Expert Tips for Perimenopause Relief

Dr. Mike: Hey, Dr. Mike here. You know, it turns out you're not too young for this. Maybe it's perimenopause. Stick around to find out.

Live Foreverish Introduction: You're listening to Live Foreverish, a show dedicated to helping you live just a little longer. Here are your hosts, Dr. Mike and Dr. Crystal Gossard.

Dr. Mike: All right, welcome to Live Foreverish. You know, Dr. Crystal, perimenopause is, back when I was in school, it was one of those things where it was always considered much later in life. [In] perimenopause, some symptoms happen, hormones start changing. And then you stop having your cycle, and then it's menopause.

Dr. Crystal: Oh, so they actually taught you all about perimenopause?

Dr. Mike: No, not much. That's what I'm saying.

Dr. Crystal: So if you're not getting much, imagine you trickle down to the patient, and now the world is finally saying, “Oh, yes, and there is this thing called perimenopause.”

Dr. Mike: I'll put it to you this way. When I was practicing, the OB-GYN doctors I worked with, if you came into their office and you were, say, 38 years old, and you said, “Is this perimenopause?” They'd be like, “Oh, you're way too young for that!” That's not the case anymore, is it?

Dr. Crystal: I think it's becoming more likely for doctors to take your symptoms seriously and tell you you’re not distressed.

Dr. Mike: Yeah, that's a good thing. So ... we don't want this to be a deep dive into the menstrual cycle and what perimenopause is. ... We want to focus more on the solutions, things that can help. But we do have to give some definition. We’ve got to have some context here. How do you prefer to define perimenopause?

What Is Perimenopause? 00:01:41

Dr. Crystal: I like to define it that the crosstalk between the brain and the ovaries is starting to not really work as well.

Dr. Mike: There’s a miscommunication.

Dr. Crystal: Maybe some miscommunication. The ovaries are saying, I'm not really going to listen to you as much as I used to. So ... ultimately, ovarian function is starting to kind of age and decline, and just you're not, maybe not, ovulating every month.

Dr. Mike: That's a key thing.

Dr. Crystal: So some variations, which ultimately can lead to irregular cycles, can lead to maybe heavier cycles. A lot of people think maybe you're missing them. But that could be a part of that profile. But even before you start seeing changes in the menstrual cycle, you start noticing other changes, kind of these random odd symptoms.

Dr. Mike: And that's what I think we're really focusing on today, is more [about] symptoms that are vague enough that you may not even think [they are] related to the menstrual cycle. But they are. ... They often kind of coincide with the cycle, but don't have to. And so we want to bring that to light a little bit, those kind of symptoms.

What Are the Symptoms of Perimenopause? 00:03:07

Dr. Mike: I have a list of vague symptoms, and I say vague because this list could be on a lot of things. That's the problem. Anxiety and depression. Brain fog.

Dr. Crystal: That's a big one.

Dr. Mike: Sleep issues.

Dr. Crystal: That's a big one.

Dr. Mike: Urination issues. You're gonna say that's a big one. That's a big one.

Dr. Crystal: Probably not. Not really.

Dr. Mike: Dry skin, joint and muscle pain, hair loss, heart palpitations, and a decline in libido. Those are kind of a collection of common, vague symptoms reported by women who we do believe end up having perimenopause.

Dr. Crystal: Yes. And then one that's starting to be recognized is kind of like ringing in the ear.

Dr. Mike: Oh, okay, that’s a new one for me. [It] doesn't surprise me, that's all kind of related to hormonal issues, stuff like that. That's kind of how we treat it with this specific hormone. ... Now you can see, though, if you go into your doctor. ... The teaser was you're not too young. You're not too young for this. Maybe it's perimenopause, and I like that you put in there: “Maybe.” That's right. But you go into your doctor's office, and you say, my menstrual cycle is still happening, but it seems a little off, and I've developed these symptoms. ... Here's what I believe. Don't let your doctor dismiss this as not being linked to some of those menstrual irregularities you're starting to report, because that's going to be easy for them to do.

Diagnosing Perimenopause 00:04:50

Dr. Crystal: That's very true. And the challenge with it all is, you can test your hormones, but unless you’re really testing them when they were all up, when you were younger.... Sometimes it's good to get a baseline when you're younger...

Dr. Mike: I’m a big proponent of that.

Dr. Crystal: Because when you start seeing these variations now, it's not always the picture that you think, where everything is low. Like, people say, “Okay, it's the decline in estrogen.” But then we know progesterone typically can decline first.

Dr. Mike: Yeah, because you don't ovulate. When you don't ovulate, that drops. FSH is another one that could start to change during this time. But you're right, without a baseline, it's hard. And then even if you just randomly check them, it's still hard, right? You have to almost catch them when they're at these [levels]. Estrogen can fluctuate during this time.

Dr. Crystal: It fluctuates during the day. So that's the other part, is it's really a lab test. It's a snapshot in time. I'm not saying that it's not beneficial to test your hormones. I think that's a good place to start.

Dr. Mike: I do, too. I agree with that. I'm a big believer in testing hormones. I don't think it's ever too late to get kind of a baseline, especially if you want to start maybe being treated with hormones. But you bring up a good point. I do wish in medicine, when young adults [are in their] early 20s, mid 20s, upper 20s, [it’s a] great time to get some baseline hormones, get some baseline thyroid, get ... baseline Lp(a), that cardiovascular one. We talked about that. So I do like that idea of having that so that when you do test at this time, you have something to compare it to.

Dr. Crystal: Right.

Dr. Mike: So testing is out there. But it's really a diagnosis of what we call exclusion, right? They're going to exclude other things.

Dr. Crystal: Yes. You're going to make sure this person's not anemic. You want to make sure they don't have a thyroid issue, you know some of these other things that relate to these common symptoms.

What Is Menopausal Hormone Therapy? 00:07:00

Dr. Mike: So we want to treat this. You're at your doctor's office. You do believe your doctor is thinking this could be related to perimenopause, some of those vague symptoms. And we want to treat it. Right off the bat, you're probably going to have a conversation about hormone replacement therapy.

Dr. Crystal: I hope so. I think you are now, in this day and age.

Dr. Mike: Well, let me say it this way. You should have a conversation about hormone replacement therapy. And if your doctor doesn't go there right away, I would stop and invite them to go there. At least have that conversation with them.

Dr. Crystal: Yes. And I think there's less resistance now, than there was even five years ago.

Dr. Mike: Yeah, well, we've learned a lot of that stuff we thought about estrogen and cancer and all that really has not panned out if you do it the right way, at the end of the day. So hormone replacement therapy is a combination of estrogens, progesterone, even some testosterone. It just kind of depends on where you're at, what your labs look like. I would suggest, even if you have a primary care doctor who's open to that, but who doesn't always work in the world of hormones, maybe find somebody, a specialist, who can help you with that. There are primary care doctors who have extra certifications in hormone therapies. Many don't, so I think finding someone who has a little bit of experience would be helpful.

Dr. Crystal: That's the most important thing I think you've said today.

Dr. Mike: Oh, good. Robson, write that down. I said something important.

Dr. Crystal: It's so true. I think the experience of the doctor is what matters most. The doctors who have seen hundreds, if not thousands, of women. That's going to be a better place to start.

Dr. Mike: Yeah. And they're just going to be more understanding about the symptoms, understanding the labs and the nuances that you find in a lot of the labs. That's important. So that's the place you want to start.

What to Eat for Perimenopause Relief 00:08:55

Dr. Mike: I want to move into diet. This [is] your realm of medicine. What do you say to women with perimenopause and diet?

Dr. Crystal: Well, I have to tell them the truth: Sugar is not your friend... processed food...

Dr. Mike: Although it sure tries to trick you [that] it is.

Dr. Crystal: You're right.

Dr. Mike: It does in the brain.

Dr. Crystal: That's the wild part is what you want and what you crave the most is not what you need as it relates to your symptoms. What your friend is going to be [is] cruciferous vegetables, those green leafy vegetables, lots of antioxidant-rich foods. Real whole food. Fiber. It's not a magical food. There's nothing special about what you should eat, it's really eating how I think we all know we should be eating. But it can be challenging when life gets in the way and we're busy and we're not cooking.

Dr. Mike: Well, I think maybe that's where we can say, we want you to eat this certain way. We want you to eat real food, fresh food. We always talk about the 80:20 plate thing, where 80% of your plate is the vegetables and their color and all that. And then, 20% is maybe a lean protein or something. That's your ideal meal every day. Listen, we're human, we get busy. It doesn't mean you're going to be able to do that every single meal. And that's fine, because if you're doing that most of the time, having that one off-meal is not going to affect you nearly as much.

Dr. Crystal: That's true. But the other thing with diet is understanding and coming to terms with the fact that alcohol is not your friend.

Dr. Mike: Alcohol is another tricky guy.

Dr. Crystal: The glass of wine at night is not going to make your symptoms better.

Dr. Mike: No. If anything, they can make it a little bit worse. That's all the sugars, the alcohol. I think you kind of hit it on the head when you start playing with the dopamine reward response and getting into that compulsive behavior with that, it's not really what you need. It's what your brain wants you to have, even though you don't need it. You’ve got to be very careful when that starts to happen. And so at the end of the day, a lot of people want to know, “What diet, doctor? What are you trying?” How about a nice Mediterranean diet? We always talk about that.

Dr. Crystal: We do. And I'm taking this deep breath because I think we say it, and it's nice to give it some context. So we're talking fatty fish.

Dr. Mike: Good.

Dr. Crystal: We're talking eating, not alone, eating with family.

Dr. Mike: Oh, yeah. That connection.

Dr. Crystal: Yeah, around the table, having the connection, having the laughter and the stories and making it more of an experience versus eating in the bed in front of the TV by yourself.

Dr. Mike: And I think in those contexts, where you're with family and you're having a conversation, I think overall you eat less, you eat slower, you get full a little bit faster. Like that kind of stuff all plays, I think, a role in all this. Last question about diet, though, for you. Phytoestrogens. What do you think? Good?

Dr. Crystal: I think they're great. And the research shows it. We know that they can help. And when we say phytoestrogens, these are foods like soy, soybeans, if you're eating edamame, and tofu. These are foods that can help to manage a lot of the night sweats, hot flashes, those vasomotor symptoms. There is data that those foods can be helpful.

How to Exercise for Perimenopause Relief 00:12:39

Dr. Mike: So moving on then to exercise. I think, for this conversation, a better way of saying this is just activity, being physically active every day. It's good to have your exercise routine, whether that's resistance training or whatever. But I also think it's just good, just try to be active even when it's a day off. Have a nice walk, 10 to 15-minute walk, even though it's not your day to exercise.

Dr. Crystal: I think it gives you a positive outlook on life when you know that you've taken a step in this day to help your body. But we cannot downplay strength training.

Dr. Mike: Yes, absolutely. I was just about to say it.

Dr. Crystal: There is this component of just being active. Take the stairs. Don't try to drive around the parking lot to find the first spot.

Dr. Mike: And that's all good advice.

Dr. Crystal: That's all good advice. But going through this transition, you have to turn it up a notch.

Dr. Mike: Yeah, muscle strength, muscle mass. Those are key. I mean, just as an example, the more muscle mass you maintain through this period, the more likely you are to have healthier bones as you go into menopause. So all of this is extremely important.

Dr. Crystal: Yes. And it also helps with the belly pouch that tends to emerge during the menopausal years. You're just like, where did this come from?

Dr. Mike: I'm doing everything the same, and now....

Nutritional Add-In: Fenugreek 00:14:11

Dr. Mike: So exercise, resistance training, strength training, staying active, that's all good stuff. Let's move into nutritional add-ins. Now, besides the exercise we talked about, the diet, labs, hormone replacement, let's talk a little bit about these nutrient add-ins that have clinical research to be helpful. Let's just say that up front. Dr. Crystal and I are big believers in providing evidence-based nutrition and nutrients. And the first one I want to bring up is fenugreek. Interesting research on this one. It's a seed, and it's popular. It's mostly used as a spice. I've never used it as a spice that much, but a lot of people call it a medicinal herb. But there are key compounds in fenugreek that actually help to maybe balance some hormones.

Dr. Crystal: And we like that. And these are, when we're talking about the research, standardized extract of fenugreek, standardized to two components. One is protodioscin, that can be converted into DHEA, which is kind of a precursor hormone to estrogen and testosterone. So this helping to promote estrogen levels. And then there's another standardization, trigonelline. Did I say that correctly?

Dr. Mike: That's the phytoestrogen component.

Dr. Crystal: Yes, and phytoestrogen—phyto meaning plant estrogen, so they can kind of mimic the effects of estrogen in the body—can bind to some of your estrogen receptors.

Dr. Mike: We have a study, 42 perimenopausal women ages 39 to 51, 250 mg twice a day for 42 days, the fenugreek extract that was standardized. They showed improved hormone levels. Estrogen improved, progesterone, total testosterone, free testosterone, all of these improved. There was a significant reduction in hot flashes, night sweats, depression and insomnia. And there [were] also beneficial effects to sexual problems and irritability.

Dr. Crystal: And that was after six weeks.

Dr. Mike: Six weeks. Yeah, so there you go. That's the evidence part of us presenting fenugreek to you. So we do like that. So, it's a spice. Use it as a spice. But you're probably also going to want to take the add-in.

Dr. Crystal: As a bonus, if you cook with it or you [have] it as a spice, like the seeds, after eating, it can help with digestion.

Nutritional Add-In: Siberian Rhubarb 00:17:10

Dr. Mike: There you go. Look at that. Let's move on to Siberian rhubarb. Now, this [is] not the rhubarb my grandma would make rhubarb pie out of. We have to be clear about that.

Dr. Crystal: Right.

Dr. Mike: Okay. This [is] a different rhubarb. And, studied extensively. There's a lot of research on this particular type of rhubarb.

Dr. Crystal: Yeah, with over 400 women.

Dr. Mike: And what we like about Siberian rhubarb, is ... again at the beginning of this show, we talked about some of the vague symptoms of perimenopause. And it turns out, Siberian rhubarb has a pretty significant effect on a lot of those vague symptoms, it's not just hot flashes. That's what most people think, [but] there's so much more to it. There's mood issues, skin changes. It turns out Siberian rhubarb is able to affect a majority and reduce those symptoms.

Dr. Crystal: Yeah. In the research, we see that with the survey that participants receive, kind of the menopausal rating scale, with the Siberian rhubarb, there are about 11 different kinds of symptoms there, and the Siberian rhubarb addressed all of those symptoms.

Dr. Mike: So hot flashes, anxiety, irritability, mood swings all these, just total menopausal perimenopausal discomforts, just put it all together.

Dr. Crystal: And that's one thing I really like about Siberian rhubarb. And again, we're talking about a standardized Siberian rhubarb, standardized to two compounds, is that we have the research in perimenopausal women. Some of our research, the participants, especially with the isoflavones we've seen historically in older women, [doesn’t] really gather the perimenopausal, the younger women, in the study. So it's nice to see that they included some younger women, and after four weeks, [they saw] benefits.

Dr. Mike: There were a couple publications. The main one you're looking at here was in 2007, where there were 109 women, and these were younger women, these were the periperimenopausal group. [They showed] significant improvement across the board on many of those vague symptoms of perimenopause. So there's two right there, fenugreek and Siberian rhubarb, that you could definitely take a look at. People may ask, “Well, can I just do hormone replacement?” Yes.

Dr. Mike: Well, diet and exercise. Maybe I should start there. But you might just choose hormone replacement, see how it goes. But you can actually do hormone replacement with some of these extracts, as well.

Dr. Crystal: Yes. And there are some non-hormonal prescription options now that can address the severe vasomotor symptoms, as well. So ask your doctor about that if you're not interested in hormones.

Dr. Mike: Life Extension has a really good, quite comprehensive protocol on female reproduction, menopause, perimenopause. You can learn way more than what we just talked about at LifeExtension.com/perimenopause.

And then don't forget you can go to LiveForeverish.com where we have tons of other episodes you can download, like, share, review and subscribe so you never miss a show. [It] pops up, lets you know. And then our sponsor, Life Extension, wants to say thank you. Use the discount code PODCAST for...

Dr. Crystal: 10% off $50 or more, plus free shipping and handling.

Dr. Mike: That's at LifeExtension.com. I'm Dr. Mike, that's ...

Dr. Crystal: Dr. Crystal.

Dr. Mike: Thanks for listening.