Hormonal Flux – Coping with Peri-Menopause
by Belle McCaleb

Peri-menopause is the timeframe leading up to cessation of the menstrual cycle or menopause. It is a time of hormonal fluctuation that can lead to a whole array of distressing symptoms including erratic and often heavy if not flooding periods. Emotionally peri-menopause can feel like “PMT all month” due to the changing hormonal milieu. The key phrase is erratic – cycles, hormones, emotions and physical symptoms including breast tenderness and pelvic congestion. And to make matters worse peri-menopause can last up to ten years before actual menopause arrives!

The underlying mechanism for many of these symptoms is irregular ovulation due to ageing unresponsive ovaries. The failure to ovulate regularly leads to imbalance in the estrogen/progesterone ratios – a term we call “estrogen dominance”. If the eggs are unresponsive or the body fails to produce adequate progesterone after ovulation then there is relatively high estrogen to progesterone. This leads to a thickening endometrial lining (estrogen effect) that is not adequately stabilised (lack of progesterone effect). This unstable uterine lining eventually comes away in an uncoordinated fashion leading to flooding, clots and just plain misery. Periods may be much heavier than usual and often frequent as well leading to iron deficiency anemia and exhaustion.

As sex hormones interplay with our brain neurotransmitters moods can be all over the place as a result of hormone imbalances. Other symptoms that are associated include breast tenderness, headaches & migraines & sleep disturbances. Women may feel anything from very emotionally vulnerable to downright aggressive – and the emotional state can bounce around. One may wonder “who is this person” when looking in the mirror!! Furthermore as the situation continues the stress coping capacity is challenged. With instability in the sex hormones the adrenals (the organs that make stress coping hormones) are heavily relied upon. Ones tolerance to stress weakens further compounding the systemic imbalance.

In order to support the peri-menopause it is important to try to balance the hormonal milieu. As it is fundamentally an “estrogen dominant” situation we try to achieve 2 major goals: clear estrogens and raise progesterone.

Estrogen clearance is particularly important because not only do we make estrogen in our body we are also living in an estrogenic soup. Household chemicals, additives, preservatives, garden sprays, plastics, cosmetics, and many other chemicals are estrogen mimickers. Limiting our exposure to these is essential to diminish our estrogen load. In addition we need to specifically support our estrogen clearance organs: our liver and gut.

Dietary approaches promote optimal estrogen clearance by the liver include a diet high in cruciferous vegies such as broccoli, cabbages, kale and Brussels sprouts. The active nutrients (Indole – 3- carbinol for example) in these foods are often recommended in supplement form. Citrus contain a substance called d-limonene which promotes detoxification of estrogen. Additional nutrients that can help are EPA fish oils, B vitamins (especially B6, B12 and folic acid), Vitamin E and magnesium. Many herbs support liver detoxification pathways including Rosemary, Turmeric, Andrographis and St Mary’s Thistle.

Estrogen can be “bound” by something called sex hormone binding globulin. This essentially takes it “out of action”. Increasing fibre in the diet, specifically fibre containing something called lignans increases the binding. Flaxseed meal is one of the best sources of these lignans, but must be freshly ground as it goes rancid very, very quickly. Flaxseed oil is not as useful for this purpose.

It is crucial to clear estrogen not only from the liver effectively but also from the bowel. Maximising your gut health through herbal medicines, probiotics and prebiotics and other treatments can help lower the numbers of “bad bugs” involved in estrogen re-absorption. Foods to include in your diet include fermented foods such as kefir for naturally occurring probiotics and high glucarate foods including apples, broccoli, spinach and Brussel sprouts. Also increase your intake of insoluble fibre such as whole grains (oatmeal, brown rice, barley), oat bran, nuts & seeds (including quinoa), peas, beans, lentils, and berries. These fibres help bind estrogen and aid its removal from the gut.

Finally it is necessary to try to raise progesterone. I am not an advocate of using synthetic progesterone (even Bio-identical is synthetic) however; there are herbal approaches that are very useful. The traditional Western herb used is Chaste Tree. It works in the brain to raise LH – the hormone that induces ovulation. This herb on its own can reduce many symptoms related to peri-menopause. However there are many other progestagenic herbs that can be used – examples would be Cramp Bark and Pasque Flower. General sex hormone balancers such as Ladies Mantle or Shatavari are also useful. The idea is to induce a robust ovulation so the body naturally produces adequate progesterone to balance estrogen.

Belle McCaleb ND, RN, MSS-C, BSN, RYT, AYT is an Accredited Naturopath, Herbalist, Yoga Instructor & Yoga Therapist as well as a Registered Clinical Counsellor & Registered Nurse. She has specialised in women’s health since 1986 and holds advanced nursing qualifications in obstetrics, gynaecology and reproductive endocrinology and infertility. Belle is also passionate about holistic cancer support and keeping cancer patients well during medical treatment and beyond. She has worked extensively with cancer patients since 2003 and is the founder of the Cancer Support Alliance (www.cancersupportalliance.com.au). Belle is a certified therapist in Yoga of Heart (for cancer & cardiovascular disease) and Critical Alignment Yoga Therapy (for musculoskeletal issues). Belle’s counselling practice “Innersight Counselling & Psychotherapy” is informed by Integral Yoga Psychology & other mindfulness based approaches and blends clinical counselling skills with age-old techniques of yoga including breath-work, deep relaxation & meditation. This therapeutic approach provides you with practical tools for health, happiness and well-being. Belle’s specific counselling interests include chronic health issues, infertility, pregnancy loss, coping with cancer, loss, grief, bereavement, anxiety & depression. Her practice is located in St. Georges (Burnside). For more info see www.mccalebhealth.com.au or ring (08) 8379 0220.