OUR BODIES: AGES & STAGES

Hormones do wondrous things. They give us our breasts and hips — as well as cramps, morning sickness, and hot flashes. To cope with those lows and celebrate the highs, try these integrative remedies.

SARAH LONG, 29, likes getting her period — even when PMS and cramps slow her down. "I get to start anew each month," she says. "And I feel linked to the natural world, which has its own regular cycle."

Despite our ages, cultures, and backgrounds, we all have the same reproductive hormones — estrogen, progesterone, and testosterone — flowing through us. They're responsible for the uniquely female changes we experience: menstruation, pregnancy, and menopause. "These milestones connect me to my mother, my grandmother, and other women who came before me," says Paula Harris, a 58-year-old mother of two. "They're a reminder that, as women, we have special life-giving abilities."

For many women, that reminder keeps them steady when they're in the throes of cramps, nausea, hot flashes, or other hormonal moments. For those whose symptoms require more than happy thoughts, we offer a range of remedies to help you stay in balance, decade after decade.

PMS
Michelle Shaw, 31, gets hit with headaches, bloating, and mood swings a week or two before her period. Her experience is typical: More than 75 percent of women suffer from premenstrual syndrome (PMS), according to the Mayo Clinic. PMS tends to intensify in your 303 and can remain problematic up until menopause, when periods stop (roughly at age 51). No matter what the symptoms — which can include everything from breast tenderness to clumsiness — the cause is elevated levels of estrogen and progesterone. "My symptoms leave me feeling sluggish and less productive," says Shaw. "But once I explain why I'm not feeling well, other women understand completely," she adds.

NATURAL REMEDIES
Diet: By cutting back on caffeine and refined sugar — at least during the premenstrual phase of your cycle — you'll lessen bloating and mood swings. Curbing your salt intake can also decrease bloating.
Exercise: Working out has been shown to ease mood swings. "When you exercise vigorously you release endorphins — natural painkillers that make you feel good," says Susan Kellogg, Ph.D., director of sexual medicine at the Pelvic and Sexual Health Institute at Graduate Hospital in Philadelphia. "Levels of serotonin, an antidepressant that stabilizes mood and gives you a sense of calm, also increase," she adds.
Supplements: Taking calcium daily (a 1,200-milligram supplement or four servings a day of calcium-rich foods such as spinach and fortified juice) along with 400 IU of vitamin D can also help with mood swings and irritability, according to research from St. Luke's-Roosevelt Hospital in New York City.
CONVENTIONAL TREATMENTS
• Oral contraceptives: If you're on the Pill and need help with bloating, your doctor may suggest switching to Yasmin, a brand containing a synthetic hormone called drospirenone that acts as a mild diuretic.

MENSTRUAL CRAMPS
Cramps begin when we first get our periods and tend to decrease in intensity as we age. But some women deal with painful cramps for decades. What causes these uncomfortable contractions? When the egg released by your ovaries isn't fertilized by a sperm, you no longer need a thick uterine lining (endometrium) to support it. So your body releases prostaglandins, hormones that induce uterine contractions to slough off the endometrium. The result: strong cramps for the first day or two of your period.

NATURAL REMEDIES
Heat therapy: Applying a heating pad to the abdominal area will help relax contracting muscles, thus alleviating cramps.
Chaste tree berry: This herb, usually sold in capsule or tea form, can also soothe tight uterine muscles, according to naturopathic physician Holly Lucille, N.D., R.N., author of Creating and Maintaining Balance: A Woman's Guide to Safe, Natural Hormone Health (Impakt, 2004).
Flaxseed: Taking two tablespoons a day of ground flaxseed, a natural anti-inflammatory, can ease cramps.
Exercise: Physical activity produces pain-relieving endorphins.
Relaxation techniques: Although stress doesn't cause menstrual cramps, reducing it through yoga or meditation can help make symptoms less intense.
CONVENTIONAL TREATMENTS
Pain relievers: Over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve) and ibuprofen (Advil), can help quell cramps by partially inhibiting the action of prostaglandins. (You'll still menstruate, but with less pain.) These drugs work most effectively when taken one to two days before the onset of your period.
Oral contraceptives: Some healthcare providers prescribe oral contraceptives for cramps, particularly acute or persistent ones. Since the hormones in the Pill keep the uterine lining thin, there's less tissue to slough off during your period, which means less cramping.
ENDOMETRIOSIS & FIBROIDS
When Jeanine Uribe, 36, stopped taking birth control pills six years ago, she began suffering from severe cramps and migraines, and she noticed breakthrough bleeding every other day. "At its worst, I'd miss work two days out of the month and would just cry," says Uribe. An OB-GYN finally diagnosed her with endometriosis, a treatable condition in which uterine cells migrate and grow on other organs. It can cause scar tissue to build up and — if the fallopian tubes are affected, as they were for Uribe — lead to infertility. Roughly 5.5 million women in North America are afflicted by this painful disorder, according to the National Institutes of Health.

A more common uterine condition is fibroids; these noncancerous growths tend to crop up during the childbearing years. Most women with fibroids have no symptoms, but some experience heavy bleeding, prolonged periods, and pelvic pain.

NATURAL REMEDIES
Bodywork: Some endometriosis and fibroid sufferers have found relief through acupuncture, massage and other forms of bodywork. Uribe makes regular appointments for a gentle abdominal technique known as Arvigo massage. "It has helped tremendously, removing scar tissue and making intercourse less painful," she says. There's no strong scientific evidence proving that bodywork can treat these ailments, but several smaller-scale studies have examined the possibility: A 1994 study of 46 patients with endometriosis showed that Traditional Chinese Medicine effectively reduced symptoms such as pain during intercourse.
Castor-oil packs: Uribe applies castor-oil packs (made from thick, flannel-like material soaked in castor oil) to her abdomen for about 20 minutes five days a week. As the oil absorbs into the skin, it may help relax muscles, reduce inflammation, and improve circulation, says Lucille.
CONVENTIONAL TREATMENTS
Pain relievers: Over-the-counter pain relievers may help with mild endometriosis. However, if you're taking the maximum dosage and are still uncomfortable, talk to your physician about other options.
Pausing your period: By taking monophasic (the same dosage in each pill) oral contraceptives continuously and skipping the placebo pills, you can pause your period. This keeps the uterine lining thin, which helps reduce pain. For fibroids, your doctor may prescribe medication such as gonadotropin-releasing hormone agonists (GnRH-a), which cause hormone levels to fall, stopping your period and shrinking fibroids, which depend on estrogen to grow.
Laser treatments: Lasers can give endometriosis sufferers temporary relief by removing wayward tissue from organs. The tissue can eventually grow back within a few months to a year, says Kellogg.
Surgery: During uterine artery embolization, small particles are injected into the arteries that supply blood to fibroids. A myomectomy or MRI-guided focused ultrasound surgery targets fibroids without disrupting the uterus. A hysterectomy is a permanent solution for fibroids, but since it involves removing the uterus (and sometimes the ovaries, too), it shouldn't be a decision you rush into.
HOT FLASHES
When Dona Day was in her early 405, she started experiencing hot flashes — sudden bursts of heat in the upper body that can strike at any time. "It's a little embarrassing when you're sitting in a meeting, you're the only one who's sweating, and you say, 'Is it hot in here?'" says Day, a 50-year-old mother of two. Hot flashes, the most common symptom of menopause, usually start in your 403 or 505 and continue for about two years. Some women experience hot flashes for longer stretches of time; Day is still dealing with them. Declining levels of progesterone and estrogen are to blame: Your ovaries produce erratic levels of these hormones, starting around age 45, before ceasing production during menopause, which usually happens by age 55. Diane Terhune, 62, began experiencing night sweats — nocturnal hot flashes — in her early 505. Getting a good night's sleep became frustratingly elusive. "I'd have a hot flash and it would take 30 minutes to fall back asleep," she recalls. "Then I'd be up again 30 minutes later."

NATURAL REMEDIES
Diet: Avoid caffeine, a known hot flash trigger, and ask your physician about phytoestrogens. They're plant compounds found in many foods and herbs that act like weak estrogens in the body, says Geoffrey Redmond, M.D., director of the Hormone Center of New York, a medical facility dedicated to the diagnosis and treatment of female hormone problems, and author of The Hormonally Vulnerable Woman (Regan, 2005). Research suggests that tofu, edamame, and other soy products that contain phytoestrogens called isoflavones may help alleviate hot flashes, he says. The herb black cohosh is also rich in phytoestrogens, but research on its ability to curb hot flashes has yielded mixed results, according to a 2006 article in Archives of Internal Medicine. Day says that cooking with soy regularly and taking the over-the-counter supplement Estroven, which contains soy isoflavones, black cohosh, calcium, and B vitamins, helps ease her symptoms.
Deep breathing: According to a 1995 study published in Menopause, the journal of the nonprofit North American Menopause Society (NAMS), women who reported high levels of anxiety experienced five times the number of hot flashes that more relaxed women did. Slow, deep, rhythmic breathing (called paced breathing) helps lower your heart rate and stress levels, reducing the frequency of hot flashes by as much as 50 percent, according to NAMS.
CONVENTIONAL TREATMENTS
Progesterone: Natural (wild yam-derived), low-dose progesterone in a cream form applied to the skin may offer some relief from hot flashes.
Antidepressants: A class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), in particular Paxil, may help reduce hot flashes, says Kellogg.
Hormone replacement therapy: Although Terhune wanted to combat her hot flashes naturally, a string of sleepless nights convinced her to go on Prempro, a low-dose hormone replacement drug. "My quality of life was more important to me than worrying about the effects of the hormones," says Terhune, who also eats healthfully and does yoga daily. Research out of the Women's Health Initiative study showed that taking a combination of estrogen and a synthetic progesterone could increase a woman's risk of heart attack, stroke, breast and uterine cancers, and blood clots. However, "the risks generally apply to older women [the study participants were 50 to 79]," notes Redmond. HRT may be safe for many younger women, he adds, so discuss it with your doctor.
WEIGHT GAIN
Increased belly fat is a common complaint among menopausal women, and estrogen deficiency is at the root of it, explains Erika Schwartz, M.D., author of The Hormone Solution (Warner, 2002). Because carrying excess pounds around the middle is a precursor to heart disease, it's essential to keep this type of weight gain in check.

NATURAL REMEDIES
Exercise: Aerobic activity keeps extra pounds off; it also promotes better sleep, protects your bones, and boosts your mood. Day maintains a healthy weight with regular walking, swimming, and Pilates.
Nutrition: A balanced diet becomes more important than ever because your osteoporosis and heart disease risks increase during menopause. Eat lots of whole-grain foods, vegetables, and fruits, and consume calcium-rich foods or take a calcium supplement to bolster your bones.
CONVENTIONAL REMEDIES
• Hormone replacement therapy: "There's some evidence that women taking hormones have greater lean body mass and less central adiposity — that tire around the middle," says Steven Goldstein, an OB-GYN at New York University Medical Center and author of Could It Be…Perimenopause? (Little, Brown, 2000).

SEXUAL CHANGES
Like most women in their 40s and 50s, when Paula Harris was a few years into menopause, she noticed her natural vaginal lubrication wasn't what it used to be. "It didn't bother me as much as it did my husband — it was uncomfortable for him." Again, declining estrogen is the culprit; the hormone helps maintain the vagina's elasticity and moisture levels. Painful intercourse can put a serious damper on your libido, so it's important to communicate with your partner. But menopause also offers the opportunity to find new ways to connect. For Day and her fiancé, sex has become a deeper, more emotional act. "Making love now is more about how we feel about each other," she says.

NATURAL REMEDIES
Lubricants and moisturizers: Over-the-counter water-based lubricants such as K-Y Liquid and Astroglide as well as vaginal moisturizers can help dryness. Harris now uses a lubricant during sex; Good Clean Fun, Sympathical Formulas, and O'My all make products that are free of parabens (chemical preservatives). Day uses the vaginal moisturizer Replens.
Zestra: Zestra (www.zestraforwomen.com), a botanical oil that's massaged into the genitals during foreplay, helps enhance arousal and orgasm, says Kellogg.
CONVENTIONAL TREATMENTS
Estrogen cream and HRT: Prescription topical estrogen cream, applied locally, can help improve vaginal lubrication and elasticity. Day's physician prescribed Vagifem, a tablet containing estrogen derived from plants that's inserted vaginally to relieve dryness and soreness. HRT yields similar results by raising falling estrogen levels.
Testosterone: Some physicians prescribe testosterone (in pill, cream, suppository, or lozenge form) to improve sex drive, although no preparations have FDA approval yet. A small study published in a 2006 issue of Menopause showed that testosterone patches helped restore libido in women who had reported low sexual desire after undergoing surgery to remove their ovaries. But Harvard Medical School research of more than 70,000 nurses determined that Estratest — a type of HRT that combines estrogen and testosterone — doubles a woman's breast cancer risk. Ask your physician to help you weigh the pros and cons of using testosterone.
"I see my period as a cleansing process. When I get cramps, I drink herbal tea with honey to relax my muscles. Sometimes my period is annoying, but if I never got it, I'd miss it."

— Jessica Gerono, 25

"Being pregnant is a wonderful internal journey. I'm amazed by what my body can do — create and nurture life."

— Vanessa Hylande, 30

"I'm at a point where I'm very comfortable in my skin. When you're accepting of your body, everything else falls into place."

— Nancy Malleo, age 42

"Sometimes I see lines or sags that could be firmer and say, 'Okay, I need to do more exercises/but I'm not neurotic about it."

— Sylvia Pilar, age 55
BABY BOOM

Many women experience a full spectrum of emotions during pregnancy, much of which is related to hormones. "Estrogen and progesterone are at their highest levels," explains naturopathic physician Holly Lucille, N.D., R.N. As a result, you'll notice all kinds of changes, from cravings (Lysa Puma, 34, wanted romaine lettuce and chicken fingers) to a heightened sex drive. "During pregnancy, I had thick, silky hair, strong nails, and bigger breasts, which was wonderful," says Puma. "I also had 'baby brain.' I'd forget to pick up the dry cleaning, and I kept repeating stories," she adds.

As you progress through those nine months, progesterone builds up the uterine lining so it can support the fertilized egg and the placenta, estrogen makes breasts larger and tender, and the hormone relaxin softens the cervix for labor, explains Lucille.

The realization that your body is preparing to bring life into the world can be awe-inspiring. Ellie Rose, 47, an adolescent-medicine physician and mother of two teenagers, was on a natural high while pregnant. "I experienced a sense of miracle every day for nine months," she recalls. Although she was nauseated throughout each pregnancy (which she treated by sucking on hard candies; ginger is also a popular natural remedy), Rose didn't mind. "Every time I felt my baby kick, I'd get excited," she says. "Being pregnant gave me self-confidence and a feeling of peace. I felt connected to everybody. Strangers would touch my stomach, which some pregnant women don't like but I loved. And I bonded with other women who were pregnant — it was like a sisterhood."

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By Rachel Grumman

Photography by Lois Greenfield

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