scan, a very accurate technique for bone density. I highly recommend it if you are trying to decide whether or not you need hormones. You may be having irregular cycles and you may not be ovulating. If you are not ovulating, you may be losing bone. You may be having normal periods and still not be ovulating.
So you are going to have to do some research and check and see if you are ovulating. Natural progesterone is a very bone specific hormone. Testosterone is often the missing key. Sometimes women have very low testosterone. Testosterone and DHEA are also very, very important for the bones. Weight training is essential because weight training actually builds bone mass as well as muscle mass.
I – Progesterone
Progesterone Is Far Lower Than Estrogen At Menopause
The problem in the trend towards hormones is the predominance of treatment with estrogen. Premarin, a synthetic estrogen derived from pregnant mare’s urine, is one of the most widely used billion dollar drugs and it is manufactured right here in Quebec. But most research on menopause hasn’t even studied progesterone. Progesterone declines far more than estrogen at menopause and that is a very key factor.
Progesterone is the mother hormone which is used to make other hormones. Progesterone, through a series of steps, leads to estrone and estradiol (two different types of estrogen) and testosterone. So it is a precursor hormone which can convert into either estrogen or testosterone. By the way, you need cholesterol to make progesterone; If your cholesterol is too low it can have a very adverse effect on your hormone levels.
Natural vs. Synthetic Hormones
All hormones, even synthetic hormones, are derived from natural ingredients but this does not make them natural. And all hormones, even natural hormones, are made in the lab. Natural progesterone is made in the lab from a natural source. Hormones are natural only if they are identical to the hormones in your own body, that is if they have identical structures or are bioidentical. If the progesterone is natural, you have something which the body can recognize.
Provera is one of the synthetic progesterones. It looks completely different from natural progesterone and it doesn’t have the same kind of action. Provera causes bloating, mood swings, depression, PMS-like symptoms, and also bleeding. It causes more bleeding than natural progesterone which can also cause a little bit of spotting.
Right now in Canada natural progesterone is not available except by prescription. It is available by prescription in an oral form called Prometrium. This same natural progesterone has been available in Europe for 40 years. European women just wouldn’t put up with a synthetic progesterone like Provera and its side effects.
Natural progesterone is broken down in the stomach. It causes drowsiness and sleepiness, which is very handy if you are menopausal, because most menopausal and peri-menopausal women have sleep problems. It may cause vaginal bleeding or spotting, but that disappears over time. Natural progesterone comes in oral, vaginal and the trans-dermal form, which is the skin creme.
Progesterone may come from wild yam or soy bean but it has to be converted in the lab from its precursor, which is diosgenin contained in the wild yam. It requires three chemical steps and it cannot be converted in your body.
The Wild Yam Scam
There are many wild yam cremes on the Canadian market today which contain no natural progesterone or only insignificant amounts that have no hormonal action whatsoever. They are being marketed as containing natural progesterone or as being equivalent to natural progesterone cremes, but natural progesterone cremes have been taken off the market.
Their sale is against the law right now in Canada. Although you cannot buy natural progesterone skin creme over the counter, I believe it is still legal to order it from the States by calling “Transitions for Women” in Portland, Oregon at 1-800-888-6814. They carry a particular creme called Progest which Dr. John Lee used.
There was another good one produced by Young Living Oils called Espro 7 which (due to complaints by the FDA) has been replaced by Proessence Plus or Prenolon which contains a much lower amount of progesterone (5 mg).
Methods Of Applying Natural Progesterone Crème
When you are applying progesterone creme to the skin, you must rotate the area where you apply the crème. Day 1 – face, day 2 – neck, day 3 – back of neck, day 4 – hands, and day 5, apply to the breast or belly. You can apply it to the soles of the feet as well. And then on day one you come back to the face and repeat the cycle.
You have to rotate the sites because otherwise the fatty tissue will become saturated with natural progesterone, and it may not absorb. You put it on and it just stays on the surface. As a result you won’t get a constant dosage. For menstruating women, the usual dose is a 1/4 to 1/2 tsp. twice a day from day 12 or 14 to 26; for menopausal women, you use it for 21 days out of every month.
According to Dr. John Lee, and I think he is right, the receptors become over-stimulated; so you must stop to give them a rest at least one week a month. You want to try and mimic the natural cycle as much as you can. I don’t think any hormone should be taken continuously, unless you are having very severe symptoms.
Pharmacies That Compound Natural Hormones
Many doctors are prescribing natural hormones, and we do have pharmacies that compound natural hormones. They have to actually grind them up as pharmacists used to do when their preparations were made from scratch. We have Kripp’s Pharmacy in Vancouver, which was the very first one to ever do that. In Toronto, we have Smith’s Pharmacy, York Downs Pharmacy, Hooper’s Pharmacy, Markie’s Pharmacy and The Medicine Shoppe at 2917 Bloor West.
All these pharmacies will make up a formula with natural progesterone, natural estrogen, natural testosterone, or whatever you need. Kripp’s Pharmacy has DHEA. You get permission from the government through your doctor, and the government has Kripp’s ship it to you.
Oral progesterone is available by prescription from a compounding pharmacy. Oral micronized progesterone does bypass the liver. The suggested dose of the oral form, oral micronized progesterone, is 25 to 50 mg to 100 to 200 mg at bedtime every night for 21 days of the month. If you are menstruating, you only take it 10 to 14 days a month.
After you stop menstruating, you take it 21 to 25 days a month. You can overdose on natural progesterone. To determine your hormone levels, ask your doctor to get a simple blood level of estrogen, progesterone, free testosterone, DHEA and cortisol.
Many drug plans will cover vaginal natural progesterone. If you take it vaginally, you require a much lower dose; it is very rapidly absorbed, and it is actually a very effective way to take natural progesterone.
Effects Of Natural Progesterone
Natural progesterone has quite a few advantages for both the peri-menopause and the menopause, and studies have indicated it protects from breast cancer and uterine cancer. One study demonstrated that oral progesterone alone provided relief from all menopausal symptoms. It appears to prevent, and even reverse bone loss. Most bone loss occurs in the early menopause, in the first five years, and after that the bone loss slows down.
Research on oral progesterone demonstrates it also has a very favourable effect on your blood lipids. It actually increases your high density HDL cholesterol, which is the good cholesterol, unlike the synthetic Provera, which actually has a very negative effect on your blood cholesterol.
II – Estrogens
Different Types Of Estrogen
There are three main types of estrogen: estrone, estriol and estradiol, and they each have a different role in the body. Estradiol is by far the strongest of these three estrogens. Estrone is one that seems to promote breast cancer. Estriol is the weakest, and appears to protect from breast cancer.
Synthetic Estrogen Prescriptions Are Not Bioidentical In The Homan Body
Premarin, a synthetic estrogen, is derived from pregnant mares’ urine. It is the most prescribed estrogen and it has estrone in it, which is probably the most breast cancer-causing of the three estrogens, and in fact, it has been associated with a doubling of breast cancer risk if you use it for six years or more.
It also has other ingredients which are not found in the female body, like horse estrogens and no one has any idea what these equilines and dihydroequilines do in the body, but they may cause some of the side effects of Premarin. Ogen is also a synthetic estrogen, and so is not identical to the body’s own estrogen, but some women find it easier to take than the Premarin. It is an estropipate.
Estraderm, the estrogen patch, contains estradiol, which is similar to the body’s own estrogen. The patch does bypass the liver. Estrace is an oral form of estradiol, also similar to the body’s own estrogen. It is relatively natural, but again, natural is a term that is kind of overused. Estradiol is a very potent estrogen. It is 80 types stronger than estriol and 12 times stronger than estrone.
Natural Prescription Estrogens – Triest
This is a natural estrogen available by prescription containing all three esterogens (sometimes known as Triest). Usually I reserve this for people who are having a very severe menopause, or who have had an early hysterectomy or who are having premature menopause. But it can be used for anyone who doesn’t respond to other natural treatments.
The tri-estrogens or Triest was formulated by Dr. Jonathan Wright, an American M.D. It has a predominance of estriol which is considered the safest and least cancer causing estrogen. It has 80% estriol, 10% estrone and 10% estradiol. Use 2.5 mg of this Triest, which has to be made up in a compounding pharmacy (see list at end).
Dr. Wright has had a very, very favourable response with Triest. The equivalency of this tri-estrogen is that 2.5 mg is equal to .625 mg of Premarin. Triest is a safer and yet natural formula for menopause. Estriol has actually been used to treat breast cancer. So it is relatively safe and some doctors will even prescribe it for women who have had breast cancer.
I personally, am a little bit wary. If you had breast cancer, I would tend to prescribe only natural progesterone by itself to control menopausal symptoms.
Benefits Of Estriol
Three new Japanese studies demonstrate that estriol will prevent bone loss. This is very exciting. It doesn’t protect the heart, but it does seem to protect the breast and uterus. The problem is there is no funding for further studies because there is no money to be made in studying estriol, which seems like a really nice natural alternative.
Some women take estriol by itself, but remember that it is 80 times weaker than estradiol so you may have to adjust the dosage and you may have to substitute with Triest until you get the same results.
Another method of taking estrogen that is very effective and inexpensive is through the vagina. If you take a very low dose, it doesn’t even enter your blood stream in any significant amount. Estriol is actually the most effect vaginal creme; it will take care of vaginal dryness immediately. There is a new vaginal ring that looks like a small diaphragm, and it will give out very minute amounts of estrogen, slowly over three months.
Discontinuing Synthetic Estrogens
If you are going take an estrogen, you don’t want to take one that is made from pregnant mare’s urine; you want to take one that at least has components that are normally present in your body. If you decide to go off Premarin, please go off slowly. You can try the Triest or you can try the Remifemin (a brand of black cohosh).
If you don’t have extra risk factors, bone loss or other things, I would go for the Remifemin. Reduce it to a half for a couple of weeks, then a quarter for two weeks, and then go off it. Start the Remifemin at the same time as you are going off the estrogen. Start taking it twice a day.
Prescription Estrogen Receptor Modulator Drugs: Raloxifene (or Evista)
This disastrous drug is being promoted for menopause. Raloxifene (Evista) has been associated recently with possibly increasing Alzheimer’s in susceptible people. Raloxifene is a tamoxifen cousin. Tamoxifen is an anti-estrogen drug. Tamoxifen has been shown to possibly increase the incidence of breast cancer after five years of use.It appears to protect the uterus, it appears to protect the breast, and is positive on the bone, but really it is premature to promote it.
We don’t know what the cancer potential of it is. In five or ten years we will find out. But it is being heavily pushed by a lot of gynecologists. Raloxifene, Evista, all these selective estrogen receptor modulators – are supposed to target some estrogen receptors, and leave the others alone. Right now I wouldn’t suggest taking it.
Advantages And Disadvantages Of Estrogen
Estrogen prevents hot flashes and night sweats. It relieves vaginal dryness and atrophy and improves cholesterol profile. It relieves urethral and urinary problems. It halts bone loss and reduces fracture rate. It increases skin thickness and has a direct positive effect on blood vessels. We can do all that naturally.
Estrogen does halt bone loss, but it does not add anything to the bone. As soon as you go off it, your bone loss accelerates. New studies have shows calcium alone will prevent bone loss. The disadvantages of estrogens are increased risk of uterine cancer by eight times. It increases breast cancer, fibroids, endometriosis, thrombophlebitis, lupus and gallbladder problems. One study showed an association between estrogen and fatal ovarian cancer.
Estrogen And Heart Disease In Women
Estrogen is not a heart protective hormone. A recent study showed women who were on estrogen did not have a lower incidence of heart disease at all, and in fact, some of them had an increased incidence of heart disease. We really don’t know if the supposed benefits outweigh the risks at this point.
Wilfred and Evan Shute, the great Canadian pioneers, discovered that vitamin E would protect the heart. Just 100 IUs of vitamin E reduces the risk of heart disease by 60%. Similar results have been shown in men. We have other means for protecting the heart like chelation therapy and wonderful herbs like hawthorn that are tonics for the heart.
III – Other Natural Solutions For All Menopausal Symptoms
You can improve your symptoms a great deal just by diet alone. You should eliminate sugar. At menopause, we really have to clean up our act with sugar and sugar substitutes which are every bit as bad as sugar, probably worse. Aspartame and Nutrasweet and all those sugar substitutes have a very bad effect on the brain function and can cause headaches.
So you are not doing yourself any favour by substituting with Diet Coke or Diet Pepsi or diet chewing gum. You should also avoid caffeine. You should eat less animal fat, and stop eating junk food, fried foods, additives, salty foods and nicotine, which of course, is a very aging drug. Drink pure water and eat a lot of fresh fruits and vegetables, organic if possible.
The soy bean has plant estrogens known as isoflavones. These estrogens are 100,000 times weaker than estradiol and solid research has shown that they reduce cholesterol, risk of breast cancer and menopausal complaints. They effectively alleviate hot flashes.
One patented soy derivative known as iproflavone has a very good safety profile, and has been approved in Italy and Japan for the treatment of osteoporosis. This is a very well researched natural alternative for treatment and prevention of bone loss. You can find iproflavone in health food stores. You take it twice a day. This is a good alternative because natural progesterone creme is not effective for everyone in terms of building bone.
A diet high in soy foods provides phytoestrogens, but you can substitute flaxseed if you don’t like soy foods (ref: Ploy of Soy, Mar.00 by Sally Fallon). Two tablespoons of flaxseed will equal two servings of soy per day and this is good for menopausal symptoms like hot flashes, breast cancer prevention and even bone loss. To reduce cholesterol, take 3 to 5 tbsp. flaxseed.
For osteoporosis, you would have to take a ton of flaxseed, or 6 to 8 servings of soy, which is hard to imagine. Iproflavone is an effective alternative. The real concern I have for all the soy that is being promoted, even in mainstream journals, is that it is made from genetically altered soy. Westbrae, Eden and a few others do have organic soy.
Vitamins And Minerals
By the time you reach menopause you should be on a basic program of at least 500 mg of vitamin C, preferably Ester C, 400 IU vitamin E and 30,000 IU beta-carotene, You can also add trace minerals in the form of a Super Green drink. Take 3 tsp. a day. Greens Plus is the one that I personally like, because it is a very high quality drink. You can also make your own green juice.
The Green Life juicer makes the best quality juice I have ever seen, but it is very pricey. Every woman over 35 should take at least 1000 to 1200 mg of calcium per night or even more. Some studies show that 1500 mg calcium will help with bone loss, PMS, and other symptoms.
Magnesium is extremely critical for women. Some of the symptoms of magnesium deficiency are irritability, memory loss, and chocolate cravings. The magnesium dosage should be anywhere from 300 to 600 mg per night. There are different types of calcium. Calcium and magnesium citrates are very good. After age 60, your hydrochloric acid declines, so you may have to take some enzymes along with the calcium so that it absorbs.
It is good to take calcium and magnesium at night because it helps you relax and sleep. The ‘B’ vitamins are extremely important and they are very calming and toning to the nerves for people who have anxiety attacks. Use a B-complex. Factors like methionine, choline, and inositol improve the liver function. You can find these in the health stores.
Herbal medicines are excellent in menopause, especially black cohosh. Black cohosh extract has a very positive estrogen effect on the vagina. The only brand of black cohosh which has been studied extensively is called Remifemin. It is available in your health food store, and you take one tablet twice a day.
It improves all menopausal symptoms with virtually very few side effects, and has been used in Europe for 40 years. The only side effect may be a gastric irritation in which case you should take it with meals. It has an estrogenic effect on the vagina. In my opinion you should combine it with natural progesterone. It has been compared to Premarin and Premarin plus Valium. It decreases anxiety and depression.
It is a very safe preparation. A lot of the black cohosh on the market is not standardized extract. There are other good black cohosh preparations, if they are standardized extracts. Natural Factors just brought out a good standardized extract of black cohosh, and they also brought out a menopausal formula that uses black cohosh and chaste berry.
You can also use kava kava, a wonderful herb from the South Pacific. It is really the perfect herb for the symptoms of menopause. Research shows that kava kava alleviates anxiety, irritability and nervous problems; it makes you calm and relaxed without sedation.
Susan Weed suggests alternating four weeks of dong quai with two weeks of panax ginseng throughout the menopause. They both have strongly estrogenic qualities and can raise your estrogen, sometimes very high. Sometimes dong quai bothers women’s breasts; they get breast swelling and tenderness.
Rina Nissam, a European gynecologist, uses black currant, stone seed, lady’s mantle, chaste tree, wild pansy and sequoia all in equal parts with alcohol to decrease estrogen overload. She uses a thyme distillation. She has used it successfully also for fibroids and other conditions that have excess estrogen. It is a very simple formula: take one teaspoon every morning. She also recommends essential oils.
Balancing The Herbs
When you are using estrogen-type botanicals like angelica, dong quai, burdock and black cohosh, you must use things like licorice and wild yam for their known progesterone-like qualities to balance the formula. Some of the menopausal formulas on the market right now are really horrific. They have just been thrown together – everything in the kitchen sink is in them and there is no knowledge of the delicate relationships between herbal balance.
The essential oils, clary sage, sage, fennel, blue yarrow, bergemot and ylang ylang are very, very useful. They help balance hormones, and increase oxygenation to the blood and brain. Geranium is another hormone-balancer, which also helps the adrenal glands. Clary sage and geranium are very powerful aids for women in menopause. These oils can all be added to the natural progesterone creme.
Acupuncture And Chinese Medicine
These will almost always get rid of all the symptoms of menopause and balance your meridians. A series of at least six acupuncture treatments is recommended.
The most traumatic kind of menopause is premature menopause, going into menopause in your late thirties. It is very harsh and there tend to be a lot of mental and emotional symptoms.
Dr. Tory Hudson, a naturopath who runs a women’s clinic in Portland, Oregon, has created a formula that decreases hot flashes. It is two parts licorice, two parts burdock, two parts dong quai, one part wild yam and one part motherwort. She stresses the need to balance the estrogenic and the progestrogenic herbs.
I usually prescribe natural progesterone along with whatever form of estrogens you are using, be they conventional, or natural or herbal estrogens. Night sweats are very easy to handle naturally, actually.
Treating Your Liver To Improve Menopausal Symptoms
Fresh juices like beet, carrot, garlic and parsley are beneficial to the liver, and a daily lemon juice is a very effective way to help the liver. When you have your first glass of water in the morning, have some lemon juice. Bitter greens like endive, raddichio, dandelion greens, stinging nettles, etc. stimulate the liver.
If you don’t have enough bitter greens in your diet, you can get Swedish Bitters at the health store. Bitters promote liver and bile function and aid digestion. Liver herbs like dandelion root, milk thistle, burdock, artichoke, turmeric are available at the health store. You mustn’t take liver herbs indefinitely or for a long period of time. You take them for up to three months to decrease the burden on your body caused by the excess estrogen.
Pesticides in our food, cosmetics and environment contribute to estrogen excess in our bodies. Liver support is absolutely critical. These estrogen-like compounds go to the estrogen receptors and mimic estrogen. So there is a constant influx of estrogen and not enough progesterone.
Most of the pesticides are concentrated in the fat of meat and dairy, so cut down on your fatty meat and dairy products or use organic products. I do support butter over margarine as a fairly healthy product and olive oil. So treating your liver can help your menopausal symptoms, especially if they are really out of control.
Results Of Liver Toxicity
When the liver is no longer able to detoxify, a second liver is created in the form of a cyst, fibroid, or arthritic inflammation where the toxins are stored. The cyst or fibroid plays a role in maintaining the organism’s equilibrium, actually doing us a favour by walling off the toxins. So if you detoxify, and you have any of these conditions like ovarian cysts, cystic breasts, fibroids, arthritis, etc., you have to detoxify very slowly because the body is trying to protect you from that toxin.
There are a couple of ways to strengthen your adrenal glands. You can take a high quality adrenal gland extract made from animals which will give your adrenal gland a rest. I happen to use Seroyal TAD Plus which is a good adrenal supplement. You take two at 8:00 am, and two at 3:00 or 4:00 pm.
There are other good adrenal supplements made by Thorne and other companies. You take this adrenal gland for three to six months if you are experiencing a stressful pre-menopause. You don’t take it indefinitely. Other supplements which support the adrenal glands are vitamin C and pantothenic acid.
Pantothenic acid is like the body’s natural cortisone. Take 500 mg four times a day, and combine it with vitamin C, 500 mg four times a day. So you take one of each, four times a day. Licorice root tea and black currant bud are excellent adrenal balancers. Young Living Essential Oils makes a Thyromin which is really excellent and Endoflex. Both are adrenal gland balancers.
It is very important for women in menopause to get adrenal support, through adrenal supplementation, licorice root tea, vitamin C and pantothenic acid, and taking extra natural hormones and liver support.
Thyromin is probably the best thyroid balancer that I have discovered so far. And the thyroid gland is often involved in menopause, but sometimes if you just correct the adrenal gland, the thyroid will kick in. A lot of women these days, have underactive thyroid problems. Thyromin contains myrtle and myrrh, which help balance the thyroid, whether it is underactive or overactive.
Fibroids, Fibrocystic Breast Disease and Endometriosis
Please see Dr. DeMarco’s book, Take Charge of Your Body which has chapters on fibrocystic breast disease and endometriosis.