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menopause... losing your mind?

anxiety disorders
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For those of you women out there who believe you are going crazy; this page says it all....
It's not mental illness although you might think it'll drive you there! What if you're experiencing panic disorder or ptsd and you are also sweating your #$@ off with those wonderful hot flashes for over 10 years?
This scenario describes me!  & I'm tired of it and I have to make some changes! This is what I found out!
kathleen !


what's the scoop?
Dr. Vanda
Discovery Health Online
Often when we hear the word "menopause" we still, even in this modern age, conjure up a picture of a woman completely out of her mind, driving her family wacky with her emotional instability.
We also may envision a sad, pathetic woman for whom life is just about over. And if we happen to be the one who has just hit this phase of life, neither of these images is particularly uplifting.
Luckily, neither characterization of menopause is accurate. Most women don't go thru any "significant & lasting emotional changes" during menopause & if you’re 40 & healthy, you could have another 40 years to live.
That’s a lot of time to fill & many women report that once they make it to the postmenopausal stage of their lives, they feel a sense of renewed energy & potential.

Biology vs. Attitude

Without a doubt there are biologically-based symptoms that go with menopause. And some women experience more of them than others. It isn't true, as some authoritarian physicians of the past would have had us believe, that we're bringing these symptoms on ourselves because of a "neurotic" reaction to the changes that are occurring.

However, complicating these very real symptoms are Western attitudes about aging. In a culture that idolizes youth, menopause becomes a dirty secret.

Educated, sophisticated baby-boomer women, who have always kept up to date with their careers, the latest in child-rearing practices & techno wizardry, may be woefully ignorant about menopause. This seems due to an unconscious denial that this "horrible thing" can ever happen to them.


The ignorance of many physicians doesn't help. When women present with symptoms of menopause in their 30's & 40's, their gynecologists may deny that these symptoms could possibly indicate the onset of menopause since the woman isn't yet 50. The doctor doesn't know that it isn't uncommon for women to have symptoms of menopause many years before 50.

The Stages

There are 3 stages of menopause:

  • perimenopause
  • menopause 
  • postmenopause

This Menopause Guide describes each phase & discusses available treatments to alleviate, or at least lessen, symptoms.

source: click here


Am I there yet?
Discovery Health
The term "perimenopause" is a relatively new one, which has only been in common usage since 1995.
Perimenopause is a time of transition when the ovaries decrease the amount of hormones they produce & as a result, a woman’s periods become less regular.
Despite the beginning of perimenopausal symptoms, actual menopause may still be 5, 8 or even 10 years away.

Age of Onset

Perimenopause usually begins in the early to mid-40s; however, it's possible for it to begin as early as the 30s, or as late as the mid-50s.

Perimenopausal Symptoms

You may have none of the following symptoms, some of them, or all of them:

  • Fatigue
  • Emotional turmoil
  • Memory problems
  • Weight gain
  • Fluid retention
  • Sore breasts
  • Painful intercourse
  • Migraine headaches
  • Irritable bowel-like symptoms or food intolerance
  • Sleep disruptions

More In-depth Discussion of Perimenopausal Symptoms


Fatigue is a common symptom of perimenopause. Many women are already working so hard at careers & running households that when the fatigue of perimenopause hits, they don’t recognize it as a symptom of anything.

Usually, this additional fatigue is due to insomnia, which is caused by the decrease in estrogen in the woman’s system; however, some of this fatigue can also be caused by the decrease in testosterone in a woman’s system that is occurring at the same time.

It's the hormone testosterone that keeps women feeling energized. Once menstruation ceases completely, women often begin to regain their energy & feelings of aliveness.

Emotional Turmoil

Many women experience mood swings during perimenopause. These could be caused by the decreased amount of estrogen in the woman’s system.

Research in Australia indicates that depression is at its worst 2 years after the last menstruation, but starts to lift after that. On the other hand, studies indicate that women are more likely to be depressed in their 20's & 30's than they're during menopause.

Weight Gain

Physical changes in the body include fat shifting from the lower to the central body without increasing the actual amount of overall body fat.

During this time, it's harder to lose weight, but easier to put it on. This is true for both men & women as they age, because of a decrease in the rate of metabolism.

Still, women between the ages of 45 & 50 put on significantly more weight than men, leading researchers to believe that perimenopausal weight gain can be separated from weight gain that is due to aging.

The extra weight actually has an adaptive purpose. The extra fat cells convert androgen into estrogen. They also produce DHEA, an anti-aging hormone. Women with a few extra pounds generally feel better than very thin women.

Painful Intercourse

40 to 60% of menopausal women find that the amount of time & sexual stimulation needed to become lubricated is greater than it was previously.

When they do become lubricated, the amount produced is far less than when they were younger. Decreasing levels of estrogen cause less blood to flow to the vagina, which causes decreased lubrication during stimulation. This decrease in lubrication is what makes intercourse painful.

Migraine Headaches

Migraine headaches have an unusual relationship to the menopausal transition. Some women who have suffered with migraines their whole life find they no longer have them when they reach this phase, while other women who have never had migraines begin to have them during perimenopause.

source: click here



Is it hot in here?

Dr. Vanda

Discovery Health Online

Menopause is the period of time during which the ovaries stop working completely, so that menstruation no longer occurs.

Menopause Symptoms

You may have none of the following symptoms, some of them, or all of them:

  • hot flashes

  • Night sweats

  • Dryness of the eyes, mouth, nose, vagina

  • Pain with intercourse

  • Decreased sexual desire & diminished orgasm

  • Dizziness

  • Migraines

  • Sleep disorder

  • Fatigue

  • Formication (an itchy sensation that feels like insects are crawling under the skin; there is no rash or redness that goes with this sensation.)

More In-depth Discussion of Menopause Symptoms

hot flashes

A hot flash is the most common symptom of menopause. Depending on which source you read, 70 to 85% of menopausal women in America have hot flashes.

A hot flash (called a "hot flush" in Great Britain) is a feeling of heat that comes over the face, shoulders, head & upper torso. It's often accompanied by sweating.

Some women, also may experience rapid heartbeat, nausea, dizziness, anxiety, or a feeling of weakness. A hot flash can last a few seconds or a few minutes. In rare incidences it may last as long as an hour. hot flashes are most common between 6:00 a.m. & 8:00 a.m. & between 6:00 p.m. & 10:00 p.m.

The cause of hot flashes

No one is really sure what causes a hot flash, but the lessened estrogen makes the hypothalamus go out of control. The hypothalamus regulates appetite, sleep cycles, sex hormones & body temperature. Like a thermostat that has been pushed up too high, the hypothalamus, under the influence of the decreased estrogen, raises the body's heat.

In response, the brain sends out a red alert in an attempt to cool down the body. The heart pumps faster, the blood vessels send more blood thru the system & the sweat glands release sweat.

Factors that trigger hot flashes

  • Stress

  • Heat

  • warm clothing

  • warm weather (There are more hot flashes in summer than winter.)

  • hot showers

  • drinking hot beverages (Tea & coffee are especially problematic because of the caffeine.)

  • drinking alcohol

  • certain medications (Sudafed & other over-the-counter sinus remedies that contain the chemicals related to adrenaline, i.e., may be a trigger.)

  • emotional upset

  • an overactive thyroid

  • high blood pressure that is out of control. (Consult a physician to be sure that hot flashes are due to menopause & not to some other underlying cause.)

  • Loss of Sexual (Desire Research indicates that 30 to 35% of menopausal women undergo some loss of sexual interest. This may be partially due to the lack of vaginal lubrication & the resulting painful intercourse. However, it's primarily due to the decrease in hormones produced in the woman's system. This reduction in hormones (both estrogen & testosterone) may also have an effect on orgasm.

Women often find it takes longer to reach orgasm & that orgasm may be reached less often &/or the orgasm may be less intense.

For the majority of women, these changes aren't serious & don't alter the woman's level of sexual pleasure. (For some women, the decrease in intensity actually leads to a deeper, "sexier" orgasm.)


post menopause
Now what?

What's best for me?
Dr. Vanda
Discovery Health Online
On July 9, 2002, the federal government halted a research study being conducted by the Women’s Health Initiative on the effects of HRT, stating that the risks of long-term use of HRT outweighed its benefits.
The study found that women using estrogen plus progestin had an increased risk of coronary heart disease, stroke, breast cancer & pulmonary embolism.

Despite the above findings, there are still some benefits to long-term HRT use that should be noted. These benefits include:

  • A decrease in hip fractures
  • A decrease in colon cancer
  • A decrease in or an elimination of hot flashes
  • A decrease in nocturnal wakefulness
  • An increase in vaginal lubrication

In her best-selling book The Pause, psychologist & sex therapist Dr. Lonnie Barbach states that a Yale University study found 90% of women who had experienced less sexual interest prior to the study “reported an increase in desire and sexual activity after being treated with estrogen for 3 to 6 months.” Barbach doesn't report the sample size of this study.

Natural Hormone Replacement Therapy (NHRT)

NHRT, or bio-identical hormones, work like hormones found in the body naturally. Natural hormones are derived from the yam plant or soybean plant. Unlike synthetic hormones, bio-identical hormones are manufactured to have the same molecular structure as the hormones produced in the body.


When the ovaries stop producing estrogen, they also stop producing testosterone. Testosterone has been called the hormone of desire.

Therefore, if a woman's testosterone level falls below her personal baseline, she'll likely experience a decrease in sexual desire.

Doctors can test the level & prescribe the appropriate amount of testosterone. If the testosterone is going to work, it'll start taking effect immediately. Taking more than is needed will not increase your sexual drive further & too much testosterone produces acne, oily skin & hair.

It can cause hair loss on the scalp & hair growth on other parts of the body. While taking testosterone it’s important to be monitored by physician.


Vitex (chasteberry) tends to balance female hormones. It evens out mood disruptions, gets rid of hot flashes & restores vaginal lubrication. It can also be used for PMS. You can take it as a tincture.

A tincture is an alcohol extract of an herb & is sold in a bottle. The directions on the bottle will state how many drops you should take in a small amount of hot water. Vitex also comes as a tea. The problem with Vitex is it takes 2 to 3 months to begin working & you must take it at least twice a day.

It also comes in pill form, but this takes 6 months to become effective.

Siberian ginseng reduces hot flashes. Like Vitex, it may take a few months to start working.

Skullcap can be helpful for irritability or anxiety.

Passionflower, motherwort & valerian are natural sedatives.

Some sources recommend dong quai to reduce hot flashes; however, others cite research that shows it's no more effective than a placebo.


Avoid or cut down on:

  • Caffeine (including chocolate)
  • alcohol 
  • spicy foods

They can increase hot flashes & cause fatigue.

Increase your intake of:

Soy products, such as tofu, miso, tempeh and soybeans, which are rich in isoflavones. They reduce hot flashes.

Eat small meals: Large meals dilate blood vessels & cause the body to grow warmer.

Cognitive Control Over Mood Swings: There are certain cognitive things you can do for yourself while you're going thru this phase.

First, you can start by being gentle with yourself. You're going thru something real. It isn't "all in your head," so take good care of yourself.

Often, just knowing that your mood is being affected by the decrease in your estrogen levels can put you back in control. Before blowing your cool, take a deep breath, reminding yourself to put your head in charge of your feelings.

Remember that this phase won’t go on forever. Once your hormones have found their new level, you’re going to feel fine again.

It's important, especially during this time, to maintain a good support network with family & friends. Research indicates that women who have a support group they can rely on experience fewer symptoms.


Exercise decreases stress. Lessening stress helps to lessen all symptoms. Exercise is good for mood swings; it increases brain endorphins, blood flow & oxygen in the cells, which makes you feel better. In one study done in Stockholm, Sweden, women who engaged in regular exercise had significantly fewer menopausal symptoms, including less negative moods, when compared with women who did not exercise. Also, doing some form of aerobic exercise three times a week for 30 minutes can prevent insomnia as well as reduce hot flashes.

Maintaining an active sex life also reduces hot flashes. A Stanford research study showed that women who have intercourse regularly (one or more times a week) have fewer or less intense hot flashes.

source: click here


hot flashes...
some older suggestions

No More hot flashes... 10 Ways to Relieve Menopausal hot flashes...

From Tracee Cornforth / about.com / 2003

Menopause & the dreaded hot flashes - it's almost impossible to think of one without the other. hot flashes are probably the first symptom we think of when we think of menopause or peri-menopause (the years before menopause).
Whether you already experience hot flashes, or you're still waiting for your turn, here are 10 tips that can help reduce the severity of hot flashes when they happen to you:
  • Research suggests that soy may have some benefit for reducing hot flashes & other symptoms of menopause. However it's recommended that you get your soy from foods rather than from supplements. Foods that contain soy include:




soy milk

whole soybeans

texturized vegetable protein

soy powder

  • Black cohosh (20 mg to 60 mg 3 times daily) often provides effective relief of hot flashes, as well as other symptoms of menopause including:


heart palpitations:


A German study of over 600 women found more than 80% of hot flashes & other symptoms improved within 8 weeks of beginning treatment with Black cohosh.

  • Natural progesterone cream available OTC, in compounded prescriptions, or as a traditional prescription called Prometrium provides relief for hot flashes & other symptoms of menopause for many women.
  • Taking 400 IU to 800 IU of Vitamin E daily significantly reduces the occurrence & severity of hot flashes & night sweats during menopause or perimenopause & provides an additional benefit of strengthening the immune system & protecting the heart.
  • Effexor is a SRNI and an antidepressant that has been found to reduce hot flashes in women undergoing treatment for breast cancer. Because it works so well for breast cancer patients, researchers believe it may be an option for women who don't want to use traditional hormone replacement therapy during menopause.
  • Exercise at least 30 minutes every day. You can walk, run, ride a bicycle, or do another activity. Just don't exercise within 3 hours of going to bed to help prevent night sweats.
  • Gabapentin is a drug currently used to treat migraine headaches, however the June 13, 2000 issue of Neurology found an 87% reduction in hot flashes among a small group of women who took the drug.
  • Dietary triggers that can start a bout of hot flashes include:




other spicy foods:

If your hot flashes seem to be worse after consuming these foods, try eliminating the offenders & see if the hot flashes subside.

  • Traditional hormone replacement therapy (HRT) that includes estrogen replacement provides relief from hot flashes associated with menopause. Before choosing estrogen replacement therapy, be sure you understand the both the risks & the benefits & how their relevance to your personal medical history.
  • hot flashes are often worse during hot weather. Wear all cotton clothes that allow your skin to breathe & keep a fan nearby during hot weather to reduce the number of hot flashes you experience.

source: about.com


this is my take on that! I take Effexor - I believe it's Effexor XR - if there's a difference & have taken it for 5 years. It doesn't help me at all with hot flashes. Now that's just me, but if you're on Effexor too & you'd like to add your 2 cents - click here - to send me an email about it! I'll post the results here!
The other thing about that from my brain...
I hate to be a baby, but I don't like the taste of soy anything. So I'm going to start this week trying some soy things that I can enjoy. This ought to be interesting!
And then, lastly for this article... I drink my weight in coffee it seems everyday. I did start drinking "half caff" about a year ago when my husband had his heart attack. That's a bit of an exaggeration, but I'm going to switch it over to only one cup in the morning starting tomorrow until I can wean myself off it without dying of a headache. I'm switching to green tea!
kathleen !


Hormone replacement therapy: Benefits & alternatives

Hormone replacement therapy benefits some menopausal women, but there are health risks. Understand the risks associated with hormone replacement therapy, when you should or shouldn't take it, & what other treatments are available.

Until July 2002, hormone replacement therapy had been the standard therapy in the US for treating menopausal symptoms.

Not only did hormone replacement therapy relieve such discomforts as hot flashes & vaginal dryness, it also seemed to protect against several post menopausal conditions, such as osteoporosis & heart disease.

But in July 2002, the Women's Health Initiative - a large, multi-tiered clinical trial sponsored by the National Institutes of Health - reported that hormone replacement therapy actually posed more health risks than benefits for women in the clinical trial. And as the number of health hazards attributed to hormone replacement therapy grew, doctors discontinued routine prescriptions for this popular treatment.

You might be wondering how this shift in opinion over hormone replacement therapy, also known as hormone therapy for menopause, affects you personally.

In some cases, hormone replacement therapy is still your best option for treating menopausal symptoms. In other cases, it's wise to consider alternatives.

A turning point for hormone replacement therapy


Concerns about hormone replacement therapy stem from the results of both the combined estrogen-progestin & the estrogen-alone arms of the Women's Health Initiative (WHI) clinical trial.

Combination estrogen-progestin therapy (Prempro)For women taking the combination estrogen-progestin used in the study (Prempro), researchers found an increased risk of:

In addition, researchers found that women taking combination estrogen-progestin experienced an increase in mammography abnormalities.

The increased number of false-positives - signs of possible breast cancer that ultimately prove inaccurate - was attributed to the increased breast tissue density that estrogen induces. Women on combination therapy should be aware that they may require more frequent mammograms & additional testing as a result of this therapy.

As for quality-of-life measures, such as sleep, emotional health, general health, physical functioning & sexual satisfaction, the WHI found that for women taking combination hormone replacement therapy - most of whom didn't have troublesome menopausal symptoms - combination HRT didn't provide meaningful improvement in symptoms.


Estrogen-alone therapy (Premarin)
For women taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease, as was found with women on combination therapy, but researchers did find a slightly increased risk of stroke.

In addition, researchers found that, as with women on combination therapy, women taking estrogen alone were more likely to have abnormal mammograms than were women not on HRT.

The increased number of false-positives - signs of possible breast cancer that ultimately prove inaccurate - was attributed to the increased breast tissue density that estrogen induces.

Women on estrogen-alone therapy should be aware that they may require more frequent mammograms & additional testing as a result of this therapy.

Some HRT benefits still valid
Researchers did note important benefits of hormone replacement therapy in the WHI study - including a decreased risk of osteoporosis-related hip fractures & colorectal cancer. These benefits were valid for women whether they were taking combination therapy or estrogen alone.

It's all in the timing: Age is an important factor

The WHI's study population consisted of older post menopausal women. Participants were an average age of 63 at the start of the trial. What's less certain is whether the study findings can be applied to younger women, such as women who typically start estrogen early in menopause.

A more complete analysis of data from the estrogen - alone arm of the WHI suggests there's less of a risk of heart disease if you take estrogen early in your post menopausal years.

The data analysis revealed participants age 50 to 59 who took estrogen experienced fewer heart attacks & deaths from coronary artery disease than study participants who took a placebo.

Many questions regarding younger post menopausal women & hormone replacement therapy exist.

To address some of these issues, a randomized, controlled clinical trial - the Kronos Early Estrogen Prevention Study (KEEPS) - exploring estrogen use & heart disease in younger post menopausal women is under way, but it won't be completed for several years.

Who can benefit from hormone replacement therapy?

Despite the inherent health risks, hormone replacement therapy still has a role in treating menopausal symptoms. For some women - such as those who experience moderate to severe hot flashes or other menopausal symptoms - the benefits of short-term therapy outweigh the potential risks.

"The absolute risk to an individual woman taking hormone therapy is quite low & may be acceptable to you depending on your symptoms," says Sharonne Hayes, M.D., cardiologist & director of the Women's Heart Clinic at Mayo Clinic, Rochester, Minn. "Talk with your doctor about your personal risks."

Hormone replacement therapy might still be your treatment of choice if you have:

  • Hot flashes. Hormone replacement therapy is still the most effective treatment for troublesome menopausal hot flashes & night sweats.

  • Vaginal discomfort. Hormone replacement therapy can ease vaginal symptoms of menopause, such as dryness, itching, burning & discomfort with intercourse.

  • Osteoporosis. Hormone replacement therapy continues to be an option for osteoporosis prevention, but it's recommended only when other medications for osteoporosis prevention have been considered & determined not to be best for you.

If you're already taking hormone replacement therapy, should you keep taking it?

If you're already taking hormone replacement therapy to relieve menopausal symptoms, review its benefits & risks with your doctor.

"Consider the reason you started hormone replacement therapy & whether the reason remains relevant," Dr. Hayes advises. "If you started hormone therapy for hot flashes several years ago, you may no longer have hot flashes & could stop taking the drug."

Your doctor may periodically advise modifications to your regimen. For example, if you're taking a particular dose of estrogen, you may be able to lower the dose. Switching from an estrogen pill to a patch may offer certain benefits.

In treating isolated vaginal symptoms, estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That's because estrogen applied directly to your vagina remains localized to that area to treat your symptoms & doesn't circulate throughout your body as does estrogen ingested thru a pill or absorbed thru a patch.

Women on hormone replacement therapy should take the lowest effective dose for the shortest amount of time needed to treat symptoms.

Who should avoid hormone replacement therapy?

Women with breast cancer or a history of blood clots shouldn't take hormone replacement therapy. Also avoid hormone replacement therapy for preventing memory loss, heart disease, heart attacks or strokes.

Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.

Alternatives to hormone replacement therapy

You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you try making changes to your exercise or eating habits before you try medication.

After adjustments to your lifestyle, if you're still dealing with bothersome symptoms, you have several options besides hormone replacement therapy to help relieve discomfort.

soruce: mayo clinic

hot flashes... the year 2007


hot flashes: Minimize discomfort during menopause

You have many options when it comes to managing hot flashes, ranging from lifestyle modifications to prescription medications. Discover what works.

hot flashes can descend on you at any time, leaving you sweaty & red-faced. But they're quite common - as many as 3 out of every 4 women experience hot flashes as they go thru the menopausal transition.

You don't need to seek treatment for hot flashes, especially if you're tolerating them well on your own. If your hot flashes are particularly bothersome, treatment options are available.

But finding the best way to control your hot flashes can take time. Start by asking yourself how hot flashes are disrupting your regular life. Then consider the benefits & drawbacks of the most common remedies, which range from lifestyle changes to prescription medications.

What are hot flashes?

When you're having a hot flash, you might experience:

  • A feeling of mild warmth to intense heat spreading thru your upper body & face

  • A flushed appearance with red, blotchy skin on your face, neck & upper chest

  • A rapid heartbeat

  • Perspiration, mostly on the upper body

  • A chilled feeling as the hot flash subsides

hot flashes vary in frequency - you may have several a day or just a few a week. You could experience full-on sweating throughout the day & night, or you may just occasionally feel warmer than you used to. hot flashes can last as long as 30 minutes, but most subside within a couple of minutes. Nighttime hot flashes - or night sweats - can wake you from a sound sleep.

hot flashes are common during peri-menopause - the period of time leading up to menopause - & tend to peak during the first couple of years after menstrual periods have stopped.

For some women, hot flashes last up to a couple of years. For others, hot flashes may continue for several years or indefinitely.

For mild hot flashes: Start with diet & lifestyle changes

If your hot flashes are mild - you have just a few a day & they don't interfere with your normal activities - you may be able to manage them with lifestyle adjustments.

For example:

  • Keep cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove clothing when you feel too warm. Open a window or use a fan or air conditioner to keep air flowing. If you feel a hot flash coming on, sip a cold drink.

  • Get active. Daily exercise is important during the menopausal years. If you aren't already exercising regularly, now is the time to increase your physical activity & add regular aerobic exercise. With your doctor's OK, try brisk walking - or a similarly vigorous exercise - for 30 minutes or more on most days of the week.

  • Watch what you eat & drink. Hot & spicy foods, caffeinated beverages & alcohol can trigger hot flashes. Learn to recognize your own triggers & avoid those foods or drinks that bring on hot flashes.

  • Relax. Many women find relief from mild hot flashes thru yoga, meditation, relaxation or other stress-reducing techniques. Even if these approaches don't quell your hot flashes, they may provide other benefits - such as easing the sleep disturbances that tend to occur with menopause.

  • Practice paced respiration. Deep, slow abdominal breathing - known as paced respiration - can decrease hot flashes. It takes some practice to perfect the technique, but paced respiration done twice daily or at the beginning of a hot flash can be quite helpful.

    To practice paced respiration, begin by sitting comfortably. Breathe in deeply for 5 seconds, pushing your stomach muscles out. Exhale for 5 seconds, pulling your stomach muscles in & up. Repeat this cycle of breathing deeply in & out until you feel calm & relaxed - for 15 minutes twice daily, at the start of a hot flash, or for a minute or two in the middle of a busy day.

  • Don't smoke. Smoking is linked to increased hot flashes. By not smoking, you may reduce hot flashes as well as your risk of many serious health conditions, such as heart disease, stroke & cancer.

What about dietary supplements?

Dietary supplements some women use to curb hot flashes include:

  • Black cohosh. Black cohosh has been used widely in Europe for treating hot flashes & has been popular among women with menopausal symptoms in the US. While its safety record has been good, there's no longer much reason to believe that it's effective for menopausal symptom relief.

    In a meticulously conducted yearlong clinical trial funded by the National Institutes of Health (NIH) & published in late 2006, black cohosh was found to be no better than placebo for relieving hot flashes. Women with hot flashes were assigned to take black cohosh alone, black cohosh in a mixed herbal supplement, hormone therapy or a placebo (inactive pill).

The women given black cohosh - containing supplements reported the same number of daily hot flashes as did women given a placebo.

  • Soy & red clover. Scientists have observed that women in Asian countries, where soy is a regular part of the diet, are less likely to report hot flashes & other menopausal symptoms than are women in other parts of the world.

One reason might be related to isoflavones - estrogen-like compounds in soy, red clover & many other plants.

However, studies giving soy to women with hot flashes have generally found no benefit. And studies giving selected isoflavones have shown mixed results for menopausal symptom relief.

Isoflavones have some weak estrogen-like effects, so there's some concern about cancer risk. If you've had breast cancer, talk to your doctor before supplementing your diet with isoflavone pills or red clover. Experts generally consider whole foods containing soy or isoflavones to be healthy & safe, when consumed in moderation.

  • Vitamin E. Studies using vitamin E in doses up to 400 international units (IU) daily have found little benefit in relieving hot flashes. Vitamin E is no longer recommended for treating hot flashes.

Take all herbal supplements with a dose of caution. Just because manufacturers claim their products are natural doesn't mean they're safe.

All supplements have potentially harmful side effects - & supplements may interact with medication you're taking for other medical conditions.

Always review what you're taking with your doctor.

For moderate to severe hot flashes: Prescription medication options

If you continue to have troublesome hot flashes despite making lifestyle changes, your doctor may recommend hormone therapy or a different prescription medication.

Estrogen therapy is the most effective treatment for hot flashes, but in rare instances, doctors might prescribe progesterone therapy.

  • Estrogen therapy. If you've had a hysterectomy, you may take estrogen alone. But if your reproductive organs are still intact, progesterone should be taken along with estrogen to protect against cancer of the lining of the uterus (endometrial cancer).

With either regimen, current recommendations are to use the lowest effective dose for the shortest amount of time needed to relieve symptoms.

It's not easy to assess whether the benefits of hormone therapy outweigh the risks in your particular situation - & the frequent revision of expert recommendations hasn't helped.

For most women, short-term hormone therapy is probably less risky than they've been led to believe since 2002, when a large clinical trial of estrogen-plus-progesterone was stopped early due to higher than expected heart disease, stroke & breast cancer rates.

A new analysis of data from the same trial found that heart disease risk, i.e., actually was reduced for women in their 50s who started estrogen therapy within 10 years of the start of menopause.

Still, one group of women - those who initiated hormone therapy more than 10 years after menopause - had increased heart disease rates according to both analyses of the trial data.

If you experience moderate to severe hot flashes & you haven't had blood-clotting problems, breast cancer or ovarian cancer, estrogen therapy may be an option for you. Your doctor can help you weigh the pros & cons.

  • Progesterone therapy. Rarely, as an alternative for women who can't take estrogen, some doctors prescribe progesterone alone to control hot flashes.

Two such medications include megestrol acetate & depomedroxyprogesterone acetate, found to provide some relief from hot flashes among women with breast cancer or at increased risk of cancer.

If you decide against estrogen or progesterone therapy, your doctor may suggest a different prescription medication. There are several non-hormonal medications that can be helpful for reducing hot flashes.

These medications aren't approved by the Food & Drug Administration specifically to treat hot flashes, but they're approved for treating other conditions.

  • Antidepressants. Low doses of certain antidepressants may decrease hot flashes. Antidepressants from classes of medications known as selective serotonin reuptake inhibitors (SSRIs) & serotonin & norepinephrine reuptake inhibitors (SNRIs) - including:

venlafaxine (Effexor):

paroxetine (Paxil):

fluoxetine (Prozac):

citalopram (Celexa):

& others:

have been found to relieve hot flashes in some clinical trials.

Many doctors now consider these antidepressants the treatment of choice if you have troublesome hot flashes & can't - or choose not to - take hormone therapy.

However, these medications aren't as effective as hormone therapy for severe hot flashes & may cause unwanted side effects, such as:



weight gain:

sexual dysfunction:

Talk with your doctor about whether the benefits outweigh the potential side effects for you.

  • Gabapentin. Gabapentin (Neurontin) is a medication approved for treating seizures or pain associated with shingles. It's also increasingly used to treat various other types of pain. Some studies have found that gabapentin is moderately effective in reducing hot flashes.

Side effects can include:




imbalance when walking & swelling

  • Clonidine. Clonidine, a pill or patch typically used to treat high blood pressure, may provide some relief from hot flashes. Side effects such as dizziness, drowsiness, dry mouth & constipation are common, sometimes limiting the medication's usefulness for treating hot flashes.

Re-evaluate your options regularly

Menopause is a natural transition. If hot flashes don't interfere with your life, you don't need treatment. If you choose to take medication or a supplement to help ease your symptoms, periodically re-evaluate your need for continuing it.

For most women, hot flashes fade gradually & require no treatment.

source: mayo clinic

Bioidentical hormones: Are they safer?

Are bioidentical hormones safer & more effective than traditional hormone therapy? They sound like they would be because they're customized to the individual.


There's a lot of interest in bioidentical - or so-called "natural" - hormone therapy for menopause symptoms.

However, there's no evidence that bioidentical hormones are safer or more effective than standard hormone replacement therapy.

Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body.

These prescription & over-the-counter products are marketed as being tailored to a woman's individual hormone needs, typically determined thru saliva hormone testing.

Manufacturers claim that bioidentical hormones are safer than standard, FDA-approved hormone therapy.

According to the North American Menopause Society (NAMS), custom compounds may provide certain benefits, such as individualized doses & mixtures of products & forms that aren't available commercially.

However, they may also pose risks to consumers. These compounds haven't been approved by the Food & Drug Administration (FDA) & as a result haven't been tested for purity, potency, efficacy or safety.

These products may even contain unknown contaminants. For this reason, NAMS doesn't recommend these custom-mixed products over well-tested, government-approved commercial products for the majority of women.

Also, bioidentical estrogen & progesterone are available in FDA-approved hormone therapy products, including:

  • Estradiol, such as Estrace, Climara patch & Vivelle-Dot patch
  • Natural progesterone (Prometrium)

These products come in many different doses & forms. So, you don't need to turn to unregulated, individually compounded products as your only source of "natural" hormones.

source: mayo clinic

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