Many women go to their health practitioners feeling uncertain of what is happening, but feeling a little like this…
Women’s Health Information Session (updated 2016)
Monterrey Wigglesworth (Pharmacist)
First, a few definitions:
Premenstrual Syndrome/Tension (PMS/PMT): Physical and emotional changes that can be bothersome and occur in the days immediately prior to a period. Most commonly; water retention, changes in mood, breast tenderness and food cravings. Premenstrual symptoms are increased by situational stresses. Many women have discovered that “PMS gets worse as we get older.”
Perimenopause: the period of time before and for a year after the final menstrual period during which ovarian hormonal patterns change. The average age at which irregular cycles develop is approximately age 47, but perimenopause may begin several years before that in women with regular cycles.
Changes characteristic of perimenopause onset in regularly cycling women.
Any three of the following can be used to define perimenopause onset: (BC Medical Journal, Vol 47, No 10, Dec 05)
Menopause: defined when a year has passed since the final menstrual period. The average age of menopause in western countries is approximately 51. The average age of menopause is younger in smokers and those who have never had children. Low levels of both oestrogen and progensterone are normal after menopause.
The normal (average) female cycle is 28 days long (if we were all textbooks). I will simplify the cycle by just speaking about oestrogen and progesterone. In the first 14 days oestrogen is dominant and promotes growth (uterine lining, breasts, dominant follicle containing an egg). There is an oestrogen peak mid-cycle when vaginal mucous is stretchy and libido may be at its peak. This is the body getting ready to ovulate and make babies! Ovulation should then occur, which is the release of an egg. What is left after the egg is released then produces progesterone. Progesterone calms down oestrogen and creates a comfortable environment for the fertilised egg to implant. If no egg comes along both hormones decrease and we have a period, which is day one of the next cycle.
A major key part of this to remember is, if we won’t ovulate, we don’t get the progesterone rise in the second half of the cycle. Or, if oestrogen is high the progesterone rise may not be as dominant in the second half of the cycle as would be ideal. Progesterone is important to calm down symptoms of too much oestrogen and the stimulation caused by oestrogen (breast, heavy periods, bloating, headaches etc.). Progesterone is calming itself and helps our deep sleep, so keeping a balance is key.
From cemcor.ubc.ca: “We now know that oestrogen levels rise in our late thirties and become erratically high through most of perimenopause.
Eventually, higher oestrogen levels along with lower progesterone levels cause symptoms like breast swelling, soreness and lumpiness.
These hormonal changes, especially if you don’t ovulate, can also cause heavier or longer flow, and premenstrual mood, fluid and appetite changes. Some women get migraines for the first time. Others start waking in the middle of the night for no reason and then toss and turn until daylight—this makes for very difficult, tired days at work.
At some point, about twenty to thirty percent of us, while we’re still having regular periods, start getting night sweats. Commonly these sweats happen in the wee hours of the night before or during flow. Others will have such heavy flow with cramps and clots that they become anaemic.”
Transitions through the Perimenopausal Years; Demystifying the Journey.
Lissa Zala, BA MEd, Andrea Swan, BScN, MA, Jerilynn C. Prior, BA, MD, FRCPC
Page V: Until the 20th century, only 15 women in every 100 lived more than 50 years...This meant that most of them did not pass through perimenopause – that is, they never made it beyond their reproductive years. By the year 2015, better living conditions, medical science, and improved birthing practices will reverse this pattern: 85% of us will celebrate our 80th birthdays and many of us will celebrate our 100th! Perimenopause is the opportune time to plan our next 30 or more years.
Currently, almost 10% of North American women are in their perimenopausal transition:
Page 26 – 28:
Summary: “Perimenopause is made up of five phases...The phases may overlap and we may have all or few of the changes indicated. By comparing changes to those in the chart, each of us can identify key issues and have some idea of the duration of these signs...Rarely do these changes persist as problems in later life but typically improve after menopause.”
What do we do?
These are mostly related to ridding of excess oestrogens and/or encouraging progesterone production and supporting digestion, the adrenal glands and thyroid.
What you eat, exercise, avoiding environmental oestrogens, and stress reduction will have a HUGE impact on this balance, which may improve PMS, perimenopause and menopause symptoms… as well as help to prevent cardiovascular disease, type II diabetes etc.
The general consensus is that perimenopause (and related oestrogen related problems such as cancers) is getting worse and is much more prevalent in “western world” countries. If we didn’t have pesticides, hormones in our meat, soft plastics etc. we wouldn’t be exposed to as many compounds, which act like oestrogen. We also eat too little fibre and too many bad fats and processed foods. Then, stress doesn’t help our body to cope with hormone changes, on top of that. Many suggest a genetic component, but take a Japanese woman out of Japan, modify her diet and lifestyle from her traditional way and suddenly she may experience perimenopause too.
Oestrogen Detox: helps problems associated with hormone imbalance problems as well as help protect from potential harm such as cancer.
General Health Tips:
Protein: Don’t forget protein throughout the day.
Eat a serving of protein at every meal and snack. Protein has an important role in maintaining the stabilisation of your blood sugar. A serving of meat is what you can fit in the palm of your hand.
Remember: vegetarians need to mix proteins to make a complete protein, therefore mix two out of three of; nuts/seeds, or beans or brown rice.
Generally aim for 30% of total diet:
1 gram/kg ideal body weight per day (kids and athletes should have 1.25-1.5g/kg)
100g = example palm size serving (these are all approximate guide lines)
Examples of approximate protein values:
1 egg = 7g protein (eggs are so great for you…ignore old myths…two a day is very ok)
1 palm of:
A Smoothie can be a great source of protein, nutrients and fibre:
eg. Whey protein or high quality legume/rice protein, LSA (ground linseed/almond/sunflower fresh from fridge/freezer), frozen blueberries and banana to start, then whatever you want to add at time…spirulina or greens powder, drops (vit d, zinc, selenium, zinc), powder vitamins like vitamin C etc. Speed up the process by keeping a mix in fridge (protein powder(s) plus LSA etc)
Fats: Good Fats are so good for you and add flavor and satisfaction to meals/snacks.
Carbohydrates: Eat “good carbs” in moderation. The Glycemic Index (Low GI) Diet helps, to start (but still think about nutritious vs confection…gluten in excess doesn’t agree with most of us)
Exercise: DO IT…decreases stress, great for heart, bones…Sometimes it is best to get basics dealt with first, to then have energy for exercise; iron, B vitamins, zinc, omega 3…
Burst exercise is being proven to benefit. Work hard then rest. Repeat.
Example: Four Exercises – Get heart pumping then rest (feel the burn) – Repeat
1) Dips – back to chair with hands on chair and dip bum down and up
2) Bum to seat (not controlled fall) then cross legs
3) Prone hold on chair or floor
4) Chest – press ups on chair or wall press ups
Walking is still great. Trying running between lamp posts (or until feel the burn, then rest).
Stress Reduction may be easier said than done, but must be addressed. If your answer is a book, walk, or yoga or a combination, please make the time. The pay off will be more energy and better health, in the long run.
Stressing about food and/or exercise, is a major societal source of stress. And often ends with the opposite of the desired effect on the body.
We need some time in a “quiet room.” We know it, but try to step outside and take a breath. Even 30 seconds. We need to feel like not everything is a threat.
Breathe – work on deep, effective breathing. Really.
Sleep – make it a priority to improve sleep quality and wake rested. The suggestions on ths handout can help. 5HTP sleep aid products help with the “mind buzz” but may interact with antidepressants, so then focus on adrenal feeding, magnesium etc.
We could stop here and make significant improvements to overall wellbeing…
Now recognized as an issue in New Zealand, but many still don’t believe it. We wear sunscreen and cover up (our sun is harsh), the darker you get the more sun you need, we have to carry our stores through the winter…
Anyone with pains, blood sugar or immune system issues should consider looking at their vitamin D status.
I’m not saying not to protect your skin, but we need some unprotected sun exposure without burning…or supplement.
Zinc is often though about with regards to skin and fertility, but it is necessary for 100’s of functions in the body. It is also lacking in New Zealand soils (along with selenium and iodine – our poor thyroids!)
If you have blood sugar issues, your food is lacking taste, skin issues, allergy, immune system, mood, digestive or thyroid issues, you must consider looking at your zinc status.
Try a simple zinc test in pharmacy (swish solution in mouth). Blood tests can be done, but must be paid for. Drink test, plus symptom monitoring can be adequate/safe management
Both Vitamin D and Zinc are funded by Pharmac by prescription. I wish magnesium was too.
Magnesium is such an essential nutrient for all of our muscles (including heart), oestrogen detoxification and helps many aspects of PMS, perimenopause and menopause. A high percentage of the general population doesn’t consume the RDA (recommended daily allowance) of magnesium, so noting magnesium foods and ways to avoid depletion are essential. We need at least 250mg daily.
Helps blood sugar regulation by helping insulin work properly. Blood sugar “crashes,” sugar cravings and hunger irritability (and resultant weight gain and susceptibility to diabetes) can be helped by chromium. Common dosing is 200mcg twice daily.
or wean off the sweet need. Take Chromium 500mg twice daily for 2-3 weeks if needed.
From drfrances.co.nz/is-your-selenium-adequate.html : Selenium is a metallic antioxidant – it stops things going ‘rancid’ in your body or oxidizing. It does this because it is associated with the most important antioxidant of them all – Glutathione. This prevents free radical build up and consequent cancer and disease.
Apart from Brazil nuts (by far the most abundant source), other sources include wheat germ, whole grain bread, barley, eggs, mushrooms, legumes, liver, kidneys, rabbit, chicken, herring, shellfish, asparagus, cabbage, garlic, onions, radish, tomatoes, etc. (drfrancis.com)
Laws in other countries limit selenium content, which New Zealanders require due to lack in soils. Low dosing will still aid thyroid and give some antioxidant action, but dosing can go up to 200mcg daily. Two to four brazil nuts (from Brazil) daily should provide the approximate daily requirement of selenium, not found in NZ soils).
Essential Fatty Acids
Omega 3 Fish Oil (high DHA and EPA)
Omega 6 (if needed)– The best choices are gamma-linolenic acid sources (not as effected by dietary insufficiencies, so get more activity as result) choices such as Evening Primrose or Borage. May aid PMS symptoms.
A few Herbs:
Women’s Herbal Tonic (practitioner only) – great for feeding the adrenals as well as:
Rehmannia (hot flushes), Withania (anxiety/insomnia), Rhodiola (stress/fatigue/sleep/mood)
Allow 6 weeks to work, but often notice a difference much earlier, especially if taken with nutrients. When hot flushes occur during menopause (no period for at least a year) women are often given no options, but feed the adrenals and flushes may be alleviated.
Not suitable for complete adrenal burn out, because we don’t want to decrease the already low cortisol levels at which case you would work with nutrients, decreasing all stresses and a herbalist if you choose herbs. (Rhodiola is definitely ok).
Chaste Tree herbal remedy (Vitex agnus-castus) can be taken to help stimulate your body to ovulate, thus helping to increase progesterone production. Eg. Mediherb tablets: 2 tablets daily
Black Cohosh German Commission E has listed black cohosh use for menopausal symptoms for decades. It appears to have an adapting action, so competes with too much oestrogen and fills in the gaps with too little. My experience has been that it either works or doesn’t (within 4-6 weeks). When it works it does so for 6 months to 2 years and then it doesn’t anymore.
Hormones - Usual Basic Hormone Choices – if necessary:
Testosterone: can be confusing to know if it is high/low testosterone, so ensure you address zinc, progesterone production, feeding the adrenals, blood testing etc first. You may just be able to improve testosterone levels and effectiveness yourself.
Oestriol Vaginal Cream (Ovestin): For vaginal dryness, thinning, susceptibility to infection. Funded safest oestrogen option. Very little (if any) turns to the less desirable oestrogens. Use daily for 2 to 3 weeks to achieve results, then use a few times per week to maintain.
Thyroid and Adrenal Glands
The thyroid gland is a butterfly-shaped organ located in the front of the neck. Its main function is to produce thyroid hormones which control the body's metabolic rate (metabolism).
Our thyroid gland Needs zinc (oysters, meat, eggs, seeds), selenium (brazil nuts) and iodine (seafood) – all lacking in NZ soils and take effort to get from food.
TSH blood test states a range of 0.27 - 4.2 mIU/L. Most practitioners consider 2-4.2 subclinical hypothyroid and prefer a reading of
See great article by Dr Frances Pitsilis : http://www.drfrances.co.nz/underactive-thyroid.html
“A zinc deficiency causes lowered production of TSH from the pituitary.”
“Increased stress causes suppression of TSH from increased release of cortisol from the adrenal glands, and release of another messenger, CRF (Corticotrophin Releasing Factor) from the hypothalamus.”
“In women, hypothyroidism is associated with menstrual irregularities, absence of ovulation, and infertility.”
Oestrogen excess and Thyroid – Dr George Gillson (referred to above…oestrogen increases Thyroid Binding Globulin, so thyroid hormone is there, but bound so can’t act properly)
“There is a close relationship between oestrogens and thyroid hormone. Basically, excess oestrogens suppress the action of thyroid hormone. Many women have normal thyroid tests but show signs and symptoms of low thyroid. This is called a functional deficiency. Progesterone can assist the action of thyroid hormones, and so excess oestrogens, low progesterone and symptoms of low thyroid hormone often run together, while thyroid labs tests are usually normal.”