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Supplement Recommendations for Perimenopause

From Sharon Montes, M.D. at WholeHealthMD:

If you're troubled by hot flashes or other perimenopausal symptoms, and HRT isn't on your (or your doctor's) agenda, try taking some of the supplements suggested here. All are safe as recommended, but they do have hormonelike effects. So while they're effective at quelling perimenopausal symptoms, supplements shouldn't be used when hormones aren't appropriate, such as when breast cancer is a concern.

How to Take the Supplements

Start with black cohosh, a reliable herbal hormone stabilizer. If your symptoms are especially uncomfortable, add either chasteberry or a women's herbal combination product, which includes small amounts of a number of herbs (dong quai, soy isoflavones, chasteberry) and other nutrients. Alternatively, if your symptoms are mild and you only need minimal doses of the various herbs, an herbal combination product alone may be all you need.

You can also add other herbs, such as Siberian ginseng,dong quai, which seems to enhance the effects of other herbs. Both are considered "female tonics" and are used worldwide for menopausal symptoms. If your symptoms don't respond to these herbs, move on to the topically applied natural progesterone cream, which can be very beneficial.

There's also recourse if you're having menstrual problems associated with perimenopause. The essential fatty acids in flaxseed oil and evening primrose oil or borage oil can help to regulate sudden hormonal shifts that can lead to irregular bleeding or cramping.

Eating plenty of soy can also reduce your symptoms, improve your cholesterol, and lower your blood pressure. Soy isoflavone capsules are a good option if you don't want to consume soy foods or beverages.

Recent studies have shown that antioxidant vitamins can be beneficial for perimenopause as well. Vitamin E in particular helped reduce the risk of heart by keeping LDL ("bad") cholesterol from adhering to artery walls.

Two other herbs have also proved beneficial for certain symptoms. Ginkgo biloba can aid women with menopausal-related concentration or memory problems. And St. John's wort has a long track record as a safe, effective remedy for the melancholy that plagues some women as their estrogen supply declines.

Of special note:

·  Adding a calcium and magnesium product (800-1,200 mg calcium and 400-800 mg magnesium twice a day) can be a protective step against osteoporosis-induced fractures, and it's particularly important during perimenopausal years.

·  If you're suffering from mood shifts, anxiety, and nervous tension, kava (250-500 mg 2 or 3 times a day) can be an herbal miracle. It works quickly, doesn't make you drowsy, and improves your concentration. Kava should be taken under medical supervision due to risk of liver damage.

·  Sleep disturbances during perimenopause are extremely common. Melatonin (1-3 mg at bedtime) can be a real lifeline--a safe, effective sleeping aid that's not addictive.


We at WholeHealthMD strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you're taking medications. Key cautions are given in the listing below, but you need to see the WholeHealthMD Reference Library for a comprehensive discussion of each supplement's cautions and drug/nutrient interactions.

MOST EFFECTIVE Check to add  
200-225 mg of the crushed fruit, standardized to contain 0.5% to 1.1% agnusides, once or twice a day; or 40 drops liquid extract added to one glass of water once a day
St. John's wort
450 mg twice a day or 300 mg 3 times a day
black cohosh
20-80 mg standardized extract twice a day or 250-550 mg freeze-dried whole root twice a day; or 1/2 to 1 tsp. liquid extract twice a day
soy isoflavones
50-100 mg once or twice a day
ALSO BENEFICIAL Check to add  
melatonin 1-3 mg at bedtime. The lower dose should be tried first. If necessary, gradually increase the dose. Doses lower than 1 mg may also work. Library
borage oil
1,000 mg a day; use as alternative to evening primrose oil
800-1,200 mg calcium and 400-800 mg magnesium twice a day to lower risk of osteoporosis. To enhance calcium absorption, be sure to get adequate vitamin D, commonly found in sunlight, multivitamins, and enriched dairy products.
flaxseed oil
1 tbsp. (14 grams) a day
ginkgo biloba
40 mg ginkgo biloba extract (GBE) 3 times a day, or 60 mg GBE twice a day, or 350 mg freeze-dried ginkgo biloba leaf 3 times a day
dong quai (angelica)
400-800 mg a day of standardized extract in 2-3 divided doses; or 1/4 to 1/2 tsp. liquid extract 3 times a day
women's herbal combination
Follow instructions on label.
Siberian ginseng
200-400 mg standardized extract each morning

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