Menopause is defined as one year without a period. However, menopausal symptoms can begin to develop 5 to 15 years before the onset of menopause. This is called perimenopause. During this time your estrogen levels begin to decrease. This lack of estrogen creates a constellation of signs and symptoms including hot flashes, vaginal dryness, mood swings, libido changes, sleep disturbances and more.
One of the most troubling symptoms of menopause or perimenopause is hot flashes. Hot flashes are a sudden sensation of intense heat, which causes the face, neck, or upper body to become flushed and sweaty. A hot flash can last 30 seconds to 5 minutes. A hot flash during the night often requires that you change your night clothes as they are all wet.
How do we treat these debilitating symptoms? There are 3 options: Do nothing and live with them, treat them with prescription medications, or treat them with herbal preparations.
Pharmacologic or prescription medicine for the management of hot flashes consists of hormonal and non-hormonal options. The hormonal option is estrogen and it can be taken as a pill, a patch or a cream. This is successful in relieving 99% of hot flashes. It is the most effective treatment. Its major disadvantage is that it may cause blood clots, or increase your risk of certain cancers, including breast cancer. It is generally a safe option for the first 5 years following menopause.
The most common non-hormonal treatment for control of hot flashes is antidepressants. These medications can decrease the number of hot flashes by approximately 80% and they are well tolerated. Their major side effect is loss of libido. These are other prescription medications such as blood pressure pills, migraine medications, and antihistamines, which have small success rates.
For patients who prefer a natural alternative, there are multiple herbal preparations, which can decrease hot flashes. The Chinese herbs like Black Cohosh and Dong Quai have been studied the most. While the data is conflicting, there still is a large body of evidence, which suggest that these herbs may improve hot flashes. Isoflavones and soy are plant-derived substances called phytoestrogens. These herbs appear to “mimic” estrogen and appear to reduce hot flashes. There are multiple studies showing improvement of hot flashes and other menopausal symptoms while taking soy isoflavones. Other herbal products, which seem to help include yams and red clover.
The ultimate decision on the correct treatment varies from woman to woman. It is important that you discuss the side effects, the risks and the benefits of each class of treatment and decide the best treatment for you. There are many health professionals and knowledgeable people who can help guide you through this process.
For more daily health enhancing tips please stay plugged into to this blog and follow us on Twitter @Miami_Nutrition
-Dr. Robert Feldman M.D. – Obstetrics and Gynecology