Changing Tides: A Natural Approach To Perimenopause



Powerful physical milestones mark our lives as women, each with its own joys and challenges. The advent of perimenopause is part of the journey.

Women’s bodies are marvels of strength and flexibility, remarkably resilient and adaptable to the many changes that occur during a lifetime. As we leave behind the chapters encompassing childbearing and fertility and approach menopause, we enter the somewhat nebulous phase known as perimenopause.

Also called pre-menopause, this period of time precedes menopause and generally begins between the ages of 35 and 45. Lasting just a few short years, or lingering for as long as fifteen, perimenopause is marked by fluctuating hormone levels that can manifest as a host of symptoms, completely dependent upon a woman’s own individual physiology, health, and family history.

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The Natural Approach Changing Tides of Perimenopause

The Association of Women for the Advancement of Research and Education’s Project AWARE has identified thirty-five symptoms considered normal for this stage of a woman’s life, ranging from such typical complaints as hot flashes, mood swings, depression, osteoporosis, and vaginal dryness, to less classic problems that can include feelings of dread, an increase in allergies, changes in body odor, and a burning tongue sensation.

One of the major reasons women experience symptoms, says Holly Lucille, ND, RN, naturopathic doctor and the author of Creating and Maintaining Balance: A Women’s Guide to Safe, Natural Symptom Relief (Impact, 2004), is due to adrenal exhaustion. As our reproductive system moves into rest mode, our bodies begin to rely upon our adrenal glands as a kind of built-in back up system for hormone production.

“The adrenal glands are also our stress glands,” she adds. “Too much unrelenting chronic stress keeps cortisol pumping and our sympathetic nervous system on high alert, resulting in the manifestation of symptoms such as anxiety. Stress relief techniques [such as meditation and yoga]are imperative to quiet the mind and the body, offering a balance between the sympathetic and parasympathetic systems, and allowing time for the body to rest, relax, and repair itself.”

Before rushing toward symptom relief, we need to understand the factors behind them, including stress and our toxic environment, explains Lucille. These include what she describes as pervasive everyday exposure to hormone disruptors like xenoestrogens, chemicals in products and the environment that disrupt the hormone-regulating function of the endocrine system by mimicking estrogen. Making our food and lifestyle choices as healthy and green as possible is essential to providing a buffer against these negatives and maintaining overall health. When it comes to herbal relief, Lucille says the most widely used and studied natural supplement for dealing with hot flashes and night sweats is black cohosh.

“It has an incredible safety profile,” reports Lucille, “and [extensive]studies backing not only its safety, but also its effectiveness. I recommend using the black cohosh product Remifemin, which has over forty published studies behind it. It’s important to know that although safe and effective, black cohosh does take a little time to become effective. I recommend staying on a standardized extract like Remifemin for twelve weeks at the minimum.”

She also emphasizes the importance of proper nutrition not only for perimenopause, but to provide a solid, healthy foundation for healthy body systems that can cope gracefully with menopause and the years that follow. Our bodies function through a complex series of cellular and biochemical reactions, all of which require vitamins and minerals. Avoiding processed and refined foods, and replacing them with organic fruits, vegetables, and whole foods help these systems to function at optimal levels. Choosing a high quality multivitamin-mineral supplement can help fill nutritional gaps.

“A strong foundation is the single most important thing I stress,” she says, “and how someone nourishes herself is key. Then the winds of change can come swirling around and the body can react with strength and gentle responses.”

Subtle Energy

Based on the theory of treating “like with like,” the gentle, centuries-old healing system of homeopathy uses infinitesimal amounts of a substance to cure symptoms that a larger amount of the same substance would cause. Safe to use in conjunction with other medicinal approaches, homeopathy offers several options for perimenopause symptoms, and numerous double-blind studies have shown it to be a viable treatment option. Dana Ullman, MPH, director of Homeopathic Educational Services in Berkeley, California, and author of numerous books including The Homeopathic Revolution (North Atlantic Books, 2007), and the on-line book Homeopathic Family Medicine: Evidence-Based Homeopathy (available at, explains that the benefits of homeopathy go beyond symptom relief and embrace general health improvements, including reduced anxiety and decreased depression.

According to Ullman, homeopaths generally find that prescribing constitutional remedies (remedies chosen based on the totality of physical and psychological symptoms a given woman is experiencing) produces optimum results.

“Homeopathy nurtures the body’s own wisdom,” he says, “and supports the immune system. There are no one-to-one cures, however. It’s very individualized, and the best treatments improve, strengthen, or tone a person’s overall immune system.”

Some of the commonly prescribed remedies tailored to each individual include Belladonna (deadly nightshade), Sepia (cuttlefish), and Sanguinaria (bloodroot) to help relieve hot flashes; Lachesis (bushmaster snake venom) for various symptoms, including hot flashes, vaginal dryness, and emotional dramas; Pulsatilla (windflower) for mood swings, depression, weepiness, and self-pity; Cimicifuga (black cohosh) for depression combined with flushes and various rheumatic pains; and Calcarea phosphorica (calcium phosphate) to help prevent bone loss.

The choice of a specific homeopathic remedy is best left to a qualified practitioner who can assess a patient’s symptoms, personality, and psychology. When the right choice is made, says Ullman, homeopathic medicines can help a woman through this change of life and substantially reduce the physical discomforts and emotional tumult that are commonly experienced.

Ancient Wisdom

“Modern medicines are usually one or more synthetic chemical compounds designed to alter a specific metabolic biochemical process,” says Scott Gerson, MD, PhD, medical director of The National Institute of Ayurvedic Medicine, and Clinical Assistant Professor of the Department of Community and Preventive Medicine at New York Medical College. “They interfere with, or in some cases simulate, a natural biochemical process somewhere in your body. Taking estrogen or taking aspirin are good examples. They may reduce certain symptoms, but only because the synthetic drug overpowers the internal human chemistry. Sure the hot flash or the fever may be diminished, but the underlying cause is not set right.”

Ayurvedic preparations, explains Gerson, help correct underlying imbalances by encouraging an energetic adjustment on a molecular level. He explains that to accurately determine which herbal medicines are indicated requires a full knowledge of the patient, including her condition (rogarogi pariksha), constitutional type (prakriti), and individual dosha.

Proper nutrition and healthy levels of exercise are also part of the Ayurvedic equation. Gerson recommends a diet low in saturated fat, moderate in mono- and unsaturated fats, and high in properly cooked whole grains, fruits, and vegetables, along with some dairy.

“Cook with olive oil or canola oil instead of butter or margarine, and limit amounts of caffeine, salt, and alcohol (no more than 6 ounces of wine per day, three days per week, maximum). Include five or more servings of fruits and vegetables daily, and make an effort to include soy products in the diet. In addition to these guidelines,” Gerson adds, “women who have reached perimenopause have specific nutritional considerations which can greatly modify the chances of developing osteoporosis and heart disease, as well as other menopausal symptoms.”

Gerson further suggests paying attention to vitamin and mineral levels, particularly vitamins D and B12, calcium, and the amino acids hydroxyproline and glycine (both of which are needed for collagen production).

“Vitamin D is important for incorporating calcium into the bones. To acquire vitamin D, Ayurveda advises 15 minutes of sun exposure daily to at least 15 percent of the skin area (equivalent to the face and arms). Calcium, along with adequate dietary protein, builds bone density, mass, and tensile strength. Though bone density peaks in the mid-twenties, decreasing by about 0.5 percent each year thereafter, adequate calcium in the diet is still vitally important as women reach menopause. Calcium is best obtained from low-fat dairy products such as milk, cheese, and yogurt (unless it can’t be tolerated for some reason). Although green leafy vegetables do contain some calcium, it’s generally unrealistic to expect to get the required amount from that source alone. If sufficient calcium isn’t found in the diet, a calcium supplement is an excellent idea.”

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Debra Bokur

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