Submitted by: Nancy W.

Q: I am confused about what the difference is between menopause and perimenopause, and what kind of natural treatment would you recommend?

A: The current generation of women who will be or are going through perimenopause and menopause may be the first generation that lives nearly half their lives without menstruation. They are navigating through uncharted waters and that may be why there is some confusion and misconception about what to expect, if anything, and what needs to be done, if anything, when symptoms arise.

The Western view would have us believe that menopause is an estrogen-deficiency disease that needs to be treated with estrogen to compensate for the normal decline of estrogen levels with aging. Contrary to popular belief, perimenopause is not a hormonal transition associated with the lowest levels of estrogen. The fact is that hormonal levels are fluctuating wildly and estrogen levels may peak to a point equal to that of when the woman was twenty years old and then as quickly as it went up, estrogen levels may then rapidly plummet.

Perimenopause, therefore, is difficult to define because follicle stimulating hormone (FSH) and estradiol (the two most common markers used to determine menopause status) can appear in the postmenopause range one day and in the premenopause range a few days later.

The most common complaint of early perimenopause is the temperature variant called a hot flash (or flush). Other common complaints are menstrual irregularities, breast tenderness, increased fibrocystic changes, growth of uterine fibroids, flare-ups of endometriosis, emotional stress, and weight gain.

Another important and common finding that warrants consideration for perimenopause is low levels of progesterone. This is especially important because, among other reactions in the body, low progesterone is related to a short luteal phase (the part of the menstrual cycle where ovulation occurs) and a short luteal phase is associated with increased bone loss. This is a very important situation to consider because bone mineral density studies are usually not ordered until after menopause but the average age of perimenopause is 47 and bone mineral loss begins at around the age of 40 - 10 or 15 years before it is usually even tested for. And as with many situations in the body, the earlier an imbalance is detected the better the prognosis. As I indicated in a previous article on osteoporosis, it is the number one bone condition in the United States. Eight million women have osteoporosis, over a million with fractures, many of which were potentially preventable. There are over 70,000 deaths related to preventable hip fractures and over 50,000 requiring long term care.

Another important aspect to recognize is that hyperinsulinemia (high levels of insulin in the blood) influences estrogen synthesis and overall hormone balance or imbalance. A number of nutritional, diet, and lifestyle interventions can improve insulin sensitivity and reduce symptoms associated with these hormone imbalances in women. The dietary program needs to include low glycemic index foods, such as most fruits, berries, nuts, a variety of vegetables, whole grains (not refined grains), fish, eggs, soy products, and lamb. Also consider the following specific nutrients: D-chiro-inositol, chromium, antioxidants, omega-3 fatty acids, and magnesium.

Thyroid function is another important area that appears to change in the perimenopausal period. Many of the common symptoms of perimenopause may be attributed to thyroid dysfunction such as weight gain, depression, anxiety, fatigue, cold intolerance, loss of libido, and abnormal menses. As part of the perimenopausal evaluation, I would, therefore, recommend a comprehensive thyroid panel. If hypothroidism is evident, I may suggest the following: elimination of dietary sources of gluten-containing grains such as wheat, and casein-containing products from dairy, such as milk, cheese, etc. These potential food antigens could induce antibodies that cross-react with the thyroid gland. I will also recommend organic iodine from fucus (seaweed), selenium, zinc, omega-3 fatty acids, and antioxidants (including vitamins A, C, and E).

One major underlying issue to consider is that a stress hormone called cortisol plays a major factor in disrupting the orchestrated symphony of the body that is the endocrine hormonal system. Among other lifestyle factors exercise has been proven time and again to have direct positive benefits on stress and on the hormone imbalances related to menopause. Some of these benefits include decreased blood cholesterol levels, decreased bone loss, decreased fat storage, improved ability to deal with stress, improved circulation, improved heart function, increased endurance and energy, increased self-esteem and mood, reduced blood pressure, and relief from hot flashes.

In summary, treatment for symptoms associated with perimenopause needs to be centered around balancing estrogen, raising progesterone levels, controlling insulin and blood sugar, and correcting thyroid imbalances.

In addition to previously mentioned nutrients, I would consider standardized botanical medicines. Black cohosh (Cimicifuga racemosa) helps to reduce hot flashes. Chasteberry (Vitex agnus-castus) used for symptoms of perimenopause. Dong Quai (Angelica sinensis) and licorice (Glycyrrhiza glabra) have also been shown to decrease symptoms associated with perimenopause and menopause. Also consider gamma oryzanol for hot flashes and soy protein isoflavones. Certain individuals may benefit from progesterone augmentation.

We live in bodies where all the systems are very interrelated in a web-like balance of interactions. We cannot just listen to one instrument when addressing the human body but rather have to respect and consider the entire symphony. As usual, I would recommend a consultation for an individualized, comprehensive assessment.

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