Hormone Repair Manual Lara Briden

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 About Hormone Repair Manual

‘The book my patients have been waiting for.’ Dr Peta Wright,

gynaecologist and women’s health advocate

The Hormone Repair Manual is a must-have guide to understanding and

overcoming the symptoms of perimenopause and menopause.

Naturopath Lara Briden, author of the international bestseller Period Repair

Manual, has more than 20 years’ experience in women’s health. Her fresh
approach aims to overturn the stigma of perimenopause and menopause and
show women that:
• many symptoms are temporary and manageable
• emotional challenges can present an opportunity to thrive
• a focus on health during this period can bring benefits for years to
come.

Addressing common symptoms such as hot flushes, insomnia, mood

changes, migraines, weight gain, low libido and heavy periods, Lara offers
practical solutions of diet, lifestyle, nutritional supplements and tips for
how to speak to your doctor about hormone therapy.

The Hormone Repair Manual is backed by evidence-based research and

case studies and is a reassuring guide to soothing, nourishing and
strengthening your body, mind and spirit during this time of change.
Contents

Cover
About Hormone Repair Manual
Contents

Introduction

PART ONE: Understanding perimenopause and menopause

1 Hormone revolution: why everything is different after second
puberty
2 Stigma, freedom, grief and everything in between
3 Cycle while you can: the value of natural, ovulatory menstrual
cycles
4 The hormonal and physiological changes of second puberty

PART TWO: Treatment

5 General maintenance for perimenopause and beyond
6 Menopausal hormone therapy (MHT)
7 Rewiring the brain: help for hot flushes, sleep, migraines, memory
and mood
8 Bodily issues: weight gain, thyroid disease, allergies, and aches and
pains
9 Estrogen rollercoaster: crazy heavy periods and breast pain
10 What comes after

Resources
Suggested supplements brands
Glossary
References
Index
About Lara Briden
Also by Lara Briden
Copyright page
To my patients
Introduction

Welcome to Hormone Repair Manual, your guide to healthy hormones after

40.
If you read my first book Period Repair Manual, you know how
passionate I am about women’s hormones and periods. In fact, you could
say I’m a cheerleader for women’s hormones and all the benefits that come
from natural menstrual cycles.
With this book, I’m equally passionate about the final few years of
periods called perimenopause, and the years after periods called
menopause. I didn’t include the word perimenopause or menopause in the
title because I didn’t want you to think, ‘Oh, this book doesn’t apply to me’,
when in fact, if you’re 40 (or even close to 40), then it very much does
apply to you.
Why am I so passionate about perimenopause and menopause?
First, because it’s happening to me. I’m 50 at the time of writing and
have started having long gaps between periods and forgetting where I
parked my car. I’m also discovering a new feeling of cheeky independence,
which I’ll explain more in Chapter 2 and which I had heard about from
patients but never really understood until it happened to me.
The second reason I’m passionate about perimenopause and menopause
is that I’m eager to shine a light on how normal and okay it is. I’m doing so
in response to an unofficial survey I conducted on my social media pages
where I asked, ‘Are you afraid of menopause?’ and 64 per cent of women
responded, ‘Yes’. In the comments, they described being frightened of
symptoms, which is understandable, but also of being frightened of the
stigma of menopause, which is also understandable, but sad. How can
society still attach such stigma to a normal natural process that happens to
51 per cent of the population?
We’ll tackle stigma in Chapter 2, where I’ll offer what I hope are a few
new angles on the whole thing. I’ll also invite you to view menopause as a
separate process from aging, which is accurate, because, although
perimenopause happens alongside aging, it’s actually an independent
process that is more akin to second puberty. We’ll explore the concept of
second puberty in Chapters 1, 2 and 4 and I’ll present the argument that,
from an evolutionary perspective, menopause may actually have evolved as
a beneficial adaptation to give rise to a longer human lifespan. Viewing
menopause as a beneficial adaptation is just one of several ways to find
meaning in the process and see beyond the common narrative that
menopause is just an accident of living too long.

How to use this book

The first four chapters are all about understanding the process of
perimenopause, both emotionally and biologically, including a discussion of
the importance of regular ovulation. If it seems strange to learn about
ovulation just as you’re about to stop ovulating forever, consider that
‘stopping ovulation’ is the cause of most symptoms that might arise. To
understand symptoms and how to treat them, you need to start by
understanding ovulation.
The final six chapters of the book are all about treatment. Drawing on
the latest research and my own twenty-five years’ working with patients,
I’ll provide nutritional and hormonal treatment strategies for symptoms
ranging from heavy periods to weight gain to anxiety and night sweats.
We’ll begin with a General maintenance chapter about the nervous system
and diet and then move into a full discussion of hormone therapy before
surveying each symptom individually and how to treat them with both
conventional and natural treatment options.
Start by reading the book from cover to cover, because there are
essential topics nestled within each chapter. For example, Chapters 5 and 8
provide a detailed description of insulin resistance or prediabetes, which,
for reasons that will become clear, is crucial for almost every part of the
perimenopause and menopause story. Chapter 7, the ‘brain chapter’, is
where you’ll learn about hot flushes, and Chapter 10 is where we’ll discuss
long-term concerns such as vaginal dryness, cognition and bone health.

Special boxes
Throughout this book, you’ll encounter definitions, tips, patient stories and
special topics.

DEFINITION
Definition boxes provide simple explanations for any technical words. You
can also find these explanations in the Glossary at the end of the book.

TIP
Tips are extra bits of information you may find helpful.

PATIENT STORIES

Patient stories are fictionalised stories based on my real patients, with names
and some details changed.

SPECIAL TOPIC: EXPLORE IN MORE DETAIL

Special topics to provide you with extra, in-depth information.
 How to speak with your doctor sections
At times, you’ll need your doctor’s help, either for diagnosis or
treatment, and I want your doctor–patient conversations to be as
productive as possible. Towards that goal, I have provided short How
to speak with your doctor sections, which are lists of statements and
questions to assist in communication about topics such as How to
speak with your doctor about progesterone for heavy bleeding.

Are the recommendations evidence-based?

For all the diet, lifestyle and supplement recommendations, I have provided
a reference to a scientific study whenever possible. That amounts to more
than 350 studies to support many of my recommendations. When I have not
provided a reference, it’s because research was not yet published on that
topic, such as for some of the herbal medicines, as well as for concepts like
the role of mast cell activation and histamine in perimenopausal mood
symptoms. I hope that scientists will one day study those treatments and
concepts, but in the meantime, I want you to have the benefit of them. If
that means being ahead of the curve of scientific inquiry, then so be it.
More importantly, my recommendations are based on the success of
thousands of my patients. Most are simple and safe to try, and when there
are precautions, I list them. I also ask that you speak with your doctor or
pharmacist about possible interactions with your medical conditions or
medications, or if you are pregnant or breastfeeding. Always cross-check
the labels or packaging for precautions and dosage instructions. To assist
you, I’ve provided a list of Suggested supplements brands on page 308, but
I have not been paid to mention any product or brand name. At the end of
the day, you should choose the supplement that is available to you and is
not too expensive.
 Chapter 6 is a big discussion of menopausal hormone therapy and is as
up to date as I could make it, given the evidence is constantly changing
from ‘hormones are good for prevention’ to ‘use them only for symptom
relief’ and back again. My observation is that estrogen and progesterone
therapy can be helpful for some things, so I’ll survey the latest research and
consensus and share the experiences of my own patients.
In the book in general and the hormone therapy chapter in particular, I
have drawn on the research and writing of my colleague Professor Jerilynn
C. Prior, who is a Canadian endocrinology professor and the author of the
perimenopause book Estrogen’s Storm Season: stories of perimenopause.
Professor Prior is a huge advocate of the benefits of progesterone treatment,
either as a companion to estrogen or on its own and you’ll encounter her
quotes and protocols throughout the book.

My education and background

My first degree was a Bachelor of Science (BSc) from the University of
Calgary, where I published my honours thesis as a scientific paper on the
foraging behaviour of male and female bats. That work in evolutionary
biology was the beginning of my love of science and the natural world, and
has informed the way I work with patients. For example, I view the body as
a logical, regenerative system that knows what to do when it’s given the
right support with nutrition and natural treatments.
After my biology degree, I went on to qualify as a naturopathic doctor
(ND) from the Canadian College of Naturopathic Medicine (CCNM) in
Toronto, Canada. It’s one of seven accredited colleges of naturopathic
medicine in North America: two in Canada and five in the United States.
The first two years of training are similar to conventional medical
programs, while the final two years provide hundreds of hours of training in
nutritional and herbal medicine, as well as clinical training in an outpatient
clinic. After graduating in 1997 under my maiden name, Lara Grinevitch, I
was certified by the Naturopathic Physicians Licensing Examinations
(NPLEX), which are professional licensing exams administered by the
North American Board of Naturopathic Examiners (NABNE).
My first five years of practice were in Pincher Creek, Alberta, Canada,
in the 1990s, which was an interesting time to be a natural doctor because
even basic things like probiotics were viewed as strange. ‘Good bacteria?’
said one colleague. ‘How ridiculous!’ The 1990s were also a somewhat
scary time for women’s health. Many of my patients were being treated
with high-dose birth control pills, routine hysterectomies, and an old style
of hormone therapy called Premarin®. As I strove to find better solutions for
my patients, I discovered that natural treatments yielded even better results
than I had been taught to expect. For example, diet and supplements worked
for many symptoms such as hot flushes, and body identical hormone
therapy (then called bioidentical) was a viable and safe alternative to the
conventional hormone replacement therapy or HRT. This treatment is now
known as menopausal hormone therapy or MHT.
Fast-forward twenty-five years and body identical hormone therapy has
become the standard hormone therapy recommended in most conventional
settings, such as your GP’s rooms. The switch to body identical treatment
took longer than I expected, but it did finally happen, and means you now
have easy access to ‘natural hormones’ as one of several options your
doctor might routinely prescribe. To be sure you do get the safer and more
natural type of hormone therapy, see the full discussion in Chapter 6.
After practising in rural Alberta, I moved to Sydney, Australia, where I
had consulting rooms for nearly twenty years before finally settling in
Christchurch, New Zealand. I currently live in New Zealand but commute
to Australia to deliver presentations and occasionally touch base with my
Sydney patients.
I’m a member of the Scientific Advisory Council for the Centre for
Menstrual Cycle and Ovulation Research, founded by Professor Prior in
2002 at the University of British Columbia, and the Endometriosis Special
Interest Group (ESIG) of Endometriosis New Zealand. I also sit on the
editorial board of Vital Link, the official journal of naturopathic medicine of
the Canadian Association of Naturopathic Doctors.
 To my thousands of patients over the years, thank you for entrusting me
with your health and stories. I dedicate this book to you.

Lara Briden
Part One

Understanding perimenopause and

menopause

‘Nothing in life is to be feared,

it is only to be understood.
Now is the time to understand
more, so that we may fear less.’

Marie Curie
1

Hormone revolution:
why everything is different
after second puberty

If you’ve picked up this book, it’s because you feel that something is
changing with your body and maybe with your life.
You’re not imagining things. By your late thirties or early forties,
something is changing with your body and, more particularly, with your
brain, and it can feel bewildering, frustrating and liberating all at the same
time. The change is not a single event, but a process called perimenopause,
which is the two to twelve years before your periods stop. Perimenopause is
different from menopause, which is the life phase that begins one year after
your last period.
This book is about both the process of perimenopause and the life phase
of menopause, which together could comprise more than four decades.
What do you need to understand about this important new chapter in your
life?
First, understand that symptoms (if you experience them) are likely to be
temporary. Not all perimenopausal symptoms are temporary but many are,
and knowing that will prevent you from thinking, ‘Oh, my goodness, this is
how I’m always going to be now’. It’s not how you’re always going to be;
this too shall pass.
Next, understand that perimenopause is not just chaotic ‘hormonal
fluctuation’, but a sequence of events, beginning with low progesterone
paired with temporarily high estrogen, and concluding with low estrogen
and some significant changes to insulin metabolism. Perceiving the process
as a sequence of describable events will help you to find the right treatment.
Finally, know that perimenopause and the early years of menopause are
a critical window for health, and that’s true even if you don’t have
symptoms. By critical window, I mean a sensitive period or inflection point,
during which time small health problems could, if not addressed, amplify
into larger and more permanent health problems later in life. The good thing
about an inflection point is it also gives you a window of opportunity to
make small changes that could pay huge dividends for your future health.
So there we have it:

Many symptoms are temporary.

Perimenopause is a sequence of events.
Perimenopause and the first couple of years of menopause are a critical
window for health.

Let’s now explore those concepts in detail.

Perimenopause is second puberty and is

temporary
Perimenopause is not about aging. If you’re 35 or even younger, then
you’re clearly still young. And even if you’re 50, perimenopause is
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