Premenopausal Symptoms: From Dr. John Lee's Premenopause Book

How to Balance Your Hormones and Your Life from Thirty to Fifty

by John R. Lee, M.D. and Virginia Hopkins

Chapter 1 - Premenopause As a Life Cycle

You're only in your mid-thirties and you absolutely do not want to hear the word "menopause" applied to you, even if it is "pre" menopause. You're not there yet. You're still young, you haven't even had kids yet for heaven's sake, or your kids aren't even out of grade school. And yet, you know something in your body isn't quite right. You haven't changed your eating or exercise habits but you're gaining weight. Your breasts are sore and lumpy, especially premenstrually, and you've started to have irregular periods. Maybe you've lost some of your sex drive or your skin is dry or isn't as smooth as it used to be. You used to think of yourself as very even tempered, but lately you're irritable and snappish, and you can't seem to get out of bed in the morning. You have friends your age who are struggling with infertility, uterine fibroids, and PMS when they've never had it before. What's going on? It's premenopause syndrome, which is not a natural or inevitable part of life, but one created by our culture, lifestyles and environment.

Premenopause is a phenomenon that all women know about, but very few have a name for. Some 50 million women are going through premenopause right now, and most of them have experienced some form of premenopause syndrome, a collection of symptoms experienced by women for ten to twenty years before menopause.

We call this pre-menopause rather than using the medical term peri-menopause, because premenopause syndrome can begin as early as the mid-thirties, while peri-menopause technically means "right around menopause," meaning the year or two before, during and after menstrual cycles end.

If you're a woman between the ages of thirty and fifty, you know a woman, maybe yourself, who has fibroids, tender or lumpy breasts, endometriosis, PMS, difficulty conceiving or carrying a pregnancy to term, sudden weight gain, fatigue, irritability and depression, foggy thinking, memory loss, migraine headaches, very heavy or light periods, bleeding in-between periods, or cold hands and feet. These symptoms are part of premenopause for a majority of today's women, and are the result of hormone imbalances, most of them caused by an excess of the hormone estrogen, and a deficiency of the hormone progesterone.

As you'll discover as you read on, natural progesterone is essential for maintaining hormone balance, and yet it has been largely overlooked by conventional medicine because of medical politics and pharmaceutical company profits.

However, premenopause symptoms are not just about biochemistry. They are also about women who are out of touch with the cycles and rhythms of their bodies, their feelings, and their souls. These are women who struggle to balance families and work; women who forget to take care of themselves, and women who aren't getting the help they need at their HMO.

There was a time when a woman's mother, grandmother and aunts would quietly let her know what to expect during each phase of her life, and help her through the rough patches with herbs and homespun, time-tested wisdom. These days the medical profession has taken over the role of a woman's extended family, but sadly, the advice they have to give out has more to do with dispensing drugs and scheduling surgery than with solutions that are healing -- or that even work!

When women have premenopausal symptoms, estrogen is commonly prescribed. When that causes irregular bleeding, cervical dysplasia, or doesn't help their symptoms, their doctors often then resort to surgically induced menopause in the form of a hysterectomy, or they try personality-altering drugs such as Prozac and Zoloft to medicate them until they get through this particular phase of their life. Or they are given more synthetic hormones -- and the wrong hormones at that. None of these approaches really improve the quality of a woman's life, and they all have grave potential to cause illness and even to be life-threatening. In spite of what a conventional doctor will tell you, you can do something about the symptoms of premenopause besides antidepressant drugs, synthetic hormones, and surgery. We're not trying to say you will never have any symptoms as your hormones wind down, or that you can live forever, or that your skin will stay smooth and unwrinkled until you're 90. But you definitely do not have to suffer from lumpy breasts, fibroids and many of the other symptoms that show up anywhere from five to twenty years before menopause.

Looking Forward to Menopause

One of the reasons that premenopausal women don't want to talk about menopause is that they dread the prospect of this hallmark of aging. This attitude is sad, and contributes heavily to the emotional causes of premenopause symptoms. This attitude is particularly true of the many women who have postponed having children and who wonder if they're going to be able to have children before their biological alarm clock goes off.

Women have been taught in countless ways that their value lies in their ability to be sexually attractive to and unconditionally supportive of men, as well as being unselfishly maternal and unconditionally loving of their children. While these are truly positive feminine traits, they are also one-sided. A woman who has only developed these traits without developing her sense of herself, will be terrified at the prospect of aging. When her children have left the house, her breasts are sagging and her skin is wrinkling, what does she have left?

Women who only develop this side of themselves also tend not to have good boundaries. They have spent so many years making themselves totally and selflessly available to their husbands and children that they don't know where their families end and they begin. They have trouble saying no, and would be hard pressed to tell you when they last had an hour to themselves -- or what they'd most like to do with an hour if they had one. It's no wonder that the process of becoming a more individualized and free woman can be a frightening one. These women are craving self definition: Who am I? What's important to me? What really matters? What am I teaching my kids? What values do I stand for in my work? What are my personal creative gifts? They have to relearn their right to say, "No, I won't do that." "No, I don't have time." "No, I'm not available right now."

Once a woman passes over the threshold of menopause and begins to redefine herself, she has the potential to discover the richest time of her life. She can look back on the energy and enthusiasm of youth as a thrilling and exciting time. Childbirth and parenting were magical and rewarding. A career was creative and empowering. Now her first fifty years life are digested and integrated into wisdom and freedom. If you talk to menopausal women you will find that once a woman comes across the 50 threshold and gets a year or two over it, very few would go back for anything other than a tight butt and fewer wrinkles. Menopause was once called the "dangerous age" because so many woman begin speaking their minds at that time of life. What the world needs more than anything is for a woman to have the courage to speak her mind.

Menopause is a life cycle to be respected and looked forward to. In the future, menopausal women will once again be cherished and appreciated for the experience they bring to the rest of us, and looked upon as role models by younger women for their sense of individuality.

Creating a Positive Premenopause Cycle

Before puberty you had the freedom of living without hormonal cycles, and the relatively steady physical and emotional balance of that freedom. During puberty you rode the ups and downs of a body getting used to the surges of sex hormones and menstrual cycles as well as the growth of pubic hair, breasts and a libido. In your twenties and early thirties, if you were lucky, you experienced a remarkable period of high energy, clear thinking and all the excitement, privileges and challenges of being an adult and building your adult life. This is also a time when your hormones reach their maximum hum. There's a rhythm working that is so genetically empowered that it's harder for all the spiritual, psychological and environmental challenges you have to knock it off balance.

Sometime between your mid-thirties and mid-forties this strong, vibrant cycle becomes more easily influenced by outside factors and lifestyle choices. You notice things are changing again. Your periods aren't a regular as they once were, and your breasts get painfully lumpy when you're premenstrual. Sometimes your periods are heavier or lighter than usual. You're at least a little moodier than you used to be, and get tired more easily. You don't recover as quickly from a long trip or a late night out. You need more sleep, or you aren't sleeping as well. You strain your muscles more easily when you exercise and you find yourself grunting a little when you stand up. If you eat poorly or miss a meal, you notice it. Those onion rings you used to scarf up without consequences now give you heartburn, and just one too many glasses of wine gives you a headache. You aren't quite the sexual tigress you used to be, and sometimes you notice you're not as lubricated during intercourse. You used to have mild PMS, but now it's distracting and unpleasant. Even though your diet and exercise is the same, you've gained a little weight, and no matter what you do it doesn't come off and stay off. You're sprouting more than a few gray hairs, and if you're over forty, chances are good that you need reading glasses, at least for the fine print.

These are the signs of a mid-cycle of life when everything is changing again. It's not as short, intense and dramatic as puberty for most women, but once again your hormones are fluctuating up and down, with a gradual and overall direction of winding down.

Hormones Across Your Life Span

The premenopause life cycle is an extremely potent and empowering time of life. A balanced premenopausal woman is confident, knows herself, and has enough experience to be moving around in the world with self-assurance. She realizes that Prince Charming is not going to gallop up and rescue her, so she is no longer looking outside of herself for security. She has achieved a level of competence in the home and the workplace, as well as familiarity with her own strengths and weaknesses. One of the keys to a healthy premenopause cycle is to make it not just OK but wonderful to be moving into a time of life when we're becoming less physically powerful but more emotionally and spiritually powerful.


Anne is a 44-year-old schoolteacher who went to her doctor a year ago complaining of weight gain, depression, and headaches. She had also been having irregular periods for about six years. The depression and headaches were very difficult for her to cope with while teaching a class of energetic junior high schoolers. On many occasions she had found herself uncharacteristically snapping at her students, or on the verge of tears.

She and her husband didn't have any children, but were avid weekend hikers and loved to travel the world to beautiful hiking spots. Anne's weight gain had made it difficult for her to keep up on the hikes, and her depression made it hard just to get out of bed on weekends. Anne was nearly 30 pounds overweight, and her face was flushed, as if she had a permanent blush.

When Anne went to her HMO's doctor, he told her she was going into menopause, and gave her a prescription for Premarin, a synthetic estrogen and Provera, a synthetic progesterone. She dutifully took them, and for about two weeks she felt better. Then her symptoms started to become worse than before she began taking the synthetic hormones, and every time she took the Provera in the middle of her cycle her depression became dramatically worse. When she called her doctor to tell him, he called in a stronger dose of estrogen to the pharmacy, which Anne began taking. Within two weeks of the new regimen she had gained six pounds and was almost constantly weepy.

She was calling in sick to work because her headaches had become so severe. After six months of enduring these symptoms and on the verge of losing her job, Anne returned to her doctor for a pap smear and it came back positive for cervical dysplasia, a potentially precancerous condition. He told her that although they could take a "wait and see" approach for six months, he recommended a hysterectomy. He promised her that after the hysterectomy, all her symptoms would disappear and she would be a much happier woman.

At this point Anne went to see Dr. Hanley, weeping through most of the appointment. She confessed that she thought some of her depression was caused by the realization that at this late stage of her life she wanted a child, even though her husband was adamantly against it, to the point of not wanting to have sex for fear of pregnancy. Anne said with a sad laugh that her sex drive had disappeared since she had started taking the synthetic hormones, so she didn't really mind that her husband didn't want to have sex.

Dr. Hanley suggested to Anne that she keep a daily journal of her feelings, including her feelings about not having a baby. She explained that while Anne's symptoms were no doubt partly related to her conflict over having a baby, the severity of her headaches, depression and weight gain, as well as her cervical dysplasia, had probably been caused by the high doses of estrogen she had been taking, as well as the synthetic progestins. Dr. Hanley did hormone tests, which revealed that Anne's FSH was still normal, but her estrogen was way too high, an indication that she was not in menopause yet. She suggested that they gradually ease her off the synthetic hormones, replacing them with natural progesterone. Dr. Hanley asked Anne to take the vitamin folic acid along with sublingual vitamin B12 and vitamin A, to help heal the cervical dysplasia, and asked her to return in eight weeks for another pap smear.

Dr. Hanley also asked Anne to take up a gentle but regular weight-lifting program at the gym to bring her metabolism back to normal and help her reduce weight. Anne added 20 minutes on the treadmill and said the workout immediately picked up her energy and she felt more hopeful and cheerful. Six months later, Anne had lost 20 pounds, and her last pap smear came back normal. She said that within days of beginning on the natural progesterone, it felt as if her body was giving a huge sigh of relief, and her symptoms began to get better. She was bubbling over with energy and enthusiasm for a hike in the Peruvian Andes she and her husband were going on in a few weeks. She still felt sad about not having had a child, but after many months of writing in her journal, she decided that her marriage was more important.

Learning to Create Balance

It's easy to believe that you're immortal right up to your mid-thirties or mid-forties, when the evidence is piling on that aging is in process. But if you take care of yourself now, your aging process will happen later in life and will be more gradual and less debilitating. If you do your best to maintain your physical, mental and emotional balance through the mid-cycle of your life, aging will be more graceful and less painful. You'll notice that balance is a key concept in this book, and is the foundation of our Premenopause Balance Program.


Marie is a very thin, attractive 39-year-old attorney with a six-figure income and a corporate career that consumes her life. She lives in a big city in a fancy condo with a doorman and spectacular views of the city, drives an expensive car, and wears nothing but the best clothes. She works out at the gym five mornings a week to maintain her trim figure, and is careful about the foods she eats. She doesn't walk through the hallways of her office, she zooms. Marie is in perpetual motion all day, and sometimes into the evening dining with clients or traveling. In the car she is on her cell phone, and on airplanes the portable computer comes out. No moment is wasted.

When Marie was in her twenties she assumed that she would eventually marry and have children, but that plan faded. She didn't even have plants or pets that would interfere with her busy travel schedule, and decided that she didn't have time for children. She'd like to be married, she thinks, and she's usually dating a corporate executive or two, but in the past few years, none of her relationships have lasted more than six months.

About a year before Marie went to see Dr. Hanley she ended up in a gynecologist's office because of severe, debilitating cramps in the middle of her menstrual cycle, and spotty bleeding throughout her cycle. She was also waking up in the middle of the night drenched in sweat, which she was afraid might be a symptom of cancer. After a long series of tests, her gynecologist recommended a minor exploratory surgery to rule out cancer. Nothing terrified Marie more than surgery except the threat of cancer, which ran in her family, so she very reluctantly agreed to it. Her doctor found that she didn't have cancer, she had cysts on her ovaries. Some of them, the doctor reported, even had hair growing on them, and the very thought of that horrified Marie. The doctor removed one ovary that he judged irreparably damaged.

After the surgery Marie's doctor told her that if she continued to have problems she could have a hysterectomy and she could then be put on hormone replacement therapy. The prospect of major surgery, and of being on HRT, was unthinkable to Marie. A year later, when her symptoms had been recurring for a few months she made an appointment with Dr. Hanley, hoping for an alternative to surgery and synthetic hormones. She was once again having heavy cramps, irregular bleeding and night sweats, and she was also experiencing vaginal dryness and pain during intercourse.

The first thing she said to Dr. Hanley after describing her symptoms was, "I know that these are symptoms of menopause, but I'm not even forty yet. How can I be in menopause -- I'm not ready for that!"

When Dr. Hanley asked about her lifestyle, Marie admitted that she knew she drank too much coffee, and she knew that caused her stomach pain and heartburn. "But," she said, "I can't seem to get going in the morning without it, and every time I try to quit I get terrible headaches." She added that in the afternoons she drank diet sodas containing caffeine, and that in the evenings she might tend to have a glass or two more wine than is good for her. "But I need it to unwind and get to sleep," she explained.

Dr. Hanley explained to Marie that from the Chinese medicine point of view she was driving her male side very hard, and neglecting her female side, and that her first step in healing was going to be to bring these two parts of her self into balance. The driving, successful corporate executive who zoomed about and never paused was thriving at the expense of her more reflective, nurturing, feminine side.

Her malfunctioning ovaries were not only symbolic of suppressing her feminine side, but she also probably wasn't making much in the way of hormones. Her remaining ovary was probably suppressed and her adrenal glands were probably exhausted. That was causing the night sweats and hot flashes, a sign of low estrogen. Dr. Hanley measured Marie's hormones and found that they were all low. Marie was very resistant to the idea of taking any kind of hormones, even natural hormones in a cream, but she agreed to make some dramatic lifestyle changes to heal her body and bring herself back into balance, and to take some herbs to help balance her hormones and support her adrenal glands.

When Marie returned a few weeks later, she told Dr. Hanley that after her first visit she had a dream that the hairy cyst on her ovary was a testicle, and that graphic vision had been a great inspiration to make the necessary changes in her life to create more balance!

The first thing Marie did was announce to her partners at the office that she was cutting her client load in half and hiring a young attorney to travel in her place. She started taking painting classes, and fulfilled a lifetime dream of spending a month in Paris in the spring painting. When she returned she bought a weekend house in the country where she planned to paint, garden and take long walks on the beach.

Marie also made smaller, but equally important changes. She taught herself to walk slowly through the hallways of her office instead of zooming, she listened to soothing music in the car instead of making phone calls, and when she did have to travel she brought along a good novel instead of working on her portable computer. She cut down her time at the gym to three days a week, and allowed herself to gain a little weight. With the help of a special herbal and nutritional supplement regimen prescribed by Dr. Hanley, she switched from coffee to herbal tea, stopped drinking sodas, and kept her wine consumption to a glass with dinner.

A year after her first visit with Dr. Hanley, Marie reported that her symptoms were ninety percent gone and that she felt she could live with the ten percent that were left. She had met a wonderful man, an artist himself, at her weekend home, and had been dating him for months to the exclusion of anyone else. She said she realized that it was her slower, more contemplative and creative lifestyle that had created the space for a relationship.


Women tend to be unclear that selfishness can actually be a good thing. Most women are taught as young girls that if they ever do or want anything for themselves that they are selfish. They are trained from early on that their role in life is to be there for everyone else. Now it's time that women take back responsibility for their bodies, their emotional lives, their children and their environment. That's selfishness with a Big S. Imagine how quickly pesticide-tainted food would disappear if women with families refused to buy anything but organic food. Imagine how quickly mainstream medicine would shift from a drugs-and-surgery mode to a prevention-and-healing mode if premenopausal women walked out on doctors who weren't helping them.

If a child has a chronic runny nose and ear infections it is most likely caused by a food allergy inherited from the parent. If the mother is not willing to give up milk products to find out if a food allergy exists, how does she expect the child to give them up? If the mother is not doing what 's good for her, how is the child going to learn to do what's best for him or her self? Parents who are sexually abusive to each other will have children who grow up to be sexually abused. A parent who is exhausted and overwhelmed all the time will raise children who abuse themselves in the same way. We all learn by example. You can't help your children if you won't help yourselves.

One of the ways of being selfish in a good way is to trust your hearts and your intuition, to be strong enough to insist on what you know, and to act on it.


Susan is 35 years old and has been married to an electrician for nine with whom she has a three-year-old son named Adam. Susan works part-time for the phone company to help ends meet, since her husband's business always seems to be struggling, but the cost of day care means at the end of the day she has barely made minimum wage. Susan and her husband want another child, and have been trying to get pregnant for a year.

Susan came to Dr. Hanley complaining of fatigue, heavy periods and puzzlement over her inability to get pregnant, since it had happened so quickly with Adam. She looked pale and drawn, with dark circles under her eyes. She was about twenty pounds overweight, with most of it in her stomach and hips.

When Dr. Hanley gave Susan a vaginal exam, she found a fibroid the size of a golf ball on her uterus, which explained the heavy periods and perhaps difficulty in conceiving. Many doctors would have immediately scheduled Susan for surgery to remove the fibroid, and some would have even advised her that she would be unable to have another baby and recommended a hysterectomy.

Dr. Hanley sat down and had a talk with Susan after the exam. As they examined her life, Susan realized that she was ambivalent about having another baby when they really couldn't afford it, and she already seemed to be exhausted all the time. Another baby seemed inconceivable, and so it was!

Susan decided that what she needed first was take care of herself, and once she gave herself permission to do that, she knew exactly what she needed. Adam still frequently woke up at night, and she was the one to go to him, so she was often sleep-deprived. Susan decided she'd begin taking care of herself by asking her husband to spend Sunday mornings with Adam so she could sleep in. One morning a week of sleeping in sounded like heaven to her. She also resolved to take more long, hot bubble baths before bed, and to be less of a perfectionist about how clean the house was. She looked considerably brighter after deciding to take just those three steps.

Dr. Hanley also recommended that Susan drink more water, eat more vegetables, and take a multivitamin. Then she explained that Susan was probably low on progesterone, and suggested a series of tests done throughout the month to measure her hormone levels. In the meantime, she started her on a good multivitamin and some Chinese herbs.

Susan's test results did show that she was low in progesterone, and in DHEA, so Dr. Hanley prescribed a regimen of a natural progesterone cream and a low dose of DHEA for three months.

Within three months Susan's energy was up, though not all the way. Her periods were normal, and her fibroid was clearly shrinking. Her husband had decided to go into partnership with another electrician, and they had postponed trying to get pregnant until they were more economically stable so that Susan could stop working when the new baby came.

Six months later, Susan was alive with energy, her eyes sparkled, her periods were normal, and her fibroid was undetectable. Within a year, she was pregnant.

In this chapter you have read about three very different women but with the same problem -- premenopause syndrome. Their personalities, lifestyles, genetics and bodies are very different, but their health and emotional problems arise out of the same cycle of life, the premenopause cycle. A combination of an aging body, an imbalanced lifestyle and a unique combination of physical predispositions set up each women to have her particular problems.

It is our hope that you will use this book as a resource for creating a healthy, balanced premenopause cycle for yourself. We're going to show you how and why your body isn't working the way it used to, and give you very practical, down-to-earth solutions that really work. But we're not offering any magic pills here. Up until our late twenties or early thirties we can get away with a lot when it comes to lifestyle choices. We can party into the wee hours, drink too much alcohol and show up functional for work the next day; we can subsist largely on diet soft drinks, French fries and candy bars and still be reasonably healthy. But as we get older we can get away with less and less, until by the time we're in our forties, if we have been careless with our bodies we've created chronic health problems that resist conventional treatments. With the information and resources provided in this book you can make the premenopause cycle of your life a healthy, energetic and deeply rewarding one.

When you reach menopause you'll be back to having lower and more stable hormone levels, with all the steadiness that goes with it, but this time you'll be in an adult body and experience tremendous freedom and creativity. Most women love it once they get there. And these days, with the help of natural hormones and a healthy lifestyle, you can maintain your health and your sexuality like never before, and fully enjoy the wisdom and privileges of growing older.

Since What Your Doctor May Not Tell You About Menopause was written, the amount of new research and clinical information we have about premenopause syndrome has grown exponentially. We know much more about what happens to a woman's biochemistry as she ages, and so much more about what drives the hormone-related cancers that begin to strike at that age, that we want to share what we know with you. We have startling new revelations to share, and can now state with authority what was only theorized or hinted at a few years ago.

If you're suffering from premenopause syndrome, there are very specific causes, and very specific solutions. Every woman's combination of genetics, personality, biochemistry and lifestyle is different, so every woman's health solutions will be unique to her. Consider this book a roadmap. You can become acquainted with what it has to offer and then choose your own personal path to health. Bon voyage!