Since the sudden halt of the National Institutes of Health clinical study of the effects of the hormone Prempro, more women than ever are interested in how to create midlife health without the use of synthetic hormones. The Women's Health Initiative study was terminated in July 2002 because Prempro, which combines estrogen with progestin, appears to increase a woman's risk of breast cancer as well heart disease and stroke.

"The NIH finding was unexpected. It has been a real negative for women, driving them to consider options besides hormone-replacement therapy," says Susan Lark, M.D., one of the nation's leading authorities on the use of lifestyle and nutritional approaches to women's health.

Further fanning the flames was the release of a study in March 2003 (from the same Women's Health Initiative) showing that conventional hormone-replacement does not significantly improve mood, mental ability, sexual function or menopausal symptoms.

Here's the good news, though. There are effective "do-it-yourself" alternatives to conventional-hormone formulations for easing the physical and emotional symptoms of perimenopause, the 10-15 years before menopause when a woman's monthly period comes to an end. Below is a "master plan" from which to create your own program for perimenopause relief.

Here, Discovery Health Online presents top solutions for seven common perimenopausal symptoms from three leading women's health experts: Susan Lark, M.D., nutritionist Ann Louise Gittleman, Ph.D., and Christiane Northrup, M.D.

Hot Flashes/Night Sweats: Occur in 70 to 85 percent of women and are triggered by falling estrogen and above-normal FSH (follicle stimulating hormone) levels. Average age of onset = 48. Mainfests as intense heat over face, scalp and chest for 3-5 minutes.
Susan Lark, M.D.	Ann Louise Gittleman (ALG)	Christiane Northrup, M.D.
Vitamin E: Start with 800 I.U. daily with doctor's okay. Supplements containing soy isoflavones (50-100 mg*) or black cohosh also have shown strong results. All can be used together or separately.	Vitamin E: 400 to 1200 I.U. Vitamin E may work by functioning like a weak estrogen in the body. Bioflavonoids: 1,000 mg of hesperidin daily. Like vitamin E, bioflavonoids may work by having a structure similar to estrogen.	2 percent natural progesterone skin cream helps 85 percent of perimenopausal women; apply ¼ tsp. daily to skin. Soy foods like soy milk and tofu (aim for 45-160 mg of soy isoflavones daily) may provide relief, as do some herbs — black cohosh, dong quai or chaste berry.

Lower Libido: Lower estrogen, progesterone and testosterone levels may dampen sexual desire. Relationship, stress, illness, life events are also contributing factors.
Susan Lark, M.D.	Ann Louise Gittleman (ALG)	Christiane Northrup, M.D.
L-arginine: Take 1,000 mg 1-2 times daily in combination with 250 mg of B-5 and 250-350 mg of choline once daily to promote better blood flow to the pelvic organs and tissue. See Dr. Lark below on vaginal dryness. She believes perimenopausal women may have lower libido because intercourse is painful.	Topical testosterone cream can be "extremely effective." ALG advises getting a baseline salivary hormone ** test to determine hormonal deficiencies. Useful herbs: damiana, horny goat weed and maca, a Peruvian herb that may also help with hot flashes, night sweats and fatigue.	Lower libido may result as a woman "reprioritizes her life and the manner in which she uses her energy" and redefines relationships to "serve the person" she is becoming. Women in love with their life tend to have high libido despite hormonal changes. Lack of libido may stem from low estradiol or testosterone. Check hormone levels with salivary hormone test. If one of these hormones is low, supplement with oral estradiol or patch; take testosterone as capsule or vaginal cream. In early perimenopause, ¼ teaspoon of natural progesterone cream twice daily may help.