Perimenopause treatment & things that can help decrease Perimenopause symptoms
Stop smoking, because it impairs the functioning of your ovaries.
Keep a menstrual diary, including dates, flow, and moods, so you will know what worsens your symptoms. See the blank diary at the end of this booklet.
If possible maintain a normal body weight via diet and exercise.
If required, use a water-based lubricant for sex, never petroleum jelly.
Avoid spicy food, hot beverages, and alcohol.
Eat soy products and soy drinks.
Avoid salt, sugar, and caffeine.
Practice good sleep hygiene by going to bed at the same time every night, using cotton sheets with a high thread count, and keeping the bedroom dark and quiet.
Exercise improves mood, keeps fatty deposits from settling around your waist, and strengthens your bones.
Dress in layers, so if you feel hot, you can remove some clothing.
Take a dietary supplement containing Vitamin D, calcium, and Vitamin E
Stay in air-conditioned areas.
If the symptoms of low libido and fatigue persist after using bio-identical progesterone cream (PROFEMEÂ®) for longer than 3 months, have your free testosterone blood level taken by your doctor. Bio-identical testosterone (ANDROFEMEÂ®) may be required.
What are my treatment options?
Perimenopausal women can effectively control their symptoms using natural progesterone, testosterone and occasionally estrogen either alone or in combination depending upon individual circumstances.
The first step in managing perimenopausal symptoms is to clearly establish the underlying hormonal imbalance (usually estrogen dominance), or if you suffer from another condition with similar symptoms. An excellent starting point is to evaluate the severity of your symptoms.
Taking a simple 15-item self-assessment questionnaire, Progesterone Deficiency Assessment Questionnaire, gives you an instant evaluation of the severity of your symptoms and also a baseline measurement by which to gauge your responsiveness to any treatment.
An assessment score of 20 or greater generally indicates there is a progesterone deficiency with the higher the score the greater the deficiency.
An estrogen dominant perimenopausal woman will often experience a worsening of symptoms if given estrogen unless hot flashes & night sweats are present. Frequently, doctors will prescribe estrogens in the form of the Pill or HRT to perimenopausal women to stabilise and override ovarian function. More often than not a hysterectomy (removal of the uterus) is the frontline treatment offered to manage heavy periods!
In a reproductive woman blood testing of hormones is the most reliable of methods for hormone evaluation. There is a big push by some pathology labs and health practitioners to use salivary hormone assays claiming the results to be more reliable than blood testing. The problem is that salivary
hormones fluctuate wildly from hour to hour (particularly during the perimenopause) as the female reproductive system winds down. To get a true picture of what is happening with hormones when using salivary tests a great many tests need to be done over many days and even weeks which becomes extremely expensive.
Blood testing at the correct time of the menstrual cycle together with a full and thorough assessment of symptoms will tell more about progesterone deficiency than dozens of salivary hormone assessments. Timing is critical when testing hormones, because they are cyclical. When testing progesterone levels in a cycling woman the ONLY time to test is between days 20-23 of the cycle.
Ovulation takes place around day 13 of the cycle. Progesterone levels increase steadily and peak around day 21-22. Testing for progesterone during a period (days 1-5), just before ovulation (days 9-12) or just before menstruation (days 25-27) is a waste of time and money, similarly so is measuring hormone levels in a woman using The Pill. Many doctors fail to advise patients of this important information at the time of ordering hormone blood tests. If they did, they would see low progesterone blood results when levels should be high and realize that their patients were failing to ovulate and hence were progesterone deficient. Hormone levels, including testosterone, should always be measured in the morning when levels are highest.
PROFEMEÂ® safely and effectively reduces most perimenopausal symptoms by replacing the hormone of greatest deficiency and opposing estrogen dominance. PROFEMEÂ® achieves a steady state of hormone balance after 6-8 weeks of regular use (one or two cycles).
The recommended starting dose for treatment with PROFEMEÂ®progesterone cream in Perimenopausal women is:
Apply 1ml of PROFEMEÂ® 3.2% cream via measured applicator (32mg progesterone) daily or in divided doses from day 12-26 of each menstrual cycle. If a menstrual period starts prior to day 26 cease using PROFEMEÂ® and consider the first day of bleeding as Day 1 of the new cycle. This is a common occur- rence when initiating treatment in peri-menopausal women and should be considered a sign that the treatment is having a positive effect. Symptoms abate in 2nd or 3rd month of use. Due to the many variations of perimenopausal symptoms, es- pecially heavy and variable periods, the dose and frequency of PROFEMEÂ® application may need to be varied. To control heavy bleeding and regulate the frequency of periods PROFEMEÂ® 10% cream may be required at a dose of 0.5-1.5ml (50-150mg) daily for 3 weeks in every four until flow and frequency normal- ize, then use a lower dose from days 12-26. This may take 3-4 months to stabilize.
Women can also add testosterone to manage poor libido and unexplained fatigue if after 3 months progesterone has not resolved these symptoms. This is a common â‚¬Å“off-labelâ‚¬Â practice among doctors in the USA and some parts of Europe, where regulators are yet to officially approve testosterone for use in women.
ANDROFEMEÂ® 1% testosterone cream is tailored especially for women. Application of ANDROFEMEÂ® 1% testosterone cream involves no surgery, no pain or visible patches and is applied by the woman in the privacy of her own home.
Importantly the dose is accurately controlled and adjustable.
Very occasionally the perimenopausal woman may require estrogen supplementation if hot flashes, night sweats and vaginal dryness is a major problem. Natural estrogen (estradiol) in the form of a transdermal patch or gel is more beneficial than synthetic tablets of estrogen for short- term management of hot flashes and night sweats. If vaginal dryness is the only problem a natural estrogen (estradiol or estriol) vaginal cream or vaginal pessary inserted two or three times weekly will work safely and effectively without being absorbed systemically.
Some perimenopausal women have more advanced, specific or severe conditions which require specialized management which is not covered in depth by these treatments.
What are the side-effects of progesterone replacement therapy?
PROFEMEÂ® natural progesterone cream has very low toxicity. Progesterone is the hormone that supports a pregnancy (pro means for and gestation means pregnancy). The most common problems associated with progesterone treatments are that they can cause symptoms similar to pregnancy:
Constipation or diarrhoea
Muscle or joint pain
Breakthrough bleeding (spotting)
If these occur, a simple adjustment of dose usually resolves the problem. Side-effects, if they occur, are usually experienced at the onset of treatment and are considered a positive sign. Side-effects usually resolve themselves fully within 10 days of a dose reduction and often sooner.
What about homeopathic and herbal treatments?
Homeopathy is a complementary therapy. Homeopaths claim that like cures like. Essentially, homeopaths believe that if a substance causes a disease, then you can cure it by taking a very minute, diluted amount of the same substance.
Homeopathic treatments contain NO progesterone or testosterone, nor have they been demonstrated to cause any change in testosterone or progesterone levels.
The herb chasteberry (Vitex agnus castus) doesn’t contain progesterone, but it may indirectly help you produce progesterone over the course of several months by stimulating your pituitary gland to produce luteinizing hormone. Chasteberry has unpleasant side effects, such as an itchy skin rash, nausea, dry mouth, digestive upset, hair loss, headaches, rapid heartbeat, and bleeding between periods. Vitex is called chasteberry and Monk’s Pepper because it was used for centuries to reduce libido. Do not use chasteberry if you are pregnant, breast feeding, or have endometriosis, fibroids, cancer of the ovaries or breast, schizophrenia, or Parkinson’s disease.
It is unsafe to take chaste berry in conjunction with these prescription drugs: Bromocriptine; cabergoline; carbidopa-levodopa; chlorpromazine; ClozarilÂ®; HaldolÂ®; MirapexÂ®; oral contraceptives; ReglanÂ®; RequipÂ®; RisperdalÂ®; SeroquelÂ®; thioridazine; trifluoperazine; and ZyprexaÂ®. Inform your doctor and pharmacist that you are taking chaste berry before starting any new medication to avoid adverse drug interactions.
The herbs tribulus, horny goat weed, Tongkat Ali Extract (Eurycoma longfolia) and Mucuna Pruriens Extract have not been shown in scientific testing to increase blood testosterone levels despite extravagant marketing claims. Inform your doctor and pharmacist that you are taking any of these or other pharmaceutical or herbal preparations before starting any new medication to avoid adverse drug interactions.
Wild yam treatments sold in health food stores contain a steroid substrate called diosgenin, which is chemically similar to progesterone, but does not act like progesterone within the body. Humans cannot convert diosgenin into progesterone â‚¬â€œ a point often misrepresented by marketers of wild yam products. Wild yam treatments are totally ineffective as a progesterone supplement or for treating estrogen
How do I use PROFEMEÂ® progesterone cream?
The aim of treatment with PROFEMEÂ® progesterone cream is to mimic the body’s normal natural hormone production as much as possible. PROFEMEÂ® dose applicators are marked in 0.5ml doses. You must tailor the strength, amount and the number of days you apply the cream to your individual requirements. Your doctor or health care professional may alter the dose recommended in this booklet.
PROFEMEÂ® 3.2% progesterone cream is used to control the symptoms of breast disorders during premenstrual syndrome (PMS), menopause, and perimenopausal symptoms. PROFEMEÂ® treats other progesterone- deficiency conditions, like surgical menopause hysterectomy, ovarian cysts, uterine fibroids and fibrocystic breasts. If you have had a hysterectomy, the doctor may prescribe estrogen-only for menopausal symptoms to manage hot flashes and night sweats. In hysterectomized women it is very important that unopposed estrogen needs to be supported with natural progesterone to prevent symptoms of estrogen dominance.
Perimenopausal and menopausal women can evaluate improvement in their symptoms when using PROFEMEÂ® progesterone cream using the online Progesterone Deficiency Symptoms Assessment questionnaire at www.understandingperimenopause.com. Ideally the questionnaire should be taken before starting PROFEMEÂ® and again after 3 months of treatment.
PROFEMEÂ® progesterone cream is supplied in two strengths â‚¬â€œ 3.2% and 10% w/v containing 32mg progesterone per ml and 100mg progesterone per ml. Each tube is supplied with a graduated dose measuring applicator.
Recommended starting doses for using PROFEMEÂ® natural progesterone cream:
Peri-menopausal women – Apply 1ml of PROFEMEÂ® 3.2% cream via measured applicator (32mg progesterone) daily or in divided doses from day 12-26 of each menstrual cycle. If a
menstrual period starts prior to day 26 cease using PROFEMEÂ® and consider the first day of bleeding as Day 1 of the new cycle. This is a common occurrence when initiating treatment in peri- menopausal women and should be considered a sign that the treatment is having a positive effect. Symptoms abate in 2nd or 3rd month of use.
Pre-menstrual syndrome (PMS) – Apply 1ml of PROFEMEÂ®
3.2% cream via measured applicator (32mg progesterone) daily or in divided doses from day 12-26 of each menstrual cycle. Significant alterations to this dosage may be made to achieve a crescendo effect 4-5 days prior to menses. Symptoms abate in 2nd or 3rd month of use.
Premenstrual dysphoric disorder (PMDD) – Apply 0.5 – 1ml of PROFEMEÂ® 10% cream via measured applicator (50-100mg progesterone) daily or in divided doses from day 12-26 of each menstrual cycle. Significant alterations to this dosage may be made to achieve a crescendo effect 4-5 days prior to menses. Symptoms abate in 2nd or 3rd month of use.
Endometriosis and Post partum depression – Apply 1.0 – 2.0ml of PROFEMEÂ® 10% cream via measured ap- plicator (100-200mg progesterone) daily or in divided doses depending upon the severity of the condition. In reproductive cyclical women initiate treatment on a day 12-26 basis, but can increase frequency to 3 week in 4 if symptoms/pain emerge upon withdrawal.
Infertility/Repeated First-term Miscarriage Luteal phase and first trimester corpus luteal support – Apply 1ml of PROFEMEÂ® 10% cream (100mg progesterone) daily or in divided doses via measured applicator from day 12-26 of each cycle until preg- nancy is confirmed and then 1-2ml daily on a continuous basis until at least week 13 or until full term.
Before conceiving, a woman prone to miscarriage should use PROFEMEÂ® 3.2% cream from days 12 to 26 of the cycle until the pregnancy is confirmed. If spotting occurs at week 6 or 7 of pregnancy, apply a high dose of 100 to 200 mg progesterone cream (PROFEMEÂ® 10%) twice or three times daily. Often, women use PROFEMEÂ® natural progesterone cream until the baby is full term (40 weeks of gestation).
Note: Amount and duration of application for all conditions must be tailored to individual requirements.
Why is PROFEMEÂ® progesterone cream and ANDROFEMEÂ® testosterone cream the best?
If one Googles “natural hormone cream”Â, “progesterone cream”Â or “testosterone cream”Â there are dozens of products claiming to be the “best”Â and “authentic”Â natural progesterone/testosterone creams or gels. Just how does one determine which product is most suited to his/ her requirements? The following is an outline of basic manufacturing processes to help you decide. The three quality standards of natural progesterone cream are:
1. Pharmaceutical Grade: The manufacturer operates to international standards of Good Manufacturing Practice (GMP). GMP means all production processes are standardized and controlled from the time the raw material is procured through to the expiry date printing on the finished product. The Australian government, like the U.S. and European regulators, enforces rigid government controls on the manufacturing facility, its equipment, processes, and packaging. PROFEMEÂ® and ANDROFEMEÂ® creams are guaranteed stable, effective, and potent in addition to being the world’s only pharmaceutical grade testosterone and progesterone creams. The final products have detailed documentation and are backed by clinical trials that substantiate their therapeutic claims.
2. Cosmetic Grade: This is the product sold over-the-counter in drug, department and grocery stores. Cosmetic grade products do not undergo the rigorous checking processes as is required of pharmaceuticals. Often, brand-names have exactly the same ingredients as generics, just with a different label. Cosmetic grade products are allowed a high bacterial content, so their shelf-life is very limited (usually 3 to 6 months). Cosmetic manufacturers are not required to register their products with the government regulators because cosmetic products do not require clinical trials to prove their worth. Cosmetic grade production is a self-regulating industry.
3. Compounded Product: Natural health products from pharmacists, herbalists, homeopaths, naturopaths, and practitioners of traditional Indian and Chinese medicines are compounded. This means the product is tailored to the patient’s individual needs in the delivery system most desired. Pharmacists compound drugs that are not commercially available, or in a different strength than that readily available. A compounded product may be needed to make a drug palatable. A compounded product may be needed if the patient reacts to dyes, preservatives, and allergens found in commercial products. Compounded products do not undergo any form of production control, concentration, impurity, stability or efficacy testing. Safe shelf- life is usually extremely short, if at all known. Compounded items are time-consuming to make, so generally they are more expensive.
Understand more on Perimenopause:
The information in this article has been taken with permission from the official Lawley booklet on Understanding Perimenopause.