It’s been just eight days since I blew out the candles on my 40th-birthday cake, yet I already have a nagging sense that something’s changing. A few times a month, I wake up in a pool of sweat, where I lie wide-eyed for hours. In the days before my period, a sink full of dirty dishes can make me weep. And menses itself is often earlier, and heavier, than I expect. Surely, I’m too young for menopause. Right? Not necessarily.
“We’ve learned that women can actually start experiencing perimenopausal symptoms up to 10 years prior to menopause,” says Laurie Steelsmith, ND, author of Natural Choices for Women’s Health (Three Rivers, 2005). “Fortunately, I see a lot more focus today on helping women through this hormonal roller coaster using natural methods.” Consider these remedies for the most common symptoms.
These are among the earliest signs of perimenopause, caused when your ovaries cut back on production of progesterone, a natural sedative.
To boost progesterone, Northrup recommends rubbing 1/4 teaspoon of 2 percent bioidentical progesterone cream (available by prescription or over-the-counter) onto your arms, thighs, or stomach nightly for at least two to three weeks each month. Or, try the herb chasteberry (aka Vitex agnus castus), a phytoprogesterone or plant with progesterone-like properties that is believed to bind to progesterone receptors in the body. A 2010 study of 67 Chinese women found that those who took standardized vitex daily for three cycles reported far more improvements in PMS symptoms (especially with insomnia and moodiness) than the placebo group. Steelsmith recommends 175 mg of standardized powdered extract, or 40 drops of liquid daily. Other milder progesterone-mimicking herbs include turmeric, thyme, and oregano. All are available in capsule or tincture form, or add herbs to meals a few times a week.
Your adrenals (two energizing glands atop your kidneys) may be fried from years of churning out cortisol and adrenaline, the body’s main stress hormones. Adrenal fatigue is particularly problematic in perimenopause because these glands also produce estrogen, progesterone, and testosterone as your ovaries slack off. When overtaxed, adrenals will preferentially produce stress hormones over sex hormones, which can worsen perimenopause symptoms.
To check adrenal health, ask your doctor for an Adrenal Stress Index, a saliva test. Then take a good look at your diet. “One of the most important things you can do to support your adrenals is stabilize your blood sugar,” says Steelsmith. Erratic blood sugar levels prompt even more cortisol production, so go easy on sweets and other refined carbohydrates, stop skipping meals, and eat plenty of protein (a natural blood-glucose stabilizer). Also, consider taking 500 mg of pantothenic acid (B5) and 1,000 mg of vitamin C twice a day. These building blocks for adrenal hormones tend to be flushed out under stress.
Women’s health experts say hot flashes are probably caused by radical dips in estrogen. But supplemental estrogen—still considered the gold standard for treating them—is associated with increased breast cancer risk.
By far the most studied natural remedy is black cohosh, a phytoestrogen or plant with estrogen-like properties. Although the overall data is mixed, one 2006 study of 301 women found that those who took black cohosh for 16 weeks saw hot flashes drop 50 percent while the placebo group saw a 20 percent drop. Try 20 to 80 mg twice a day of standardized extract, says Wroth. Soy is another promising phytoestrogen. Researchers have long suspected that one reason Japanese women have fewer hot flashes is because of their high soy intake, and a growing body of evidence bolsters this hypothesis. Twelve weekly acupuncture sessions—or a twice-daily, 20-minute deep-breathing practice—can also cut hot flashes significantly, according to recent studies.
Because vaginal tissue depends on estrogen to remain moist and elastic, the hormonal nosedive at menopause often leads to a thinning and drying of tissue, making women more prone to yeast and urinary infections and painful sex.
Steelsmith recommends vitamin E vaginal suppositories (available over-the-counter at most pharmacies), Kegel pelvic-floor exercises to bring blood flow to the area, and plenty of sex to restore elasticity. “If you don’t use it, you lose it,” she says. The Asian botanical Pueraria mirifica (PM, also known as Thai kudzu) has also been shown to relieve vaginal dryness, in some cases better than Premarin. Look for a product with the standardized active ingredient miroestrol. Typical dose is 50–80 mg daily. Northrup recommends applying 0.5 mg of topical bioidentical estrogen, estriol, to the vagina; talk with your health care provider before starting treatment.
A 2009 University of California study of 2,362 women between 42 and 52 found that 60 percent suffered memory and mental-processing problems. The good news: According to the study, cognitive function tends to return to premenopausal levels after menopause.
Try 2,000 mg of omega-3 fatty acids daily, including both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA is believed to promote production of brain-derived neurotrophic factor (BDNF), a hormone that helps neurons function better and fuels brain-cell growth. One 2009 study of 485 healthy adults found those who took 900 mg per day of DHA for six months made “significantly fewer errors” on memory tests than at the study’s onset. Another 2009 study found that perimenopausal women who took 1,000 mg of EPA daily for eight weeks saw psychological distress and mild depression lift. Finally, get moving. “Research shows the more people exercise, the better their brains function,” says Wroth.
Perhaps the most intimidating symptom facing women entering perimenopause is fear—a fear “they are going to come out of it old and wrinkled and lacking vitality,” says Steelsmith. That’s far from reality. Symptoms typically subside within three years of the last period. The emotional highs and lows and discomforts that accompanied menstrual cycles are replaced by a more even keel. And thanks to shifts in wiring in the temporal lobe (associated with intuition) and permanently elevated levels of follicle-stimulating hormone and luteinizing hormone–which previously spiked only at ovulation–many postmenopausal women report a renewed mental clarity.
So enjoy the ride, says Northrup. “What we have to lose is not nearly so valuable as what we have to gain.”