FOREVER  YOUNG  -  and  Menopause

chapter  six


Although I am often referred to as an "antiaging expert" and often use the term, my goal has never been to minimize the many positive qualities that we gain with age. Optimum health, beauty, and wisdom occur when we embrace the benefits and joys that come with healthy aging. These attributes include the power to learn from past mistakes, helping us to build character, compassion, tolerance, and kindness, as well as enhanced spirituality.

This philosophy defines my approach to healthy menopause and beyond. Even if you have years to go before menopause or if you have experienced this change years ago, you can significantly benefit from the Forever Young strategies delineated throughout this book. We are never too young or too advanced in years to enjoy all of the benefits of supple, youthful skin, a clear mind, abundant energy, and overall good health.

Half  a  Lifetime

After decades of research, designing an effective program to keep us healthy and youthful has been both a labor of love and a labor of necessity. When it comes to healthy menopause, women face unique challenges as well as opportunities. My patients all report that they are responding beautifully by following the anti-inflammatory lifestyle.

Consider this fact: most women now spend one-third to one-half of their lives in post-menopause. The vast majority of women have no clear understanding as to what to expect from their post-menopausal years. They lack the knowledge they need to stay vital and glowing with health and energy.

For those who have read my books and seen my public television specials, you are familiar with the idea that our appearance can be a prime motivator for starting a health program. The good news is that the benefits go far beyond a rejuvenated and more radiant beauty. Taking pride in how you look means taking proper care of yourself. When you do so, your risk of developing such diseases as heart disease, diabetes, cancer, and more is greatly reduced.

Menopause and Healthy Aging

Every day, new studies are published in the fields of health, beauty, and aging that portend a brighter future in which the negative effects of aging on mind and body are greatly mitigated.

Forever Young has not just been about introducing new strategies to reverse many of the debilitating diseases associated with so-called normal aging. As a physician with more than two decades in private practice and a dermatologist who has spent more than twenty-five years studying the aging process, I can categorically state that nothing can compare with untreated menopause as a model for accelerated aging, although high levels of stress and diabetes come very close. Throughout these chapters, I have introduced strategies that help all of us in general, and menopausal and post-menopausal women in particular, avoid the damaging effects of aging. What I have learned and shared in this book will mitigate many of the less positive aspects of aging and menopause—both physically and mentally.

Understanding Menopause

Simply put, menopause is the time in a woman's life when menstrual periods cease, the end of the reproductive phase of a woman's life. During menopause, a woman's hormone production drops below the level necessary to continue her periods. Menopause, a normal, natural part of aging, becomes official when you have gone twelve months without a menstrual period. Menopause occurs when your ovaries no longer produce eggs. That change is accompanied by a concomitant decrease in the hormones estrogen and progesterone.

There are three different types of menopause: natural, medically induced, and what some people refer to as "cold turkey." 

Natural menopause is the result of normal aging. 

Medical menopause is the result of chemotherapy, a hysterectomy, or another medical intervention. 

Cold turkey menopause results from ceasing to take hormone therapy for the treatment of breast cancer or simply ceasing to take hormone replacement therapy (HRT).

Regardless of the type of menopause, the physical transition will dramatically alter a woman's physical appearance if left untreated. At the same time, all organ systems can experience a decline in function. The changes experienced during what can be an emotionally and physically tumultuous period all point to the same conclusion: a rapid and obvious decline.

Perhaps the most devastating part of the clinical picture is the emotional aspect of this event. My patients describe many disturbing symptoms, ranging from simple irritability to wide emotional swings, from prolonged depression to unfounded fears and anxiety. These mental states are often accompanied by many physical changes, including increased thinning of the skin, loss of facial contours, increased lines and wrinkles, increased body fat, loss of muscle mass, decreased athletic performance, decreased bone density, and loss of sexual desire. Symptoms of menopause can include the following:



Weight gain


Loss of libido (sex drive)

Tender breasts

Fibrocystic breasts

Vaginal dryness

Uterine fibroids

Heart palpitations

Fluid retention (edema)


Irritability (mood swings)


Hot flashes, resulting in flushing and redness

Night sweats

Joint and/or muscle pain

Skin wrinkling

Loss of skin tone/firmness   

Loss of skin radiance



Osteoporosis, bone loss, increased risk of fractures

These psychological and physical symptoms indicate measurable physiological changes and accelerated aging. An increased risk of age-related diseases, such as heart disease, including hardening of the arteries, chest pains, and high blood pressure, is among the changes.

Take Heart

After menopause, the risk of heart disease in women becomes comparable to the incidence in men. Even I was surprised to learn that heart disease kills eight times as many women as breast cancer. In fact, as we learned in chapter 2, heart disease is the leading cause of death for woman aged 65 and over. Conversely, only about one-third of women younger than 65 with heart disease die. With proper guidance, especially nutritional and lifestyle guidance, we can significantly decrease this cardiovascular risk.

Since the number of women experiencing menopause is growing significantly, physicians and scientists need to introduce effective therapeutic strategies to ensure that women do not needlessly suffer the debilitating effects of untreated menopause. Note these national and global statistics:

North American Menopause Society, 2000

The median age of onset of peri-menopause is 47.5 years.

In the United States, there are an estimated 41.75 million women over the age of 50.

Most women spend one-third to one-half of their life in post-menopause.

Smoking has been identified as a cause of early menopause.

Natural menopause occurs at the average age of 51.4 years in Western women.

The menopausal transition lasts an average of four years.

In 2000, there were 45.6 million post-menopausal American women; 39.9 million of them were over the age of 51.

International Menopause Society, 2004

Half of all women over 50 will at some time have a fracture caused by osteoporosis.

Menopausal women are up to three times as likely as men to have Alzheimer's disease, and research suggests that menopause may play a significant role.

Recent surveys have found that more than half of all women don't know that menopause is associated with an increased risk of heart disease.

By the year 2025, the World Health Organization estimates, 1.1 billion women will be age 50 or over.

Decelerating the Aging Process

Despite the seriousness of the risks that accompany menopause, we know that we can overcome many of the avoidable illnesses resulting from the accelerated aging associated with untreated menopause. As we have learned in earlier chapters, we can help maintain radiant, healthy, and firm skin; an athletic and toned body; elevated mood; clear, logical thinking; and freedom from memory loss, maintaining the same problem-solving abilities we had in our twenties and a renewed enthusiasm for all aspects of life. Forever Young offers a simple and realistic approach to facing a new and different reality, one that shows you how to experience the joys of continued health, vibrancy, and beauty throughout life.

Menopause is a wake-up call to our own mortality. You will see and feel the negative effects if you don't rise to the challenge; the choice is yours. This goes too for men, who also go through a prolonged and not-so-obvious change, a male menopause known as andropause.

Making the Most of a Major Milestone

Menopause does not have to be a model for accelerated aging. Instead, it can symbolize a milestone in your life, one that motivates you to achieve a new level of health, beauty, wisdom, and spirituality. This is not hyperbole but well-researched, science-based information that can change the way you look and feel as you approach this momentous event on the biological timeline.

Menopause does not mean farewell to femininity and glamour, health and well-being. The Perricone philosophy is firmly rooted in mental and physical health and function. I often tell my patients that radiant health is true beauty. This starts with the foods we eat. In fact, I have discovered that the greatest gift I can give my readers is permission to eat healthful, delicious food. There is no more powerful medium for good or ill than our daily food choices. This simple concept is hugely empowering, because it means that the most effective health and beauty strategies are accessible to everyone, every day.

Reducing Menopausal Symptoms with Diet

I place nutrition, the foods we eat, and the beverages we drink at the very center of the Forever Young program. Regardless of your age, you can and will benefit from following the anti-inflammatory diet. In this book a number of outstanding foods that slow aging and also rejuvenate the body at a cellular level have been introduced. Many of my patients are surprised to learn how much power our food choices wield, and this is particularly evident when it comes to some of the common discomforts that women experience during menopause.

During this time frame a number of health concerns surface, affecting women during this stage of life and into their later years. There is a wide variation of symptoms both among women of the same culture and among women of different cultures. A common link in these differences appears to be lifestyle and diet, although as with most health concerns, genetic factors play a role as well, but a genetic predisposition to a health condition can be influenced greatly by both diet and lifestyle.

***Cultural differences underscore the importance of vegetable consumption in preventing menopausal symptoms. A much lower percentage of Asian women than U.S. women experience menopausal symptoms. For example, for women over 50 years of age, hot flashes are experienced by approximately 75 percent of American women and less than 25 percent of Asian women. This dramatic difference in the occurrence of hot flashes may be attributed to differences in diet. Americans consume a diet much higher in meat and animal fats and lower in vegetables, fruits, and fiber than do Asian women. Due to dietary differences and perhaps higher activity levels as well, Asian women have a lower percentage of body fat than do American women. This contributes to a lower circulating level of estrogen, since fat cells, as well as the ovaries, produce estrogen***

Therefore, a diet high in meat and animal fat that does not come from organic, 100 percent pasture-raised animals and low in vegetables and fiber promotes higher circulating levels of estrogen in premenopausal women. This may result in more noticeable symptoms once the body ceases to produce estrogen. This contrasts with the situation of Asian women, who, because of their low intake of animal fat and high vegetable and fiber intake, have lower premenopausal circulating levels of estrogen. This means that they do not undergo as dramatic a decrease in circulating estrogen levels during menopause. Reducing the intake of animal fats and increasing that of fiber-rich vegetables (which can also help lower body fat), as well as cold-water fish, can help decrease menopausal symptoms by reducing the circulating levels of estrogen prior to the onset of menopause.

That is not all. A diet rich in plant foods provides many other health benefits, including support for digestion and liver function, cardiovascular health, bone strength, energy levels, immunity, vision, and mental function, among others. As you know, the antioxidants in plant foods act as natural anti-innammatories. In that capacity, they are able to ameliorate a great many unpleasant symptoms associated with menopause as well as aging in general.

Fortunately, diet and lifestyle can be adjusted to help reduce, prevent, and even reverse some of the menopausal and post-menopausal symptoms. Though genetics plays a major role in determining the age of onset of menopause, diet and lifestyle are key players in determining the intensity, frequency, and duration of menopausal symptoms. Adopting dietary and lifestyle strategies to help cope with menopausal symptoms will improve overall health, vitality, and longevity. Leading nutrition and medical experts advocate daily consumption of fresh vegetables and fruits as a prerequisite for good health. Fresh vegetables and fruits also contain phytonutrients and phy two chemicals that I believe can help reduce menopausal symptoms as well.


While an anti-inflammatory diet high in vegetables and healthy fats from cold-water fish, olive oil, nuts, and seeds (especially chia seeds) and low in animal fat can help lower body fat and pre-menopausal estrogen levels, vegetables are also a source of certain phy to chemicals known as phytoestrogens that may help lessen menopausal symptoms. Phytoestrogens, chemicals found in hundreds of different plants, have a structural similarity to estrogen. Understanding the role of phytoestrogens in women's health is of particular importance in this chapter because it is a key factor in health and well-being both during menopause and beyond. Understanding the different sources of phytoestrogens and how they work in the body is critical in making the right choices. Supermarkets, drugstores, and natural food market shelves are filled with myriad products from supplements to foods, protein bars, and drinks, directed at women with claims about their targeted health benefits. Unfortunately, many women make choices based on the extensive marketing and advertising that these companies pay for rather than on a clear understanding of the products' mechanism of action.

Mechanism of Action

Phytoestrogens bind to estrogen receptors and may exhibit weak estrogenic or anti-estrogenic effects. Phytoestrogens do not have the same ability that estrogen has when it comes to effecting changes mediated by the estrogen receptor. The small effect that phytoestrogens do have appears to help offset some of the more common menopausal symptoms. These include hot flashes, irritability, mood swings, and sleep disturbances. Studies also suggest that phytoestrogens may play a role in preventing the occurrence of chronic diseases during post-menopause, including coronary heart disease, atherosclerosis, hypercholesterolemia, cancer, and osteoporosis.

Soy and Flaxseed: The Pros and Cons

Both laboratory and clinical studies indicate that phytoestrogens provide health benefits during both menopause and post-menopause. 

These include protecting cardiovascular health by lowering levels of blood cholesterol and increasing the strength and elasticity of blood vessels, inhibiting the onset and progression of cancer, and conserving bone mass. 

In this regard, two major sources of phytoestrogens have been the focus of epidemiological studies: soy and flaxseeds. Soy and flaxseeds have both been reported to reduce the frequency and intensity of hot flashes during menopause. They have also been reported to decrease rates of cardiovascular disease, cancer, and osteoporosis during post-menopause.

Isoflavone phytoestrogens such as genistein from soy and certain lignan phytoestrogens may protect against the possible carcinogenic actions of estrogen by: 

*Inhibiting the production of estrogen by the enzyme aromatase, which is responsible for a key step in the biosynthesis of estrogens.

*Competing at the estrogen receptor level, with either estrogen or xeno- estrogens (industrial and agricultural chemicals such as bisphenol-A and pesticides), which have potent estrogen-like and carcinogenic activities.

Preventing overstimulation of estrogen receptors and providing low-level estrogen stimulation help prevent the negative effects of estrogen while providing a beneficial lower level of estrogen stimulation.

There is somewhat of a catch-22 to this scenario. Some isoflavones from soy may actually increase estrogen activity rather than inhibit it. These opposing effects of different soy phytoestrogens maybe responsible for reports of both negative and beneficial actions of soy on women's health. Using soy is somewhat controversial, and it may be safer to avoid soy and soy-based products.

Estrogen is produced in a series of enzymatically controlled biochemical reactions. Aromatase is a key enzyme that converts testosterone into estrogen. The good news is that, at low concentrations, phytoestrogens have been found to inhibit aromatase activity, lowering estrogen production and estrogen-related changes in the body. At high concentrations, phytoestrogens may mimic the effects of estrogen. Inhibition of aromatase at low concentrations may contribute to the reported anticancer effects of phytoestrogens.

The plant lignans secoisolariciresinol diglucoside (SDG), ma-tairesinol, and pinoresinol in flaxseeds are converted in the colon of humans and other animals into the mammalian lignans enterodiol and enterolactone, which are more potent phytoestrogens than plant lignans. Enterodiol and enterolactone are called mammalian lignans because bacteria synthesize these lignans in the mammalian colon from plant lignans. They are found only in mammals, not in plants.

This is another important reason why we need to keep the natural flora in our colon intact by eating the right foods and supplements that supply both probiotic bacteria, such as that found in plain unsweetened yogurt and kefir, and the fructo-oligosaccharides that the bacteria feed on.

Chia Seeds Versus Flaxseeds

Though almost all research on lignans has centered on flaxseed lignans, there are concerns regarding the content of cyanogenic glycosides in flaxseeds and the potential for oxidation of ground flaxseed powder and flaxseed oil. Chia seed, which contains the same or higher levels of lignans as flaxseed, has no known toxins, is resistant to oxidation (a key point), and may be preferable to soy and flaxseeds as a safe, effective source of phytoestrogens.

Chia Seeds, a Remarkable Superfood

I introduced chia seeds in chapter 3, "The Metabolic Miracle," and reintroduce them here as an important food to eat during menopause. As with any food, especially food eaten specifically for health reasons, it is best to consume those with organic certification. One of the few organic chia seed products on the market is Green Foods organic chia seeds. This is made from organic chia seeds grown in fertile, organic soil in an ideal subtropical climate that provides the best possible conditions for growth and nutrient content, eliminating the need for herbicides, fungicides, or pesticides. Organic chia seeds from Green Foods Corporation also contain many other nutrients, including vitamin E; minerals for hone support; high-quality protein; a perfect balance of omega-3, -6, and -9 fatty acids; and soluble fiber for gentle internal cleansing and digestive support.

Omega-3 s and Hot Flashes

For many years, hormone replacement therapy (HRT) has been the only reliably effective treatment for hot flashes, but unfortunately it may pose real risks. The good news is that the results of a new trial, reported in the Vital Choice newsletter and generously shared here, supports prior indications that omega-3 fish oils may substantially reduce hot flashes.

While several non-prescription treatments—isoflavones and black cohosh, for example—have shown promise in preliminary investigations, none possess conclusive evidence of efficacy. One challenge facing any alternative to HRT is that hot flashes respond to placebo (inactive) treatments more strongly than most medical conditions do.

Accordingly, any proposed treatment for hot flashes has to be highly effective to improve on the very strong placebo effect seen in most clinical trials. 


Dr. Michel Lucas and his colleagues at Quebec's Universite Laval recruited 120 women aged 40 to 55 and divided them into two groups.

When the study started, the average number of daily hot flashes experienced by all of the women was 2.8.

Women in the first group took fish oil capsules standardized to provide one gram of EPA—one of the two key omega-3s in fish oil—every day for eight weeks.

Women in a second, "control" group took capsules containing sunflower oil free of EPA. The women taking omega-3 EPA reported 1.58 fewer daily flashes, compared with only 0.5 fewer flashes in the control group, taking sunflower oil.

The researchers found that the odds of experiencing positive results were about three times greater among those taking EPA than among those taking the placebo. The Canadians did qualify their results, saying their findings needed to be confirmed by a clinical trial specifically designed to evaluate hot flashes in more symptomatic women. What is remarkable about their findings is that the decrease of 1.1 hot flashes per day that they attributed to the use of omega-3s is equivalent to results obtained with hormone therapy and antidepressants.

To conclude, I want to assure you that menopause is not synonymous with loss. Menopause does not have to herald a precipitous decline into old age. It is a time of transition, like adolescence, except now you have the experience and power to move through these changes with grace and serenity. Forever Young has given you the tools to manage your menopause, to reduce, prevent, and reverse some of your symptoms so that you can live life to the fullest.

In the following chapter we will explore the physical and mental revitalization that practicing yoga can produce—just a few simple yoga poses a day will result in wonderful and very visible benefits regardless of your age or physical condition.





Keith Hunt