Within the last several years, the medical research field has made some incredible advances in the area of anti-aging, preventative medicine, and natural hormone therapies.

WHAT IS PERIMENOPAUSE?

Perimenopause refers to the years of transition from regular monthly menstrual periods to full menopause (total cessation of menstrual period). This usually occurs between the ages of 40-55. Many women may begin experiencing uncomfortable symptoms 5 -10 years before their periods cease. At this time they may still menstruate but not ovulate.

By this time, about 70% of women have lost 1/3 or more of the estrogen levels that they had in their mid twenties. However, it is the changes in the hormone progesterone that causes the greatest problems. All women in perimenopause and beyond have a progesterone deficiency. This overall reduction in progesterone happens earlier, but is more rapid and persistent than the decrease in estrogen. The reason for the reduction in progesterone is that progesterone is released at the same point and time as the egg is released from the ovary. If the ovary isn’t releasing any eggs, it also isn’t releasing any progesterone

The root words of progesterone are “for” and “gest” (gestation). It plays a major role in a woman’s ability to conceive and sustain her pregnancy. It balances her estrogen, sort of like a shock absorber. By the time a woman reaches actual menopause, her progesterone level has fallen to nearly zero.

This departure of progesterone can leave the body vulnerable to estrogen dominance. Estrogen dominance is a condition in which there is not enough progesterone in the woman’s body to balance the effect of the estrogen in her body. A woman with estrogen dominance can either have deficient, normal, or excessive estrogen levels in her body and still have estrogen dominance. This is because even a woman with low estrogen levels may have even lower levels of progesterone. The key is developing a “balance” in the woman’s system where there is the proper ratio of estrogens to progesterone. Estrogen dominance and progesterone deficiency is epidemic among women in industrialized countries. This hormonal imbalance (between estrogen and progesterone) causes almost all menopause symptoms. Natural progesterone is essential to counteract this estrogen dominance.

As you already know, women in perimenopause experience numerous ups and downs as their body reacts to these changing hormonal levels. Those who experience a lot of physical as well as emotional turbulence, prior to starting hormone replacement, are more likely to require frequent adjusting of dosages. In contrast, those who only have minor discomfort, prior to starting hormone treatment will likely require only minimal adjustments.

The typical treatment for women in perimenopause is to increase their estrogen levels by giving the women artificially produced estrogen. Actually, of the three main estrogens, only one of them is increased, and this one is the least important of the three. By increasing estrogen levels, the imbalance is increased, causing greater and greater health problems.

THE DANGERS OF SYNTHETIC HORMONES

The usual drugs that are prescribed for women in perimenopause are artificially produced estrogens and progestrerones.

The most common estrogen hormone prescribed in the United States contains estrogens that are derived from the urine of pregnant mares (horses). It can cause hypertension, blood clots and fluid retention.

Doctors also commonly prescribe a synthetic form of progesterone and is usually taken with the estrogen mentioned above in order to prevent cancer of the uterus. It has many potential adverse reactions. These include blood clots in veins (thrombophlebitis) and blood clots in the arterial system of the lungs (pulmonary embolism). Other adverse reactions are jaundice, anaphylactic reactions, rashes, depression, nausea, swelling, weight gain, changes in menstrual flow, and hair loss.

Unfortunately, these hormones cause water retention and excessive accumulation of fat, especially in the breast, abdomen and thighs. Even though Premarin and Provera can help prevent uterine cancer, they do not prevent breast or ovarian cancer. In fact, this form of estrogen actually fuels these cancers!

When both of these are used together, in combination, the adverse reactions may include rise in blood pressure, hirsutism (an increase in body hair – especially on her face), headaches, dizziness, nervousness, and much more.

The “typical” treatment of a perimenapausal woman is to start her on a regimen of Premarin and Provera. When these side affects occur, they are then treated as separate problems, adding additional medications and often surgery. Many times, hysterectomies are performed which could have been prevented, if only she had been given “natural hormones.”

Obviously, synthetic hormones, anti-depressant drugs and surgery are not the best answer to take care of the woman’s health. However, due to medical politics dictated by pharmaeceutical profits, natural hormones are not widely recommended. The pharmaeceutical industry is in the business of selling patented drugs; not the business of educating the public concerning economical, effective, non-patented natural medicines.

COMMON SIGNS OF PROGESTERONE DEFICIENCY

During perimenopause, a woman’s estrogen level will have fallen by about 50% of what it was in her 30’s, whereas her progesterone level will likely be at about 5% or less of what it was during the same time period. Hormone imbalances can be further agravated by stress and poor diet.

• No menstrual period or infrequent periods, perhaps every few months. This is a direct result of minimum progesterone production.

• Heavy and frequent periods. This can be caused by tissue buildup in her uterus because of prolonged progesterone deficiency

• “Spotting” a few days before her menstrual period. This is caused by the level of progesterone dropping too soon and too rapidly during her monthly cycle.

• Emotional turmoil: anxiety, irritability, nervousness, difficulty sleeping and difficulty relaxing

• Problems in her breasts such as pain, cysts or lumps

• Problems in her uterus such as fibroids, endometriosis, and adenomyosis

• Water retention – This is most easily recognized because she can’t fit into her shoes

NATURAL HORMONE REPLACEMENT

Instead of augmenting estrogen by using synthetic hormones, recent medical evidence points to the advantages of augmenting progesterone levels by using natural progesterone (what is knon as USP progesterone, not wild yam). This is most easily applied with a cream, and does not require a prescription.

HOW TO TREAT WITH NATURAL PROGESTERONE CREAMS

It is best to use progesterone on the same schedule as the woman's normal menstrual cycle; whether present or past. Beginning the progesterone regimen right before the normal time for ovulation (day 12 of the cycle) and end when it is time for menstruation to begin (day 26).

Perimenopausal Women: who are still menstruating regularly or irregularly, should apply ½ tsp. of progesterone cream to their skin two weeks per month (days 12-26 of her cycle). We recommend applying the cream in two treatments per day, ¼ tsp. in the morning and ¼ tsp. in the evening.

Menopausal Women: or woman who have had a hysterectomy (with or without the ovaries removed). Chose a day of the month and count it as day 1. Apply ¼ tsp. of cream for the next 21 days both morning and night. Discontinue using cream for 7 days each month.

For all Women: Absorption will be better if you spread the cream thinly over a large fatty area of the body such as the breasts, the belly, or inside of the thighs. It is best to apply the cream in different areas on different days so as to promote absorption. You will need to learn to adjust the dosages according to your body's needs.

HOW TO ADJUST DOSAGES OF NATURAL PROGESTERONE

You will need to wait two to three months (two to three menstrual cycles) to see results of progesterone regimen before making any adjustments to progesterone cream.

If your symptoms are improving and you feel great you are probably receiving the right amount for your body. Try to gradually lessen the dosage until you find the minimum amount required to feel good.

If there is no improvement after two to three months, you are probably not getting enough progesterone. Increase the dosage (1/2 tsp two times per day).

If you feel drowsy, you are getting too much progesterone. Lower the dosage until you no longer experience drowsiness (1/8 tsp. twice daily).

BUT WHAT IF...

Because each person's body chemistry is different, sometimes perimenopause brings different reactions to treatment requiring different strategies. In addition, as a woman goes through perimenopause her hormones are constantly fluctuating. This necessitates regular diagnosis and adjustment of hormonal levels.

If you occasionally spot, the hormonal therapy is fine and it is okay to continue with the same dosage.

If your menstrual period begins before the end of the 2 weeks on progesterone, or if you have repeated problems with spotting, that's a clue to take more progesterone. Raise your level as high as possible without any negative side effects. If you do not experience regularity, you may have a condition developing in your uterus like polyps, adenomyosis, or fibroids.

If you experience a heavy flow of blood while taking progesterone stop administering treatment. Consider this to be the first day of a new cycle. Resume the hormone treatment 2 weeks later.

If your period doesn't come within a week after you stopped taking the progesterone consider the last day you took progesterone as day one of a new cycle. Resume the administration 2 weeks from that date.

GENERAL REACTIONS AND SIDE EFFECTS WITH PROGESTERONE TREATMENT

Most reactions will occur within 30 minutes of taking progesterone. Mild reactions tend to last less than 2 hours. These can include: drowsiness, slight dizziness and physical instability. Severe reactions are extremely rare; they may last up to 8 hours. This would include a feeling as if you were drunk or as if you were spinning, or perhaps a heaviness of hands and feet.

HOW TO TREAT COMMON PROBLEMS

(Standard natural progesterone treatment: ¼ to ½ tsp USP cream, applied externally to skin, twice daily: morning and evening. If treating a topical problem, it is best to apply the cream to the area where the problem exists. For example, breasts, vagina, face, abdomen. Apply cream only on days 12 through 26 of the menstrual cycle.)

Migraine Headaches - Apply standard progesterone treatment to the head and neck area when the pain begins, and then every 3 hours until symptoms have subsided. This treatment does not work for other types of headaches.

Regular Premenstrual Headaches - Apply standard progesterone treatment, but only during the 10 days prior to the menstrual period (days 16-26 of the cycle).

Vaginal Dryness - There are several options for treating this common complaint. It will probably be necessary to use a combination of these treatments to obtain the best results. We have listed them in order of effectiveness.

• Best long-term advice is to apply standard progesterone treatment. This will take about four weeks for noticeable results.

• Make love frequently. This will increase the blood flow to this area and keep the tissue healthy. Vaginal dryness occurs because of lack of use of vaginal tissue. Women who make love frequently with their husbands do not have this problem.

• Puncture a capsule of vitamin E and insert it into the vagina. Or, take one capsule of vitamin E orally every day. Vitamin E promotes healing.

• Apply a water-soluble lubricant before intercourse ("Replens" is the best, its effects can last up to 72 hours, another is "astro-glide").

Hot Flashes - Use ¼ tsp. natural progesterone cream immediately following the first flash, and then every 15 minutes following for 1 hour after the first episode. The following vitamin supplements will also help:

• Vitamin E - 800mg IU per day. Also called d-alpha tocopheryl (not the synthetic dl-alpha). Do not exceed this amount daily. Reduce to the lowest effective dose as hot flashes decrease.

• Evening Primrose Oil - one capsule daily.

Premenstrual Syndrome (PMS) - Apply standard natural progesterone cream treatment. During the first month of use only, double the normal dosages. If breasts are tender, apply cream there as opposed to other possible locations.

Fibroid Tumors - Instead of standard natural progesterone treatment increase the treatment to days 7 - 26 of the monthly cycle. It is best to apply the cream on abdomen, vagina, and inner thighs.

Endometriosis - Instead of standard natural progesterone treatment increase the treatment to days 7 - 26 of the monthly cycle. It is best to apply the cream on abdomen, vagina, and inner thighs.

Osteoporosis - Instead of standard natural progesterone treatment increase the treatment to days 7 - 26 of the monthly cycle. Rub cream alternately on any area of body - especially fatty tissue areas. Women who no longer menstruate may use it any 21 days of the month, and then use nothing for 7 days.

Excess Facial Hair - Apply standard natural progesterone treatment. Rub cream on face and neck.

Severe Stress/Insomnia - At bedtime take 1mg of melatonin in capsule form, available in retail stores. This will decrease the cortisol level in the body. High amounts of cortisol accelerate aging and contribute to sleeplessness. An added benefit is that melatonin maintains hair color and slows down graying. It is also one of the strongest antioxidants in the body. It is a non-addictive sleeping pill. (Do not administer melatonin to someone who has exhausted adrenal glands. If you feel worse after taking melatonin, this is an indication that the adrenal glands are exhausted.)

GENERAL TIPS TO HELP WOMEN FEEL BETTER DURING PERIMENOPAUSE

Eat healthy! Avoid junk food: sodas, fried foods, sugary snacks, caffeine, alcohol and processed foods. Especially avoid lard, pork fat, vegetable oil, and margarine.

Decrease starches like white bread, rice, pasta, crackers, and potatoes.

Eat more fresh fruits and vegetables - raw if possible

Drink ½ to 1 gallon of water daily. (distilled if possible)

Take a multivitamin/multimineral tablet once a day with meals.

Take St. Johns Wort, an herb, and vitamin B complex. These have been shown to improve overall mood and reduce depression.

Avoid eating late night meals.

Eating healthy and exercising daily will begin to increase metabolism, regulate blood sugar levels, and lower stress and irritability.

DISCLAIMER

This information is provided as an aid in for women in perimenopause. We are not doctors, nor do we claim to have any specific medical knowledge. However, the information contained in this packet is a distillation of the information contained in a number of books written by doctors. Since we are not doctors, nor are we prescribing medication, we do not accept any medical liability for anyone who uses these products.

This information is intended only for those who are NOT on synthetic hormones of any sort, or who have stopped using them for at least two months. If you want to stop synthetic hormones (Premarin, the pill, patch, estrogen cervical ring...) you needs to be under a physician's care while weaning off of these. The physician can watch for symptoms which indicate your body is reacting negatively to the change in hormonal regimen.

Natural Progesterone Cream is available from Maranatha Life for a cost of $22.00 per 2 oz. jar. A two ounce jar is enough for about 2 months of treatment for most women.