Decades ago, menopause used to be referred to in whispers as The Change. The mystery surrounding the event gave it a sinister aura. Now, though, more than 5,000 women enter menopause every day in the United States.721 That’s because the baby-boom generation is aging. We are not a bashful bunch, and female boomers have brought menopause out in the open. Women refer to hot flashes, somewhat jokingly, as power surges. But few women relish them. Most would like some way to ease this symptom, even if it is the consequence of a perfectly natural biological process.
We ought to begin with some explanation of menopause. Most people know this refers to the time when a woman’s ovaries stop making the hormones that support the ripening and release of eggs. It is a gradual process that may be spread out over years, perhaps even a decade, and is properly referred to as perimenopause. Menopause itself is technically just one point in time: the day when an entire year has passed since the end of a woman’s last menstrual cycle.722 The average age on this day is 51 years, but women may be as young as 40 or as old as 58 and still be within the normal range for menopause.
Just as the timing of this change in ovarian function differs from one woman to another, so do the timing and intensity of menopausal symptoms (yes, we should be calling them perimenopausal symptoms). Some women barely notice a hot flash or two. We’ve even spoken with women who had “cold flashes” rather than hot flashes. Others are distressed by intense heat waves that may plague them daily for years. Most fall between those extremes but would still welcome some respite from the sweating, the flushing, and the distracting feeling that they might spontaneously combust. (Not to worry–that has never happened!)
“I hope you can recommend something for my wife, who feels like she is about to burst into flames. Her doctor suggested Premarin, but she refuses to take it because she is worried about the increased risk of breast cancer. What other options are there?”
If it is any comfort, this period of discomfort lasts about 4 years, on average. That means, though, that some women zip through it much more quickly, whereas others take longer, sometimes much longer, to get through to relief.
Although menopause is a natural process, hot flashes and night sweats can be bothersome. Vaginal dryness also may be uncomfortable. The ideal treatment for these symptoms should be used at the lowest effective dose for the shortest possible period of time, since most symptoms will eventually fade away on their own.
Here is an overview of our recommendations.
- Keep cool by turning down the thermostat and wearing layers that can be easily removed if you start to sweat. A tall, cool (nonalcoholic) drink is less likely to trigger a hot flash than a steaming cup of coffee.
- Keep exercising to minimize your hot flashes and help you sleep. Then follow up with relaxation and deep breathing.
- Try Remifemin. Black cohosh can help with hot flashes if they are not too extreme.
- Eat moderate amounts of soy products with isoflavones. They may help reduce hot flashes.
- Take vitamin E capsules. Up to 400 IU daily should be safe and might help.
- If nothing else helps with the hot flashes, try hormone replacement therapy at the lowest effective dose for the shortest possible time. Transdermal estrogen might be worth considering.
- An antidepressant such as Paxil (paroxetine), Effexor (venlafaxine), or Prozac (fluoxetine) may calm hot flashes even if you are not depressed. Don’t take any of these drugs for longer than you need them; you may need help getting off them.
- The antiseizure drug Neurontin (gaba-pentin) may ease hot flashes and does not have the same risks as hormone replacement therapy. Do not stop this drug suddenly, though, since that could trigger withdrawal symptoms.
- Vaginal dryness may respond to olive oil, almond oil, or the oil from inside a vitamin E capsule.
- Corn Huskers Lotion or Albolene offers slippery lubrication for sexual relations.
- For more natural lubricants, try the gel from a broken aloe vera leaf or Sylk, which has kiwifruit extract.
- Estring is the most convenient form of vaginal estrogen. The need for Estring should be reevaluated every 3 or 6 months so you won’t use it for longer than necessary.
