Judy, my 48-year-old patient from Kailua, wanted to know what she could do to alleviate her hot flashes – or “power surges,” as she called them – without having to take hormone replacement therapy. She had done a lot of reading about hormones and found the studies confusing regarding side effects. Since her menstrual cycle was still regular (although her periods were lighter), I explained to her that she was in early perimenopause.
Judy is one of an estimated 80 million women going through the hormonal changes of midlife. Vasomotor flushes, more commonly known as hot flashes, are experienced by 80 to 90 percent of women during perimenopause and menopause. Perimenopause is the period of time before menopause, which can last from two to eight years, when a woman’s ovaries decline in hormone production. What is menopause? The term describes the last period plus one year without a period.

Many women are confused about what to do at midlife regarding the hormonal changes in their bodies. Some women sail through the changes while other women struggle with physical symptoms that can be very uncomfortable. Symptoms (ranging from mild to severe) can include insomnia, irritability, hot flashes, premenstrual syndrome, vaginal dryness, mood swings, and heavy or scanty periods.

The majority of women are told to take hormone replacement therapy to alleviate their symptoms. However, many women do not feel comfortable jumping into hormones right away. A meta-analysis of the studies shows that the longer a woman is on HRT and the higher the dose, the higher the risk that she will experience side effects such as gallbladder disease, breast cancer or blood clots. The good news is that there are alternatives that can be used to alleviate mild symptoms in perimenopause.

According to best-selling author Susan Love, M.D., author of “Dr. Susan Love’s Hormone Book,” women can control hot flashes using herbal medicine, acupuncture, exercise, nutrients such as vitamin E and bioflavanoids, and by avoiding caffeine and alcohol. She mentions specific herbal medicines such as black cohosh, motherwort, vitex (chaste tree berry), dong quai, sage, and a natural product called Remifemin, which is available at health food stores.

In Chinese medicine, hot flashes are seen as a deficiency of yin or blood. In this system of medicine, there are two kinds of Chi or energy in the body; one that is yin (cool) and one that is yang (hot). When a person is in good health, the yin and yang are in balance. When there is too much yang and not enough yin, a person feels hot. Stress, smoking and poor diet consume the blood and make the yin more deficient. It is recommended that women support their yin (blood) during midlife by following a diet that is cooling. A cooling diet consists of tofu, seaweeds, fruits, vegetables, fish, and yogurt and avoids foods such as kim chee, coffee, garlic, and ginger.

Christiane Northrup, M.D., author of “Women’s Bodies, Women’s Wisdom,” states that hot flashes are increased by stress and that many women find relief through stress-reduction techniques such as regular exercise, yoga, tai chi, and meditation. She often refers her patients for acupuncture to help control their symptoms.

My patient, Judy, is no longer experiencing “power surges” since she started eating a diet which supports her yin, began taking the herb black cohosh and lessened her stress level. I explained to her that as she continues to go through the changes of perimenopause and menopause, we may need to revisit her symptoms and adjust her treatment so she can continue to sail through midlife right on course.

Article was originally printed in the Honolulu Advertiser, honoluluadvertiser.com.