The average age of menopause in the United States is 51 years old. Most women will have their last period sometime between 45-55 years old and by definition menopause is: the absence of a menstrual cycles (periods) for one full year. However, up the ten years before a woman enters menopause bothersome symptoms may start.

These can include (but are not limited to):

1. Hot Flashes
2. Mood changes
3. Difficulty going to sleep or staying asleep
4. Vaginal dryness
5. Low libido

These symptoms are related to a decrease in estrogen production in the ovaries. Some of these symptoms are easy to address and others have multiple causes and can not be treated with a single approach. Very importantly: Your doctor can help you treat these symptoms without checking any labs.

As long as you start to see improvements in your symptoms then the treatment regimen that you and your doctor have selected is correct. This treatment plan may need to be adjusted over time but lab tests are not required.

Many women are hesitant to try to treat their symptoms with traditional estrogen and progesterone hormone replacement, usually in the form of pills or patches. There are risks to consider when using estrogen and/or progesterone. In this article we will review the non-hormonal options to treat hot flashes. Traditional hormone replacement in the form of estrogen and progesterone will be discussed in future posts.

The main complaint for a great number of menopausal women is hot flashes. This can impact up to 80% of women. Hot flashes can be disruptive at work, in social situations and during sleep. Though most women say their hot flashes are severe, only 20-30% actually seek out treatments.

Hot flashes usually start as a sudden onset of heat in the chest and face. The symptoms can last for a few minutes and can cause excessive sweating. There can even be the sensation of heart palpitations. Once the hot flash resolves the sensation of chills, shivering or feeling of anxiety can be noted. These symptoms can occur once per day or up to once per hour, day or night!

There are some risk factors for hot flushes:

1. Obesity
2. Smoking
3. Reduced physical activity
4. Ethnicity
5. Genetics

COMMON TREATMENTS: some basic lifestyle changes that can help minimize the impact of hot flashes include: lowering the room temperature, using fans, dressing in layers (that can easily be removed), and avoiding triggers (sometimes food or stress)

ANTIDEPRESSANTS: these medications are commonly used to treat hot flushes. Specifically, Paxil has been approved for the treatment of hot flushes. Other medications like Effexor and Pristiq have also been shown to reduce hot flashes but may have more side effects

GABAPENTIN: is a medication that is normally used to treat seizures but can also relieve hot flashes in some women.

OXYBUTYNIN: is a medication that is usually used for overactive bladder symptoms and has also been shown to treat hot flashes, however it has the side effect of dry mouth

PHYTOESTROGENS: these are plant-derived estrogens that are found in many foods like:

soybeans

chickpeas

lentils

grains

It is unclear if theses phytoestrogen containing products reduce hot flashes or night sweats but they may act like estrogen in some parts of the body.

HERBAL TREATMENTS: Black cohosh is a commonly used herb for hot flushes. Clinical trials have not shown it to be effective. It has not been proven to be harmful either.

MIND-BODY & OTHER TREATMENTS: some nonmedicinal approaches to off-setting menopausal symptoms include stress management, relaxation, meditations, deep breathing and yoga. Though acupuncture has not been proven to be helpful some women have seen improvements in their symptoms.

Hot flushes can be very disruptive for many menopausal women. A detailed discussion of the frequency and duration of these symptoms can help your doctor offer you the best treatment options.