Survival Blueprint for Perimenopause (aka a hormonal rollercoaster rid – Dr Wendy Davis ND

Survival Blueprint for Perimenopause (aka a hormonal rollercoaster ride)


Support for the Perimenopausal transition

As a practicing Naturopathic Doctor for just over 20 years it never ceases to amaze me how the words of one of my favorite mentors at CCNM told me that I would learn more from my patients and my personal experiences than I would from the books and lectures at CCNM.

He was not denigrating the college I went to as I know my formal education was incredible, but what I have learnt from my patients and my personal experiences is the knowledge I know in my heart is true.

And as many wise teachers have said “where focus goes, energy flows” (Tony Robbins) and the energy that you put out comes back to you (Eckart Tolle).

And so in order to set a framework for this article, I will disclose that I am a perimenopausal woman, and humbly admit that  being a Naturopathic Doctor does not make me immune to all of the many changes that comes with this hormonal transition. However, because I am experiencing the flux that many of my patients are also experiencing, I have a lot of empathy and understanding and a very strong desire to help women that are also going through this change of hormones.

What is the Perimenopause Transition?


The 5-10 (even 15) years before menopause, which on average is said to occur at age 51, are commonly  associated with a number of hormonal changes. This time period is referred to as the Perimenopausal transition and is subject to many hormonal changes. Progesterone is the first casualty as this hormone starts to decline while at the same time there are erratic fluctuations in estrogen exacerbated by lower levels of testosterone as well.

Not only do women’s menstrual cycles become more irregular but there are many other changes, some subtle, some not, that are associated with this transition.  The most well known are hot flashes, night sweats and genitourinary symptoms.  Weight gain, increased joint pain, bone loss and reduced cardiovascular health all deserve our attention, but one of the most troubling symptoms my patients experience are insomnia and mood changes.

Many women note that for the first time in their lives they are experiencing anxiety, depression, impatience and unexplained mood swings, all which correlate to the variability in our hormones. Unfortunately, this is exacerbated if a woman suffers from mood instability prior to perimenopause.

How to determine root cause


A thorough history taking is crucial to help determine the root causes of these symptoms, however, it is also incredibly beneficial to have additional diagnostic findings.  

Although there is no one test that accurately confirms perimenopause or menopause, it is prudent to look at levels of FSH, estradiol, progesterone, testosterone, cortisol as well as other markers that can impact mood and feelings of wellbeing such as hemoglobin, ferritin, iron/iron saturation, TSH, T4, Vitamin D and Vitamin B12.
Other metabolic and cardiovascular changes are common during this time and so fasting blood glucose, insulin and HbA1c are important tests, as are lipids and triglycerides.

Urinary hormone and metabolite testing is also invaluable as this gives not only estrogen (E1,E2 and E3), progesterone and testosterone levels but also insights into how well these hormones are being metabolized through the liver.  Cortisol, cortisone and melatonin are important to evaluate as are gut health and various other neurotransmitters.

All of these markers play important roles in our patients mental and physical health.

Common findings


Variable estrogen levels can impact women’s blood glucose and insulin results and higher TSH, elevated triglyceride, LDL and ferritin levels are frequently seen. It is common to see low progesterone levels, poor liver detoxification, elevated cortisol levels and variable estrogen metabolites in perimenopausal women, all of which impact moods and sleep.

Poor mental health impacts more women than men on average, and this number increases as women enter the Perimenopausal transition.

This change in mood can be due to a number of factors


The decline in progesterone is one of the most important changes that impacts women’s mental health. Progesterone is crucial for adequate levels of GABA (gamma-aminobutyric acid) in our brains. GABA is an inhibitory neurotransmitter that is known for helping to calm our brains and improve sleep and mood.  As progesterone levels decrease, so does GABA.

Decreased or compromised phase 1 and phase 2 detoxification in the liver can lead to both reduced clearance of estrogen, exacerbating the symptoms of progesterone deficiency, but also lead to  increased brain fog, poor memory, a lack of mental clarity as well as increased feelings of anger and irritability.

Elevated cortisol levels, which are often seen in conjunction with decreased melatonin production not only impact our patients ability to fall asleep, but to stay asleep as well.

Yes, there is a LOT going on and treatment requires a multi-faceted approach.

Treatment options


Supplementation


I am very comfortable with bio-identical hormones and use these a great deal in my practice, especially in women in the perimenopausal transition, however, some women are not able to or choose not to use bio-identical hormones for various reasons. Fortunately there are some excellent options to support mood, sleep and the many other changes that come with Perimenopause, and these do not depend on traditional hormone replacement.

First, however,  it is crucial to ensure severe depression and anxiety is evaluated and that any glaring nutritional deficiencies that can impact mood and sleep are looked after such as  low iron, vitamin D, Vitamin B12 and low thyroid function.
Once these have been addressed I often use a tried and true combination of herbal and homeopathic remedies that have been incredibly successful in my practice.

Sleep and Mood Support


Sleep is essential in all stages of life to feel healthy and vibrant, but especially important during the perimenopausal transition, as it is hard to be emotionally balanced when you are sleep deprived and exhausted.

Depending on the severity of insomnia and mood instability I will use a combination of a few remedies that work well for symptoms due to fluctuating hormones.

Pascofemin drops


Pascofemin drops are a very safe and effective homeopathic combination of Vitex agnus-castus (chasteberry), Pulsatilla, Lilium tigrinum (tiger lily) and Cimicifuga racemosa (black cohosh) that work to improve many of the symptoms associated with perimenopause.


20 drops 3x daily helps to improve overall mood, while reducing night sweats and hot flashes and sleep disturbances

Pascoflair


Many peri/menopausal women complain about not being able to stay asleep and find they wake up multiple times before their alarm clocks go off. For these women Pascoflair (Passionflower/Passiflora incarnata) is a supplement I would never be without.  Pascoflair is an anxiolytic and improves GABA concentrations, reducing the time to fall asleep, but more importantly helping improve how long they are able to stay asleep.  


I will commonly have my patients take 1-2 tablets 30 min before bed.

Neurapas Balance


For women with mild to moderate depression, anxiety and for those who suffer from a ‘monkey mind’, a mind that never slows down and seems to speed up as soon as their head hits the pillow, Neurapas Balance is my go to recommendation.  This miracle remedy has a combination of St John’s Wort (Hypericum perforatum), Passionflower (Passiflora incarnata) and Valerian (Valeriana officianalis). Valerian has been shown to reduce the time it takes to fall asleep while also reducing anxiety. St John’s Wort is a commonly used herb for mild to moderate depression, also helps to reduce both psychological and somatic symptoms of perimenopause.

I generally suggest that my patients take 2 tablets at breakfast and 2 tablets before bed for 3 months and then they can reduce down to 1 tablet 2x daily, increasing as needed.

Increased Cortisol/Sympathetic Overdrive


Pasconal


I have observed in many of my perimenopausal patients that they have imbalanced cortisol levels, which is understandable considering the many stressors these women manage on a daily basis.


Pasconal drops are a homeopathic blend with a combination of Avena sativa, Valeriana officinalis (Valeriana), Strychnos ignatii (Ignatia) andLycosa (Tarentula hispanica) that work magically to reduce elevated cortisol levels, promoting more parasympathetic balance.


I tend to dose this remedy to match my patients level of stress and so vary the dosage 10-20 drops 2-3x daily as needed.

 

Detoxification Support


Pascoe Detox Kit


For some of my patients who  have had urinary hormone levels tested I commonly see compromised phase 1 or 2 liver detoxification.  For these women I will generally recommend nutriceuticals such as Calcium d-glucarate, glutathione and methylation support in addition to overall liver and detox assistance.


The Pascoe whole body detox kit is incredible. It supports the liver (Quassia), kidneys (Juniperus) and the lymphatics (Lymphdiaral) and offers a really gentle cellular detoxification. 


I will recommend my patients do this kit quarterly, and dose 10 drops of all 3 of these remedies 2x daily

Diet


A healthy diet is fundamental for good health as you can not out supplement a poor diet.


There are 3 key recommendations I promote to all of my perimenopausal patients
Protein (at least 20-25g at every meal), Fibre (aka eat a whole foods diet) and Hydration (drink half your body weight in ounces of water daily).

All of the supplements in the world will not help if women do not support the fundamentals of a healthy diet.

Lifestyle


Stress management, sunlight and exercise, specifically resistance training, are crucial. It is often easier to convince patients to take pills and potions but once they start to feel better with improved sleep and moods, they are more willing to make the diet and lifestyle modifications needed for long term health benefits.

The Perimenopausal transition is a tumultuous time for many women but utilizing the many tools in our Naturopathic Medicine kits can do a long way to ameliorating symptoms and improving quality of life for these women


Resources

  1. The Effects of Valerian on Sleep Quality, Depression, and State Anxiety in Hemodialysis Patients: A Randomized, Double-blind, Crossover Clinical Trial
    Mohammad Reza Tammadon1 , Monir Nobahar2,3,4*, Zaynab Hydarinia-Naieni4 , Abbasali Ebrahimian2,4, Raheb Ghorbani3,5 and Abbas Ali Vafaei6,7
  2. The Medical use of Lemon Balm (Melissa officinalis) and Valerian (Valeriana officinalis) as Natural Sedatives: Insight into their Interactions with GABA Transmission
    Stéphanie Pineau, Christian Legros, César Mattei* Laboratory of Neurovascular and Mitochondrial Integrated Biology, UMR CNRS 6214, INSERM 1083, Faculty of Medicine, University of Angers, France
  3. Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep
    Oliviero Bruni 1,* , Luigi Ferini-Strambi 2,3, Elena Giacomoni4 and Paolo Pellegrino 4
  4. Modulation of the γ-aminobutyric acid (GABA) system by Passiflora incarnata L
    Kurt Appel 1, Thorsten Rose, Bernd Fiebich, Thomas Kammler, Christine Hoffmann, Gabriele Weiss
  5. Preoperative oral Passiflora incarnata reduces anxiety in ambulatory surgery patients: a double-blind, placebo-controlled study
    Ali Movafegh 1, Reza Alizadeh, Fatimah Hajimohamadi, Fatimah Esfehani, Mohmad Nejatfar
  6. Anxiolytic activity of a phytochemically characterized Passiflora incarnata extract is mediated via the GABAergic system
    Oliver Grundmann 1, Jie Wang, Gerard P McGregor, Veronika Butterweck
  7. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam
    S Akhondzadeh 1, H R Naghavi, M Vazirian, A Shayeganpour, H Rashidi, M Khani
  8. Passiflora incarnata in the treatment of attention-deficit hyperactivity disorder in children and adolescents
    Shahin Akhondzadeh†, MR Mohammadi & F Momeni