 We think that one of the reasons menopause happens is that there's a by-date on the eggs in your ovary and those eggs were formed, believe it or not, literally when you were developing as a fetus and you were born and you carry those eggs throughout the rest of your life. And those eggs unfortunately age as you age. And the DNA damage to those eggs can accumulate. That's why many of you know that if you get pregnant in your late 30s and early 40s, you may get genetic testing of your fetus to make sure that it doesn't have a genetic defect, for instance, like down syndrome. So we think that the reason menopause happens is to keep you from having a potential child with significant genetic damage. Now men in general, we make new sperm forever. And one of the reasons that men can still foster children in their 80s, even 90s in some cases, is that we're not born with our sperm supply. We constantly regenerate, make new sperm. So it's probably a protective mechanism to keep children being born with severe genetic defects. And the way to stop that is simply to have you stop cycling estrogen and progesterone. So it's not a bad thing. It's not a horrible thing. It's just a way to prevent you from having babies. Now, there's a lot of interest in, okay, do hormones keep us healthy? Do they keep us young? That's a very, very, very controversial subject. And let me say this about how I approach this in my practice. There's evidence from the women's health study and evidence from Europe in particular that in the perimenopausal period, the time when your periods are becoming different, where you're maybe having intermittent periods, you still have some estrogen and progesterone levels that are measurable, that hormone replacement, primarily topical estrogen, and you can, believe it or not, swallow progesterone safely. But please, whatever you do, do not swallow an estrogen-containing compound. It probably is safe. You probably have a three to five-year window where starting hormone replacement may be safe. Now, I use the word maybe because, quite frankly, the long-term studies are not there. Now, when I say safe, what does that mean? The worry about continuous estrogen and progesterone treatment as we age is that up until menopause, you always cyclically had periods of high estrogen, then low estrogen, high progesterone, then then low progesterone. And you never had a period in your life where you had constant levels of estrogen and progesterone. And the lining of your uterus and your breast tissue and your ovaries are never accustomed to continuous stimulation by estrogen and progesterone. So that's the caution with all that. There's even a interesting protocol based out of Santa Barbara, where one of my offices is, that uses cyclic estrogen and progesterone therapy with about a 10-day cycle per month where you stop both of those. It's called the Wiley protocol. I know Ms. Wiley and it's a fascinating idea. One of the problems with that protocol is that most women will have a period once a month, even in their 50s, 60s, and 70s. And many women don't want to do that. But in terms of physiologically how to use estrogen and progesterone, it actually makes a lot of sense. Now, on the other hand, many women come to me in their 60s or 70s and they've heard that estrogen and progesterone and testosterone is going to keep them young. There's actually very little evidence that that will occur. And in fact, there is unfortunate more evidence that the exact opposite may occur. That estrogen late in life can actually promote bone loss, can actually promote cancer, and can promote cardiovascular disease. The main three reasons why women are told to use hormone replacement. So as a general rule, and I'm not giving medical advice here, if you're thinking about hormone replacement and you're in the perimenopause period, that's the appropriate time to discuss this with your physician. If you're later than the perimenopausal period, if you've been in menopause over five years, in general it's probably not time to start hormone replacement. Now, does the plant paradox help with perimenopause? The answer to that is fairly complex, but a lot of the compounds that I recommend people eating in the plant paradox have definitely been shown to help with menopausal and perimenopausal symptoms. And one of the best examples is actually flax seeds. Flax seeds are actually in several of my products. And flax seeds contain estrogen-like compounds that can substitute for estrogen with an important proviso. They are not estrogen per se. And many people, particularly if they have breast cancer or varying cancer, are told, please avoid flax seeds because they have estrogen in them. Well, in fact, that's absolutely contrary to the evidence. Flax seeds and the estrogen-like compounds in flax seeds actually block the estrogen receptors in cancer cells. And there's several clinical trials that show that eating ground-up flax seeds, a tablespoon or more a day in women with breast cancer, improve breast cancer survival. So please don't be afraid of the estrogen in flax seeds. They're going to really help a lot of women get through this time period. Now, pomegranates, pomegranate seeds and pomegranate juices have a number of estrogen-like compounds. And if you are going to take one supplement or eat one fruit to help you get through menopause, definitely consider flax seed oil and flax seeds and pomegranate seed oil or pomegranate seeds themselves. They're available right now. The fall is the best way to get them. But you can actually take pomegranate seed extracts throughout the year. There's several companies that make pomegranate seed oil and pomegranate powder. The other opportunity is that most yams, now I'm not talking sweet potatoes, but actually yams, how do you tell the difference between a sweet potato and a yam? Yams in general are the long, ugly, skinny ones. And they're usually pale flesh. Most sweet potatoes are the bigger, rounder ones that usually have an orange flesh. Now in the supermarket, they're often mislabeled. The sweet potatoes are often labeled yams, and the yams are often labeled sweet potatoes. So as a general rule, if it's ugly and it's white inside, it's probably a yam. Yams have estrogen-like compounds that also block the estrogen receptors on cancer cells. You can actually use wild yam cream or just make a habit of eating yams, and you'll get these estrogen-like compounds to help you through the perimenopausal period. Finally, there's a really great oil called borage oil. Now, borage oil has several interesting compounds that will get you through the perimenopausal period. You'll see a lot of these compounds advertised in magazines, but borage oil of all the different oils that you'll see advertised has the highest amount of these compounds. And borage oil is actually very cheap. It's convenient. And the dosage is 1,000 milligrams. They usually come in 1,000 milligram capsule and take two a day. And that's another great way to get these estrogen-like compounds into your system without the fear of estrogen. Now, everybody knows about what's happening in perimenopaus. You usually have hot flashes. You can have mood swings. Many women notice that their sex drive may diminish. Obviously, vaginal dryness and hand dryness is a big deal for many women. There are many ways to avoid these problems, including using flax seeds and borage oil and pomegranates and wild yam creams. There are even vaginal wild yam creams that can be used for vaginal dryness. Believe it or not, lubricants are perfectly appropriate to use at this time. There are prescription vaginal suppositories of estrogen-like compounds. Be careful with these. I see a lot of women who think they're supposed to use one of these vaginal suppositories every day. And unfortunately, they don't know that you will absorb estrogen through your vagina if you use them every day. On the other hand, it's usually safe, and I track this in all my female patients. If you use them every day for two weeks when you're first starting and then go to twice a week thereafter, you'll stimulate the vaginal mucosa enough to have lubrication, but you will not absorb estrogen for the most part. And even if you do that, make sure your physician or your nurse practitioner or physician assistant is tracking your estrogen levels whenever you're using these. Finally, I'm going to make an editorial comment about getting pellets for testosterone, estrogen, and progesterone. Let me please ask you not to do that. And I ask you having looked at thousands of women who've gotten these pellets. I see some women with testosterone levels, the level that we see in men, and they're growing hair and they're aggressive. I see some women who have estrogen levels higher than would be normal and they're continuing for months at a time. These are uncontrollable once you get them inside of you. It's much easier to topically use estrogen, progesterone, and testosterone if you and your physician decide to do this. But please avoid the pellets at all costs. I've seen too many examples of damage done with pellets that can't be reversed. And that's an editorial comment from me. Again, I'm not giving medical advice, but please be cautious with pellets. So that's how to get through this. Is there one food that you should be eating? I think if I want to get you through menopause properly, yams are really one of the ways to do this. And interestingly enough, as you'll see in the longevity paradox, one of the foods that are going to be most useful for you for maintaining vitality late into life is the use of yams and tubers and fungi like mushrooms. In fact, I'm having some mushroom tea right now. And these compounds have been shown in animals and humans to make you die young at a ripe old age.