The Peri-menopause is referring to the period prior to menopause. It is the transition from the 2 to 6 years preceding the last period to 12 months after the final menstrual cycle. This is when menopausal symptoms begin. The scientific term is called “Climacteric”, yet rarely used.
Signs and Symptoms
Due to the number of hormone variations with a combination of oestrogen decline, there are a few biochemical and physical changes. Peri-menopause starts to become evident in women’s 30’s. Early changes to the follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels slowly rise over the next decade and are indicative of follicle loss and ovarian aging.
Whilst the symptoms may vary from woman to woman, they typically include;
- Mood changes/anger
- Night sweats
- Hot flushes
- Weight gain
- Mastodynia (breast pain)
- Formication (sensation of crawling insects on skin)
Many of these symptoms appear to be due to the fluctuations of oestrogen rather than low oestrogen levels as in menopause.
What can we do about it?
While medical doctors prescribe Hormone Replacement Therapy (HRT), the type of hormones they use are different to menopause. As Naturopaths, we also treat and prescribe differently for these two phases. As mentioned earlier, each woman is different, and treatment is based on individual needs and symptoms. The goal is to alleviate symptoms and reduce risk factors such as osteoporosis, heart disease, colon cancer, glaucoma, macular degeneration and Alzheimer’s disease.
Until recently, HRT was the gold standard to prevent these age-related conditions like heart disease. However, there seems to be allot of controversy about HRT therapies.
The first randomised clinical controlled trial on the subject was conducted in the year 2000, known as the Heart and Oestrogen/Progestin Replacement Study (HERS), compared the use of HRT with placebo in postmenopausal women with heart disease, and found no benefit in terms of preventing heart disease (BITTNER, 2000). In fact, evidence from the secondary trial suggested that the first year, women who took the HRT known with cardiac disease, may be at risk of thromboembolic events, including stroke and heart disease (Herrington et al., 2002).
The Million Women Study was a very large cohort study in the UK, set up to investigate the effects of HRT on fatal breast cancer and on incident. There was 1,084 110 UK women aged between 50-64 years were recruited in this study between 1996 and 2001 (5 years). The findings were astonishing!
Half of the women had used HRT: 9364 incident invasive breast cancers and 637 breast cancer deaths were registered after an average of 2.6 and 4.1 years of follow-up, respectively. The effect is substantially greater for oestrogen-progestagen combinations than for other types of HRT. Current users of HRT at recruitment were more likely than never users to develop breast cancer (adjusted relative risk 1.66) and die from it (Banks et al., 2003).
Considering all of these factors and risks involved. I have only listed a few here, there are many more studies showing that HRT can be risky with woman with health conditions or predispositions or none.
For this reason, I highly urge to consider alternative approaches for both symptom relief and prevention of long-term illness is important. The following has the most up-to-date and scientific support.
How can Naturopathy help?
Nutrition and Supplements
Phyto-oestrogen are plant derived compounds, including Ligans and isoflavones, that exert both oestrogenic and anti-oestrogenic effects. Soy products have isoflavones called genistein and daidzein and also in the herb Trifolium pratense (red clover) (Chen, Ko and Chen, 2019). Flaxseeds are high in ligans and contain omega-3 fatty acids and studies suggest that it is considered to be protective against the development of breast cancer by taking just 5 to 10 grams a day (Haggans et al., 1999).
Phyto-oestrogens provide the following benefits;
- Reduce Cardiovascular risk
- Diminish vaginal dryness
- Reduction of Hot Flushes
- Increase bone mineral density
- Improve cognitive function
- Possible prevention of hormone-related cancers (breast, endometrial and ovarian)
Calcium is especially important to maintain bone density. The National Institutes of Health recommend that postmenopausal women should take 1000 to 1500 mg per day. In a randomised clinical trial post-menopausal women were taking 800mg per day and had maintained bone density in compared to the placebo group who had bone loss (Ruml et al., 1999).
Foods rich in calcium are cruciferous foods (leafy green, broccoli, spinach etc), almonds, dried beans, diary products. When there are not sufficient amounts obtained through diet, supplementation should be considered.
Vitamin D is necessary for calcium to be absorbed by the intestines. The recommended dietary intake for vitamin D is currently 400 IU/day for women aged 51 to 70 and 600 IU/day for women more than age 70. Vitamin D can be obtained from sunlight and fatty fish, as well as dairy products fortified with vitamin D. Most women can meet their vitamin D needs with a combination of moderate exposure to the sun and 400 IU vitamin D supplements (‘The role of calcium in peri- and postmenopausal women: Consensus opinion of the North American menopause society’, 2001).
Boron and Magnesium
I like to prescribe both calcium and magnesium together as it helps the absorption in the gut.
Boron is a cofactor for magnesium metabolism, so when low on boron, it exacerbates magnesium deficiency.
Vitamin K can decrease bone resorption and increase bone formation. A recent randomised controlled trial suggested a trend towards prevention of spinal bone loss over 12 month period receiving either 45mg Vitamin K or 1gram a day of Vitamin D (Iwamoto et al., 1999). Vitamin K should not be used in those taking anticoagulant medication.
Omega-3 Fatty Acids
Omega-3 Fatty Acids are basically fish oil and are important for cholesterol balance between the good and the bad cholesterol. A small double blind placebo controlled study found 2.4g of EPA and 1.6g of DHA daily significantly decreased serum triglyceride concentrations (bad fat) after 28 days (Stark et al., 2000).
Herbs are extremely useful and I have seen some amazing results! I have only put some main contenders here but there are plenty more!
These herbs are particularly relevant to peri-menopausal women however, please do keep in mind that each individual case is carefully considered and tailor made to suit your individual needs.
The aim is to manage adverse responses to cyclic hormone fluctuations.
Vitex agnus-castus (Chaste tree berry)
Used for hormone modulation. It is a highly affective herb to balance out hormones in women and especially for relieving PMS symptoms. Not only associated with PMS and peri-menopause but it is also specific adjunct to promoting overall reproductive health.
A randomized, placebo-controlled, double-blind study, from 134 selected patients 128 women suffered from PMS. In this study the therapeutic effect of Vitex agnus castus on women who had the PMS, in comparison with placebo, were investigated. It concluded that Vitex agnus can be considered as an effective and well tolerated treatment for the relief of symptoms of mild and moderate PMS (Zamani, Neghab and Torabian, 2012).
Withania somnifera (Ashwagandha)
Specifically used as a nervine. Withania somnifera is the most important tonic in the ayurvedic tradition of healing of India. The therapeutic effects are adaptogenic, anti-inflammatory, antioxidant, cardioactive, and immunomodulatory activity and most importantly its ability to reduce cortisol levels under stress (Lopresti et al., 2019).
Hypericum perforatum (St John’s Wort)
Also used specifically as a nervine tonic and for emotional support. For those that are struggling with the emotional effects and can get depressed. There are several proposed mechanisms of action for Hypericum’s anti-depressant effect. It appears it may exert its effectiveness via several mechanisms involving a number of neurotransmitters and hormones. Initially, inhibition of monoamine oxidase (MAO) was believed to be the primary mode of action (Frank M. Painter, 1999).
Eleutherococcus seniticosus (Siberian Ginseng)
Mainly used as an adaptogen, yet there are many more adaptogens such as, Rhodiola rosea, Schizandra chinemsis, Withania somnifera is also an adaptogen and Panax ginseng. There are lots of studies to prove it is efficacy. But in general, it provides support to the nervous system to fight fatigue, stress intolerance, poor stamina, mental fatigue, poor concentration, mood disorders, improve the immune function and in both chronic and acute infection. So, you see there are many benefits to this unique herb.
Weight-bearing, strength training, Kegel and endurance, exercises all provide the following benefits for peri-menopausal and menopausal women (Miszko and Cress, 2000).
- Improve mood
- Improve blood lipid profiles and help normalise blood pressure
- Slow the rate of bone loss, particularly when used in combination with other factors to strengthen bone such as calcium
- Maintain health and strength that are necessary for independence later in life including improved gait
- Enhance memory and concentration
A low-fat diet may lessen the likelihood of developing heart disease in a menopausal woman by lowering risks that can contribute to the development of cardiovascular disease. The Women’s Healthy Lifestyle Project (WHLP) evaluated a dietary approach to reducing the cardiovascular risk factors of rising LDL cholesterol and weight gain in perimenopausal women. However, it is also important to note that too much weight loss can increase bone loss. So there needs to be a balance. After a consultation, a diet will be suggested to suit the individual needs.
So, you see, there are plenty of alternative solutions to synthetic drugs. All of which have no side effects and tailored specifically for you!
Why not book yourself a consultation now for personalised treatment plan to suit your needs.
Banks, E. et al. (2003) ‘Breast cancer and hormone-replacement therapy in the Million Women Study’, Lancet. Lancet Publishing Group, 362(9382), pp. 419–427. doi: 10.1016/S0140-6736(03)14065-2.
BITTNER, V. (2000) ‘Hormone Replacement Therapy in Clinical Cardiology’, Cardiology in Review. Lippincott Williams and Wilkins, 8(1), pp. 57–64. doi: 10.1097/00045415-200008010-00010.
Chen, L. R., Ko, N. Y. and Chen, K. H. (2019) ‘Isoflavone supplements for menopausal women: A systematic review’, Nutrients. MDPI AG. doi: 10.3390/nu11112649.
Frank M. Painter, D. . (1999) ‘St. John’s wort (Hypericum perforatum) Monograph’, Alternative Medicine Review. Available at: https://chiro.org/nutrition/ABSTRACTS/St_Johns_Wort_Monograph.shtml (Accessed: 18 March 2021).
Haggans, C. J. et al. (1999) ‘Effect of flaxseed consumption on urinary estrogen metabolites in postmenopausal women’, Nutrition and Cancer. Lawrence Erlbaum Associates Inc., 33(2), pp. 188–195. doi: 10.1207/S15327914NC330211.
Herrington, D. M. et al. (2002) ‘Factor V Leiden, hormone replacement therapy, and risk of venous thromboembolic events in women with coronary disease’, Arteriosclerosis, Thrombosis, and Vascular Biology. Lippincott Williams & Wilkins , 22(6), pp. 1012–1017. doi: 10.1161/01.ATV.0000018301.91721.94.
Iwamoto, I. et al. (1999) ‘A longitudinal study of the effect of vitamin K2 on bone mineral density in postmenopausal women a comparative study with vitamin D3 and estrogen-progestin therapy’, Maturitas. Maturitas, 31(2), pp. 161–164. doi: 10.1016/S0378-5122(98)00114-5.
Lopresti, A. L. et al. (2019) ‘An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study’, Medicine (United States). Lippincott Williams and Wilkins, 98(37). doi: 10.1097/MD.0000000000017186.
Miszko, T. A. and Cress, M. E. (2000) ‘A lifetime of fitness: Exercise in the perimenopausal and postmenopausal woman’, Clinics in Sports Medicine. W.B. Saunders, 19(2), pp. 215–232. doi: 10.1016/S0278-5919(05)70200-3.
Ruml, L. A. et al. (1999) ‘The Effect of Calcium Citrate on Bone Density in the Early and Mid-postmenopausal Period’, American Journal of Therapeutics. Lippincott Williams and Wilkins, 6(6), pp. 303–312. doi: 10.1097/00045391-199911000-00004.
Stark, K. D. et al. (2000) ‘Effect of a fish-oil concentrate on serum lipids in postmenopausal women receiving and not receiving hormone replacement therapy in a placebo-controlled, double-blind trial’, American Journal of Clinical Nutrition. American Society for Nutrition, 72(2), pp. 389–394. doi: 10.1093/ajcn/72.2.389.
‘The role of calcium in peri- and postmenopausal women: Consensus opinion of the north American menopause society’ (2001) Menopause. Lippincott Williams and Wilkins, pp. 84–95. doi: 10.1097/00042192-200103000-00003.
Zamani, M., Neghab, N. and Torabian, S. (2012) ‘Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome’, Acta Medica Iranica. Acta Med Iran, 50(2), pp. 101–106. Available at: https://pubmed.ncbi.nlm.nih.gov/22359078/ (Accessed: 18 March 2021).