Menopause, Perimenopause and Postmenopause Part 1

Compiled by John G. Connor, M.Ac., L.Ac., Edited by Barbara Connor, M.Ac., L.Ac.

TABLE  OF  CONTENTS
Part 1
1)  Introduction
2) Western Medical View of Menopause
3)  Chinese Medical View of Menopause
4)  Natural Approaches to the Management of Menopause
a. Comprehensive Menopause Protocol for Our Patients
b.  Chinese Medical Pattern Discrimination of Menopause
c.   Menopause Types
d.  What is Estrogen Dominance?
e.   Phytoestrogens
f.    Isoflavones
g.   Natural Hormones
h.   Herbs
i.   Vitamins, Minerals and Supplements
j.    Dietary and Lifestyle Recommendations for Balanced Hormones
5)   Management of Menopausal Symptoms Naturally
a.  Anxiety and Nervousness
b.   Decreased Libido
c.    Depression and Irritability
d.   Facial Hair and Hair Loss
e.    Fatigue
f. Heart Disease
g.    Hot Flashes
h.    Insomnia
i. Migraines
j. Mood Swings
k.   Night Sweats
l. Osteoporosis
m.  Stress Incontinence
n.   Vaginal Dryness

Part 2
1)  Research on Menopause
a.   Estrogen and HRT Studies
b.   Phytoestrogen Studies
c.    Acupuncture Studies
d.   Herbal Studies
e.    Progesterone Studies
2)   References

1)  INTRODUCTION
In our practice, Barbara and I treat many patients going through menopause.  We have very good success in our treatments using a combination of acupuncture, craniosacral therapy, hara visceral work, herbs, supplements, dietary and lifestyle recommendations.  The following article has been written with you, our patient, in mind and we hope you find the material presented below helpful to you in your journey through this changing time of your life. In light of the results from recent studies revealing the serious health risks of Hormone Replacement Therapy (HRT) (See Part 2, 1, a.) many of our patients are seriously questioning the conventional medical wisdom of continuing to use HRT.  One of the objectives of this article is to provide you with accurate and up to date information on the question of hormone replacement therapy and the natural alternatives available to you to enable you to pass through menopause happily and healthfully.  Your comments or feedback on this article are welcome.

2)  WESTERN MEDICAL VIEW OF MENOPAUSE    
A woman’s ovaries cease producing estrogen and progesterone between the age of 50 and 52.  The range for menopause can be from age 40 to 60.  Eventually the lowered levels of estrogen are no longer adequate to cause a buildup of the uterine lining and there is not enough tissue to produce a menses so a woman’s periods gradually cease.  A woman is said to have reached menopause if she goes for 12 months without a period. The time prior to the official designation of menopause if often referred to as perimenopause and the time after menopause is called postmenopause. Western medicine essentially defines menopausal problems as a lack of estrogen production and therefore the main Western therapy prescribed for menopausal women has been estrogen replacement therapy.

As estrogen levels begin to drop it can result in more frequent periods.  Sometimes women will start bleeding immediately after an unsuccessful ovulation and have two periods a month.  If they also get longer, heavier flow at this time, they may feel that they are always bleeding.  On the other hand some women may have longer cycles because they are not ovulating as frequently.  When periods have not occurred for a full year menopause is considered complete.

Prompted by the decline in estrogen and progesterone production, and rising FSH (Follicle stimulating hormone)* and LH (Luteinizing hormone)* levels, menopausal symptoms may include hot flashes or night sweats, decreased vaginal lubrication, mood swings, insomnia, depression and urinary problems.  Menopausal women also experience a decline in testosterone, although this aspect of menopause is often neglected.  Ovarian testosterone production is said to be substantially decreased in 50% of postmenopausal women.  Loss of libido is attributed to declining testosterone levels.  Testosterone is produced in both the ovaries and adrenal glands.  Its primary job is to provide vital assertive energy and sexual drive.

*FSH causes the production of estrogen in the first half of the menstrual cycle by the ovarian follicles and develops the egg for fertilization.  LH  stimulates the further development of the ovarian follicles, brings about ovulation, stimulates the production of progesterone, inhibin* and relaxin*; and lower levels of estrogen during the second half of the cycle.  

*Inhibin inhibits the secretion of FSH and GnRH, and to a lesser extent LH. 

*Relaxin relaxes the pubic symphysis and helps dilate the uterine cervix to ease delivery.

Summary of the Effects of Estrogen, Progesterone and Testosterone:
At least six different estrogens have been isolated from the plasma of human females.  However, only three are present in significant quantities: beta estradiol, estrone and estriol.  Estrogens have three main functions: 
1) They promote development and maintenance of female reproductive structures (especially the endometrial lining of the uterus), secondary sex characteristics and the breasts.  The secondary sex characteristics include fat distribution to the breasts, abdomen, mons pubis, and hips; voice pitch, broad pelvis and hair pattern. 
2) They help control fluid and electrolyte balance and
3) They increase protein anabolism.  In this regard estrogens are synergistic with human growth hormone.  Moderate levels of estrogens in the blood inhibit the release of gonadotropin releasing hormone (GnRH)*  by the hypothalamus and secretion of LH and FSH by the anterior pituitary gland.  *(GnRH stimulates the release of FSH and LH from the anterior pituitary gland.)

Estrogen works with progesterone to prepare the uterine lining each month to receive and nourish a fertilized egg.  Estrogen maintains the structure of the vulva and vagina.  It seems to have a direct effect on libido making a woman feel sexier.  During puberty estrogen causes the growth of the breasts and once developed it helps maintain their size and density.  Estrogen contributes to the health of the skin.  It also increases the number of blood vessels in the skin making the skin feel warmer and is one of the factors that causes hot flashes.  It increases the release of norepinephrine in the brain, and may decrease the action of monamine oxidase.  It also plays a role in the normal function of other neurotransmitters that affect mood, including serotonin, dopamine and gamma-amino-butyric acid type A.  As well as having mood-elevating effects estrogen improves memory and certain mental functions.  Estrogen protects the bones and heart.  And it protects against insulin resistance.

Progesterone works with estrogens to prepare the endometrium for implantation of a fertilized ovum and the mammary glands for milk secretion.  High levels of progesterone also inhibit secretion of gonadotropin releasing hormone and prolactin*. 

*Prolactin, together with other hormones, initiates and maintains the effect of LH in promoting milk secretion by the mammary glands.

While estrogen stimulates the uterine lining to grow; progesterone ensures that it sheds in monthly periods (if no conception occurs).  Progesterone decreases libido.  It increases the body’s metabolic rate and warms you.  Your body uses progesterone to make chemicals that soothe your nervous system.  It protects against osteoporosis by stimulating the growth of new bone cells. 

Testosterone is necessary in females for proper function of the brain, heart, bones and many other tissues.  There is growing evidence that it is the most important hormone for maintaining sex drive in women.  It also has important  healthful effects on the vagina and vulva.  Testosterone maintains muscle tone, is a hormone that greatly influences motivation, drive, and confidence, and has a direct, beneficial effect on bone.

3)  CHINESE MEDICAL VIEW OF MENOPAUSE 
In TCM  Menopausal Syndrome is known as Jue Jing Qian Hou Zhen which means “The syndrome before and after menstruation stops”.  It is not a disease but involves the natural decline of Qi, Blood and Jing.  Menopausal Syndrome is the imbalance that occurs with this natural decline.  In TCM terms when Blood and Yin become too weak to root or anchor Qi or Yang then the Qi or Yang rises up to the surface of the body creating such symptoms as hot flashes, night sweats, insomnia, anxiety and nervousness, mood swings, depression and irritability, forgetfulness, fatigue, headaches, migraines, vertigo, decreased libido, vaginal dryness, dry eyes, weight gain, palpitations, urinary tract infections, fibromyalgia, irregular periods and extremely heavy bleeding and the beginning stages of osteoporosis and heart disease.

Menopause should be regarded as a normal, natural event of aging except when it is brought about by surgery, medications or radiation. The changes associated with menopause can be mild, moderate or severe.  Some women may have no significant menopausal symptoms at all.  Many women have more symptoms during perimenopause and find that when they finally reach menopause they feel better.

In TCM Menopausal Syndrome is almost always connected to the Kidneys – either Kidney Yin or Kidney Yang.  So our treatment protocol focuses on balancing both the Yin and the Yang.  If you would like to find out more about the principles of TCM please read our article entitled How Acupuncture Works available on our website.

4)   NATURAL APPROACHES TO THE MANAGEMENT OF MENOPAUSE
a.    Comprehensive Menopause Protocol for Our Patients   
 1.  Receive regular craniosacral acupuncture treatments to balance and enhance your energy and organ systems, release your restrictions and harmonize your body, mind and emotions. For more information on craniosacral acupuncture please read our article entitled What is Craniosacral Acupuncture? available on our website
2.  Take good quality supplements for basic nutritional support and to insure that you get enough calcium as well as other nutrients for menopausal support.  Soy isoflavones, herbs, glandular extracts and natural hormone supplements may also be useful to help alleviate your menopausal symptoms.  

3.  Follow our practical dietary and lifestyle recommendations listed below. (See section 4, j.)      i.  Barbara and I get excellent results treating menopausal symptoms using a combination of acupuncture and craniosacral therapy.  By normalizing the flow of life energy or qi and releasing restrictions that naturally occur in the body over time we find it very helpful for menopausal symptoms.  We have found this combination to be extremely effective for relieving hot flashes, insomnia, night sweats, anxiety, restlessness, emotional instability, moodiness, fatigue, menstrual cramps, excessive bleeding and general menopausal and perimenopausal symptoms.  We complement this body/energy work with appropriate herbs and supplements and dietary and lifestyle recommendations which we will describe in detail later on in this article.   
    
  ii. According to Dr. Collins in his book, What’s Your Menopause Type? many women can restore their bodies’ hormonal balance without taking hormones at all.  Natural therapies involving herbs, diet and lifestyle changes can work very effectively to relieve menopausal symptoms and prevent serious health problems.  Dr. Michael Murray, in his book,Menopause, suggests that the endorphin-releasing effects of both exercise and acupuncture might be effective in relieving many menopausal symptoms, especially hot flashes.

iii.   In her book Managing Menopause Naturally with Chinese Medicine Honora Lee Wolfe writes that Traditional Chinese Medicine has many safe and effective treatments for menopausal complaints and much wisdom concerning the whys and wherefore of these complaints.  You will experience in your treatments with Barbara and I how we combine the treasures of the ancient healing wisdom of the East while taking advantage of many of  the very useful discoveries of modern Western medicine.

b.      CHINESE MEDICAL PATTERN DISCRIMINATION OF MENOPAUSE
Barbara and I have endeavored to describe the most common Traditional Chinese Medical (TCM) patterns which we see in our practice connected with menopause.  There are often many other symptoms in each of these patterns, but in the interest of brevity we have limited the descriptions below to their main symptoms.  In our practices we see various combinations and permutations of these main patterns. There are also other minor patterns involved that we are not describing here.
   i.   Kidney Yin Deficiency and Liver Yin Deficiency – manifests as dizziness, headaches, vision problems, memory loss, night sweats, vaginal dryness, irritability, insomnia, blurry vision, low back pain, tinnitus, difficult dry stools and dry eyes.
  ii.   Heart Yin Deficiency and Kidney Yin Deficiency – manifests as anxiety, poor memory, mood swings, insomnia, fatigue, hot flashes, night sweats, irritability, dizziness, tinnitus, low back pain, scanty dark urine and dysfunctional uterine bleeding.
  iii.   Spleen Yang Deficiency and Kidney Yang Deficiency – manifests as mental and physical sluggishness, loss of libido, fatigue, depression, desire to lie down, abdominal distention, poor appetite, cold limbs, abundant-clear urination, loose stools and edema.
iv.   Liver Qi Stagnation – manifests as depression, anger, irritability, dysfunctional uterine bleeding, irregular and painful periods, breast distention, PMS, hypochondriac pain, sighing, hiccups, melancholy, moodiness, fluctuations of mental state, nausea, vomiting, epigastric pain, poor appetite, sour regurgitation, belching and diarrhea.
v.   Kidney Yang Deficiency – manifests as loss of sex drive, urinary incontinence, sore low back, weak legs, weak knees, impotence, lassitude,  apathy, edema of the legs, poor appetite, loose stools, infertility in women and abundant clear urination.
   vi.   Kidney Yin Deficiency and Kidney Yang Deficiency – manifests as headache, hot flashes, loss of sex drive, fatigue and urinary incontinence.
vii.   Liver Blood Deficiency and Kidney Yin Deficiency – manifests as hot flashes, sweats, headaches, blurry vision, spots in front of the eyes and insomnia.
 viii.   Liver Yang Rising – manifests as migraines, headaches, irritability and even irascibility, hot flashes and sweats, dizziness, tinnitus and insomnia
 ix.   Accumulation of Phlegm and Stagnation of Qi – manifests as depression, fear, anxiety and insomnia.
  x.   Heart Blood Deficiency and Spleen Qi Deficiency – manifests as anxiety or emotional instability, loss of mmory, insomnia, fatigue, shortness of breath and itchy skin.
  xi.   Heart Yin Deficiency and Blood Deficiency – manifests as loss of memory, insomnia, night sweats and restlessness.
 xii.   Liver Blood Deficiency and Kidney Yang Deficiency – manifests over time as osteoporosis.

c.    MENOPAUSE TYPES
Dr. Joseph Collins, ND in his book What’s Your Menopause Type has identified 12 different menopause types, Dr. Christiane Northrup, in her book The Wisdom of Menopause,identifies and describes 7 menopause types, and Dr. John Lee has his own theory called “estrogen dominance”.  What follows is a summary of these different types and how Barbara and I have linked them to the various Chinese Medical (TCM) Patterns listed above. This is a novel approach to the understanding of menopause blending the ancient healing knowledge of Chinese Medicine with a modern Western approach.  We hope you will find it helpful.

We strongly advise you not to self-prescribe but to consult your health care practitioner before using any phytoestrogens, soy isoflavones, herbs, glandular extracts or natural hormone supplements.
 i.   Type 1 – Adequate Estrogen and Progesterone – is an ideal menopause where hormonal changes happen so smoothly that you might not even notice them.  You may have a few hot flashes or a little fatigue.  TCM Patterns: Some minor generalized Yin Deficiency and Qi Deficiency.
ii.   Type 2 – Low Testosterone – manifests as hot flashes and decreased energy overall, decreased libido, decreased sense of well-being, low grade depression, wrinkles in the skin, chest pain, shortness of breath and increased risk of osteoporosis.  TCM Patterns: 1) Liver Blood Deficiency and Kidney Yin Deficiency   2) Heart Blood Deficiency and Spleen Qi Deficiency  3) Kidney Yang Deficiency.  Consider using boron, Siberian ginseng and licorice root to increase testosterone levels.  Avoid chasteberry and saw palmetto as these herbs may lower your testosterone levels.  Studies have found that taking adrenal glandular or ovarian tissue extracts can increase a woman’s testosterone levels.  Consult your doctor before using glandular extracts.
iii.   Type 3 – High Testosterone – manifests as agitation, irritability, fatigue, sleepiness, oily skin, acne, facial hair, deepened voice, menstrual irregularity and risk of ovarian disease.  TCM Patterns: 1) Liver Qi Stagnation   2) Spleen Qi Deficiency with Dampness.  Avoid boron, DHEA and glandular supplementation.  Saw palmetto and chasteberry may help bring down high testosterone levels.  Black cohosh is excellent for this type.
  iv.   Type 4 – Low Estrogen  – manifests as hot flashes, night sweats, vaginal dryness and thinning skin, tiredness, lack of motivation, depression, frustration, dampened mood, sense of being weighed down, mental dullness, poor memory, headaches and migraines, vaginal infections, stress incontinence and decreased libido.  TCM Patterns: 1) Kidney Yin Deficiency and Heart Yin Deficiency   2) Kidney Yang Deficiency and Spleen Yang Deficiency   3) Liver Qi Stagnation.  Estrogen deficiency symptoms can often be relieved by increase in exercise, dietary changes and by the use of natural estrogen and progesterone supplementation  (See section 4, g. for more information on natural hormone supplementation).  Boron, soy isoflavones and foods rich in phytoestrogens are helpful.   Dong quai which has estrogen-like activity may be helpful.
  v.   Type 5 – Low Estrogen and Low Testosterone – manifests as listlessness, dampened mood, decreased libido, loss of mental clarity, depression, mood swings, vaginal atrophy and dryness, stress incontinence, thin skin, wrinkles and increased risk of osteoporosis.  TCM Patterns: 1) Kidney Yang Deficiency and Spleen Qi Deficiency   2) Liver Blood Deficiency and Liver Qi Stagnation.  Boron, soy isoflavones and foods rich in phytoestrogens may be helpful.  Siberian ginseng may be useful to help increase testosterone levels. Estrogen mimetics such as dong quai and licorice may be helpful.  Avoid chasteberry and saw palmetto.  Ovarian glandular extracts raise both estrogen and testosterone levels and so may be useful for this type.  DHEA supplementation may be helpful to raise both estrogen and testosterone levels. (For more information on DHEA please see section 4, g., iii.)
  vi.   Type 6 – Low Estrogen and High Testosterone – manifests as irritability, vaginal dryness, exhaustion upon awakening, loss of scalp hair, insomnia, oily skin, mood swings and irregular periods prior to menopause.  TCM Patterns: 1) Kidney Yin Deficiency and Heart Yin Deficiency   2) Liver Yin Deficiency.  Avoid glandular extracts and boron with this type.  Soy isoflavones and phytoestrogens may be helpful.  Chasteberry can be used to reduce testosterone levels.
  vii.   Type 7 – Low Progesterone – manifests as irritability, anxiety, moodiness, inability to relax, nervousness, insomnia, exhaustion, hot flashes, premenstrual migraine, PMS-like symptoms, irregular or excessively heavy periods, increased risk of endometrial cancer.  TCM Patterns:  1) Heart and Kidney Yin Deficiency   2) Liver Qi Stagnation.  Chasteberry reportedly increases progesterone levels so it is a useful herb for this type.  Black cohosh is also good for this type.  Natural progesterone supplementation can be very effective for this type.
   viii.   Type 8 – Low Progesterone and Low Testosterone – manifests as depression, restlessness, low libido, stress incontinence, worry, sadness, low spirits, anxiety, gloominess, loss of motivation and self-confidence, increased risk of osteoporosis and endometrial cancer.  TCM Patterns: 1) Liver Blood Deficiency and Kidney Yang Deficiency   2) Heart Blood Deficiency and Spleen Qi Deficiency.  Avoid boron and chasteberry.  Siberian ginseng and licorice may be useful.  Adrenal or ovarian tissue glandular extracts can be helpful.  Supplementation with low doses of natural progesterone is often helpful.
  ix.   Type 9 – Low Progesterone and High Testosterone – manifests as panic attacks, migraines, fright, breakthrough bleeding, acne, poor sleep, nerves on edge, facial hair, obesity, increased risk for ovarian cysts, endometrial cancer, insulin resistance, hyperinsulinemia, breast cancer and osteoporosis.  TCM Patterns:  1) Accumulation of Phlegm and Stagnation of Qi   2) Heart Yin Deficiency and Kidney Yin Deficiency   3) Liver Qi Stagnation.  Avoid boron and DHEA supplementation.  Chasteberry and black cohosh are useful for this type.  Natural progesterone supplementation is especially helpful for this type because it tends to lower testosterone while raising progesterone levels.
 x.   Type 10 – Low Estrogen and Low Progesterone with Normal Testosterone – manifests as depression, decreased libido, fatigue, vaginal dryness, memory not as sharp as usual, urinary incontinence, hot flashes, poor sleep, sense of futility, increased risk of osteoporosis and heart disease.  TCM Patterns:  1) Kidney Yang Deficiency and Spleen Yang Deficiency   2) Liver Blood Deficiency and Kidney Yin Deficiency.  Boron, soy isoflavones and foods containing phytoestrogens can be helpful.  Natural progesterone supplementation may be helpful.
 xi.   Type 11 – Low Estrogen, Low Progesterone and Low Testosterone – manifests as hot flashes, fatigue, vaginal dryness, low libido, apathy, urinary incontinence, anxiety, depression, memory problems, trouble sleeping, increased risk of osteoporosis, insulin resistance and hyperinsulinemia plus symptoms from type 4 and 7.  TCM Patterns:  1) Kidney Yang Deficiency and Spleen Yang Deficiency   2) Kidney Yin Deficiency and Heart Yin Deficiency   3) Liver Blood Deficiency.  Boron, soy isoflavones and foods containing phytoestrogens may be helpful.  Dong quai may be useful.  Avoid saw palmetto and chasteberry.  Natural progesterone supplementation may bring progesterone levels into normal range.  You may be able to raise your testosterone levels with DHEA.
xii.   Type 12 – Low Estrogen and Low Progesterone with High Testosterone – manifests as agitation, aggressiveness, frustration, hair loss, memory loss, deepening voice, facial hair, shrinking breasts, strong libido with vaginal dryness, working hard depletes the body,  increased risk of insulin resistance, endometrial cancer, breast cancer, non-insulin dependent diabetes and heart disease plus symptoms from types 3, 4 and 7.  TCM Patterns:  1) Liver Qi Stagnation and Liver Yang Rising   2) Kidney Yin Deficiency and Liver Yin Deficiency.  Estrogen mimetics such as dong quai may be helpful.  Glandular extracts are not recommended for this type because of the likelihood of increasing your already high testosterone levels. Avoid DHEA for the same reason.  You may also consider natural estrogen and progesterone supplementation.  Saw palmetto and chasteberry can be used to reduce testosterone levels.
xiii.   Type 13A – Relatively High Estrogen with Low Progesterone (Estrogen Dominance) – Dr. Northrup sees this manifesting as decreased sex drive, irregular or otherwise abnormal periods, bloating, breast swelling and tenderness, mood swings (most often irritability and depression), weight gain, cold hands and feet, headaches — especially premenstrually.  TCM Patterns: 1) Spleen Yang Deficiency and Kidney Yang Deficiency   2) Liver Qi Stagnation.  Supplementation with natural progesterone may be helpful.
  xiv.   Type 13B – Relatively High Estrogen with Low Progesterone (Estrogen Dominance) – Dr. John Lee sees this manifesting as bilateral pounding headache, recurrent vaginal yeast infections, breast swelling and tenderness, depression, mood swings, nausea, vomiting, bloating, leg cramps, decreased libido, memory loss, increased fluid retention, cold hands and feet, fatigue, foggy thinking, hair loss, irritability, insomnia, dry eyes, yellow-tinged skin and excessive vaginal bleeding.  TCM Patterns:  1) Liver Qi Stagnation   2) Liver Yin Deficiency and Kidney Yin Deficiency   3) Spleen Yang Deficiency and Kidney Yang Deficiency.  As excess estrogen is processed through the liver it is important top keep the liver functioning optimally, so it would be advisable to avoid drinking too much alcohol in cases of excess estrogen.  Natural progesterone supplementation may be helpful for hot flashes, vaginal dryness or any of the symptoms of estrogen dominance.

d.   WHAT IS ESTROGEN DOMINANCE? 
 i.   According to Dr. Lee in his book, What Your Doctor May Not Tell You About Menopause he does not agree with the “estrogen deficiency” hypothesis of modern Western medicine as an explanation of menopausal symptoms.  He feels that estrogen dominance does not necessarily mean a woman has too much estrogen; it simply means that estrogen levels are relatively higher than progesterone, creating a hormonal imbalance with its attendant estrogenic side effects.  And although estrogen levels may be below that necessary for pregnancy they are nevertheless sufficient for other normal bodily functions.  So a woman may have deficient, normal or excessive estrogen but she has little or no progesterone to balance its effects in the body.  Without ovulation, progesterone production is essentially zero, and estrogen receptors become less sensitive to the estrogen still being made. 

   ii.   And according to Dr. Northrup in her book The Wisdom of Menopause in natural menopause, the first hormonal change that occurs is a gradual decline in levels of progesterone, while estrogen levels remain within the normal range or even increase.  Because progesterone and estrogen are meant to counterbalance each other throughout the menstrual cycle, with one falling while the other rises and vice versa, an overall decline in progesterone allows estrogen levels to go unopposed – that is, without the usual counterbalance.  The result is a relative excess of estrogen, a condition that is often called estrogen dominance.

e.   PHYTOESTROGENS – are plant substances that have estrogen-like activity, that is, they mimic estrogen activity in the body.  Phytoestrogens don’t behave exactly like estrogen but that can actually be an advantage when you are going through menopause.  At that time, your body is adapting to having less estrogen in the system, and there may be a protective effect when you get estrogen-like activity from eating phytoestrogen-rich foods, rather than taking full-strength estrogen in HRT.

Phytoestrogens exert their effects on cells in two ways: 1) They bind to estrogen receptors of the cells allowing the receptor site to respond by initiating changes within the cell. Such as decreasing hot flashes and 2) They decrease cancer stimulation by steroid hormones such as estrogen by taking up the receptor space and competing with steroid hormones that would normally bind to the hormone receptors, but they do not stimulate the cells as much or as strongly as estrogen steroid hormones.

Food sources include apples, cherries, olives, plums, broccoli, cauliflower, Brussel sprouts, cabbage, eggplant, tomatoes, garlic, onions, potatoes, alfalfa sprouts, peppers, chilies, carrots, yams, peanuts, soy products, peas, garbanzo beans, barley, brown rice, bulgur oats, wheat, wheat germ and rye.

For more information on the benefits of phytoestrogens for treating menopausal symptoms please see Part 2, section 1, b.

Flaxseed  – is the best available source of the phytoestrogenic compounds known as lignans.  Lignans are plant substances that get broken down by intestinal bacteria into two chemicals – enterodiol and enterolactone.  Flaxseed is an excellent source of fiber and of omega-3 fatty acids.  In women who consume flaxseed, studies have shown significant hormonal changes, including alterations in estradiol levels, similar to those seen with soy isoflavones.  This makes flaxseed a great choice for women who can’t use soy.

f. SOY ISOFLAVONES
Because of their weak estrogenic action soy isoflavones reduce hot flashes and vaginal dryness while offering protection against bone loss due to natural estrogen loss.  In breast tissue there are two types of estrogen receptors (ERs).  In the breast genistein stimulates the Beta Receptors which are protective of the breast.  And in bone genistein stimulates the Alpha Receptors which lead to the health of the bone.  In animal studies, genistein is as effective as steroid estrogens in preserving bone. In addition soy has been demonstrated to decrease the risk of  uterine cancer and heart disease.  Use organic, non-GMO soy products.  CAUTION:  Children, pregnant women and individuals with known weak thyroid function should not use soy isoflavones.

According to Dr. Hudson the benefits of soy for menopausal women are diverse.  Soy appears to have an effect on hot flashes, vaginal dryness, lipids and coronary arteries, bone, mental function, and the prevention of breast and uterine cancer.

For more information on the benefits of soy isoflavones for treating menopausal symptoms please see Part 2, section 1, b.

g.   NATURAL HORMONES  
 i.   NATURAL PROGESTERONE
Barbara and I are not big fans of so-called bio-identical hormone replacement therapy.  We believe it is better to add specific botanicals and nutrients to the diet that support balanced progesterone and estrogen hormone levels.

According to Dr. Collins in What’s Your Menopause Type? Excessively high progesterone levels can cause health problems and uncomfortable symptoms.  Excessive progesterone may counteract some of estrogen’s helpful effects in your body. If you use topical progesterone, you and your health-care professional should monitor your hormone levels, and you should pay close attention to any signs such as fatigue, weight gain or disorientation.  Dr. John Lee also cites observations by Dr. David Zava that excess progesterone results in higher cortisol levels, which can cause increased water retention.  Dr. Zava believes that this is the cause of breast swelling sometimes caused by long-term progesterone supplementation or high-dose progesterone.  Dr. Lee also notes that if progesterone levels are higher than normal for more than six months people become mentally lethargic and even depressed.  Fortunately, the effects of using too high a dose of progesterone over time is reversible by returning to normal levels of progesterone.

What are progestins? 
According to Dr. Lee most of the progestins are synthesized from progesterone or from another hormone called nortestosterone and are not found in any living forms.  Progestins have undergone molecular alterations at unusual positions.  As they travel down the hormone pathways, they occupy progesterone receptor sites, create actions different from natural progesterone, cannot be used as precursors of other hormones (as progesterone can) and are difficult for the body to metabolize and excrete.  They also have potential undesirable side effects.  It is these synthetic progestins that are used heavily in HRT.

   ii.  ESTRIOL   
According to Dr. Northrup preliminary studies have shown that women who excrete the highest levels of estriol in their urine appear to have a lower risk of breast cancer.  Estriol is biologically weaker than estradiol and estrone, the two other estrogens produced naturally in the body.  It works very well when applied locally to estrogen-sensitive tissue such as the vagina. In individualized doses, estriol is a perfectly reasonable estrogen to use for replacement.  According to Dr. John Lee estriol is the estrogen most beneficial to the vagina, cervix and vulva.  In cases of postmenopausal vaginal dryness and atrophy, which predisposes a woman to vaginitis and cystitis, estriol supplementation would theoretically be the most effective (and safest) estrogen to use.  He believes that all the available evidence we have so far indicates that estriol is the safest estrogen to use to control menopausal symptoms, and it may even be protective against breast cancer.

   CAUTION:  Natural estrogen supplementation is not recommended in those women with a history of breast or uterine cancer, obesity, diabetes or a history of clotting or vascular disorders.  Evidence from controlled studies indicates that oral estriol presents risks comparable to those with other forms of estrogen. (Takahashi, et al, 2000; Weiderpass et al, 1999)

iii.  DHEA
DHEA (dehydroepiandrosterone) is primarily a precursor to androstenediol, testosterone and the estrogens; it is not a precursor to pregnenoline, progesterone, the cortisols or aldosterone.  If progesterone is deficient in pre and postmenopausal women, the DHEA pathway tends to take up the slack.  However, most of it is not converted to estrogen and at higher doses, DHEA-induced androgens can lead to male pattern baldness, excessive facial hair growth, abdominal obesity and some studies suggest an increased risk of heart disease and insulin resistance.

DHEA helps to neutralize cortisol’s immune-suppressant effect, thereby improving resistance to disease.  It also helps to protect and increase bone density, keeps “bad” cholesterol (LDL) levels under control, provides a general sense of vitality and energy and helps keep the mind sharp.  One of the cardinal signs of adrenal exhaustion is relentless, debilitating fatigue.  DHEA levels can be measured accurately through urine testing.  If, after testing, you find that your DHEA levels are low DHEA supplements are available.  If you take supplemental DHEA urine levels should be taken every three months.  When levels return to the normal range, the dose should be gradually tapered off until you are off the supplement completely.

DHEA and cortisol are inversely proportional to each other.  When one is up, the other goes down.  Cortisol increases your appetite and energy level while taming the allergic and inflammatory responses of your immune system.  It helps the body resist the stressful effects of infections and trauma and helps you maintain stable emotions.  Synthetic versions of cortisol such as prednisone and cortisone are often prescribed.  Undesirable side effects can occur if cortisol levels become too high for too long.  These include loss of bone density, muscle wasting, decreased ability to build protein, kidney damage, fluid retention, spiking blood sugar levels, weight gain, and increased vulnerability to bacteria, viruses, fungi, yeasts, allergies, parasites and even cancer.  Ideally cortisol is released into the system only on an occasional basis, rather than in response to chronic stress.

CAUTION:  If you have had endometriosis, breast cancer, uterine pain or are overweight supplemental DHEA is not for you.  It may increase your estrogen levels.  According to Dr. Mark McClure in his book, Smart Medicine for a Healthy Prostate, men with prostate cancer should avoid DHEA supplementation as it can make prostate cancer grow faster by boosting serum IGF-1 levels.

h.    HERBS
In addition to the craniosacral acupuncture treatments Barbara and I get very good results treating menopausal symptoms with the following herbs:  

i.   Ashwagandha – helps preserve adrenal size and function, enables the body to adapt to stress and increases muscle mass, endurance and strength.  It can also be used to treat anemia, lower cholesterol and increase libido.
   ii.   Astragalus – is a good herb for women who have a weak immune system with a history of frequent infections.
   iii.   Black cohosh root (Cimicifuga racemosa) – contains triterpenoid glycosides, specifically actein and cimicifugoside.  It also contains isoflavones and formononetin.  It binds to estrogen receptors where it selectively represses the elevation of LH that occurs at menopause.  Its estrogenic effect decreases hot flashes, night sweats, and emotional lability.  It has the ability to decrease hot flashes, vaginal dryness, melancholy, fatigue, irritability, relieve spasms, menstrual cramps, inflammation, and has a mild euphoric effect resulting in mood elevation and control of menopause-related depression.  Experimental studies indicate no toxic, mutagenic, carcinogenic or teratogenic properties of black cohosh.  It is a safe and appropriate treatment for all menopause types especially when there are symptoms of decreased estrogen.  CAUTION: Black cohosh can interact with high blood pressure drugs and may result in excessively low blood pressure in some women.
 iv.   Chasteberry fruit (Vitex agnus castus) – helps to normalize and regulate irregular menstrual cycles.  It has also been shown to suppress appetite, relieve depression and improve sleep. Its active constituents include the monoterpenes: agnuside, euroside, aucubin and the flavonoid vitexin.  It increases the secretion of LH and decreases the production of FSH which in turn shifts the production of hormones toward more progesterone and less estrogen.  Therefore, it is useful for low progesterone types. It is best avoided in menopause types with low or slightly or slightly low testosterone.  CAUTION: Do not take it with Haldol or Mellaril, or when pregnant or nursing.
 v.   Dong Quai  (Angelica sinensis) – like many phytoestrogens, it has no true estrogen action, so it may be considered safe for women who need to avoid steroid estrogens.  It has antioxidant and anti-tumor activity that can benefit women needing to avoid steroid estrogens.  It is a blood building herb and also decreases the risk for heart disease.  It will also increase vaginal lubrication.  It contains vitamin B₁₂, ferulic acid, ligustilide, folic acid, choline and iron. It is good for all menopause types that need estrogen.  CAUTION:  Dong quai may increase the flow of a period so if you are having heavy flow during your periods you should not use dong quai.  It is useful to bring on a period if you have not had one for many months.
 vi.   Licorice root (Glycyrrhiza glabra) – contains the phytoestrogens beta-sitosterol, formononetin, coumarin and others.  It may be that licorice has both hormone and anti-hormone effects or it may in fact lower estrogen levels while simultaneously raising progesterone levels which creates some confusion as to when to use it.  CAUTION: Prolonged use of licorice can cause high blood pressure.
   vii.   Asian Ginseng (Panax ginseng) – contains at least 13 different triterpenoid saponins, collectively known as ginsenosides.  It can be calming to over-stressed women as it supports the adrenal glands.  It increases the overall energy and vitality of the body.  It increases ACTH secretion by the pituitary gland.  It is also good for depression, improves the mood, helps with digestion, mental function and immune function.  It can also help with glucose metabolism and can decrease mildly elevated blood sugar levels thus helping in the management of insulin resistance.  It is appropriate for all menopause types.  Dosage: 125-250 mg in the morning and another 125-250 mg at noon if necessary.
  viii.   Rehmannia root, prepared (Rehmannia glutinosa) – contains sterols, compesterol, catalpol, rehmannia and some alkaloids.  It appears to work by preserving adrenal gland function and weight, and helping the body adapt to stress.  It has the ability to decrease hyperglycemia and has been used to treat diabetes.  It can normalize heart function, lower cholesterol and increase blood flow to the brain. (See Part 2, section 1. d. i. for more on rehmannia)
  ix.   Schisandra (Schisandra chinensis) – is an adaptogenic herb used to treat insomnia, irritability and forgetfulness while at the same time being effective against fatigue and exhaustion.  It is also used to treat spontaneous sweating and can improve concentration, coordination, vision and hearing.  It is useful for any menopause type that has decreased nervous system function, especially due to estrogen deficiency.
 x.   Siberian ginseng (Eleutherococcus senticosus) – can help maintain adrenal gland size and weight.  It improves general resistance, physical performance and stamina, increases mental awareness and the ability to learn.  It is appropriate for all menopause types.
xi.   Skullcap (Scutellaria lataeriflora) – is soothing and restoring to the nervous system.  It is useful in menopause types that include irritability, anxiety and nervous exhaustion.  Women of all menopause types can use it; except those suffering from depression should use it with caution.

i.  VITAMINS, MINERALS AND SUPPLEMENTS    
The following are the basic vitamins and minerals that are helpful in menopause and most of them will likely be included in a good quality vitamin-mineral supplement:
i.   Vitamin A and Beta Carotene –  are both important antioxidants required for the health of the adrenal glands and the ovaries.  The antioxidant capability of vitamin A affects the ovary’s ability to make hormones and overall ovary health.  In animal studies vitamin A and beta-carotene have been shown to stimulate progesterone secretion in luteal cells – the cells that produce progesterone.  Women of all menopause types should take these supplements. Vitamin A dosage: 2,000 to 10,000IU daily.  Beta-carotene dosage: 2,000 to 50,000 IU daily.  Food sources include liver, fish liver oils, green and yellow fruits and vegetables, apricots, asparagus, beet greens, broccoli, cantaloupe, carrots, collards, dandelion greens, dulse, garlic, kale, mustard greens, papayas, peaches, pumpkin, red peppers, spirulina, spinach, sweet potatoes, Swiss chard, watercress and yellow squash
 ii.   Vitamin B₁ (thiamine)– is needed for the activation of enzymes in the adrenal glands as part of the steroidogenic pathway.  Dosage: 30 – 100 mg daily.  Food sources include brown rice, egg yolks, fish, legumes, liver, peanuts, peas, pork, poultry, rice bran, wheat germ, asparagus, broccoli, oatmeal, raisins and plums
   iii.   Vitamin B₂ (riboflavin) – is a component of two compounds called cofactors (FAD and FMN) which the body, especially the thyroid gland, needs for proper function.  Dosage: 10 to 100 mg daily.  Food sources include cheese, egg yolks, fish, legumes, meat, milk, poultry, spinach, whole grains and yogurt; asparagus, avocados, broccoli, Brussels sprouts, currants, dandelion greens, dulse, kelp, leafy greens, mushrooms, molasses, nuts and watercress.
   iv.   Vitamin B₃ (niacin) – is an element in the NADH and NADPH enzyme cofactors.  These two cofactors are very important for the steroidogenic pathway and are also involved in energy conversion.  Women of all menopause types should take niacin.  Dosage: 100 mg daily.  Food sources include avocados, brewer’s yeast, broccoli, carrots, dates, eggs, figs, fish, peanuts, potatoes, prunes, tomatoes, wheat germ and whole wheat products
  v.   VitaminB₅ (pantothenic acid) – is required for the production of adrenal gland hormones, and is involved in memory and brain function. Dosage: 250 mg daily.  Food sourcesinclude brewer’s yeast, eggs, fresh vegetables, kidney, legumes, liver, mushrooms, royal jelly and saltwater fish.
vi.   Vitamin B₆ (pyridoxine) – plays a critical role in the metabolism of tryptophan to serotonin as well as in the manufacture of other amino acid neurotransmitters (e.g. GABA).  Because of this role it helps to regulate mood and sleep. An insufficiency may cause insomnia, irritability and depression.  High levels of estrogen interfere with B6 metabolism.  Impaired metabolism of tryptophan can be responsible for symptoms such as depression, anxiety, decreased libido and glucose intolerance in estrogen users. Vitamin B₆ also plays a role in homocysteine metabolism. Animal studies have shown deficiencies to cause increased fracture healing time, impaired growth of cartilage, defective bone formation and more rapid development of osteoporosis. It may also stimulate the production of progesterone and through this hormone’s activation of osteoblasts have a distinct role in preventing osteoporosis.  Pyridoxine may also inhibit platelet aggregation, reduce total plasma lipid and cholesterol levels and enhance HDL-cholesterol levels.  Food sources include brewer’s yeast, carrots, chicken, eggs, fish, meat, peas, sunflower seeds, walnuts, wheat germ, avocado, bananas, beans, broccoli, brown rice and other whole grains. Dosage: 50-150 mg daily.
  vii.   Vitamin B₁₂ (cobalamin)- is required for red blood cell production and nerve function.  A B₁₂ deficiency can result in lowered progesterone and estrogen levels.  B₁₂deficiency can also result in increased levels of homocysteine which has been linked to heart disease, osteoporosis and many other conditions.  Food sources include: Brewer’s yeast, clams, eggs, herring, mackerel, dairy products, meat and fish; also dulse, kelp, kombu, nori, soybeans and soy products.  Dosage: 100 micrograms daily.
   viii.   Vitamin C – is required by the ovaries for steroidogenesis.  Animal studies have shown that supplementation with vitamin C can increase the ability to produce progesterone.  It is also helps the adrenal glands to regulate steroidogenesis.  Dosage:  1000 mg daily.  Food sources include berries and green leafy vegetables.
   ix.   Vitamin D – enhances intestinal calcium absorption and promotes bone mineralization. Vitamin D has been shown to inhibit the function of osteoporosis promoting cytokine, IL-1.   It is therefore, especially important for women of menopausal age. The ability of the pancreas to release insulin appears to depend on the active form of vitamin D₃.  Insulin release is impaired by a vitamin D₃ deficiency.  If one cannot get vitamin D from sunshine one must obtain it from foods such as fish, eggs, liver and vitamin D fortified dairy products. Dosage: 400 IU daily.
   x.   Vitamin E – is an important antioxidant that protects adrenal and ovarian tissues from damage by free radicals produced during steroidogenesis.  According to Dr. Collins there is convincing evidence that the ovaries depend on vitamin E to function properly and efficiently.  Studies demonstrate that vitamin E exerts a protective effect on beta-endorphin neurons in the hypothalamus. Estrogen may be toxic to these nerves and may be connected to anovulation, vaginal dryness and polycystic ovary disease as well as the onset of menopause.  It is recommended for women of all menopause types to take vitamin E.  Dosage: 400 to 800 IU daily.  Food sources include cold-pressed vegetable oils, dark green leafy vegetables, legumes, nuts, seeds and whole grains, brown rice, cornmeal, eggs, milk, oatmeal and soybeans.
  xi.   Vitamin K – is best known for its ability to help blood to clot properly.  It  is also required for the production of osteocalcin the protein matrix on which mineralization occurs. Osteocalcin attracts calcium to bone tissue, enabling calcium crystal formation to occur. Dosage: 150 mcg daily. Food sources include dark green leafy vegetables, blackstrap molasses, broccoli, Brussels sprouts, cabbage, cauliflower, egg yolks, liver, oatmeal, rye, safflower oil, soybeans and wheat.  CAUTION: If you are taking blood thinning drugs consult your doctor before taking vitamin K.
  xii.   Boron –  improves the body’s absorption of calcium, magnesium and phosphorus and it also works with vitamin D to decrease osteoporosis, increase mineral content in bone and enhance cartilage formation.   CAUTION: Since boron helps to significantly increase estrogen production it would be contraindicated in cases of estrogen-sensitive tumors. Use it cautiously if you have a progesterone deficiency or an excess of testosterone.  Foods sources include apples, carrots, grapes, leafy vegetables, nuts, pears and grains.  Dosage: up to a maximum of 3 mg daily. Do not take more than 3 mg of boron daily. 
xiii.   Calcium – is important for proper bone formation and preventing osteoporosis.  It also plays a vital role in cardiovascular health, blood clotting, muscle and nerve function.  To be most effective, calcium supplementation must include vitamin D.  Dosage: 1 gram daily. Calcium is best balanced with magnesium.  For 1 gram of calcium 500 mg of magnesium should be sufficient. Foods high in calcium include:  kelp-300-1000 mg per 1/4 cup, collard leaves (cooked)-300 mg per cup,   kale-200 mg per cup, turnip greens (cooked) 450mg per cup,   dandelion greens-150 mg per cup, tofu-150 mg per cup, shrimp-300 mg per cup,  yogurt-272 mg per cup,   whole milk – 288 per cup,    broccoli-178 mg per cup, sunflower seeds – 70 mg per 1 /4 cup,   mustard greens (cooked) -180 mg per cup.
 xiv.   Chromium – helps with glucose metabolism by improving the effectiveness of insulin.  It can reduce bone loss by slowing down bone resorption and also may raise levels of DHEA.  DHEA can act as a precursor to androstenedione and other androgens.  Dosage: 200 to 400 micrograms (mcg) daily
  xv.   Copper –is one of the important minerals required for the production of adrenal and ovarian hormones, and the protection of these tissues from free-radical damage.  Without adequate copper, hormone production may eventually cause decreased progesterone production. Adrenal function is impaired significantly when there is a copper deficiency.  Copper should especially be taken if a zinc supplement is used, since zinc supplements will lower copper levels.   Food sources include buckwheat, crab, liver, mushrooms, peanut butter, seeds and nuts, split peas and sunflower and olive oil.  Copper supplementation is appropriate for all menopause types.  Dosage: 2 mg daily
   xvi.   Folic Acid – is necessary for the production of red blood cells.  It is also essential for the health of all tissues, especially mucous membrane tissues such as the GI tract and vagina.  A deficiency in folic acid may increase the risk of heart disease.  The adrenal glands may also experience problems if folic acid levels are low.  Women of all menopause types should take this supplement.  Dosage: 400 mcg daily.  Food sources include barley, bran, brewer’s yeast, brown rice, cheese, chicken, dates, green leafy vegetables, lamb, legumes, lentils, liver, milk, mushrooms, oranges, spit peas, pork, root vegetables, salmon, tuna, wheat germ, whole grains and whole wheat.  Note: Oral contraceptives may increase the need for folic acid.  CAUTION: Do not take folic acid for extended periods if you have a hormone-related cancer or convulsive disorder.
xvii.   Iron – You should not take an iron supplement unless you have a medically proven iron deficiency
   xviii.   Magnesium – is one of the many key nutrients that work in the initial steps of the steroidogenic pathway.  It is an important mineral required for proper function of heart muscle and smooth muscles found in blood vessels and airways.  A deficiency may increase risk of heart disease and high blood pressure.  Foods high in magnesium include kelp, wheat bran, wheat germ, buckwheat, Brazil nuts, dulse, filberts, peanuts, and millet.
xix.   Manganese – is necessary for the proper health of the bone, for a healthy nervous system and for a healthy immune system.  It is also necessary for optimal adrenal and ovarian function.  Manganese supplementation is appropriate for all menopause types.  Dosage: 5 to 10 mg daily.
 xx.   Selenium –  is a strong antioxidant that is an important mineral for the health of the ovary.  It also has cancer-preventive, anti-aging and heart and liver protective properties.  Selenium supplementation is appropriate for all menopause types.  Dosage: 100 to 200 micrograms daily.  Food sources include Brazil nuts, brewer’s yeast, broccoli, brown rice, chicken, dairy products, dulse, garlic, kelp, liver, molasses, onions, salmon, seafood, vegetables, wheat germ and whole grains.
xxi.   Zinc – is necessary for the production of sex steroid hormones, growth hormones, energy reactions and glucose tolerance, bone repair and growth. It is necessary for the proper function of adrenal and ovarian tissues. Dosage: 30 mg daily.  When taking zinc take 2 mg of copper daily to prevent copper deficiency.  Food sources include brewer’s yeast, dulse, egg yolks, fish, kelp, lamb, legumes, lima beans, liver, meats, mushrooms, pecans, oysters, poultry, pumpkin seeds, sardines, seafood, soybeans and whole grains.
xxii.   Gamma-oryzanol  (ferulic acid) – Due to its ability to reduce LH by the pituitary and promote endorphin release by the hypothalamus it is very effective for treating hot flashes, insomnia, mild depression and minor anxiety.  It is extremely safe and no significant side effects have ever been produced in experiments or clinical studies.  This supplement is optional.  Dosage:  50 to 100 mg 2 to 3 times daily.  Food sources include rice, whole wheat, whole barley, whole oats, tomatoes, asparagus, olives, berries, peas and citrus fruits.
 xxiii.   Hesperidin – is a flavonoid found in citrus fruit.  It improves vascular integrity and relieves capillary permeability.  Combined with vitamin C, hesperidin and other citrus flavonoids can provide very effective relief from hot flashes.  This supplement is optional.  Dosage: 4 to 6 capsules (500ml each) 3 to 4 times daily.
   xxiv.   PABA –  along with folic acid increases estrogen levels. A deficiency of  PABA may lead to depression fatigue, graying of the hair, irritability, nervousness and patchy area of white skin.  This supplement is optional.  Dosage: 200 mg daily.  Food sources include kidney, liver, molasses, mushrooms, spinach and whole grains.

j.     DIETARY AND LIFESTYLE RECOMMENDATIONS FOR BALANCED HORMONES  i.   Eat organic food whenever possible. Avoid processed foods.  Eat plenty of fresh, whole unprocessed vegetables as they are rich sources of vitamins, minerals, carbohydrates and proteins.  The little fat they contain is in the form of healthy essential fatty acids. Fresh fruits are excellent sources of many vital antioxidants, vitamin C, carotenes and flavonoids. And drink plenty of clean water.  Women who eat a plant-based diet that is rich in a variety of fresh fruits and vegetables are less likely to experience premenopausal or menopausal symptoms.
  ii.   Avoid refined grains.  Eat whole grain breads and cereals.  Legumes when combined with grains form complete proteins. 
   iii.   Avoid refined hydrogenated oils which contain transfatty acids that can damage the arteries.  Avoid unsaturated vegetable oils which are so unstable that they will become rancid within hours after opening the bottle.  Rancid oil is notorious for creating oxidation in the body. Instead use unrefined extra virgin olive oil which is monounsaturated and has a long history of being healthy.  A little butter is OK too – just don’t eat an excess of it.
  iv.   Eat meat sparingly.  It is a high energy, high-fat, concentrated food  and too much protein can cause calcium to be leached from the bone, which contributes greatly to osteoporosis.  When buying meat make sure it is organic and free of antibiotic and hormone additives.
   v.   Eat more fish.  Fish is an excellent source of protein, and also contains the omega-3 fatty acids EPA and DHA.  These oils have been shown in a number of studies to reduce inflammation, to lower cholesterol, thin blood and reduce your risk of heart attacks and stroke.
  vi.   Eat more fiber.  Lack of fiber causes constipation, which causes all kinds of problems from gas and indigestion to varicose veins in the legs caused by straining during a bowel movement.  Fiber passes all the way through the digestive tract absorbing waste products as it moves along.  One of the waste products absorbed is estrogen.  If you don’t have enough fiber in your diet, the estrogen may be recycled back into your body.  Sources of fiber include whole unprocessed foods, whole grains, fresh fruits, vegetables, legumes and nuts.
 vii.   Exercise.  The human body is built for movement.  Every system in your body — from your organs, to your muscles, bones, blood, endocrine system and lymphatics — works best when it is harmoniously moving and free from restrictions or stagnation.  A brisk 60 minute daily walk will do the job.  You may also get exercise through gardening, raking leaves, sweeping the floors, swimming, bike riding, tennis, golf, yoga, qi gong, tai chi, dancing, working out in the gym, etc.      
 viii.  To relieve stress, try meditation, yoga, tai chi or qi gong.
    ix.  Avoid xenobiotics and xenoestrogens. According to Dr. Lee in his books What Your Doctor May Not Tell You About Perimenopause  and What Your Doctor May Not Tell You About Menopause xenobiotics or xenoestrogens are foreign substances originating outside the body that have hormone-like and estrogen-like activity in the body and thus have a profound impact on hormone balance.  Xenobiotics have hormone-like effects on the body and xenoestrogens have estrogenic effects on the body.   Xenoestrogens are more potent than the natural estrogens of the body.  The major source of oral intake of xenoestrogens is by way of animal fats, particularly red meat and dairy fats because they are given estrogenic substances to fatten them up for market.  They are also exposed when they eat grains that have been sprayed with pesticides. The xenoestrogens accumulate in their fat.  Anyone who eats meat and dairy products from animals raised this way is eating these xenoestrogens.  When we eat them they accumulate in our own fatty tissues causing estrogen dominance.

 Dr. Lee states that nearly all xenobiotics are petrochemically based.  Common sources of xenohormones include : solvents (as found in fingernail polish and fingernail polish remover, alcohol and ethylene glycol), petrochemically derived pesticides, herbicides and fungicides, car exhaust, emulsifiers found in soaps and cosmetics, nearly all plastics, PCBs, dioxins and meat from livestock fed estrogenic drugs to fatten them up. He believes that all xenohormones should be considered toxic, that they are extremely potent and are active in almost unbelievably small doses, and  that most xenohormones have estrogenic effects, which has created an epidemic of estrogen excess worldwide.
x.  Stop smoking — if you haven’t already done so.  It is well documented that smoking poisons the ovaries, decreasing your estrogen levels about two years sooner that would normally occur.  Cigarettes are well-known factors in causing lung cancer and cardiovascular disease.  Cigarette smoking also causes an increase in lung carbon dioxide and serum carbonic acid.  And one of the body’s response to this acidosis threat is to buffer the excess acid with calcium which is usually taken from your bones for this purpose increasing your risk for osteoporosis.
xi.  Caffeine results in increased urinary excretion of calcium; the more you consume, the more calcium you lose.   According to Dr. Northrup, if your calcium intake is relatively low to begin with, regular caffeine consumption could result in significant loss of bone over time.  If, on the other hand, your calcium and mineral intake is high, a couple of cups of coffee a day probably won’t matter much.  Even though tea contains caffeine, both green and black tea have been shown to build bone mass — probably because of their phytoestrogen content.

5)   MANAGEMENT OF MENOPAUSAL SYMPTOMS NATURALLY
a.   Anxiety and Nervousness – Barbara and I have very good results with craniosacral acupuncture, specific herbs and supplements for relief of these symptoms.
b.   Decreased Libido – High-dose soy isoflavones can often help.  If testosterone or adrenal hormone levels are low supplementation with small amounts of DHEA may restore libido to normal levels.  Barbara and I have very good results with craniosacral acupuncture, specific herbs and supplements for relief of these symptoms.
c.    Depression and Irritability – We have very good results with craniosacral acupuncture, herbs and specific supplements for relief of these symptoms
d.   Facial Hair and Hair Loss – Regarding hair loss Dr. Lee notes that when progesterone levels are raised by natural progesterone supplements, the androstenedione level will gradually fall, and your normal hair growth will eventually resume.  He also observes the disappearance of facial hair by using natural progesterone supplements.
e.   Fatigue –  Siberian ginseng is a very good herb to boost energy.  We also have very good results with craniosacral acupuncture, other herbs and specific supplements for relief of fatigue.  You may also want to consider adrenal glandular extract.
f. Heart Disease – Please see the section on Estrogen and HRT Studies in Menopause, Perimenopause and Postmenopause Part 2  For a thorough and detailed discussion of heart disease and its treatment we invite you to read our article entitled High Blood Pressure and High Cholesterol on our website.
g.   Hot Flashes  – may be due to bursts of activity from your hypothalamus and pituitary attempting to restimulate your ovaries into maintaining estrogen levels.  Dr. Lee feels that hot flashes are not a sign of estrogen deficiency per se, they are a sign of lack of estrogen and/or progesterone response to the urgings of hypothalamic centers.  About 75% of women will experience hot flashes.  The occurrence of hot flashes is highest in the first two years of postmenopause.  For most women hot flashes last about two years, although some women experience them for 5-10 years.  Barbara and I have very good results with craniosacral acupuncture, specific herbs and supplements for relief of these symptoms. 

  Some useful foods to eat for hot flashes include soy, fennel, celery, parsley, flaxseed oil, nuts and seeds.  Hesperidin, vitamin C and gamma oryzanol are also helpful.  According to one study regular physical exercise lowered the frequency and severity of hot flashes. 

  According to Dr. Lee often when progesterone levels are raised the pituitary stops trying to signal the ovaries to ovulate, the hypothalamus settles down and the hot flashes usually subside. The presence of progesterone makes estrogen receptors more sensitive, so that your own endogenous estrogen is sufficient.  He feels that since progesterone is a biochemical precursor to estrogen, it alone should be sufficient to restore estrogen levels to normal and eliminate hot flashes and vaginal dryness.  He contends that if a three-month trial of progesterone plus proper diet and supplements of magnesium and B6 do not relieve hot flashes or vaginal dryness, then low-dose natural estrogen may be helpful.

  A group of 58 menopausal women, who experienced an average of 14 hot flashes per week, supplemented their diets with either wheat flour or soy flour every day for 3 months; the women taking the soy reduced their hot flashes by 40%. (Murkies et al, 1995  

A double-blind, placebo controlled study involving 104 women with menopausal symptoms found that soy protein provided significant relief as compared to placebo.(Albertazzi et al, 1998)  Similarly, after 3 weeks, participants taking daily doses of 60 g of soy protein were having 26% fewer hot flashes, and by week 12, the reduction was 45%. (Albertazzi et al, 1998)

h.   Insomnia – We have very good results with craniosacral acupuncture, specific herbs and homeopathy for relief of insomnia.
i. Migraines – Dr. Lee contends that since estrogen causes dilation of blood vessels, contributing  to the cause of migraines, natural progesterone helps restore vascular tone, counteracting the blood vessel dilation causing the headache.  According to Dr. Northrup hundreds of women have been able to completely recover from menopausal migraines through the use of 2 percent progesterone cream.  For a thorough and detailed discussion of migraines and its treatment we invite you to read our article entitled Headaches and Migraines on our website.
j. Mood Swings – Barbara and I have very good results with craniosacral acupuncture, specific herbs and supplements for relief of mood swings. .According to Dr. Lee estrogen inhibits MAO and thus raises mood.  Long term use of estrogen, however, can have a negative effect on mood.  Synthetic progestins tend to stimulate MAO and can lead to a depressed mood.
k.   Night Sweats – can be relieved by taking black cohosh extract. We have very good results with craniosacral acupuncture, herbal formulas and specific supplements for relief of night sweats.
l. Osteoporosis – For a thorough and detailed discussion of osteoporosis and its treatment we refer you to our article on Osteoporosis on our website.
m. Stress Incontinence – For a thorough and detailed discussion of stress incontinence and its treatment we refer you to our article on Incontinence  on our website.
n.   Vaginal Dryness – Make sure your diet is adequate in essential fatty acids.  This is very important in the treatment and prevention of vaginal dryness.  Also a topical estrogen cream, vitamin E suppositories or increased intake of soy can be very helpful.  Dr. Lee feels that since progesterone is a biochemical precursor to estrogen, it alone is sufficient to restore estrogen levels to normal and eliminate vaginal dryness.  He contends that if a three-month trial of progesterone plus proper diet and supplements of magnesium and B6 do not relieve vaginal dryness, then natural estriol may be helpful.