Here are the symptoms you don’t want to talk about. Heavy, flooding periods. Mood swings. Insomnia. Hot flashes.
They’re not nice symptoms because, well, it’s not fun to bleed through your clothes or wake at night with your heart pounding and your sheets all wet.
And part of you is thinking that maybe you’ve done something wrong to get into this situation. Or, at the very least, that you’ve made the shameful mistake of getting older in a society that doesn’t want to hear from older women. And so you keep quiet.
You’re okay. I’m here to throw you a lifeline and to assure you that you’ve done nothing wrong and that these symptoms won’t last forever. And there are simple things you can do now to feel better quickly. (Things that aren’t the hormonal IUD or antidepressant your doctor wants you to take.)
Please try them IN ORDER, adding the next treatment only if you need it.
Step 1. Magnesium plus taurine
Together, magnesium and taurine boost GABA which is the calming neurotransmitter your brain needs as it adjusts to the great progesterone crash in your 40s. They’re incredibly soothing and can improve sleep, mood, and hot flashes. I recommend 300 mg magnesium plus 3000 mg of the amino acid taurine. If you’re lucky, you’ll find them together in the same formula like the one I give my Australian patients.
⚠️ Tip: For additional relief, consider adding 50 mg of vitamin B6, which is another good way to boost GABA.
⚠️ Tip: In a 2017 paper called “Magnesium in the gynecological practice: a literature review,” magnesium was found to be effective treatment for symptoms of menopause and perimenopause.
For mood and sleep and hot flashes, this could be as much treatment as you need. Try it for a few weeks, and then if you’re still suffering, consider adding progesterone.
Step 2. Natural progesterone cream or capsule
Natural progesterone or micronized progesterone is entirely different from the progestins used in birth control or conventional hormone replacement (HRT). It’s not a drug. It’s the beneficial hormone you used to make in your 20s and 30s.
Progesterone has many benefits.
- It makes periods lighter so progesterone can be used together with turmeric and other treatments to relieve the crazy heavy periods of perimenopause. For very heavy periods, a progesterone capsule such as Prometrium is preferable to a cream. (For a full discussion of heavy periods including the very important treatments of iron and stopping dairy, please see Chapters 9 and 10 in my new book as well as my Heavy Period post.)
- It relieves hot flashes—even on its own without estrogen. Progesterone works best in combination with magnesium and taurine.
- It improves sleep. For severe sleep problems, a progesterone capsule such as Prometrium is preferable to a cream. By ingesting progesterone, you can convert more of it to the sedating metabolite allopregnanolone (which is like a natural sleeping tablet).
- It helps to clear histamine thereby relieving the histamine intolerance that can flare up during perimenopause and menopause.
- It stabilizes the HPA or adrenal axis and improves your ability to cope with stress.
⚠️ Tip: Other strategies to stabilize the HPA adrenal axis include rest, meditation, and adaptogen herbs such as ashwagandha and Rhodiola. All are valuable treatments during the menopause transition.
⚠️ Tip: I recommend that natural hormones not be taken continuously. Instead, I recommend that both progesterone and estrogen be stopped for at least five days per cycle.
Magnesium + taurine + progesterone should be enough for most of you. Try it for a few weeks, and then if you’re still suffering, consider adding a small amount of estrogen.
⚠️ Tip: Do not take estrogen until you are first taking natural progesterone.
Step 3. Estrogen
It’s okay to add a small amount of estrogen. It’s a lot safer than you’ve been led to believe and can be incredibly helpful for sleep and mood and hot flashes. (Please read In Defense of Estrogen).
⚠️ Tip: Most of the cancer risk from conventional hormone replacement was from the synthetic progestin—not estrogen.
If you do decide to add estrogen, please choose one that is:
- Low-dose. When it comes to estrogen, the lower, the better. If you can get away with a little dusting of Vagifem cream or a pessary, then stick with that. The next step up is a low-dose patch like Estraderm 25.
- Bioidentical, which means it is identical to human estradiol or estrogen. Fortunately, most (not all) modern conventional estrogen products are bioidentical. That includes brands like Vagifem, Estraderm, and Sandrena gel. If you’re not certain if your estrogen prescription is bioidentical or not, please ask me in the comments.
- Transdermal, which means you absorb it through your skin from a cream, gel, or patch. Estrogen is better and safer when taken this way.
⚠️ Tip: Please also take progesterone—even if you don’t have a uterus! You need natural progesterone for mood and to protect your breasts.
⚠️ Tip: Do not take estrogen if you’re still having periods. A common situation is first, your periods stop (you need estrogen). Then, your periods return for a few months (you should stop estrogen). And finally, your periods stop again (you need estrogen again). But you can take the basic prescription of magnesium + taurine + progesterone during all the tumultuous years when you’re having symptoms but still having periods.
Please comment to share your story. Have these treatments worked for you? What else have you tried?