I'm Too Young for This!: The Natural Hormone Solution to Enjoy Perimenopause (22 page)

Women have so many questions when entering perimenopause. It takes a qualified doctor to help a woman navigate this difficult and confusing passage. I asked fourteen of the doctors at ForeverHealth.com to answer my readers’ most common questions. Each of the doctors in the Forever Health Network has been vetted and trained to provide optimal, cutting-edge new medicine, including bioidentical hormone replacement therapy.

If you see yourself in these questions (or answers), these doctors and others at Forever Health will be able to help you find relief. Please first talk with your personal physician before attempting treatment or going it alone or better yet, go to
ForeverHealth.com
and connect with the doctor of your choice in your area. These doctors know what they are doing, they understand the changing planet, and they understand the effects of stress
and toxicity on the hormonal system and how it affects each woman differently.

The contributors to this chapter include:

All these doctors are at the top of their field and leaders in the new way to age with quality of life.

Q: I am just beginning to see the signs of perimenopause kicking in. I don’t want to lose my sex drive or vitality. Are there steps or hormones I can start taking now to avoid those issues? And are there other changes I can make in my diet and exercise to help, too?

DR. MICHAEL GALITZER: Yes, there are plenty of things you can do. As far as diet is concerned: eat organic, and avoid wheat and dairy products. Eat high-quality protein at each meal, and
take a multivitamin, 2,000 mg of vitamin C daily, and 4,000 IU vitamin D daily. Get a blood test for all your key hormones on day 20 or 21 of your menstrual cycle (first thing in the morning)—thyroid, cortisol, DHEA sulfate, estrogen, progesterone, testosterone, FSH, LH, and insulin. See a physician who is well versed in BHRT to assist you in balancing these hormones. Also, combine aerobic exercise with yoga and/or Pilates four times a week.

Q: Are excessive bleeding, longer periods, and shorter duration between periods part of perimenopause? I take birth control pills to regulate my periods—would I be better off with bioidentical hormone therapy? How do I know if I am in perimenopause?

DR. JOSEPH RAFFAELE: Perimenopause is defined as the four to six years (sometimes longer) before a woman has her last period. During this passage, your time between periods (your cycle length) can vary by more than seven days, both longer and shorter. So, if you have periods that vary by this much or if you miss more than two periods in your mid to late forties, then you are likely in perimenopause. If your doctor tests your FSH level and it is above 25 and you have these symptoms, then you are assuredly in perimenopause.

The shorter cycles usually occur because you are not making adequate progesterone during the second half of your cycle and that causes your uterine lining to shed off prematurely and sometimes very heavily. I usually treat this by adding progesterone on the fifteenth to twenty-eighth day of the cycle (day one being the first day of the period). Sometimes, not enough estradiol is made by the ovaries and you don’t have enough lining to shed off so you can miss a period altogether, or it can happen late. If a woman has symptoms of estrogen deficiency such as brain fog, night sweats, and hot flushes, I add some estradiol to her regimen. At times, some women make more estrogen than they ever have and
experience severe bloating, cramps, breast tenderness, and heavy bleeding. These women often benefit from daily progesterone to dampen the effects of the excessive estrogen production.

Birth control pills are commonly prescribed to perimenopausal women to control their irregular cycles and heavy bleeding. In most cases it does this quite well and is simple to do. But I
never
prescribe oral contraceptives to perimenopausal women. First, I can almost always get control of these symptoms in the ways described above, though I’ll admit it can take a little more work to find the right combination and dose than just popping a pill out of a plastic dial. Second, and more important, the estrogen and the progestins in BCPs are not bioidentical and they can lower free testosterone, decrease the effectiveness of growth hormone secretion, increase the risk of blood clots, and expose your breasts to much higher levels of estrogen than is necessary. Gynecologists often counter that my recommendation puts the patient at risk of getting pregnant. True, there is a
small
chance that she may get pregnant, but that can be addressed by nonhormonal means and most patients agree that the convenience of the pill isn’t worth the adverse effects.

Q: I was told that I am in perimenopause. I’m thirty-nine years old. This was told to me by the acupuncture doctor. But my primary doctor says I’m “fine.” I don’t know what to believe. I don’t feel like myself, I have anxiety, and I can’t lose weight no matter what I do
.

DR. PRUDENCE HALL: Your question is one that frustrates me as well. Patients experiencing major symptoms of perimenopause constantly tell me that their hormones were “normal,” per their doctors. They were then denied treatment. Many doctors simply don’t even recognize that perimenopause exists, and if they do, aren’t aware that it commonly begins in a woman’s mid to late thirties and into her early forties. Because estradiol levels
are frequently only slightly decreased on blood work at these ages, the deficiency is overlooked. The pituitary hormone goes above 20 in menopause, but in perimenopause is either totally normal or just slightly increased a bit beyond the normal 2 to 5 range. Doctors are so used to looking at lab values that we can forget to actually listen to what our patients are telling us. Perimenopausal patients tell us that they are tired, have worsening PMS, wake up in the middle of the night, are gaining weight for no reason, feel anxious and depressed, and are also quite irritable. A lowered sex drive also comes out of the blue, which is common with low estradiol states. When patients describe these symptoms, I usually prescribe a low dose of bioidentical estradiol at their PMS time, or all cycle long depending on what is needed, per their individual symptoms. In thousands of cases, patients feel normal again, and feel their symptoms reversed. Because low thyroid and adrenals can mimic many of these symptoms, I always do a panel to check all hormones and correct any hormone that is deficient, even if it is only slightly low.

Q: I have been suffering through perimenopause for a year now. I turned fifty this past April and since then I feel like I’m falling apart! I am trying to find a natural hormone replacement doc in my area but I also know they can be expensive. What other natural steps can I take?

DR. ANJU MATHUR: You sound like someone who really needs to get on bioidentical hormones as soon as possible. In the meantime, you can improve your diet to support optimal female hormone activity. Eat enough calories. Follow a Paleolithic diet: one that focuses on fruits, vegetables, meat, poultry, and fish. Add amino acid supplements and eat organic foods. Avoid caffeinated drinks, sugar, sweets, soda, cookies, bread, and pasta. Avoid grains and dairy products. Avoid being
overweight. Avoid excessive chronic stress, Avoid cigarette smoking or any drugs.

Q: I want to know your thoughts about the general dosing schedule for bioidentical compounded testosterone. Is it generally the norm to apply the cream every day or should we take a few days off each month as is the case with progesterone?

DR. MICHAEL GALITZER: Bioidentical testosterone is usually applied as a cream in a dose of 1–5 mg
every
morning depending on the results of a blood test for testosterone.

Q: I would love to know what I can do to alleviate my mood swings! I’m like Jekyll and Hyde!

DR. PRUDENCE HALL: Mood Swings R Us should be the name of perimenopause and menopause. They are caused by a combination of fluctuating and declining estrogen, as well as the thyroid and adrenal glands becoming imbalanced. I am, of course, a big proponent of women rebalancing every hormone that becomes deficient back to a youthful, healthy level. This involves getting your hormone levels checked, as well as having your doctor prescribe bioidentical hormones to correct each deficiency. To help the rebalancing process along naturally, I suggest you begin Mark Whitwell’s seven-minute daily, “The Promise Practice” [
ThePromise.com
]. It helps the natural healing forces of life to operate powerfully in you. Also get eight or nine hours of sleep, begin eating an anti-inflammatory diet
(eliminating dairy, gluten, eggs, and soy), and take digestive and systemic enzymes.

Q: Why is my PMS getting worse?

DR. MICHAEL GALITZER: Stress is the major reason for worsening PMS symptoms. The adrenal glands are the organs that have to secrete hormones in response to stress. With continued stress, the adrenal glands become depleted. They then draw from the ovarian hormones—estrogen and progesterone. Consequently, you get depleted of your ovarian hormones, and your PMS gets worse. Get a blood test for all your key hormones (DHEA, cortisol, thyroid, estrogen, progesterone, LH, and FSH) on day 21 of your menstrual cycle, and see a physician who is well versed in BHRT. The three supplements that are most helpful with PMS are zinc, vitamin B
₆
, and evening primrose oil.

Q: I took birth control pills for twenty years and stopped a year ago. Since then I have experienced severe PMS, cramps, mood swings, etc. Working during this time every month is quite difficult. My husband says that I become possessed during this time. Once I start my period, then I’m fine. I’m ready to go back on the BCPs to control my PMS. What else can I do and will hormones help?

DR. NEIL ROUZIER: Your PMS symptom complex is very common and needlessly suffered by many women like you. As you have experienced, there are times that you feel great and times that you can’t stand it. Some women have no symptoms of PMS and others suffer terribly. Fortunately there is a very effective, safe, and healthy solution to your PMS: progesterone. It is the fall in your progesterone levels that is causing your symptoms. It is
the fall in progesterone levels at delivery that results in postpartum depression. If you suffer from PMS, you may also be the one who encounters depression after delivery. Both are easily treated with progesterone.

In the past, I used to treat PMS by having women take progesterone just during the days of PMS, seven to ten days before their period. Patients would tell me that they did not stop the progesterone but continued to take it throughout their cycle because they felt better on the progesterone than off. I now treat with daily progesterone and increase it as needed on days of PMS. A common error in treating PMS is that many women do not use enough progesterone to control symptoms. One has to sometimes use high doses of progesterone, and only then will the symptoms of PMS be relieved. If you still have symptoms of PMS, then you are not taking enough progesterone.

Q: I am a migraine sufferer and this phase has been at times overwhelming. Is there any help?

DR. MICHAEL GALITZER: Migraines may sometimes be a result of an overloaded liver, but there can be associated triggers such as food sensitivities, mercury toxicity from excessive ingestion of fish (such as tuna and swordfish), as well as the presence of silver amalgam fillings, and pesticides, to name a few of the environmental toxins that we are constantly exposed to.

Optimizing the health of your liver is paramount. You can do the following:

Please get a blood test for all your hormones including: thyroid, DHEA sulfate, cortisol, estrogen, progesterone, FSH, and LH. You will most likely need supplementation with bioidentical estrogen and progesterone, by a physician well versed in this type of treatment.

Q: I’m forty-seven and have been on bioidentical progesterone for ten years, and it’s been wonderful. Lately, though, I have experienced bad headaches prior to my cycle. Is this a sign of me needing to start using estrogen also?

DR. MARSHA NUNLEY: Possibly. It is likely that you are having increasing fluctuations in your hormones, particularly estrogen. The body prefers for things to be stable, so the hormone fluctuations of the perimenopausal period can bring on symptoms like headaches. It could also be related to adrenal or thyroid issues, and diet and lifestyle could be a contributing factor. Testosterone can drop significantly during perimenopause and replacement might be helpful. You may also need to increase the progesterone.