By: Michael Lam, MD, MPH


A woman that may be going through menopauseThe onset of menopause signals the ending of a woman’s reproductive cycle. Menopause actually begins after the women’s last period. This event marks the culmination of several years of peri-menopausal changes during which hormones secreted by the ovaries (estrogen and progesterone) gradually decline.

Peri- and menopausal symptoms vary considerably from person to person. Asians are known to have few to no symptoms other than irregular menses. Western women, however, have much higher incidences of body changes such as hot flashes, night sweats, reduced libido, forgetfulness, heart palpitations, loss of bladder control, frequent urination, and joint pains, to name a few. For some, these symptoms are like a “living hell”.

All women go through menopause. There is no escape for anyone. What can you do to pass through this life stage in the most comfortable and protective manner?

Effects of Menopause

Once menopause arrives, the body’s internal production of estrogen and progesterone stops. Women can no longer depend on their own body to produce these two hormones to protect themselves against osteoporosis and cardiovascular disease. The result to their health can be devastating.

Symptoms of Menopause

Symptoms: night sweats, mood swings, depression, hot flashes, sagging breast, vaginal dryness, osteoporosis, fibrocystic lumps, night sweats, painful intercourse, memory problem.

This hormone imbalance is most common in menopausal women; especially if you are petite and/or slim.

Solution: Progesterone is a biochemical precursor to estrogen. Progesterone cream alone is sufficient to restore estrogen balance and relief many of the symptoms. If after 3 months of progesterone cream, proper diet, nutritional supplementation of magnesium and B6 do not relive the symptoms, then low-dose natural estrogen may be considered. 2.5 mg of natural tri-estrogen cream (10% estrone, 10% estradiol, and 80% estriol) provides the equivalent action of 0.625 conjugated estrogen such as Premarin. Herbs like black cohash have weak estrogenic effect and may be considered as well.

Osteoporosis is the loss of bone density, leading to fractures. Post-menopausal women low in estrogen have a 25% chance of serious bone loss and fracture. The lifetime risk of hip fracture approaches 30% for those afflicted with osteoporosis, resulting in the loss of independent living. Many will die from their injuries.

Estrogen increases pliability of blood vessels, lowers “bad” LDL-cholesterol, increases “good” HDL-cholesterol, and decreases platelet aggregation that leads to blood clots. These protective properties of estrogen result in pre-menopausal women having a lower risk of heart disease than either men, or post-menopausal women. Post-menopausal women are just as vulnerable to heart disease as men of the same age. Cardiovascular disease is the leading cause of death in women over 45 years of age.

HRT – Gambling with Cancer

The solution for overcoming menopausal symptoms appears simple – Hormone Replacement Therapy (HRT). This has been a widely accepted practice for the past 40 years.

Studies and clinical experience have repeatedly shown that HRT using the widely prescribed estrogen Premarin® and progesterone Provera® does alleviate menopausal symptoms and protect against heart disease and osteoporosis. The bad news is that they also increase the risk of some forms of cancer, including breast, ovarian, and uterine.

Simply put, the millions of women worldwide who have chosen to say “yes” to HRT in the past 40 years are gambling on feeling better immediately, having an increased risk of cancer at age 60, a reduced risk of heart attack at 70, and a reduced chance of hip fracture at age 80.

Alternatives to Conventional HRT

What if you want HRT but not the associated increased risk of cancer that comes along with it? Are there other options?

Some doctors are proposing treatment alternatives, using a different form of replacement hormone. These doctors theorize that the increased cancer risk associated with conventional HRT arises from its failure to use the natural form of the hormones, estrogen and progesterone.

Specifically, these doctors postulate that the hormones currently used in HRT have mis-matched molecules. The commonly used estrogen preparation Premarin® is made from horse urine (equine based), so the molecular structure is slightly different from the natural form found in women’s bodies. Furthermore, the hormones in Premarin® are “unbalanced” in that the ratio of the estrogen combination, estrone/estradial/estriol is different from the ratio found in humans.

How valid is this hypothesis? Let’s take a closer look.

Primer on Sex Hormones

The two primary hormones secreted by the ovaries are estrogen and progesterone. The properties of one offset the other and together they are maintained in optimal opposing balance in our body at all times. Too much of one hormone or the other leads to significant medical problems.

Estrogen actually is not a single hormone but a trio of hormones working together. The three components of estrogen are: estrone, estradial, and estriol. In healthy young women, the typical mix approximates 15/15/70 percent respectively. This is the combination worked out by Mother Nature to be optimum for human females.

Out of the three components of estrogen, estrone and estradiol are pro-cancer, while estriol is anti-cancer. Synthetic estrogen such as Premarin® contains the pro-cancer components of estrogen (estrone and estradiol) in higher proportions compared to estriol.

Progesterone is made from pregnenolone, which in turn comes from cholesterol. Production occurs at several places. In the women, it is primarily made in the ovaries just before ovulation and increasing rapidly after ovulation. It is also made in the adrenal glands in both sexes and in the testes in males.

Its level is highest during the ovulation period (day 13-15 of the menstrual cycle). If fertilization does not take place, the secretion of progesterone decreases and menstruation occurs. If fertilization does occur, progesterone is secreted during pregnancy by the placenta and acts to prevent spontaneous abortion. About 20-25 mg of progesterone is produced per day during a woman’s monthly cycle. Up to 300-400 mg are produced daily during pregnancy. During menopause, the total amount of progesterone produced declined to less than 1% of the pre-menopausal level. This drop is extreme.

Functionally, progesterone acts as an antagonist (opposite to) to estrogen. For example, estrogen stimulates breast cysts while progesterone protects against breast cysts. Estrogen enhances salt and water retention while progesterone is a natural diuretic. Estrogen has been associated with breast and endometrial cancer, while progesterone has cancer preventive effect.

Most significantly, it is known that high amounts of estrogen can induce a host of metabolic disturbances, and the body’s way of counterbalancing estrogen naturally is progesterone. When this balancing mechanism is dysfunctional, a multitude of health related problems arise.

Natural vs. Unnatural Hormones

Recall that the estrogen in our body is composed of a ratio of estrone, estradiol, and estriol of 15/15/70 (that is, heavy on estriol). We call this “natural estrogen” as it is the proportion Mother Nature intended it to be for humans. “Natural estrogens” are defined as those coming from natural sources with hormonal molecules identical to that found in the human body.

Commercial synthetic estrogen preparations such as Premarin® have a ratio of approximately 75/15/10 (heavy on estrone). We call this “unnatural estrogen.” While it comes from a natural source (horse’s urine), the ratio of the 3 components within this estrogen is more heavily estrone, and therefore is not similar to human estrogen. “Unnatural estrogens” in this case, come from sources other than plants with hormonal composition not 100% identical to that found in the human body.

When it comes to hormones, synthetic hormones (those made in a laboratory) may not work as well as the original, natural form. The body knows and can recognize the difference between many natural and synthetic compounds. Take Vitamin E as an example. After decades of study and debate, the National Academy of Science now acknowledges that natural Vitamin E is better absorbed and is twice as potent as the synthetic version.

Estrogen and Progesterone are both readily available in the natural and unnatural forms from the pharmacy. Conventional HRT does not use the natural forms of the hormones. The reason is simple. Any naturally occurring compound cannot be patented and drug companies control the prescription market. A slightly modified and patentable form of the hormone therefore has to be developed to ensure protection and commercial viability. Such synthetic “unnatural” modified forms of hormones developed by drug companies have been extremely profitable, but they are not exactly what the body is used to.

Hormones Used In Conventional HRT

Two forms of synthetic (unnatural) estrogen are used in conventional HRT:

Estradiol. Consisting of only one of the components of natural estrogen, this unbalanced synthetic form of estrogen contains no estrone and no estriol. It increases your risk of cancer.

Premarin®. This consists of a combination of 75 – 80% estrone, 5 – 19% estradiol, and 6 – 15% equilin (a horse hormone), plus a trace amount of other horse hormones. Not only is this form unbalanced compared to the human body’s natural estrogen ratio of 15/15/70%, the molecules of estriol which are derived from horse urine may be carcinogenic.

The common synthetic form of progesterone used in conventional HRT is called Provera, a synthetic progesterone which is called progestin.

HRT – Advantages

For your bones:

There is no doubt that the three-pronged approach to maintaining optimum bone health during menopause – HRT, nutritional supplementation with appropriate minerals, and weight-bearing exercises – decreases the risk of osteoporosis by preserving bone density.

Estrogen does not stimulate the growth of new bone but saves the bone already present in the body. Don’t forget that estrogen takes 7 years to work. Meanwhile, progesterone (together with DHEA and testosterone) stimulates osteoblast formation. Osteoblasts are cells that lay down new bone. In other words, progesterone replacement heals weak bones, while estrogen merely prevents further bone deterioration. They work together. Any complete osteoporosis program should therefore incorporate both estrogen and progesterone replacement therapy if possible. Either one alone is also helpful in cases where, for medical reasons, the combination is not possible.

For your heart:

Premarin®, (an unnatural form of estrogen), does appear to reduce heart disease risk by almost half after women have taken it for several years, as seen in the long term study of more than 48,000 nurses. Unfortunately, the study also showed that Premarin® contributes to an increased risk for uterine cancer.

Premarin®, in combination with Provera® (an unnatural form of progesterone), eliminates the risk of cancer, but not the heart disease risk.

According to a large-scale study reported in the Journal of the American Medical Association, combining Premarin® with natural progesterone reduced heart disease risk to almost the same level as when Premarin® was taken alone. It can be deduced, therefore, that natural progesterone has cancer and cardiovascular protective effects when used in conjunction with Premarin®.

HRT – Disadvantages

Unnatural estrogens such as Premarin® have been associated with increased risk of cancer of the breast, uterus (endometrial), and ovary. Women taking unnatural estrogen are at least four times more prone to developing endometrial cancer. They also have a 40% increased risk of developing ovarian cancer.

Researches at Harvard Medical School report that women who use unnatural estrogen for 5 years or more have a 30% higher chance of developing breast cancer compared to the control group.

Where is the Evidence?

Millions of American women have elected to be on conventional HRT based on the hundreds of studies and research done over the past 40 years. Unfortunately, the estrogen used in studies is not the natural form found in the human body. There is not even one well-controlled, large-scale study on the long-term use of natural estrogen as part of a HRT program for women.

Natural or Unnatural?

We know that estrogen, whether natural or unnatural, helps relieve symptoms of menopause, prevents heart disease, and slows the development of osteoporosis.

We also know that long-term use of unnatural estrogen causes cancer. And we have no proof that natural estrogen that is identical to that made by human bodies does not cause cancer.

So, those who elect to consider natural estrogen replacement therapy must proceed based on common sense. Recent interest in alternative and natural forms of HRT has spurred research on these forms, but it will take many years to complete.

How About Progesterone?

Dr. John Lee is a world-renowned authority on natural hormonal balance and author of the book Progesterone: The Multiple Roles of A Remarkable Hormone. He has treated thousands of menopausal women in the 1980s and 1990s with a program that was contrary to popular medical thinking at that time. Instead of prescribing estrogen alone ( the standard of medical practice then), Dr. Lee prescribes natural progesterone alone as treatment of menopausal symptoms. In addition to relief of menopausal symptoms, he was able to reverse osteoporosis and prevent cancer. Studies have confirmed Dr. Lee’s approach, that progesterone alone has vast ranging palliative effects.

The key to Dr. Lee’s approach is to understand the balance between estrogen and progesterone. In the pre-menopausal women, estrogen is always in balance with progesterone. When these two important hormones are out of balance, hormone related illnesses would emerge. Symptoms include weight gain, fatigue, auto-immune disorders, fibrocystic diseases, loss of libido, depression, headaches, joint pain and mood swings . These are just some of the common symptoms experienced during menopause, peri-menopause, and pre-menstrual time among those who have estrogen/progesterone imbalance.

According to Dr. Lee, what is commonly perceived as an absolute estrogen level deficiency during the menopausal years is in effect estrogen dominance in relative terms caused by extremely low progesterone level and thus unopposed estrogen dominance. Since progesterone’s role is to balance estrogen, the extremely low level of progesterone experienced after menopause leads to a relative dominance of estrogen, despite a 50 percentage drop.

Dr. Lee treats menopause as an estrogen dominance syndrome. His treatment is simple – reduce estrogen to progesterone ratio by increasing progesterone. When the opposing force of progesterone is increased, the toxic effect of estrogen is decreased. Fortunately for the many women who followed Dr. Lee’s advice, their menopausal symptoms improved remarkably.

The natural form of progesterone is quite different from the synthetic unnatural form made in a laboratory (the widely prescribed Provera®). The synthetic version is not really progesterone, but a compound called “progestin”. Progestin is far more powerful than a woman’s natural progesterone, and is metabolized as a foreign substance into toxic metabolites. These synthetic progesterones can severely interfere with the body’s own natural progesterone, creating other hormone-related health problems, further exacerbating estrogen dominance, if the dosage is not adjusted properly. Side effects of synthetic progesterone include increased risk of cancer, abnormal menstrual flow, nausea, depression, masculinization, and fluid retention. It is usually used in small amounts to balance the estrogen effect in a HRT program.

Natural progesterone made from wild yams and soybeans is nearly identical to the progesterone a woman produces. This form of progesterone comes in micronized capsules or in creams. Creams are easily applied to the skin with the breast, thigh, and abdominal areas being the most common areas. The body easily converts these natural progesterones into the form identical to that found in the human body. Adverse side effects are very rare. If taken inappropriately, it might slightly alter the timing of the menstrual cycle. Please note that yam-derived natural progesterone should not be confused with “yam extracts” sold in health food stores. The effectiveness of “yam extracts” remains in doubt.

How to use Progesterone?

Direction: For those who are not on estrogen supplement: Choose a calendar day, such as the first day of the month. Apply 20 mg of natural progesterone (one full pump when properly dosed) of natural progesterone daily from day 1 to 25. Let the body rest the rest of the month. If a woman has not been making progesterone for a number of years, the body-fat progesterone is probably low. In this case, double up on the application for the first 2 months, and return to normal physiological dose thereafter.

Direction: For those who are on estrogen supplement: reduce the dosage of estrogen supplement to half when starting the progesterone. If not, you will likely experience symptoms of estrogen dominance during the first one to two months of progesterone use. Every two to three months, reduce the estrogen supplement again by half again. Estrogen and progesterone can be used together during a three-week cycle each month, leaving a rest period of 7 days without either hormone. The estrogen dose should be low enough that monthly bleeding does not occur but high enough to prevent vaginal dryness or hot flashes.

Direction for those taking an estrogen and synthetic progesterone (such as Provera) combination: Stop the synthetic progesterone immediately when progesterone cream is added. Estrogen should be tapped off slowly.

Low dose natural estrogen (estriol) may be added for 3 weeks out of the month in cases of menopausal symptoms such as vaginal dryness and hot flashes unrelieved by progesterone cream alone.

Testosterone for Women?

Both men and women make testosterone. Testosterone is made by the adrenal glands, and the amount made by women is much less than the amount produced by men. A decline in testosterone levels in the body is associated with a decrease in sex drive and libido in both sexes. More than 50% of women past menopause report a decline in sexual desire. Testosterone replacement re-energizes the entire body, increases lean muscle mass, reversing the fat accumulation and muscular atrophy characteristic of aging.

For women, a small amount of testosterone, when added to the HRT, can work wonders to revive a sagging sex life. Note that other causes of decreasing sex drive (like depression) should be ruled out first.

Incidentally, for men, replacement and restoration of testosterone levels to the level of a 30 – 40 year old has a tremendous anti-aging effect. In addition to increasing libido, testosterone may protect men from heart disease. The normal blood level of testosterone ranges from 15 – 100 mg/dL in women and from 300 – 1,200 mg/dL in men. While there is no evidence that testosterone replacement causes cancer, men who do have cancer should not be on testosterone. Furthermore, complete laboratory testing is needed on a regular basis. Testosterone replacement may prove beneficial for women whose blood levels are below 65 and for men whose blood levels are below 800. Various forms (tablets, capsules, patches) are available in addition to injections.

Going Natural In HRT

Natural estrogen mimics nature and can be formulated by any compounding pharmacy in accordance to the prescription by a physician. A popular combination commonly called “triple estrogen” consists of 10% estrone / 10% estradiol / 80% estriol. The usual oral starting dose is 2.5 mg per day. This is equivalent to 0.625 mg of Premarin®.

Since unopposed estrogen is unhealthy, micronized progesterone capsules (100 to 200 mg per day) or progesterone cream (½ to 1 teaspoon) daily should be considered together with estrogen.

The exact dosage varies from person to person. Both hormones need to be stopped for the first 7-10 days of the menstrual cycle or for one week each month if menstruation has stopped.

For those who are already on the unnatural form of estrogen, switching to the natural “triple estrogen” should be gradual. The transition should take place over a period of 3 months or more. Start with using the natural estrogen instead of unnatural estrogen and progesterone once every 3 days for the first month, increasing to once every 2 days for the second month, and so on.

Some may experience a transient resurgence of some menopausal symptoms. This is a sign that the body is adjusting itself back to the normal form.

Menopause Protocol


Because of tremendous individual variation, the use of nutritionals should therefore be personalized for your body. One person’s nutrient can be another person’s toxin. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.

1. Exercise Considerations

Properly performed exercises have been shown to modulate hormonal imbalance through the menopausal years and beyond. For example, strength training has been shown to increase growth hormone secretion. Those who exercise regularly are also happier, less depressed, and have an optimistic outlook on life. This results in increased life expectancy. Statistically, life expectancy increases by two hours for every hour spent.

Precision anti-aging exercises must incorporate flexibility, cardiovascular and strength training exercises. All it takes is 5 minutes of flexibility training every day, 20-30 minutes cardiovascular training 3 times a week, and 15-20 minutes of strength training 2 times a week. A properly structured program takes an average of 30 minutes a day, which is less than 2% of the entire day.

2. Dietary Considerations

dietary changes may help with menopausePopulation data has shown that Asian women generally do not exhibit the symptoms of menopause to the same degree as Western women. Many Asian women have no symptoms of menopause at all! Epidemiological studies suggest this phenomenon may be due to the dietary habits of the Asians. In particular, the high proportion of fruits and vegetables such as alfalfa, which contain phytoestrogens, in the Asian diet.

Phytoestrogens are a diverse group of plant-derived substances that have estrogenic properties. The structure of these compounds is very close to estrogen, but their actions are much less powerful (about 1/1000 as potent). Consequently, when estrogen levels are high, phytoestrogens compete for estrogen receptors, reducing the number of estrogen receptor sites and thus decreasing the effects of excessive estrogen. The excess estrogens, in this case, are safely metabolized (broken down) by the liver. When estrogen levels are low, as in peri- and post-menopause states, phytoestrogens act as an estrogen supplement. Phytoestrogens therefore help balance both excess and insufficient estrogen by acting both as an anti-estrogen as well as a weak estrogen, respectively.

Asians also depend on soy (such as tofu) as a source of protein (rather than red meat). The active ingredient in tofu is a nutrient called genistein. Studies have shown that genistein may reduce the symptoms of menopause, prevent bone loss, and possibly provide a safe alternative for prescription estrogens. Those who are serious about optimizing their health during peri- and post-menopausal years may find it helpful to embark on a diet similar to Oriental women, in addition to any HRT. The Mediterranean diet, consisting of 50% complex carbohydrates (fruits and vegetables), 25% protein (from plant source such as tofu and from cold water fish) and 25% fat (from fish and from olive oil) is an excellent life-long anti-aging diet.

Calorie restriction (restricting dietary intake to that which maintains your weight at or slightly below ideal body weight) has been proven in many scientific studies to be a sure way to prolong life.

Your ideal body weight can be calculated easily. For women, the formula is 100 pounds plus 5 pounds for every inch above 5 feet. Therefore, for a women standing 5 feet 6 inches tall, her ideal weight is 100 + (5 pounds/inch x 6 inches)=130 pounds. Give or take 5 pounds for large or small frame size respectively.

For the average American woman who is slightly overweight, this means reducing caloric intake by at least 25% from 2000 calories a day to 1500 calories a day. Any weight reduction must be done gradually, with recommended loss of no more than one pound per week.

The lifespan of animals has been increased by 200% or more by calorie restriction alone. These calorie-restricted animals remain active, live longer, and get sick less frequently. Their fur and skin remain pretty and white, and their eyes remain clear and bright. The body self-adjusts and slows its metabolic rate to accommodate the lower caloric intake. This means less wear and tear on the body organs to process food and their by-products. Like an engine that is not revved as much, body components are stressed less when calorie intake is lowered.

While there is a universal agreement among scientists that calorie restriction works, the problem is that even the best Mediterranean diet cannot give you adequate amounts of nutritional factors for anti-aging purposes. Take Vitamin C as an example. For prevention of scurvy caused by Vitamin C deficiency, 65 mg of Vitamin C is all that is needed. However, the National Academy of Science now recommends a daily Vitamin C intake of 90 mg for men and 75 mg for women, with an established upper limit considered safe of 2,000 mg per day. The average RED contains 65 mg of Vitamin C. To reach 2,000 mg, you would have to consume 30 REDs a day. Similarly, a 5,000 calorie diet is needed to acquire the commonly recommended 400 IU of Vitamin E a day. Clearly, the catch-22 is that one cannot have calorie restriction and optimum nutrition at the same time from diet alone.

Optimal nutritional supplementation therefore is a necessary foundation and pillar of a successful anti-aging program. This will ensure that the body receives optimum amount of nutrients without an excessive number of calories.

3. Cruciferous Vegetables, I3C, and DIM

In addition to anti-oxidants, steps should be taken to neutralize the amount of excessive estrogen ingested. Environmental estrogen (also called xeno-estrogen) is omni-present in the developed world. Chemicals with weak estrogen effects are present in the pesticide sprayed on fruits, poly-carbons of our utensils made from plastics , hormone laced beef and poultry, and shampoos we use, just to name a few. Excessive estrogen is a leading cause of breast cancer in the female as well as a multitude of symptoms related to estrogen dominance, including pre-menstrual symptoms, pre-menopausal symptoms, and menopausal symptoms. Estrogen is also an antagonist of the small amount of testosterone in the female body. Elevated estrogen levels can be neutralized by a reduction of estrogen exposure through a proper wholesome fresh whole food diet, especially a diet rich in cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, bok choi, and brussels sprouts.

Fortunately, scientists are able to isolate the active ingredient of cruciferous vegetables. It is called Indole-3-Carbinol (I3C). Unfortunately, I3C has drawbacks. Numerous studies have shown that I3C, and in particular its reaction product ICZ, are associated with a number of unwanted activities that are not compatible with safe, long-term use. I3C supplementation is not recommended. Fortunately, I3C combines with stomach acid to form 3,3-Diindolylmethane (DIM). DIM supplementation is available. It is safe.

DIM is a balancer of estrogen metabolism. Let us review the pathway of estrogen metabolism first. Estrogen is metabolized in the liver . One of its metabolites – 16 alpha hydroxy estrone – is a carcinogenic metabolite implicated in propagating and promoting many hormone-sensitive cancers. Studies have shown that it was not the absolute amount of it, but the ratio of another estrogen metabolite called 2 hydroxy estrone to 16 alpha hydroxy estrone that was the more important predictor of cancer risk. The 2 hydroxy estrone is therefore known as the good or protective estrogen, and the 16 alpha hydroxy estrone has been deemed to be the bad or carcinogenic estrogen. One of the most efficient and healthiest ways to increase the ratio of these estrogen metabolites in favor of the good estrogen, is to eat large quantities of cruciferous vegetables or take DIM supplements.

In addition to the estrogen balancing effect, DIM stimulates progesterone production and compete with testosterone for protein binding. This helps to maintain testosterone in its free form. As estrogen metabolism slows due to the aging process (especially prevalent when coupled with obesity and regular alcohol use), estrogen metabolism is reduced. DIM reduces the conversion of testosterone to estrogen. Once absorbed, DIM promotes healthy estrogen metabolism and improve symptoms of estrogen-related imbalances.

Over 40 studies on DIM is on file in the National Library of Medicine database. As little as 0.5mg/kg body weight/day of DIM has been demonstrated as an effective dose. DIM can be used in conjunction with phytoestrogens such as isoflavones. Its use is cautioned in women taking the oral contraceptive as it theoretically may reduce effectiveness.

The use of DIM is compatible with other phytonutrients such as soy, black cohash, red clover, and chasteberry extract. Especially popular in recent years are soy products which contain isoflavone, a phytoestrogen that is 500 times weaker than estrogen. More than 1,000 medical and scientific papers have been published on isoflavones. There are three primary isoflavones in soybeans: genistein, daidzain, and glycitein. In various experimental models, isoflavones have exhibited properties that suggest they may help to lower the risk of cancer, heart disease, osteoporosis, and for the relief of menopausal symptoms such as hot flashes. In addition to breast cancer, soybean isoflavones may help reduce the risk of several types of cancer, including lung, colon and rectal cancer.

As a result, soy products have been heavily promoted in recent years. It should be noted that only soy that is fermented (such as miso or tempeh) is completely beneficial; as unfermented soy can do more harm than good in our body due to its toxic metabolites, if the intake is too much.

Isoflavone and DIM work under different pathways. While studies have shown that supplementation with 200 mg/day of soy isoflavones increase the production of estrogen metabolites, the effect is much less than that seen with absorbable DIM or I3C. As competitors to estrogen, phytoestrogens may interfere with normal brain aging. Recent studies suggest that soy phytoestrogen may be associated with accelerated brain aging and cognitive decline in both women and men. Mother nature has taught us that excessive use or ingestion of any one food is not good. A proper balance is the key. From a nutritional supplementation perspective, both DIM and isoflavone supplement should be considered, both in optimum and not in mega doses


Because of tremendous individual variation, the use of nutritionals should therefore be personalized for your body. One person’s nutrient can be another person’s toxin. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.

4. Nutritional Supplementation

The body goes through 3 phases of aging. Before age 35, it is in the sub-clinical phase where symptoms of aging are hardly detectable. The transition phase starts at age 35 and ends around age 45 or so. During this phase, gross signs of aging starts become evident as the body prepares itself for menopause. From age 45 onwards, the body enters phase 3, or the clinical phase of aging. During this phase, rapid decline in physical health and symptoms of aging come into full bloom. The nutritional needs of the menopausal woman are different from her child-bearing years. Some of the differences

  1. Musculo-Skeletal System.
    Osteoporosis sets in, and additional calcium and magnesium in a balanced ratio is needed to
    enhance bone health. Magnesium and malic acid are other nutrients
    essential for the maintenance of proper joint function.
    Over 75% of Americans do not meet
    even the recommended daily allowance (RDA) of magnesium, which is 300 – 400 mg.

  2. Digestive System.
    Our digestion slows and absorption of vital nutrients decreases with age.
    such as amylase, cellulase, bromelain, and lipase may be needed to help
    digest protein and enhance gastro-intestinal heath. They should be part
    of the daily supplemental intake.

  3. Neurological System.
    Mental function, especially memory and concentration, usually decreases with
    age and the decline is accelerated during menopause.
    Fortification with potent B vitamins is needed to enhance the memory and concentration
    functions of the aging brain.
    Deficiency of B12 leads to symptoms mimicking
    Alzheimer’s disease.
    24% of adults age 60 – 69 are deficient in
    Vitamin B12,
    and over 40% of adults over 80 are deficient. Those with memory impairment worse than normal should
    also consider phosphatidyl-serine and ginkgo biloba as additional nutrients.

  4. Cardiovascular
    The risk of atherosclerosis and cardiovascular
    disease rises substantially during peri- and post-menopause as estrogen
    levels decrease. Ascorbyl palmitate, L-lysine, and L-proline should be incorporated
    to promote vascular heath. Coenzyme Q10, lipoic Acid, and L-carnitine
    are important nutrients if heart function is compromised.

  5. Dermatological System. Our
    starts to thin during peri-menopause as collagen repair slows. Hair loss becomes more diffuse
    and global. To maintain hair health, extra Vitamin C to fortify collagen
    formation is helpful, along with minerals like zinc and boron.

  6. Hormonal System.
    Hormonal health, in addition tothe sex hormones, is on the decline during menopause and beyond. The level of
    growth hormone
    declines about 14% per decade after age 20, as do many other hormones. Hormonal
    modulation is enhanced by Vitamin E. This is an important vitamin for anyone who is in the menopausal
    age or beyond. Vitamin E has the additional benefit of possessing cancer prevention
    properties. This has been well documented in hundreds of scientific double-blind
    placebo controlled studies. One catch – you have to take Vitamin E consistently
    for at least 1 – 2 years for it to have any effect.

    L-Glutamine is an important amino acid with pro-hormone properties.
    Studies have shown that glutamine increases growth hormone release in our body. Growth hormone has been
    shown to reverse our physical age by up to 15 years in a double-blind
    placebo controlled landmark study conducted by the late Dr. Rudman and
    published in the New England Journal of Medicine.

  7. Endocrine System..
    As you age, your pancreatic function declines, leading to glucose imbalance. Just as “pausing” of
    the ovaries leads to menopause with decreasing estrogen output, “pausing”
    of the pancreas leads to decreasing secretion of insulin. This can lead
    ultimately to diabetes. To normalize
    blood sugar levels,
    adequate chromium is a must.

    Over 90% of Americans are deficient in meeting the RDA of 50 mcg of chromium
    a day. Many anti-aging researchers recommend 200 mcg a day, which would
    require a 5,000 calorie diet! Chromium polynicotinate is the most bioavailable
    form of chromium and supplementation may be beneficial to help normalize
    blood sugar levels.

  8. Immune System.
    The biggest fear for anyone over 45 is cancer. By age 50, about 30% of the body’s cellular protein has been damaged by
    free radicals. Cancer is one of the
    leading causes of death in all countries. Damaged proteins lead to mutations
    that can result in cancer. Strong antioxidants like grape seed extract, citrus bioflavonoids,
    selenium, and beta-car
    otene are well-documented free radical scavengers
    and cancer fighters. For extra cancer protection, consider
    calcium d-glucarate
    and additional antioxidants such as
    quercetin, and green tea.

  9. Stress.
    As the body cycles through its daily diurnal phase, extra Vitamin B12 and ginseng
    will enhance the body’s ability to cope with stresses during the day, while herbs such as kava kava and valerian should be taken to
    help produce a calming effect for rest and relaxation at night.

Summary of the daily nutritional consideration for women 45 and over:
Ascorbyl Palmitate: 100 – 200 mg
-Lysine: 150 – 250 mg
L-Proline: 100 – 200 mg
Amylase: 1,500 SKBU
Cellulase: 500 ECU
Lipase: 4800 IU
Ascorbic Acid (Vitamin C): 1,000 – 3,000 mg
Magnesium: 400 – 1,000 mg
Malic Acid: 100 – 500 mg
Grapeseed Extract: 50 – 100 mg
Citrus Bioflavinoids: 50 – 100 mg
Selenium: 200 – 300 mcg
Beta Carotene : 15,000 – 30,000 IU
L-Glutamine: 1,000 – 2,000 mg
Chamomile: 50 – 200 mg
Calcium: 500 -1,000 mg
Chromium: 200 mcg
Vitamin E: 400 – 800 IU
Beta Carotene: 15,000 – 30,000 IU
DIM: 35 – 50 mg
Progesterone Isoflavone Extract: 200 mg
Natural Progesterone Cream: 20 mg a day


Because of tremendous individual variation, the use of nutritionals should therefore be personalized for your body. One person’s nutrient can be another person’s toxin. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.


Menopause can be seen as an estrogen and progesterone deficiency disease in an aging body. Many have found estrogen replacement a relief for their symptoms. However, more than 50% of all women taking conventional estrogen (unnatural) replacement therapy go off it after 1 year. Its side effects such as bloating, lethargy and fatigue can be as unbearable as the symptoms of menopause. Obviously there is much to be desired.

For women who find hormonal replacement therapy necessary, the choice of whether to use the natural versus unnatural forms of hormone remains a difficult decision. Both forms have cardio-protective properties and prevent osteoporosis. While unnatural forms have been documented to also be associated with an increased risk for certain types of cancer, the natural forms have not yet had sufficient long term studies to show results regarding their relation to cancer risk. While there is no proof that cancer will not occur with the natural form, there is no reason to suspect that it would since the natural form is identical to that produced by the human body. Regardless of whether the natural or unnatural form is used, the risk of cancer associated with hormone replacement therapy is real and cannot be discounted.

The Big Picture

Those who are age 45 or over are in the clinical phase of aging, a phase where declining bodily function is grossly evident causing rapid deterioration. This phase lasts for approximately 35 years based on the current life expectancy in developing countries of 78 years. Menopausal symptoms are most prominent for the first 10 years or so of this phase.

It is so easy to become preoccupied by focusing on managing menopausal symptoms that one misses the big picture – how to optimize bodily function from age 45 onwards, realizing that menopause is just one short phase within that continuum.

The goal in any peri- and post-menopausal program should be the same: to keep the body in optimum anti-aging health. The best protocol is comprised of a consistent regimen of:

Ant-again can help with menopause

  1. Balanced anti-aging diet
  2. Precision anti-aging exercise
  3. Optimum nutritional supplementation
  4. Stress reduction

During the approximately 10 years of transition years from pre- to post-menopause, faithful adherence to the above protocol will resolve many of the uncomfortable associated symptoms for the vast majority. If hormone replacement therapy is desired, before proceeding, consult a physician who is well versed in both natural and conventional forms of hormone replacement therapy.


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Balch J and Balch P. Prescription for Nutritional Healing 1997 Avery Publishing, Garden City Park, New York 383-85.

Christy CJ. Vitamin E in menopause. Am J ObGyn 50 (1945) 84-7.

Murray M et al. Encyclopedia of Natural Medicine. 1998 Prima Health, Rocklin, Ca. 628-45.

Reichman J. I’m too Young to Get Old. Times Book / Random House Inc. 1966.

Rubin G.L. et al. Estrogen replacement therapy and the risk of endometrial cancer: remaining controversies. Am J Obstet Gynecol 162 (1990) 148-54.

Session DR et al. Current concepts in estrogen replacement therapy in the menopause. Fertil Steril 59 (1933): 277-84.

Tavain A et al. Hormone replacement treatment and breast caner risk: an age-specific analysis. Canc epidem Biolmark Prev 6 (1997) 11-4.

Whitehead MI et al. Effects of estrogen and progestins on the biochemistry and morphology of the postmenopausal endometrium. N Engl J Med 305 (1981) 1599-685.

Zand J et al. Smart Medicine for Healthy Living. 1999. Avery Publishing Group, Garden City Park, New York.


Message from Dr. Lam

I hope you have enjoyed reading this article. If you have areas you don’t understand,
or if you have a specific health concern, feel free to write to me by clicking here.