Dr. Christiane Northrup, author of The Wisdom of Menopause , gives you the information about perimenopause and menopause you need to know.

  • Perimenopause is a change in hormonal functions leading up to menopause. It is a "wake-up call" for your body! Dr. Northrup, explains that many perimenopausal women describe it as "Having our foot on the gas and not enough on the brake."
  • The symptoms of pre-menopause , or perimenopause as it's called, begin years before your period ends.
  • Some women experience no symptoms at all.
  • Perimenopause is a process similar to puberty: it doesn't happen overnight. As menopause approaches, women gradually go through changes physically, emotionally and spiritually. For many women, perimenopause can last anywhere from five to fifteen years.
  • Perimenopause occurs typically around age forty, but it's normal to begin in your thirties when your menstrual cycle is normal.
  • The onset of perimenopause doesn't mean you can't get pregnant. Women who do not want to get pregnant should use a form of birth control for one full year after their final period.
  • Menopause is officially defined as that point in time when your periods stop permanently.
  • Even though your periods may have stopped occurring regularly, you are not completely done menstruating until one full year has passed from your last menstrual period.
  • The average age of women whose menstrual periods have completely stopped is 52.
Remember: many of the symptoms can also be related to serious health conditions, so it's always best to consult your doctor.
  • Heart palpitations
  • Migraine headaches
  • Night sweats
  • Insomnia
  • Hot flashes
  • Fibroids
  • Weight gain
  • Aching and sore joints
  • Increase in allergies
  • Cold hands and feet
  • Tingling in hands and feet
  • Dizziness
  • Disorientation
  • Fatigue
  • Itchy, "crawly" skin
  • Change in libido
  • Breast swelling and tenderness
  • Heavy menstrual periods
  • Irregular or erratic periods
  • Vaginal dryness and/or painful intercourse
  • Urinary symptoms
  • Skin problems
  • Bone loss
  • Depression
Now that you know the symptoms, what can you do about them?
How can you reduce the uncomfortable symptoms of menopause?
Women going through perimenopause and menopause may experience many uncomfortable symptoms. Use this chart to find solutions to help ease your discomfort.

Many different treatments are effective, so choose the ones that appeal most to you. Remember, it's very important to check with your doctor before trying any of these remedies!

Symptom and Solutions

Hot flashes
  • Estrogen replacement
  • 2% bioidentical progesterone cream
  • Meditation and relaxation
  • Dietary improvements, like eliminating white rice and foods made from white flour from your diet, as well as soda, alcohol and sweets
  • Add 45–160 mg of soy isoflavones to your daily diet.
  • Herbal therapies such as Remifemin or Women's Menocaps, reliable brands found in natural food stores
  • Acupuncture
Night sweats
  • Solutions are the same as for hot flashes.
Heart palpitations
  • If you are experiencing these, see your doctor immediately. They could be symptoms of a much more serious condition.
Migraine headaches
  • Avoid trigger foods like caffeine, alcohol, red wine, chocolate, peanuts and aspartame (found in some diet drinks). If there is no change, try eliminating wheat, sugar, corn and dairy for two weeks.
  • Avoid or transform potential stress by keeping a journal of what's going on when your headaches start. You should begin to see a pattern that you can then take steps to change.
  • Balance your hormones with a 2% bioidentical progesterone cream, applied to the skin.
  • Eat more soy.
  • Try herbal remedies like feverfew . and butterbur that have been shown to relieve migraine pain.
  • Supplements such as Magnesium and EPA and DHA (fish oil) are also effective at relieving migraine pain.
Breast swelling and tenderness
  • Follow a hormone-balancing diet
  • Take 100 to 200 mg of B vitamins and omega-3 fats such as EPA and DHA once or twice daily.
  • Cut out caffeine.
  • Use a 2 percent bioidentical progesterone cream.
  • Add whole soy foods to your diet.
Heavy menstrual periods
  • Consult your doctor about progesterone or birth control pills.
  • Investigate acupuncture and traditional Chinese medicine.
  • In severe cases, laser surgery can help. Check with your doctor.
Irregular or erratic periods
  • If you can live with it, hang in there. The problem will go away.
  • Talk to your doctor about alternatives such as birth control pills, progesterone cream or the herb chaste berry.
  • These growths will usually shrink dramatically after menopause and don't require surgery.
  • Consult your doctor about having the growths removed if necessary.
  • Weight loss, acupuncture, herbal remedies, dietary change and progesterone are effective alternatives in many cases.
Change in libido
  • Have your hormonal levels checked.
  • Adrenal exhaustion can be helped with supplemental amounts of testosterone or DHEA.
  • Have your doctor check for reduced amounts of estrogen or thinning of the vaginal tissue.
  • If your sex drive has increased, channel your extra energy into a creative outlet that helps you get the most out of your life.
Vaginal dryness and/or painful intercourse
  • Try a vaginal lubricant during intercourse.
  • Topical estrogen cream, vitamin E suppositories, systemic estrogen therapy, or increased intake of soy can be helpful. Check with your doctor.
Urinary symptoms
  • Can often be resolved through the use of a locally applied estrogen cream.
  • Kegel exercises (contracting and strengthening the muscles of the pelvic floor) can increase blood flow to the area and help with stress incontinence.
Skin problems
  • A variety of treatments will help build collagen, resurface the skin, and prevent wrinkles. Try systemic hormones, adding soy to your diet, and antioxidant supplements like vitamin C and E.
Bone loss
  • Get adequate phytohormones from foods such as soy, from herbs, hormone replacement and calcium and magnesium supplements.
  • Strengthen your bones by beginning a weight-bearing exercise program.
  • If related to hot flashes, try the solutions listed above.
  • If related to anxiety, you may need to make some changes in your life that the anxiety is bringing to your attention.
  • You may just need more sleep than you previously did. Try daytime naps to relieve your insomnia.
Fuzzy thinking
  • Try herbs such as ginkgo and St. John's wort.
  • Soy isoflavones or hormones like progesterone or estrogen are also helpful.
Information taken from The Wisdom of Menopause by Christiane Northrup, MD (Bantam Books).
Some pre-menopausal women may experience problems maintaining their weight. According to Dr. Northrup, this is because your body is actually trying to hold onto fat, particularly in the abdominal area. Fat secretes estrogen—a valuable hormone during menopause.

Dr. Northrup has devised a "hormonal balancing program" to create physical and emotional well-being.

Increase Your Intake of:
  • Soy
  • Herbal supplements: such as dong quai, chaste berry, black cohosh, licorice root (see the Menopausal Symptoms Chart for a complete list)
  • Water
  • Flaxseed: lignans, fiber and Omega-3 fats (such as fatty fish)
  • Bioflavonoids in fruits and vegetables: cherries, cranberries, blueberries, bilberries, whole grains, grape skins and red clover)
  • Green tea
  • Calcium
Reduce Your Intake of:
  • Caffeine
  • M.S.G
  • Smoking: Dr. Northrup recommends quitting.
  • Aspartame (found in some diet sodas)
  • Highly glycemic foods: white bread, white rice, sweets and candies. Eating them during mid-day instead of the evening helps your metabolism.
  • Chocolate
  • Refine and high-glycemic-index carbohydrates
  • Grain products
  • Red wine and alcohol
  • Peanuts
Also Keep in Mind:
  • Eat at least three meals a day.
  • Focus on portion size, not calories.
  • Eat protein at each meal.
  • Eat a wide variety of fresh fruits and vegetables daily.
  • Eat healthy fats each day.
Dr. Northrup recommends:

  • Sustain at least 30 minutes of exercise at least five times a week.
  • Diversify your exercise routine to speed up your metabolism; working different muscles will allow you to burn more carbohydrates and body fat, protect your bones and your heart.
More Helpful Ideas
  • Yoga and meditation increases progesterone levels that will allow you to feel calmer and more centered in your life.
  • Use 1/4–1/2 teaspoons of 2% natural progesterone cream to reduce the occurrence of hot flashes and migraine headaches. You can pick this up at a natural food store or your doctor can prescribe it.
  • If you have an increased sex drive, find a creative outlet to channel your new energy into.
  • Try traditional Chinese acupuncture and Chinese herbs.
Some medical tests and treatments are available for women who are experiencing perimenopausal symptoms. Consult your doctor for advice on whether they make sense for you.

Blood Hormone Levels: FSH and LH
  • This test measures the amount of FSH and LH levels in your blood; levels are higher during menopause.
  • The drawbacks of this test are: (1) it does not measure the level of estrogen, and (2) during the five or ten years of perimenopause, FSH and LH levels fluctuate widely.
Blood Hormone Levels: Estrogen, Progesterone and Testosterone
  • This test measures the total amount of estrogen, progesterone and/or testosterone in the bloodstream.
  • Unfortunately, the test measures primarily inactive, protein-bound hormones.
Hormone Replacement Therapy
  • An estimated 20 million women take some kind of hormone replacement therapy.
  • On the pro-side, it is thought to reduce the risk of osteoporosis, relieve hot flashes, improve sexual function and control mood swings.
  • The drawbacks are side effects such as bloating, stimulated fibroid growth and an increased risk of breast cancer, blood clots or having a stroke.
Preferred Testing Methods

The following are two less common but more useful tests, according to Dr. Northrup, that measure your hormonal status.
  • Salivary hormone testing
  • Blood tests for free (unbound) hormone levels


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