Kiss Hot Flashes Goodbye
BY MARGARET NACHTIGALL, M.D.
Some women experience hot flashes form their 40s well into their 60s. What percentage of women have this experience and is there anything outside of HRT that reliably makes a difference?
Hot flashes are really the hallmark of menopause and are the most common symptom women experience during menopause. There was a recent practice bulletin for physicians published by the American College of OBGYN and they said that approximately anywhere from 60-82% of women will experience hot flashes during a natural menopause. So, they are a very common symptom of menopause. Therefore, many women experience hot flashes. Women vary on the age they enter menopause, the average age is 51, but can range from 45 to 55 and many women will start experiencing hot flashes in their 40s.
There are definitely many treatment options for women who are experiencing hot flashes. One of the most common and effective treatments that alleviates hot flashes is estrogen, or hormone therapy. Estrogen can make a huge difference in lowering the number of incidents of hot flashes. Some women do not want to take hormone therapy (HT) or cannot because it is contraindicated for them. For these women, there are non-hormonal options, including prescription medication as well as over-the-counter products that can be helpful.
There is increasing evidence that the antidepressant agents SSRIs and SSNRIs are effective for the treatment of flushes associated with menopause. Gabapentin and Clonidine have also shown some benefit in decreasing hot flashes during menopause.
Over-the-counter options are also available to aid in the treatment of hot flashes. Femarelle is an excellent non-hormonal option for women It is made from an extract from soy, DT56a, but is not soy, combined with flax and other ingredients. When taken by women, it binds to the estrogen receptors and so the body thinks there is estrogen, but there is not. It can really make a difference in reducing hot flashes and alleviating a lot of the symptoms that go along with menopause, so this is an attractive option for many women. Relizen is another OTC product which has shown promise in reducing hot flashes. I recommend that women discuss options with their physician to see what is best for them. No two women are the same and individualized care is ideal when choosing the right help for menopause.
Do diet and exercise play any real part?
I really feel like a healthy diet and exercise plays a role in everything. I’m a huge proponent of getting some exercise, even if it is a small amount every day. You really do see that a healthy diet which has enough protein and has good amounts of vitamin D makes a difference. Exercise certainly has been shown to improve overall health; better for the heart, better for the brain and may have some effect on reducing hot flashes. Exercise and diet definitely play a role and definitely improve your health.
Why do some women suffer while others never experience a hot flash? What is the physical explanation for that?
Women are all so different. We still don’t 100% understand the mechanism of a hot flash, but when women go into menopause, or when their estrogen levels become really low, there is a change in the thermoregulatory zone. Women will feel hot at lower temperatures and cold at higher temperatures, compared to when estrogen is present. Imagine a thermostat. In a room, normally the heat comes on when the temperature is below 60 degrees and will shut off above 80. Now, when menopause kicks in, that range is going to narrow. Now, instead of it being 60, it’s pushed up to 70 and instead of 80 it’s turned down to 75. So, in menopause, a woman has a very narrow window when they are comfortable. So, anything one can do to avoid your body temp going too high or too low will decrease the timing and frequency of your hot flash.
Why are some women affected, while others are not? I believe genetics play a role. Different receptors act differently in every woman. One thing that we do know, is that women who have a gradual menopause usually have fewer symptoms than those that have abrupt transitions into menopause, whether a sudden natural transition or because they had their ovaries surgically removed.
If we want to look on the bright side of menopause, what do you suggest we focus on? What are some of the advantages of being on the other side of this stage of life?
Well, one big plus to menopause is not having regular periods. When you are not bleeding, it’s less of a nuisance and that also means that you are not losing blood, so you are less likely to be anemic, and that is a big benefit. Also, for people that have struggled with fibroids before menopause, menopause is a time when fibroids shrink, so that’s another plus there.
Another advantage is that you have your experiences of what you have done and accomplished, and I think experience is knowledge. So, I think you can have a better perspective of what you have done and what you can do in your future. You have more people that you have met and can rely on, people that will support you through menopause.
I like to think positively and really looking at the pluses and happy parts of your day really help too. This can be helpful at any age. One of my friends, Barbara Hannah Grufferman, recently wrote a book called Love Your Age. One of the many things I learned from reading her book is that whether you’re 20, 30, 40, 50, 60, it doesn’t really make a difference. I think bottom line is that being healthy and trying to really recognize what’s good in every day could be as simple as writing down three positive facts or just recognizing that where you are is a good place, no matter how old you are.
Additionally, I suggest focusing on our blessings and being happy for who you are. Look forward and try to do everything you can to be healthier, whether that is in terms of exercising more, eating better, meditating, reading books or developing our relationships with friends and family. Happiness matters. Find those things that you love in life and don’t let menopause hold you back. Find new things that make you happy and learn something new. Don’t limit yourself..
If we were going to advise women on the top 5 ways to prepare for menopause, what would they be? We know it’s coming. What can we do to ease the transition physically and mentally?
I think that when you know menopause is coming, you know that there will come a time when your ovaries stop working. So, what can you do that is going to ease that transition? Eat well and be healthy from a nutritional standpoint. Get plenty of Vitamin D so that you can protect your bones. I think that getting a regular amount of exercise so that your heart and brain can be in the best possible shape will help prepare your body as well.
Many people have asked me what they can do to prepare and if women are in their 40’s and are starting to feel symptoms of menopause, they can start using products, such as vitamin D supplements or Femarelle’s Rejuvenate, which is made for women that are still in their 40’s and helps them while estrogen levels are starting to decrease. Feel comfortable to talk with your physician to get the advice that is right for you.
When preparing, it’s important to know that the sooner you treat, the better. With estrogen there’s a treatment window. You really want to start in the first five years of menopause. One nice thing about Femarelle is there is no timing issue. You can start it in your 40s, in your 50, in your 60s. You can start it at any time.
What should mothers tell their adolescent daughters about this stage?
There are many similarities between women who are just going through puberty and women who are going into menopause. They are times of a lot of transition with great hormonal fluctuations. Mood changes are common in both puberty and perimenopause. It may be that mothers are going through perimenopause at the same time that they have adolescent daughters going through puberty, so it could be a way to relate and discuss the similarities.
Vaginal dryness is a problem some people are hesitant to discuss. We’d like to know, what percentage of women experience this, and which is a better solution: OTC lubricants or natural solutions like olive oil?
Vaginal dryness is a real problem for menopausal women. Like hot flashes, this is a symptom where every woman is different. Some women will experience vaginal dryness very quickly in the onset of menopause, in their 50s, others do not develop vaginal dryness until they have not had estrogen for a long period of time, for instance their 60s or 70s or 80s. But, at some point, just about every menopausal woman, who is not on some type of treatment, will develop vaginal dryness. I hope that all women who desire treatment will feel comfortable to reach out to their doctor and discuss possible options for them.
A lot of women are uncomfortable talking about vaginal dryness, but it really is something women should discuss with their physician or find a physician that they are comfortable speaking with because there are so many good solutions. I think it’s really important that people realize they are able to get treatment.
When I talk to my patients about relieving vaginal dryness, we break it down into systemic treatments, that help the entire body, and treatments that are local to the vagina. If we talk about systemic treatments, something that you would take by mouth or patch or cream or foam, I would recommend either an estrogen treatment or using Femarelle to treat vaginal dryness. We did a study in our office that showed 11 out of 12 women improved their vaginal dryness taking Femarelle. A woman could also use Osphena, which is a by-mouth treatment without estrogen. Some local treatments would be vaginal estrogen as a tablet, ring or cream or non-estrogen options such as the new treatment Intrarosa (DHEA), moisturizers such as Replens and some lubricants that would be used during intercourse. Vaginal Hyluronic acid has also been shown to improve vaginal dryness for women who either cannot or prefer not to use hormonal treatments.
What is the best way to deal with the slowed metabolism/weight gain factor of menopause?
It is really interesting to know that estrogen is actually an insulin sensitizer. So, the reverse of that is that women who do not have any estrogen basically become a little more insulin resistant, which means that it is much easier for them to gain weight in the middle, the visceral fat increases.
So, a good way to try to alleviate this is to make your body more sensitive to insulin. How can you do that? You can do that with exercise. I’ve already mentioned my appreciation for exercise and helping live a healthier life, but exercise can actually help the body’s metabolic rate and help it become less reliant on insulin.
Also, in terms of diet, try to eat more protein and less sugar, and certainly eliminate the simple sugars and really concentrate on fiber and more healthy carbohydrates.
I have also recommended at times, over-the-counter products such as Inositol, which has been shown to improve insulin sensitivity. I have not seen a study specifically looking at Femeralle and insulin sensitivity, but as a more natural approach, Femarelle could also possibly help because of its ability to mimic estrogen which some women use for better weight control.
Many women complain of snoring as a problem that began as part of the menopause stage. Is this true? Common? What do you recommend to alleviate this nighttime annoyance?
I think that snoring increases as you get older, so that could be why it increases as you begin to go through menopause. There could be other reasons such as sleep apnea or obesity which increases the incidence of sleep apnea. Ask your doctor and get evaluated for snoring, because it might be the sign of a larger problem.
Speaking of nighttime, trouble with sleeping is something many women notice as menopause begins. What five things do you recommend we do to rest more peacefully?
Many people are not aware of the association between estrogen and sleep. Sometimes difficulty sleeping is a sign of estrogen decreasing, even before periods are disturbed. Lower estrogen disrupts sleep and many women tell me they are having trouble sleeping as a first symptom of peri-menopause. Definitely reach out to your physician and let them know that you are having difficulty sleeping because there are a lot of things that you can do to help with sleep.
Many things you can do are done simply by restructuring your day. When does your exercise come in in your day? Your physician may recommend not to have caffeine beyond a certain time. There are also apps available which track your sleeping patterns or help you meditate.
Something that I do with my patients is to take the opportunity to take the time to talk over whether they want to use something like estrogen (HT) or Femarelle, something that can help them to have a more peaceful sleep. It’s incredible what a difference anything that binds to the estrogen receptor can positively do. I have a lot of women who have had such incredible relief using Femarelle, I have women who had incredible relief using even low doses of estrogen. They can make such a big difference in quality of sleep.
Many women (in fact this was the issue our readers felt was their most important question about menopause) report a significant drop in libido and/or desire as a result of menopause. What do you recommend for those who don’t feel it physically but emotionally would like to bring desire back into their lives?
Loss of libido is a very common symptom in menopause. Libido is complicated in women, there are so many factors involved; hormonal and non-hormonal contributions. There is probably a component of a decrease in testosterone, a decrease in estrogen, a lot hormonaly, a lot situationally, depending on where people are in their life. It’s a complicated issue.
Each person is different, and this is something to discuss individually with their doctor. But this is also an area where hormones can play a role. You could use Femarelle, you could use estrogen, some women use testosterone, although it’s not FDA approved, and some women use over-the-counter DHEA. These are all options that increase libido. The FDA also recently approved a medication called ADDYI for improved libido in women, which has some side effects and should be prescribed by a doctor.
In Love Your Age, there is a whole chapter about living better through better sex, which describes what you can do in a non-hormonal way to improve your relationship, put a spark back in your love life and reinvent your relationship in ways that can make a difference.
Some say menopause has a bad rep. If you were going to be a PR rep for this stage of life, what might you say to accentuate the positive? How can we change society’s view of menopause from the “grim reaper/harbinger of the end of life” to something more appealing?
Fortunately, the life expectancy of both women and men has increased so much and a woman entering menopause now hopefully has half her life left. There are many great years to come and a lot of fun to be had. It’s all about being positive and staying positive, and if you feel like things are becoming negative, then get help. During menopause, there is no reason to suffer. Get help! I say it all the time, there is no reason to suffer. Appreciate where you are and look forward to a bright future.
ABOUT THE AUTHOR
Dr. Margaret Nachtigall is an assistant professor of obstetrics and gynecology at NYU School of Medicine and is a highly regarded reproductive endocrinologist. She specializes in infertility, menopause and hormonal management and has a busy clinical practice in Manhattan. Margaret actively conducts and publishes research and is a founding member of the North American Menopause Society and on the Board of Directors for the Foundation for Women’s Wellness. She is a graduate of Princeton University and NYU Medical School and completed her Reproductive Endocrine fellowship at Yale University.
