The recognition of the stage of life now called perimenopause is relatively new.  Women enter this stage of life, marked by a significant decline of estrogens, progesterone, and specific neurotransmitters, at different ages,  This variability is due to both genetic factors , environmental issues, and the specific conditions with which each woman is dealing in her life.

Dr. Denise Mark, M.D., refers to these women as the "wired and tired perimenopausal women." (Mark, 2005,)  They usually present with a wide range of symptoms that include insomnia, depression, sugar cravings, anxiety, nervousness, weight gain, fatigue, poor memory, skin aging and dryness, and blood sugar disregulation.  (Mark, 2005.)  For a more complete list of symptoms, you can refer to Louise Gittleman's book Taking Charge of Your Perimenopause. (Gittleman, A.L., 1998.)

There are a number of current trends in food patterns that make the conventional food supply less nutritious and more toxic.  These trends put the entire population's health at risk, and the "wired and tired" perimenopausal woman is no exception.

Fast foods are one such trend.  They are processed, refined, adulterated and synthetic, non-natural foods that are ingested in large quantities in America.  Ed Bauman, Ph.D., says "These foods are made from the least expensive materials and are loaded with chemicals, trans-fats, artificial ingredients, and flavor enhancers.  Fast foods are stimulating without being nourishing." (Bauman, 2005; p.43.)

The media, television advertising, and marketing shape our unhealthy preferences for these foods, and our fast-paced lifestyle demands that we cut corners for convenience' sake.

Another trend is the dramatic increase in high fructose corn syrup.  "High fructose corn syrup replaced  refined sugar in 1970 as the sweetener of choice for its low cost claims … Fructose is processed in the liver, as a chemical that increases oxidation, inflammation, and allergic responses.  These effects make it debilitating and stimulating at the same time.  A combination of either artificial or refined sugars with poor quality fats is a recipe for flab, weight gain, and brain chemistry alterations, which manifest as depression, insomnia, and panic." (Bauman, 2005; p. 43.)  These are all symptoms of the perimenopausal woman.

Dr. Ronald Schmid, N.D., in his book Traditional Foods (Schmid, R., 1987), reports that the changes from organic agricultural methods to chemical agricultural methods now leave poisonous pesticides and herbicide residues in both the soil and plant tissues of the crops.  André Leu builds on that subject when he reports that "Research published in a 2001 study showed that the current fruit and vegetables in the United States have about half the vitamin content of their counterparts in 1963."  (Leu, A., 2005; p. 49.)

The bottom line is that our conventional non-organic food supply is generally less nutritious and definitely more toxic.  On top of this, there are some specific environmental factors such as xenoestrogens (synthetic estrogens from plastics and petrochemicals) that accumulate in the fat tissues over time and cause women to become estrogen-dominant.

This brings us to the population that is the focus of this paper: the wired and tired perimenopausal woman.  Dr. Denise Mark, M.D., who specializes in treating this population, says that "neuro-endocrine imbalances are nearly always a part of the etiology of patients" (Mark, D., 2005) whom she classifies as perimenopausal.  She further writes that "Hormonally, this patient's presentation is characteristic of estrogen dominance.  Women in their forties commonly experience a shift in their estrogen metabolism toward a proliferative estrogen-dominant state." (Mark, D., 2005)  Dr. Mark believes this estrogen-dominant state leads to declining thyroid function, lowered progesterone production, and a shift into dangerous proliferative 4-OH and 16-OH estrogen metabolic pathways, which are considered to be cancer-promoting.

Sanesco International, an integrative medical company that specializes in addressing the neuroendocrine communication system, says that of 60,000 patients tested for their neuro-transmitter levels, 80% presented with low serotonin levels.

This seems to be a result of the stressful fast-paced culture of today, and women in the population on which I am focusing are often juggling both work and family, often being the primary care provider at home.
Seratonin levels are a major contributing factor in the "wired and tired" symptoms of the perimenopausal woman.  For example, insomnia, depression, and anxiety can all be attributed to low serotonin levels.  This helps to explain the tired part of "wired and tired".  Ongoing high levels of stress can raise the stress hormones cortisol, norepinephrine, and epinephrine, which contributed to the wired aspect of the symptom constellation of this population.  Also, over time, with extended stress, the adrenals will fatigue and be unable to produce adequate amounts of these stress hormones, which compounds the level of the patient's fatigue.

Another trend in food patterns that has contributed to the uncomfortable symptoms of the perimenopausal woman has been health professionals' strong emphasis on a lowfat, high-complex carbohydrate diet.  These complex carbohydrates act in the same way as simple carbohydrates by causing a surge in blood sugar levels, which raises blood insulin levels.  The insulin stops the body from burning stored body fat as fuel, causing a sharp decrease in blood sugar level.  This causes the brain to signal for more blood sugar, which we feel as a craving for something sweet.

Dr. Gittleman says that in the early 1980s, she noticed "Many people on a lowfat, high complex carbohydrate diet often suffered from low energy, fatigue, mood swings, allergies, and dry skin."  (Gittleman, A.L., 1998; p.31.)  These are many of the same symptoms found in the wired and tired perimenopausal woman.
An improved diet and neuroendocrine balancing, along with stress reduction and lifestyle change, are recommended by many of the experts in the field.

RECOMMENDATIONS

Ann Louise Gittleman, Ph.D. is a noted expert in the field of nutrition, and she recommends a very specific diet for this population of perimenopausal women, which she refers to as "the changing diet"  The changing diet is the hormone-regulating eating plan that women need during their 30s, 40s, and beyond … This diet emphasizes low glycemic carbohydrates, phytohormone-rich fruits and vegetables, protective fats, and quality protein that will help balance your body's hormones." (Gittleman, A.L., 1998; p.31.)

She recommends eliminating sugar, all refined carbohydrates, and in addition, suggests avoidance of overly promoted complex carbohydrates like potatoes, pasta, rice, and cold cereals.

The phytohormone-rich fruits and vegetables she recommends are either mildly estrogenic or progesterogenic, and she suggests a balanced variety in the diet.  For a list of these foods, please refer again to her book Taking Charge of Your Perimenopause.

The healthy fats she recommends are flaxseed oil, olive oil, nuts, seeds, and avocado, to help balance blood sugar and provide raw material for hormones.

She encourages eating lean complete proteins in the form of fish, free range organic poultry, lean organic meat, lowfat cottage cheese, eggs, and nonfat dairy products.

Her diet advises avoiding stimulants like coffee, soda, and alcohol, because they are known to alter hormonal balance.

She stresses that the diet is most effective at regulating hormones if it has a 40/30/30 ratio of carbohydrates/proteins/fats.

Dr. Mark M.D. also recommends having neurotransmitters, sex hormones, stress hormones, and insulin levels tested, and once imbalances are assessed, she would recommend targeted nutritional therapy to rebalance the patient's neurotransmitter levels, and bio-identical hormones and an insulin-sparing diet to balance hormone levels.

If testing reveals adrenal fatigue, Dr. James Wilson, N.D. also recommends targeted nutritional therapy.  He emphasizes vitamins C, E, B5, B6, B complex, magnesium, calcium, trace minerals and the botanicals licorice root, ashwagandha, Korean ginseng, Siberian ginseng, ginger, and ginkgo.  For specific dose, please refer to Adrenal Fatigue: The 21st-Century Stress Syndrome, the book by Dr. James Wilson N.D. (Wilson, J., 2001; p. 193.)

I would personally emphasize the importance of reducing stress for this population by making lifestyle adjustments, adding stress reduction programs like meditation and yoga, as well as regular exercise.
The first step towards implementing these recommendations must be education — education not just for health care practitioners but also for the women themselves who are experiencing this stage of life and the concomitant symptoms.  Once women have the knowledge, they will be the ones that educate their doctors.  Books and lectures by experts like those I have mentioned in this paper will pave the way for the implementation of the interventions and recommendations I have presented in this paper, and I look forward to being a part of this process.

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