Some women sail through menopause, hardly noticing. Most are happy they are no longer having periods and find the personal freedom of not worrying about getting pregnant adds to the richness of their sex life. By the time we are in our 50s, most of us have shifted our priorities from ego-based love to appreciating true intimacy, which is all good except for those of us who are highly sensitive. When you're sensitive, live with a chronic condition, or coexist with Herpes Simplex Virus, menopause may be the time in your life when you're bombarded with many challenging symptoms, including more frequent and severe herpes breakouts.

When Does Menopause Begin?

Menopause begins at the end of your last period when the ovaries no longer respond to releasing eggs each month, which reduces the amount of estrogen and progesterone produced. The decreased levels of these hormones give rise to the symptoms of menopause. In the United States, women are as young as 30, with girls reaching their menses earlier than ever due to poor food quality.

You may have irregular periods, even as much as a few years, before ever reaching menopause. And you may or may not experience some of the symptoms of menopause during this time. This particular cycle of menopause is called perimenopause. During these irregular periods, you may bleed more heavily.

Post-menopause is associated with the phase after menses stop altogether, for whatever reason. Women with only their uterus removed (with ovaries left intact) will go through menopause within 2-3 years after surgery. 

Signs & Symptoms of Perimenopause

• Stubborn belly fat
• Changes in mood, angry, blue, sad, or blah (meh)
• Insomnia
• Hair Loss
• Low energy
• Fatigue
• Brain fog and memory issues
• Tingling in hands and feet
• Overwhelm and anxiety

Signs & Symptoms of Menopause

• Changed or absent monthly flow 
• Tinnitus (ringing in one or both ears)
• Feeling overwhelmed, easily irritated, anxiety attacks, mood swings, aggressiveness or violence, Depression, and apathy.  
• Loose teeth and receding gums 
• Appetite changes 
• Mid-body weight gain
• Hair thinning or falling out (taking prescription drugs, such as Acyclovir, can cause this too)
• Feeling like a case of ugly or a hot mess 
• Lack of interest in making love
• Loss of muscle tone (upper arms, breasts, stomach, and butt sag, crepey skin)
• Mourning your youthfulness (dwelling on how you used to look or feel)
• Headaches, backaches, muscle and joint aches and stiffness, and overall pain
• Tiredness and fatigue
• Losing words and forgetfulness
• Sleep disturbances, including insomnia
• Suicidal daydreams
• Feeling too warm, flushing, having hot flashes, or night sweats.
• Vaginal complaints (dryness, irritation, pain, discharge, and vaginal skin color changes)
• Brain fog and lack of focus or perspective
• Bladder changes (sensitivity, urgency, burning, incontinence, the tendency to experience bladder infections)
• Having no interest in leaving the house
• Chronic pain

The Role of Hormones

Estrogen, the female hormone, is a steroid, a fat-soluble molecule related to cholesterol. Estrogen provides a female appearance, stimulates the uterine lining, and helps maintain bone mass by preventing calcium loss. One of estrogen's other functions is to support collagen and elastic fibers. During menopause, estrogen levels decline, which can cause unpleasant symptoms, such as Vaginal Atrophy and dryness. Progesterone and testosterone levels may decrease instead of estrogen, creating a state of estrogen dominance. Estrogen dominance triggers the release of the stress hormone cortisol, which activates the release of histamines, resulting in herpes breakouts. Unbalanced hormonal levels cause the symptoms of menopause, such as moodiness, because our hormones make up who we are on an emotional level. 

Progesterone is the precursor to estrogen and must be available to produce all other hormones. While estrogen can help with hot flashes and vaginal dryness, it's believed that taking progesterone alone can return estrogen levels to normal. However, only some agree with this theory. Most agree that cycling both estrogen and progesterone provides the best results in relieving menopausal symptoms in women who still have their uterus intact. Women who have had their uterus removed (even if they still have ovaries) don't need to use progesterone products.

A sign of progesterone deficiency (and resulting estrogen dominance) is weight gain. Ask any woman on Estrogen Replacement Therapy (ERT), and she will tell you she has gained weight since beginning treatment from using estrogen alone.

Progesterone FYI

• Zinc, magnesium, GABA, and B-6 help to produce progesterone. 
• Low progesterone (and low iron) can cause anxiety attacks.
• Too much copper (due to zinc deficiency) leads to progesterone deficiency and estrogen dominance.
• Progesterone triggers herpes breakouts

Synthetic vs. Bioidentical Hormones

• Synthetic Estrogen: Premarin and other conjugated estrogens.

• Synthetic Progesterone: Provera, Amen, Prempro (a combination of Premarin and Provera), Norethindrone, Norgestimate, and Norgestrel

• Synthetic Testosterone: Methyltestosterone, Estratest (Estradiol and synthetic Testosterone), and Premarin (plus synthetic Testosterone).

• Bio-identical Estrogen: Estradiol, Estrone, and Estriol are synthesized in a lab from plant extracts (soybeans and yams) and designed to be molecularly similar to hormones in our bodies.

• Bio-identical Progesterone: USP Progesterone (Pro-Gest, Prometrium, and Crinone) is produced from Wild Yam and designed to be molecularly the same as the hormones in our bodies.

• Bio-identical Testosterone: Dehydroepiandrosterone (DHEA) is an adrenal precursor to Testosterone.

NOTE: While bio-identical hormones are much safer, they can still have the same side effects as synthetic hormones. For example, estrogen creams (including bio-identical and over-the-counter) commonly cause very severe intestinal cramps. I've experienced this myself. Also, HRTs can cause deficiencies in B vitamins, especially B-6 and folic acid. Therefore, eating more B vitamin-containing foods or taking a B complex supplement is helpful. Furthermore, studies show that Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT), where Estrogen and Progesterone are combined, with all of the good and the bad that go along with them, work no better for you than stress management, alternative therapies, lifestyle modification, a healthy diet, and exercise. 

Before Using Hormone Products of Any Kind, Be Tested

You can have your hormones checked through saliva and blood tests. However, saliva testing may more accurately reveal hormone levels. Regardless of the method used, you should probably test your hormones every 3-6 months and have the doses of any hormonal product you use changed accordingly. It is essential to have your hormone dosages prescribed according to your blood test results. Should you have a higher risk of cancer, you'll want to discuss your options with your doctor before using HRTs (synthetic or bio-identical).

Hormonal changes can trigger a breakout, which is why PMS triggers monthly breakouts in many women. Furthermore, if you have had your ovaries removed, had a hysterectomy, or are post-menopausal, you may begin to suffer from more frequent breakouts due to a decrease in estrogen levels. Esrogen has many functions in the body, including helping to maintaining immunity and skin suppleness. The idea that herpes breakouts become less frequent as you age is a complete myth. As you age, hormones and immunity decline, which can bring on herpes breakouts under stress.

Over-the-Counter Bio-Identical Hormones

Bio-identical hormones are not to be used indefinitely but only for as long as you are going through menopause or your blood tests reveal their need. At some point, your body should stabilize, although in today's world, with today's ever-increasing stressors, it can be hard to say when that might be, which is where having blood tests would be beneficial for testing for deficiencies. However, when you begin to feel balanced (after about three months), you may reduce the dosage and continue the same schedule at the reduced dose for as long as you think you need it. If you wake up feeling "blah", unmotivated, and generally like you could say "Whatever." to the world, you might need to increase your estrogen. On the other hand, if you wake up feeling anxious, uptight, and have tender breasts, you might require a little less. Bio-identical estrogen cream is available over the counter. Also, see Resources for online testing resources. 

Progesterone Cream

Progesterone cream, derived from wild yam or soy, is available for purchase in stores and available online. A two-ounce jar should contain 800 mg of progesterone. Make sure it states "USP Progesterone" on the label, which means it's been made in a lab with the guarantee of the correct dosage per ounce. Don't use a cream containing mineral oil that blocks progesterone absorption. Also, before sexual encounters, apply your cream to an area that won't be receiving skin-on-skin friction, or your partner will absorb your "hormones".

They say there are no known adverse effects of using progesterone creams. However, be a little wary when told there are no side effects. There can be side effects to anything and everything. Many progesterone cream labels will suggest you stop taking it if you develop a skin rash or acne or begin to spot or bleed vaginally. Are these not side effects? Generally speaking, progesterone cream is very safe to use when used correctly. And once you reduce your dose or stop taking it, it leaves your system within as little as 24 hours. 

Some say women who no longer have a uterus have less need for progesterone because one of progesterone's primary functions is to keep the uterus healthy and prepared for an embryo. However, this doesn't mean none is needed. Some say progesterone is the only hormone worth taking whether you have your uterus or not because progesterone is the precursor to estrogen, so taking progesterone is all that's necessary. However, not all agree, so you should always have your sex hormones tested. Test results will vary according to your cycle, the food you recently ate, and so on, but at least you have a ballpark figure. Testing hormones should be ongoing as long as you take HRTs.

Bio-identical progesterone is available over the counter and is either taken by mouth or applied to the skin.

One drop usually equals 3 mg. If you weigh under 150 pounds, 20-30 mg is the daily dose (10 drops = 30 mg). You can go as high as 50 mg. If you're over 150 pounds, the usual dose is 40-50 mg daily. You should use progesterone 25 days on and 5-7 days off. I suggest starting with only half as much (10-15 mg if you're under 150 pounds or 20-25 if you're over 150 pounds) and gradually increasing to the higher dose until you find your sweet spot. /any time you feel worse, cut back to the previous amount.

DHEA Creams & Suppositories

Dehydroepiandrosterone (DHEA), also known asandrostenolone) creams and suppositories also combat menopausal symptoms, such as vaginal dryness and atrophy. DHEA is a steroid hormone made from cholesterol that circulates in the body abundantly. When DHEA is delivered vaginally, it goes to work to produce other sex hormones as needed. Prasterone is an example of an over-the-counter product. As a warning, some DHEA products contain alcohol, which can irritate and sting vaginal tissues that are inflamed. So that you know, glycerin can also sting and irritate sensitive vaginal tissue.

NOTE: While bio-identical hormones are considered natural, it doesn't mean there can't be adverse side effects. Some studies show that topical bio-identical hormones can cause the same long-term adverse side effects as synthetic, oral HRTs. Generally speaking, HRTs (both types) have far fewer potential side effects when used intravaginally, so doctors prescribe vaginal creams to women when oral hormones could be harmful. When used vaginally, very little of the hormone enters the bloodstream. Still, some do, and you must be aware of the symptoms.

• Headache
• Sore throat
• Mood changes (teariness, sadness, depression)
• Indigestion
• Nausea
• Leg cramps
• Breast pings, aches, tenderness
• Feeling sick (general malaise)
• A burning sensation in or around the vagina or pelvic area, which may not be a reaction to the hormone but to the ingredients in the product

Holistic Alternatives for Navigating Menopause

First Things First, Your Diet

The body still operates the way it did some 50,000 years ago. Modern-age stresses, chemicals, preservatives, and fast foods affect hormone levels, and some of us have never been hormonally balanced. Processed and packaged foods confuse the natural function of hormones. 

Foods That Effect Hormones

Hormones are also found in meat and dairy products. The overabundance of pesticides, antibiotics, and hormones in meats and dairy causes you harm. Hence, your animal protein sources and dairy from them must be from wild, grass-fed, and free-range animal and poultry sources.

Certain foods (and herbs, such as red clover and chasteberry) contain phytoestrogens, which are natural stand-ins for estrogen. Phytoestrogens bind to estrogen receptors, potentially blocking excess estrogen or quieting the need for estrogen when estrogen is low. You can reduce PMS symptoms in perimenopause and menopause by eating fewer foods containing phytoestrogens. However, the idea isn't to use these foods in excess but to balance hormones naturally. Excessive consumption of phytoestrogens may increase the chances of migraine headaches.

Also, if you have had, have, or have risk for Cancer, please speak to your care provider before consuming foods rich in phytoestrogens. Increased estrogen levels have been associated with a greater risk for Cancer and escalated tumor growth.

As it turns out, the ovaries need iodine, like the thyroid glands. Eating seaweed, such as kelp, can help you maintain healthy iodine levels. Of course, if you have thyroid problems, doing so can worsen your symptoms.

Foods Containing Phytoestrogens

The foods listed below contain phytoestrogens. The names of foods highlighted in bold letters are better at balancing whatever sex hormone imbalances you have.

• Fruits: Grapes, pears, plums, pineapple, papaya, pomegranates, dates, raspberries, apples, cherries, and apricots
• Vegetables: Sprouts (all), beets, cabbage (raw), yellow string beans, cucumber, clover, brussels, garlic, rhubarb, peppers, sweet potato, potatoes, pumpkin, yams, squash, tomatoes, carrots, and eggplant
• Grains: Barley, millet, rye, and rye bran, lentils (pea pods), oats, navy beans, garbanzo beans, red beans, black-eyed peas, soybeans, chickpea, pinto beans, haricot beans, whole wheat, brown or wild rice, and cereal bran
• Other: Olives and olive Oil, Baker's yeast, and eggs
• Herbs: Hops, licorice, sage, and parsley
• Seeds, Oils & Nuts: Flaxseed (ground), sesame seeds, anise seed, sunflower seeds, fennel seed, and peanuts

NOTE: Flaxseed improves your liver's function and helps moisturize dry skin, hair, and nails. It alleviates some allergies, eases depression, improves energy, lowers LDL Cholesterol by 18%, and encourages weight loss. It also decreases the risk of heart disease and some cancers. However, you must grind your flaxseed and consume one to three tablespoons daily to receive its benefits or consume one to two tablespoons of flaxseed oil daily. A small coffee grinder will do for grinding. For the sake of freshness, grind only the amount you need. When living with Herpes Simplex Virus, you'll want to limit your flaxseed intake as it is incredibly high in the amino acid arginine, which feeds the herpes virus. 

Foods That Inhibit Estrogen

Except for the foods listed above under Foods Containing Phytoestrogens, foods better at inhibiting Estrogen are berries, citrus foods, green beans, broccoli, corn, melons, buckwheat, figs, onions, tapioca, white rice, white flour, and all fruits.

The Soy Controversy

Soy contains estrogen-like properties (isoflavones). Soy is reportedly safer than taking black cohosh, as long as you are not allergic to it. Studies show that soy does not affect flushing and sweats, but it does help balance hormones in general. Soy sauce, tofu, and miso are popular soy choices. Unfortunately, western women cannot break down soy into useable nutrients, and soy may cause "fuzzy" thinking in some who have food sensitivities. There is concern over soy being too high in fat and even more concern over how it is processed. Still, it is a good source of protein and, therefore, an advantage for vegetarian diets. Soy is listed in some reports as food that deposits acid waste in the body, raising blood acid levels and creating poor pH. However, others say it's fine as long as it's fermented. When using soy supplements, limit your combined daily sources of soy to no more than 40 mg divided throughout the day.

Coffee & Menopause

There is a positive side to drinking coffee. It helps to reduce the risk of Parkinson's and Alzheimer's. However, caffeine is a diuretic, and being dehydrated causes calcium loss, which causes Osteoporosis. In addition, it seriously upsets hormone balance, especially insulin levels, causing blood sugar problems. Stay under two 8-ounce beverages containing caffeine daily. Use 2% milk and no white sugar in your coffee (or tea). Ensure you're getting your B vitamins and some extra calcium and water.

The Adverse Effect of Combining Cheese With Your Wine

If you like an occasional alcoholic beverage, stick with red wine, particularly Pinot Noir, which contains a high amount of resveratrol, an antioxidant that protects the heart. Resveratrol is also found in the skin of grapes. Limit wine consumption to two drinks per day. People often have a hard cheese snack along with their wine because the protein keeps blood sugar balanced. However, both wine and cheese trigger mast cell activation in those with Histamine Intolerance, and together, they're a double whammy. 

Avoid the Following Food Additives

• Acesulfame-Kis a sweetener that has not been tested much, with some studies showing the additive may cause Cancer in rats. Aspartame, better known as Equal and Nutra-Sweet, causes Cancer and neurological disorders, such as dizziness and hallucinations.

• BHA (butylated hydroxyanisole) and BHT (butylated hydroxytoluene) are preservatives that form potentially Cancer-causing compounds in your body.

• Food Colors: Blue #1 and #2, Red #3, Green #3, and Yellow #6 are linked to Bladder Cancer, Thyroid Cancer, and tumors of the adrenal glands and the kidneys.

• Olestrais a synthetic fat linked to severe diarrhea, abdominal cramps, and gas. Olestra also inhibits vitamin absorption from fruits and vegetables.

• Potassium bromate causes Cancer.

• Monosodium glutamate (MSG) is an amino acid used as a preservative and causes headaches, nausea, and damage to nerve cells in rats.

• Propyl gallate is a preservative with links to Cancer in animal studies.

• Sodium chloride(ordinary table salt) is linked to high blood pressure, heart attack, stroke, and kidney failure. Use sea salt, instead.

• Sodium nitrate (or nitrite) is a preservative linked to Cancer.

• Trans fats cause heart disease.

• White sugar promotes poor nutrition, Hypoglycemia, and Sugar Disease.

Hormone Balancing Dietary Tips

• Eat natural oils like real butter, extra virgin olive oil, and other cold-pressed oils.
• Eat whole, unprocessed foods, such as fresh fruit and vegetables, whole grains, nuts, and seeds.
• Don't overdo fruit (it's full of sugar).
• Use rice or goat's milk. Limit yogurt, but use only plain, organic yogurt.
• Eat more wild and deep-sea fish, flaxseed (not in excess), or krill oil (for omega-3s).
• Choose meats from animals that have been grass (organically) fed or raised free-range.
• Grind some psyllium or flaxseeds and toss them into recipes for more fiber. You'll need to grind your flaxseeds for them to be of any benefit. So, you know, flaxseeds are high in arginine, which feeds the herpes virus.

Supplements for Navigating Menopause

Take a whole-food daily multivitamin and mineral supplement, not synthetic vitamins. Whole-food vitamins and minerals will say as much on the label. It would help if you got enough of the following vitamins:

• Vitamin A, no less than 2500 - 5000 IU, no more than 8000 IU per day. (Vitamin A can build up and become toxic in the body).

• Vitamin C, at least 500-1000 mg per day, in a buffered form with bioflavonoids. Vitamin C increases progesterone levels by 77%. Divide this into three doses of 400 mg per day. If you suffer from stress syndromes, you can take more. Cut back as you feel better. Indicators of deficiency are bleeding gums, bruising and slow wound healing, Diabetes, and reoccurring infections.

• Take vitamin E (D-alpha-tocopherol), at least 400 IU per day, no more than 800 IU per day. Once you feel balanced, stick with only 400 units. Indicators for deficiency are muscle weakness, Diabetes, acne, Angina (heart pain), hot flashes, heart disease, tender breasts, and Arthritis. Vitamin E also aids in Cancer prevention.

• B-vitamins, particularly B-6 (pyridoxine) 25-100 mg daily and B-12. Activated B-6 lowers estrogen and increases progesterone. You might take a high-potency B complex (50-100 mg) until you feel balanced. Reduce to no less than 4 mg of B-6 daily and no less than 400-800 mcg of B-12 daily. Other B vitamins requirements each day: B-1 (thiamine) 10-100 mg, B-2 (riboflavin) 10-50 mg, B-3 (niacin) 10-100 mg, B-5 (pantothenic acid) 25-100 mg. Indicators of vitamin B deficiency are fatigue, water retention, mood swings, canker sores,frequent cold sores or genital herpes breakouts, elevated cholesterol, and cardiovascular markers. When in doubt, get tested. 

• Calcium, 1000-1200 mg per day in 600 mg doses. It works synergistically with magnesium, zinc, and vitamin D. Take it separately from your other vitamins for at least an hour or two. For every caffeinated coffee, tea, or cola you drink, add an extra 20 mg of calcium. Indications of deficiency are muscle cramps and aches, joint pain, Osteoporosis, Diabetes, migraines, high blood pressure, and insomnia.

• Take magnesium citrate or glucose, no less than 400 mg. However much calcium you are taking, you should take a third as much magnesium. Do not take more than 1000 mg of magnesium per day. Once hormones are balanced, you can stop taking the extra amount. Magnesium at higher levels can cause loose stool. Indications of deficiency are muscle weakness, spasms and soreness, insomnia and fatigue, irritability, heart palpitations and anxiety, irregular heartbeat, high blood pressure, Fibromyalgia Syndrome, a sweet tooth, kidney stones, fatigue, and osteoporosis. If you have MS, FS, or Irritable Bowel Syndrome, use magnesium lactate, which is more easily absorbed by sensitive systems. So that you know, magnesium neutralizes and eliminates excess estrogen from the body and magnesium glycinate helps to raise progesterone levels. 

• Vitamin D, 200-400 IU per day (if you are over 60 years old, use 600 IU). Vitamin D turns estradiol back into estrone, a weaker estrogen, which can help your body regulate estrogen output according to need. You can get vitamin D from sun exposure for 20 minutes 3 times per week, but only from April 15th through October 1st. The rest of the year, the sun is too far away.

• Vitamin E (600 mg daily) increases progesterone 67%.

• Folate (not folic acid) decreases Cancer risk by 60%. You have four kinds of cells in your body: A, C, G, and T. T cells prevent misduplication (wrong making) of cells. Take no less than 400 mcg daily and up to 800 mcg. 

• Omega 3 essential fatty acids are essential supplements unless you already eat fish 2-3 times per week, which should contain sufficient amounts. Essential fatty acids are necessary for bone and brain health. They improve calcium absorption, increase calcium deposits in the bones, and reduce calcium excretion from your bones. They also decrease pain. Walnuts, fish oil, and krill oil are all high in omega-3s. Krill oil is also full of antioxidants. Or, you can use flaxseed Oil if a "fishy" taste bothers you or you are allergic to seafood. So that you know, you must crush flaxseed for it to be of any benefit. It's also important to note that flaxseed does not work for pain like omega-3 fish oils. Walnuts and flaxseeds are incredibly high in arginine, an amino acid that feeds the herpes virus. If you live with cold sores or genital herpes, go with fish or krill oil.

• You need a total of 15-30 mg of zinc daily. However, you can bump up to 50 mg when suffering from a virus, but only temporarily.

• Selenium, 200 mcg per day. Selenium guards against breast and colon Cancer in women and Prostate Cancer in men. Selenium also causes the herpes virus to remain dormant.

• Also, copper, 1-2 mg, manganese, 5-15 mg, molybdenum, 10-25 mg, boron, 1-3 mg, silica, 1-20 mg, vanadium, 50-100 mcg, inositol, 10-100 mg, and choline, 10-100 mg are essential.

Worthwhile Supplements to Consider, But Not Completely Necessary

• Quercetin, found in green tea, red wine, apples, berries, cabbage, onions, broccoli, cauliflower, turnips, ginkgo biloba, and St. John's Wort, reduces the risk of some types of Cancer (especially stomach) and helps with Asthma. If you cannot take quercetin due to taking prescribed medications, you might take CoQ10 (30-50 mg per day). Take 100-300 mg per day of CoQ10 if you already have heart disease. However, always consult with your doctor before taking any new supplement. I talk more about quercetin in Colds, Flu & COVID-19. 

• Artichoke extract accelerates the process of balancing estrogen and progesterone ratios. 

• L-carnitinehelps the heart use fat for fuel and is beneficial for high triglycerides (fat in blood cells) and Angina (heart pain). Take 250-500 mg daily. Take 1500-3000 mg per day if you have heart problems already. Again, always consult with your doctor before taking or changing the supplement dose.

• Chromium and potassium are found in sufficient quantities in a healthy diet, and you only need to supplement if you are athletic and risk losing significant amounts of water through sweat. Chromium is touted to help relieve blood sugar imbalances by assisting with the proper transport and metabolism of glucose within cells. Your physician should monitor dosages. Chromium is often one of the key ingredients in energy drinks. However, it can dangerously lower blood sugar levels. These supplements aren't usually necessary for managing menopausal symptoms unless lab tests reveal otherwise. 

• Do not take a supplement that contains more than 10 mg of iron unless directed by your physician. Iron can build up in the body and become toxic. Postmenopausal women who no longer have periods are at the highest risk for this. If you no longer have periods, do not take iron unless your physician advises. You should always be tested before supplementing iron.

The Navigating Menopause Guide PDF

The Navigating Menopause Guide contains all of the information above plus holistic alternatives for menopausal symptoms.