T Nation

Perimenapausal Nutrition?

What supplements or nutritional advice will help a 47 year old perimenapausal woman who is in good physical shape and health otherwise?

http://www.nytimes.com/specials/women/warchive/980127_1235.html

You can increase your body’s overall estrogen supply naturally by eating flaxseed (two or three tablespoons a day) and more soy-based foods, including tofu, soy milk, soybeans and soy nuts. Consult “Estrogen: The Natural Way” by Nina Shandler (Villard, 1997, $24.95) for amounts and recipes using foods rich in plant estrogens. But eating large amounts of estrogen-rich foods exposes you to unopposed estrogen, which, without the balancing effects of progestin, may result in overstimulation of the uterine lining and heavier menstrual bleeding. When hormone replacement is given in pill form to a woman who still has a uterus, estrogen is combined with a progestin to diminish the risk of uterine overstimulation and prevent uterine cancer. Even if you are still menstruating regularly, hormone replacement can help to reduce perimenopausal symptoms.


Unfortunately the above information is way out of date and incorrect. Studies show you get just about nothing from soy in the way of estrogen.

I am 59, I am not as consistent as most of the people dedicated here but I take pretty good care of my health and most people considerer that I have aged incredibly well.

This is what I recommend: go on Hormone replacement therapy BUT make sure you get what are commonly referred to as “Naturals.” You want the estrogen that women have before perimenopause, which is estradiol. The synthetics, like Premarin tend to load you up with estrone, the dominant estrogen after menopause in women. That is ass-backwards. You want to restore yourself to your pre-menopausal state not accelerate to your post menopausal state. (The pharmaceuticals do this because they can patent it. They get the estrone from pregnant mare’s urine-- hence the name like Premarin.)

If you can in anyway afford it, go with the brand name Estrace. I did both. When I switched to generics because I found it too prohibitively expensive to continue with the brand name because my insurance covered less and less of the cost, I was pre-cancerous in my uterus within 2 years and ended up with a hysterectomy.

Generics are NOT bio-equivalent to Estrace…even the FDA site acknowledges that. Uterine cancer comes about through overdoses of estrogen. The generics caused my estrogen levels to be way too high. It was noticed in my annual check-up by my internist in the fall. By the time I saw my gyn in the spring, I had already started the symptoms of pre-cancerous stage and it was too late.

You also need to “oppose” the estrogen with progesterone. It is critical to get the natural progesterone, not the synthetic progestin that is in Premarin and all the other versions that are most typically described by doctors. (Again used for patent reasons.)

It is also critical that you get progesterone in adequate dosages. This means you do not use progesterone creams, even if it is progesterone. You can not control the quantity absorbed by your body. It is critical that you have a sufficient amount.

Ironically, my closest friend was on the generic estradiol but at half the dose I was but was prescribed progesterone cream. At precisely the same time as me she also developed the symptoms of problems in her uterus and had a hysterectomy.

In her case it had already developed to cancer. But thank goodness they got her uterus out in time. It was concluded that her problem was inadequate doses of progesterone.

Estrogen causes you body to build up its lining in anticipation of a potential impregnated egg becoming embedded and growing to term. Once a month, when your body does not become pregnant, your body release progesterone to slough off the uterine lining that as built up over the month.
That is what causes your period.

If you go into menopause, it means you hormones are declining in production in a zig zaggy way. It is the zig zag fluctuations in your estrogen as it declines in production that causes the night sweats, the hot flashes and the “fuzzy -brained” thinking.

That is why so many women in their late forties and 50’s often seem like ditzes. Their estrogen levels are constantly changing, going up and down and seriously affecting their ability to focus and remember. HRT levels that out.

But if you don’t take a proper amount of progesterone, your body will not slough off the uterine lining that the estrogen you were taking causes to build up. The progesterone is what triggers the monthly slough off. If the lining doesn’t get sloughed off, it keep growing and growing and there is a 30 % chance it will turn into cancer.

The right (and only) brand of progesterone to take is Prometrium. A lot of pharmacies compound it themselves but the quantity control is poor. And inadequate progesterone won’t cause you to slough off your lining causing the risk of cancer.

And as stated above, it is important that you do not rely on progesterone cream instead of taking the pill, because you cannot get enough progesterone in a controlled regulated way to oppose the estrogen.

Progestin, the synthetic substitute for progesterone is known to give all kinds of PMS side effects. Furthermore, all the studies using HRT that show it increase the risk for breast cancer in the long run and other forms of cancer were using the synthetic HRT’s, which are also the mostly widely prescribe. So do not fear the concerns for cancer that recent tests show – those were done with the synthetics,which are bad for you to take anyway.

The last is about testosterone. Women’s levels of testosterone also decline. But measuring it in any one woman’s case to see if it declined in her is impossible since the normal range is from zero to 70 or something like that and fluctuates throughout the cycle.

The way to know if you need testosterone is based on your physiological reaction to sex. If your libido is low, you are not having the physiological responses to sex you normally have (you are not as naturally lubricated, your vagina doesn’t swell during excitement, your clitoris doesn’t swell, you have a hard time achieving an orgasm) then you probably need testosterone supplements.

Again I recommend natural. I have tried the methyl testosterone and it boost my sex drive and physical response like crazy but it boost my appetite as well and I can gain ten pounds in a week from minuscule doses.

You can get a testosterone (of natural testosterone) cream to apply in the outer lips of your vagina and clitoris. You can do this on a regular bases, at night, or before you have sex. When I tried to do it on a regular basis, it also increased my appetite, not as badly as with the methyl testosterone but still troublesome enough for me.

It also did not have as powerful effect on my sex drive. The compromise I have reached is to use it before sex. My physiological response is not as strong, the orgasms are not as powerful, physically – but most of the satisfaction from an orgasm is mental. If you have an imaginative partner that you are in good and connected communication with and are into fantasies – you can easily make up for much (but not all) of the short-fall :-).

The testosterone cream is compounded by your pharmacist so quality control is a probe,m. The only issue however is not a safety one… it is just what its affects on you are. Too much, you may eat to much, too little, you may not have satisfactory response. It is important to find a pharmacy with very high quality control with first rate pharmacists who know what they are doing.

There is supposed to be a testosterone patch coming out that has been shown to be enormously effective for women. It is is called Intrinsa and manufactured by Proctor & Gamble.

It actually was available over a year ago. But the tests were on restoring sexual functioning for women with surgically induced menopause (i.e., hysterectomy with ovaries removed.) But the FDA knew it would be instantly prescribed by doctors “off-label” meaning prescribed for a purpose not tested for in the clinical trials. It would be prescribed for women who were naturally in the state of perimenopause and menopause.

Though the FDA had never in its history(if I remember correctly) rejected a valid drug that passed all the clinical standards required because of fear of off-label use, it decided to do so for the first time, for a drug that would benefit aging women.

Though most speculate that this was in the wake of the scandal of Vioxx, the pain drug that subsequently proved to cause cardio vascular disease and death is some instances and was recalled, nevertheless, nevertheless many people wondered why the FDA decided to chose a drug designed to enhance women’s sense of well-being as their first instance of concerns for off-label use, thereby demonstrating the “new, stricter” FDA.

Regardless, Intrinsa is supposed to come out soon if it is not already out – probably because of the widespread backlash to the FDA decision. SO look for it soon and ask your doctor about it.

There is a big difference among pharmacies, despite it appearing that they just pour pills in a bottle. Using generics, it will depend on what company’s generics they get… cheap ones that have poor bioavailibility in their compounds, ones that do not have good quality control over the essential ingredient, etc.

And don’t let anyone fool you. Even when the FA declares a generic is bio-identical to the brand it still isn’t. The only requirement is that the generic have the same essential ingredient as the formerly patented brand. But there is a lot more to making a pill effective than the essential ingredient. What the ingredient is compounded with varies from company to company. The brand one, in order to develop the drug, pass muster with the FDA, test all kinds of methods of compounding the pill that will carry their patented ingredient.

They look for maximum delivery effect in the body, minimal side effects in as broad a population as possible and so forth. They want their drug to be as much a “wonder drug” so it will sell, be widely prescribed and make them a lot of money.

Once it is well established that the essential ingredient is highly effective for whatever it is used for, when the patent wears off, the marketing impact is already done and the generic manufacturers can free-ride on that built up publicity and public good will. The FDA does NOT require the generics to pass the same tests for their pills that was required of the original brand name.

That is my 2 cents, 10 years of research and having one of the worlds leading researchers on HRT as my gyn. When we first started working together he wanted me on the synthetics because that was tried and true and tested. But I knew of the side effects and I didn’t want it.

So we made a deal. He would prescribe the naturals, I had to have a uterine biopsy every 6 months. Which was fine with me. after a few years he saw that things were working well, he got grants to study it further. As he needed a well-regulated supply of progesterone, he could not rely on compounding and so a company developed Promertium for his experiments. The quality was so good that they now market it.

So you can make of what I wrote what you will. But this is the result of extensive research, knowledge and self observation.

A good source of pharmaceuticals for this plus the latest info is Women’s International Pharmacy, which is located in Wisconsin and you can find it by googling on the internet.

What a marvelous post! Thanks for that, Justitia. I’ll be adding it to my links on HRT info.

Just want to note that I updated my post to include more information,particualrly about new testosterone treatments for menopausal women and sbout the use of generics and compounding.

Sorry for the lengthy post.

Some women find that DHEA increases their T levels… something that does not happen for men.