When the dark hairs began sprouting on her chin and her libido plummeted, Sherrill Sellman of Tulsa, Oklahoma, suspected changes inside her body. When she started kicking off sweat-drenched sheets every night and rocketing out of bed because of predawn anxiety attacks, she resigned herself to the inevitable: Perimenopause had set in.
Sellman assumed these symptoms stemmed from her body reducing its estrogen production to shut down her baby-making ability. She’d heard about the dangers of conventional hormone-replacement therapy (HRT)—a synthetic estrogen-progesterone cocktail linked to breast cancer in major studies, including the 160,000-participant Women’s Health Initiative of 2002. But she’d also heard that using progesterone alone could relieve her perimenopausal symptoms. So Sellman tried a natural progesterone cream, and for three months felt like a 30-year-old again. The night sweats stopped and panic attacks ceased. “Then the progesterone started to lose its punch,” she says. As the symptoms returned, Sellman decided there had to be a better solution. Putting her medical training as a psychotherapist to work, she investigated the causes of perimenopause and menopause.
What Sellman discovered convinced her to change careers. She became a naturopathic doctor and wrote the book Hormone Heresy: What Women Must Know About Their Hormones (Bridger House Publishers, 2009). “Our bodies have the amazing capacity to transition through life symptom-free,” Sellman says. “But to do that, we have to understand that our hormones are not separate from all the other systems functioning in our bodies.”
The current research suggests that looking beyond the ovaries is key to reducing or even eliminating the symptoms associated with perimenopause. Scientists are finding that the entire endocrine system—from the hypothalamus in the brain to the adrenal glands above the kidneys—contributes to the hormonal changes that cause everything from hot flashes to mood swings to osteoporosis in women in their 40s and 50s. Here’s a look at the latest theories on treatments for menopause.
Boost the adrenals
Estrogen levels fluctuate during perimenopause and drop drastically in the year or two before menopause (defined as 12 months without a period). Sellman says that when the ovaries begin operating irregularly in the early stages of perimenopause, the hypothalamus and pituitary glands, which regulate hormone production, send extra estrogen to the ovaries to “try and kick-start them one last time.” Simultaneously, the body reduces progesterone, the hormone that tells the uterus to shed its lining—because without ovulation there’s no need for a monthly lining flush (your period). The result? A condition called “estrogen dominance,” which creates symptoms like weight gain, anxiety, bloating, hot flashes, and poor concentration, says Elizabeth Yurth, MD, founder of the Boulder Longevity Institute, a Colorado clinic that specializes in hormone testing and modulation.
The adrenal glands supply two key hormones associated with perimenopause: testosterone and dehydroepiandrosterone (DHEA). Low testosterone in women reduces libido and can cause weight gain, Yurth says, while too little DHEA can cause bone loss and symptoms of aging like wrinkled skin. The adrenals also produce small amounts of progesterone, but Sellman says if your adrenals are exhausted because of too much stress or a poor diet, they will devote all their remaining energy to one of their primary jobs—producing the hormone cortisol, which helps with immune functions, mineral absorption, and energy production.
Sellman’s research shows that progesterone is a precursor hormone, meaning it can turn into other hormones the body lacks, especially cortisol. So if your stressed-out adrenals can’t produce enough cortisol, they may steal from your body’s progesterone store. “That’s why progesterone cream may seem to lose its punch after a few months—instead of balancing estrogen, it is being diverted to make cortisol,” she says.
What to do: Sellman says a good way to reinvigorate your adrenals is to keep blood-sugar levels steady: “One of the adrenals’ jobs is to balance blood sugar; if you do it for them, they won’t have to devote energy to that task.” Don’t skip meals, and eat complex carbohydrates, healthy fats, and protein at every meal to slow the release of blood sugar into your body, she says. (For more about adrenal fatigue, plus recipes, type “The Adrenal Fatigue Fix” into the search box at naturalsolutionsmag.com.)
Because of the HRT-cancer scare, women have turned to supplements as a safer way to reduce menopausal symptoms. One herb that has dominated the conversation is black cohosh—it’s one of the most recommended herbs for menopausal women and has been historically used to relieve hot flashes, night sweats, anxiety, and vaginal dryness.
Originally, researchers and healthcare practitioners believed that black cohosh contained chemical compounds that could mimic estrogen in the body. But several studies have disproved this theory. Research published in The Journal of Agriculture and Food Chemistry theorized an alternate reason for the herb’s efficacy: Black cohosh targets the serotonin receptors in the hypothalamus—the part of your brain that produces hormones to regulate body temperature—to offer relief from hot flashes. Serotonin also affects mood, which is why the herb helps to abate mood swings, says Susan Lark, MD, a women’s health specialist.
Offering another explanation, Marcus Laux, ND, author of Natural Woman, Natural Menopause (Harper, 1998), says that black cohosh affects the brain’s pituitary gland, lowering levels of hormones that are linked to menopause symptoms. “If the hormones are imbalanced, the pituitary gland will send out signals to create more hormones.” Black cohosh, he says, may “dampen down” the pituitary’s frantic hormone-boosting attempts.
It’s worth noting that not all black cohosh is created equal. As we first reported in 2006, Asian varieties of the herb were found to have no effect on symptoms, while Remifemin (a proprietary version of black cohosh) was found to produce significant relief, says a study in Obstetrics and Gynecology.
Another herb to consider is rhubarb—specifically the Siberian rhubarb root extract ERr 731—which, according to David Riley, MD, Natural Solutions’ medical editor, has been shown to have estrogenic effects in the body. Recent studies in Menopause and Alternative Therapies (Natural Solutions’ sister publication) found that the extract significantly reduced the occurrence of hot flashes in perimenopausal women. Siberian rhubarb root extract is marketed as Estrovera and available only through authorized healthcare practitioners.
What to do: If you take black cohosh, Sellman recommends 80 to 160 mg daily. For Remifemin, Laux suggests taking 20 mg twice a day. For rhubarb, Riley suggests taking one tablet (4 mg) daily, which can be increased to two tablets after three to six weeks. The key with any supplementation is patience, says Catherine Austin, LAc, a faculty member at the Pacific College of Oriental Medicine in San Diego. It can take six to 10 weeks for daily herb supplements, coupled with weekly acupuncture treatments, to have an effect, she says. The earlier you start an herb regimen—she recommends visiting your acupuncturist or herbalist as soon as your periods become irregular—the easier it is to treat symptoms.
Bioidentical hormones, which are made from plants that mimic human estrogen and progesterone (and are available as gels, patches, creams, or pills), are considered safer than synthetic hormone-replacement therapies. Yet Laux, who patented bioidentical hormones in 2002, says the mind-set today is “shifting toward the next medical revolution—that hormone intervention is unnecessary.” In most cases, women (unless they are not responding to other therapies) don’t even need bioidentical hormone replenishment, he says. This is because, as Sellman points out, taking hormones doesn’t heal at the root level or rejuvenate your body. “If underlying problems like adrenal fatigue are addressed, you may not have to take bioidentical hormones for long, if at all,” she says.
Yurth says another option is to simply take a soy supplement, which boosts estrogen. The same ingredient is used in bioidentical hormones, but because supplements aren’t as concentrated as prescription hormones, you’ll have to load up.
What to do: Lark says if you do opt for hormone therapy, stick with topical bioidentical hormone gels, which can be prescribed by your doctor or naturopath and custom made for you. Because topical gels allow hormones to be directly absorbed into the bloodstream rather than through the digestive tract, they usually have lower dosages of hormones than pills.
Find Relief With These Remedies
In her book Hormone Revolution (Portola Press, 2007), Susan Lark, MD, a women’s health specialist, recommends a daily cocktail of botanicals, vitamins, and minerals to decrease menopausal symptoms.
Black cohosh (standardized) to relieve hot flashes (40 to 80 mg)
Bioflavonoids like quercetin to reduce estrogen levels (1,000 to 2,000 mg)
Calcium carbonate to ease mood swings, bloating, and cravings (1,200 to 1,500 mg)
Ground flaxseed to promote progesterone production (4 to 6 tablespoons)
Magnesium to reduce water retention (600 to 750 mg)
Soy isoflavones to normalize estrogen levels (50 to 150 mg)
Vitamin B6, taken with magnesium, to decrease PMS-related anxiety (50 to 100 mg)
Vitamin C to lower estrogen and lessen menstrual bleeding (1,000 to 4,000 mg)
Perimenopause The two-to-eight year interval when the body begins its transition into menopause. It is characterized by rising and falling estrogen levels, with a gradual increase in irregular periods, mood swings, hot flashes, and vaginal dryness. The average age of onset is 40.
Menopause Marked by one year without a menstrual period. The average age of onset is 51.
Postmenopause The time after a woman has gone 12 months without a period. Symptoms caused by estrogen swings will tend to cease.
6 Supplements for Menopause
EstroSoy Plus: Made with fermented soy and black cohosh. $20, 60 capsules; naturesway.com
Estrovera: Made with a Siberian rhubarb root extract. $30, 30 capsules; metagenics.com
Femi-Yin for Menopause Relief: A blend of traditional Chinese medicine herbs, including wild yam, which may boost progesterone. $26, 60 capsules; biomed-health.com
i-Cool for Menopause: Made with geniVida, a proprietary isoflavone (found in soy) believed to reduce hot flashes. Available in stores at the end of June. $20, 30 tablets; i-cooltoday.com
Menopret: Made with proprietary black cohosh (formerly called Klimadynon). $22, 30 tablets; bionoricausa.com
Remifemin: The first standardized, proprietary black cohosh product. $20, 60 capsules; enzymatictherapy.com