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Menopause is a transition, and like many transitions, is easier on some women than others. One rule of thumb for treating perimenopause—the time around a woman’s menopause—is that there are no hard and fast rules.

Menopause is a transition - easier on some women than others

Some women have no problems at all associated with menopause—and others are just miserable.  Most women fall somewhere between the two extremes and have good days and not so good days.  I remember hearing a lecture on perimenopause one day in medical school—I thought it would be interesting because here I was, starting with perimenopausal symptoms.  The woman lecturing was a young and vital 30-something…and was saying that menopause is “just like a second puberty!”  Uh….no, not one bit, at least not for me.  Hey, maybe I was just being a bit irritable. Though I’d be willing to bet in a few years, she wasn’t going to be sounding quite so certain---or so cheerful! After all, puberty can be a tough time as well!

The point here is that every woman’s perimenopausal phase is unique to her—and just because one woman has no hot flashes, night sweats or mood swings doesn’t mean her co-worker is going to go through the same process.  Also, just because eating soy was sufficient to handle one woman’s hot flashes doesn’t mean it’s going to work for everyone!  Every woman is different and what works for some will not work for others.  It’s a trying time and tough to be patient and work through all the symptoms or difficulties—but its’ also important to remember that menopause is NOT a disease!  It’s a transition phase that is perfectly natural and normal.  Our goal should be to smooth out the process and minimize the interference with our lives.  I find it useful to remember that in many cultures, a woman in menopause is revered and honored for her wisdom….yes, about time!

What is happening during menopause?

During menopause, your body is beginning to shut down the cyclic production of the hormones estrogen and progesterone.  This cyclic production is very complex—and as with any complex system, you can get variations in the amounts of estrogen and progesterone—and testosterone—that is produced.  Those variations—the highs and the lows—seem to be responsible for all the signs and symptoms of menopause. Naturopaths will often talk about estrogen dominance—but it is really the relative levels of estrogen to progesterone that appear to cause most of the signs and symptoms.

Signs of menopause (there are more—these are just the most common)

  • Irregular periods—and they can get very irregular!  You can skip periods or have 2 in one cycle.  Very heavy periods can signal a thyroid problem—have your thyroid checked.  Low thyroid is very common in perimenopausal woman.
  • Vaginal dryness-Vitamin E directly applied to the vulva can relieve this.
  • Hot flashes—many women feel these in the upper body and facial areas. They can last a few seconds to a few minutes. A cool shower helps, if you can take the time.
  • Sleep disturbances-insomnia, waking up in the middle of the night.
  • Mood swings- increased irritability, sadness, being emotional
  • Headaches
  • Water retention and bloating
  • Abdominal weight gain
  • Thinning hair
  • Breasts can lose their fullness and get flatter

Herbal supplements to relieve menopausal symptoms

  1. Chaste tree (Vitex agnus-castus)

    • In the middle ages, monks took Vitex agnus-castus to ensure that they kept their vows of celibacy—it is also known as Monk’s pepper.  Chasteberry appears to suppress prolactin and to have estrogenic effects.  Chasteberry also appears to affect different neurotransmitters and help with depression and irritability.
  2. Black cohosh (Cimicifuga racemosa) 

    • Black cohosh is an estrogenic herb—a phytoestrogen—this means that some of the constituents of black cohosh don’t necessarily “look” like estrogen, but act like estrogen in the body.   Black cohosh is also anti-inflammatory and relieves muscular pain and cramping.  Black cohosh is effective in some women in reducing hot flashes. The most common problems associated with black cohosh are stomach upset.  

  3. Dandelion (Taraxacum officinale)

    • Dandelion leaves have been used for centuries as a diuretic—an herbal “water pill”.  The roots have been used to support liver function. Since estrogen is processed in the liver, naturopathic physicians will often use dandelion to support this. Dandelion also supports the immune system  and is an ant-inflammatory.  Spring teas made from dandelion leaves were used as a cleansing spring tonic.

  4. Dong quai (Angelica sinensis)

    • Dong quai is the traditional Chinese name for an herb that has also been used for centuries to treat perimenopausal symptoms and also appears to be an estrogenic herb.
  5. Other estrogenic herbs

    • Raspberry
    • Red clover
  6. Other herbs used in perimenopause

These are herbs that do not necessarily directly affect female hormones but are often are useful to support sleep and overall health.  These include:
  • Licorice (for immune and adrenal health)
  • Ginkgo biloba (for mood and circulation)
  • Ginseng (for mood, fatigues, immune function)
  • Sarsaparilla(improves libido and increases energy)

Vitamins and supplements for perimenopause

  • Vitamin A—take as β-carotene or eat plenty of yellow vegetables and fruits such as carrots, apricots, cantaloupe melon and sweet potato.
  • Vitamin D—being in the sun is best (about 10-15 minutes at a time), but not always possible.  Vitamin D is helpful not only for strong bones, but is related to the prevention of autoimmune diseases as well. Food sources include fish, eggs and dairy products.
  • Vitamin E—Vitamin E, directly applied to the vulvar area relieves the dryness sometimes associated with peri-menopause. Many women have found it useful in minimizing hot flashes as well.  As an anti-oxidant, Vitamin E may also be useful to relieve fatigue and mood swings. Food sources include wheatgerm, avocados, beans and leafy green vegetables.
  • B-vitamins—the B vitamins are extremely important in maintaining energy levels and reducing fatigue. Food sources include leafy green vegetables, nuts, organ meats, whole grains and beans.
  • Omega-3 fatty acids—including EPA and DHA are anti-inflammatory agents.  The best source of omega-3 fatty acids are fish or krill oils.
  • Evening primrose oil—contains another type of fatty acid—the omega-6 type.  These fatty acids are also anti-inflammatory and seem to help balance hormones. It has been used successfully to treat breast pain.
There are also many foods (including soy) that can help you through this time of transition.  A well-balanced, whole food diet with plenty of water and a solid exercise plan is always good advice.  Remember, it is a natural transition—find other women going through menopause. I had a patient who, in the middle of our discussion of HER menopausal symptoms realized I was having a hot flash right then and there!  Believe me, the 5 minutes of total laughter and support we gave each other was absolutely priceless—even better than a cool shower (which, by the way, is VERY helpful sometimes!)

  • Shams T, Setia MS, Hemmings R, et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. Altern Ther Health Med 2010, 16:36-44
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  • Cheung KL. Management of cyclical mastalgia in oriental women: pioneer experience of using gamolenic acid (Efamast) in Asia. Aust N Z J Surg 1999, 69:492-4.b

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