Menopause & Perimenopause

Beginning in a woman’s mid-30s to early-40s, her ovaries naturally begin to decline in their production of estrogen and progesterone. This is the stage known as ‘perimenopause,’ which can last for several years. When 12 full months have lapsed since the last menstrual period, menopause is officially considered to have begun.

During perimenopause, fluctuating hormone levels (including gonadotropin-releasing hormone from the hypothalamus (GnRH); luteinizing (LH) and follicle-stimulating (FSH) hormones from the pituitary) begin ‘working overtime’ in an attempt to signal the decreasingly responsive ovaries. The result of these fluctuations include hot flushes/flashes, irregular cycles, insomnia, mood disturbances, and other physical changes such as vaginal dryness, change in skin tone, and loss of bone mass. In addition, some women may experience mental and emotional disturbances. Sleep disturbances and insomnia are common and can disrupt one’s ability to effectively handle stress, leading to irritability and anxiety which can then further aggravate the stress cycle. Re-establishing healthy sleep patterns can help enormously in offsetting this pattern.

Botanicals to ease the transition

Many herbs have traditionally been used to help ease the physical and emotional changes associated with menopause including Dong Quai, Black Cohosh, Vitex, Wild Yam, Red Clover, Motherwort, and many others.

Black Cohosh is probably the most widely researched western botanical for menopause. Conflicting reports regarding its effectiveness in alleviating hot flushes may stem from dissimilar preparations being compared in studies. Many women experience improvement in hot flushes and heart palpitations when using this herb, as well as improvement in mood and lessening of depression. The latter is thought to possibly be due to its binding to serotonin receptors.

The constituents in Black Cohosh which contribute to its hormone-balancing and hot flash-mitigating effects are known as triterpene glycosides. Triterpenes are not classical ‘phytoestrogens’ in that they do not bind to estrogen receptors (as do the isoflavonoids from soy and red clover) but otherwise modulate the activity of luteinizing hormone (LH). They also have a distinct antiestrogenic and pro-apoptic (enhancing cell death) effect on breast cancer cells.

From the Orient comes Dong Quai, considered to be an “Empress herb” in the TCM tradition and reflecting its revered status as a herb once reserved for royalty. Dong Quai is often combined with other ‘yin tonifying’ herbs such as Rehmannia and White Peony.

Both the TCM and Ayurvedic traditions utilise asparagus root for female hormone balancing; in the Ayurvedic tradition, asparagus root is known as Shatavari (or more poetically, “herb of one hundred husbands”).

Chaste Tree berry (Vitex) is beneficial for regulating the menstrual cycle and relieving symptoms associated with low progesterone. Its action is theorized to be upon increasing dopamine production, thereby reducing prolactin levels. Decreased dopamine levels are associated with increased prolactin which, in turn, is associated with lowered progesterone levels.

Phytoestrogens – What are they?

Phytoestrogens are not estrogen. They are estrogen-like in their effect. The estrogen that we produce is actually a group of several steroidal hormones, notably estradiol, estriol, and estrone, the most biologically active of these being estradiol.

Phytoestrogens describe a class of primarily nonsteroidal plant constituents that resemble estradiol in their structural (3-D) configuration. There are a few plants that do actually contain steroidal phytoestrogens which resemble estrone, the weakest of the estrogens. These include French beans, rice, apple seeds, licorice, and pomegranate seeds.

Because of their similar structural shape to estradiol, phytoestrogens bind to estrogen-receptor sites in the body and, thus, mimic estrogen. Although weaker in effect than estradiol itself binding, phytoestrogens can, nonetheless, provide appreciable estrogenic-activity and help to alleviate symptoms of menopause including hot flushes, sweating, irritability, and vaginal dryness. They can, additionally, ameloriate other conditions associated with lowered estrogen levels, including osteoporosis.

Phytoestrogens can, conversely, also act as estrogen antagonists. This can be a desirable feature in hyperestrogenic states such as endometriosis, fibroids, or ‘estrogen dominance’ (a common feature of PMS). Estrogen dominance is more often a reflection of a progesterone deficiency, whereby there is a relative estrogen excess rather than an absolute estrogen excess. By binding to estrogen receptors, phytoestrogens can competitively block the binding of endogenous estradiol. This results in reduced physiological effects relative to if estradiol were to bind.

In estrogen-positive tumours (the most common type in breast cancer), phytoestrogens can competitively bind to estrogen receptors and diminish cellular proliferation and tumour growth. (Both of these are promoted under the influence of estrogen.) The application of phytoestrogens in this capacity should be done under the supervision of a qualified health professional.

Plants that Contain Phytoestrogens:

• Red Clover
• Alfalfa
• Soy
• Flax
• Hops
• Fennel
• Licorice
• Ginseng (Korean)

Dietary Sources of Phytoestrogens:

• Soy (tofu, tempeh, edamame, soy ‘dairy,’ processed soy products)
• Flax seed
• Alfalfa sprouts
• Sesame seeds
• Wheat berries & wheat germ
• Oats
• Barley
• Dried beans, lentils, mung beans
• Rice & rice bran
• Apples
• Carrots
• Pomegranate seeds

Phytoprogesterones – What are they?

Like their phytoestrogenic counterparts, phytoprogesterogenic herbs do not contain progesterone. They are progesterone-like in their effect, which may help to re-establish balance when there is a progesterone deficiency present. The best known phytoprogesterogenic botanical in the western herbal tradition is Vitex (Chaste Tree berry).

Vitex is theorized to support progesterone production by increasing dopamine levels in the brain which, in turn, decrease prolactin. Progesterone is decreased when prolactin is increased, as prolactin inhibits follicle-stimulating hormone (FSH) from the pituitary which results in decreased progesterone production in the ovary.

Wild Yam vs ‘Natural’ or ‘Bio-Identical’ Progesterone

The confusion around Wild Yam (Dioscorea villosa) and its erroneous regard as being synonymous with ‘natural progesterone,’ arises from the historical use of Mexican Yam (Dioscorea mexicana). Mexican Yam was the original source of diosgenin, a steroidal saponin which was extracted and used as the substrate for making progesterone for birth control pills (as well as in the semi-synthesis of other steroid drugs, including cortisone, prednisone, estrogen, and androgens).

Some manufacturers would have you believe that by using their Wild Yam-containing product (either orally or by applying topically), you are actually getting natural or bio-identical progesterone. This is not the case. Wild Yam does not contain progesterone, nor will your body produce progesterone from Wild Yam.

The conversion of diosgenin to progesterone, however, requires an extensive, multi-step laboratory process. Within our body, we cannot convert diosgenin to progesterone – we lack the many enzymes necessary for this process. Thus, Wild Yam can indeed be said to be a “source of natural progesterone” – when diosgenin is converted in the lab, to such – but our body cannot utilise diosgenin as a precursor for endogenous progesterone production.

The benefits of Wild Yam are primarily due to the ability of diosgenin (and possibly other constituents) to influence hormonal balance in ways other than through directly binding to hormone receptors.

Supportive natural remedies including botanical medicine, supplements, and dietary and lifestyle adjustments have much to offer in the natural transition of perimenopause and menopause.