Hot flashes are the most reported problem associated with menopause, affecting 50 to 85 percent of women. These can vary in severity from a low-grade warm flush enveloping the body to heavy sweating. They may last a few moments or for several minutes, and they may occur infrequently or many times each day. Most often, they last a few minutes, occur several times a day, and continue for two to five years. While they are at least an annoyance and frequently a nuisance, fewer than 40 percent of women suffer enough distress to seek medical attention due to mild hot flashes alone.

For some women, hot flashes occur at night as night sweats, disturbing their sleep patterns—sometimes frequently enough to cause severe energy loss, mood swings, irritability, headaches, and lack of concentration. Hot flashes give no warning; they occur unexpectedly, sometimes at the most inopportune moments, causing embarrassment when the skin reddens due to increased blood flow. Some women find that overeating, alcohol, stress, or exercise can activate hot flashes. Other hot flash stimulators include caffeine, spicy foods, sugar, drugs, and hot temperatures. Eating smaller amounts at more frequent intervals will usually help curtail hot flashes.

Because 80 percent of women’s hot flashes fall into the uncomfortable or nuisance category, medical treatment is not usually necessary. If this statement describes your flashes, simply try wearing natural fabrics such as cotton or wool, which may help you stay drier and more comfortable when symptoms occur. If you frequently experience hot flashes while away from home, such as while on the job, keep cold packs handy; you can place them against your forehead, face, and wrists to counteract the warm cocoon enveloping you.

If, however, your hot flashes are so frequent or intense that you are losing sleep or experiencing other serious problems such as dizziness or heart palpitations, you may want to consider medical treatment.

Hormone Therapy A common treatment for hot flashes and other physical problems associated with menopause, hormone therapy involves replacing depleted estrogen in a woman’s body. The two options are estrogen replacement therapy and hormone replacement therapy; the latter involves a combination of estrogen and the hormone progestin (a synthetic version of the natural hormone progesterone). Most physicians prefer the combination, since estrogen alone increases the chance of cancer of the endometrium, plus can harm the liver and gallbladder. The progestin has been found in some cases to not only prevent the added estrogen from causing cancer, but to decrease the risk of heart disease, long-term uterine damage, atherosclerosis, and osteoporosis, and other bone deterioration.

When handled properly, hormone therapy can reduce and possibly eliminate hot flashes and other symptoms. Women should be aware, however, of factors that would exclude them from treatment, such as a personal or family history of breast cancer, liver cancer, or endometrial cancer. The negative side effects of progestin may include monthly bleeding or spotting, breast tenderness, mood changes, fluid retention, pelvic cramping, and swelling. It is important to discuss these concerns with your physician from the very beginning; once treatment has begun, be sure to report any side effects right away.

Estrogen can be administered in the form of patches. The Climara patch, introduced in mid-1995, is as thin as a piece of tape and needs to be changed only once a week, compared to earlier estrogen patches that were more rigid and needed to be changed twice as often.

Diet A 1990 study noted that Japanese and Indonesian women have very little incidence of hot flashes, especially compared to American women. Researchers believe this is due to the traditional Oriental diet that incorporates many soybean dishes. Soybeans are high in phytoestrogens (phytohormones with estrogenlike properties) which stimulate the woman’s body to produce more estrogen, if it needs it. (Phytohormones are plant substances that function similarly to human steroids; they have a weak effect on humans.)

Nutritionists have found that the following foods help alleviate or even stop hot flashes:

• whole-grain cereals

• legumes

• fruits

• vegetables, especially broccoli

• low-fat protein foods

There are a number of foods that nutritionists say should be avoided as well. These include caffeine, alcohol, dairy products, and sugar, all of which have been known to increase hot flashes and discomfort. If you have to consume these then moderation plays an important roll here.

Nutritional Supplements Vitamin E is widely recommended by nutritionists in treating hot flashes because it naturally balances the level of estrogen. If you have low levels of estrogen, vitamin E increases its output—and it miraculously decreases output in women whose levels are high. If you eat a high percentage of refined foods, combined with few whole grains or seeds, you could be shortchanging your body, only providing low levels of natural vitamin E. Natural sources of vitamin E include sunflower seeds, almonds, fish, sweet potatoes, wheat germ, and whole wheat bread. Nutritionists also recommend primrose oil or black currant oil to stimulate the production of estrogen.

To relieve hot flashes, nutritionists recommend starting with a low level of vitamin E (30 to 100 IU), then gradually increasing over several weeks until the frequency or intensity of your hot flashes decrease. While it may take as many as 1,200 IU of vitamin E per day to alleviate your hot flashes, experts suggest not going above 600 IU without first consulting your health care practitioner, taking large amounts of vitamin E over long periods of time can lead to abdominal pain, nausea, and diarrhea. Because vitamin E is fat-soluble, you will assure effectiveness by taking it along with food containing some fat.

Potassium supplements are important if you experience very intense hot flashes with resultant heavy perspiring. Nutritionists suggest a daily intake of 99 mg.

Bioflavenoids taken along with vitamin C strengthen blood vessel walls, which helps them prevent hot flashes. Divided doses—totaling from 500 mg to 2,000 mg per day—are recommended by health care providers, with hesperidin the most recommended. Natural bioflavenoids are present in citrus pulp, grape skins, berries, cherries, leafy vegetables, and wine. Some experts prefer bioflavenoids derived from citrus fruit for menopausal treatment.

Herbalism Ginseng has been used for centuries around the world to correct temperature imbalances such as heat stress and hot flashes. Many forms and sources of ginseng exist; most health care experts agree that the best for regulating hot flashes is American ginseng. Mix it with hot water for a soothing tea; it is most effective when taken on an empty stomach. It may be ineffective if taken along with vitamin C tablets or foods high in vitamin C, which tend to neutralize it.

Vitex, also known as chaste tree or chasteberry, is the primary European herbal treatment for menopause. Taken regularly over several months, it will help control your hot flashes by increasing your natural levels of progesterone. Do not, however, take Vitex if you are on birth control pills. Follow the instructions on the bottle’s label; it may be available in capsule form or as an extract, which you add to juice or water. You will need to take it two months or longer for it to be effective. You may find Vitex already combined with other herbs such as black cohosh, sage, dong quai, gotu kola, wild yam, licorice root, or sarsaparilla. If you have palpitations along with your hot flashes, take motherwort.

Black cohosh is a mild herb that is a source for progesterone and can relieve hot flashes. You may find it under the name squawroot or snakeroot, as it was known by the American Indians, who used it widely in treating “women’s” problems related to menstruation. Try one capsule per day; if necessary, increase to two capsules. Do not take if you are being treated for any type of chronic disease or if you are or are trying to become pregnant.

Dong quai, a source for estrogen, has been the Chinese treatment of choice for hot flashes for centuries. If you notice any extra degree of nervousness while taking it, change to black cohosh.

If you do not have problems with high blood pressure, which licorice can exacerbate, combine licorice root and sarsaparilla. This is a good combination because the licorice is a source of estrogen and the sarsaparilla is a source for progesterone.

Homeopathy Homoeopathic specialists suggest pulsatilla if you have mild flushing in the face, lachesis if you experience sweating, and kreosotum if you suffer intense burning and sweating over the entire body. Sulphur is also a treatment for intense hot flushes extending over the entire body. Other homeopathic remedies for hot flashes include ignatia and mulimen.

Acupuncture Acupuncturists treat hot flashes by applying needles at points in the neck, back, lower trunk, abdomen, upper limb and lower limb, thus affecting the vasomotor nerves.

Aromatherapy Massaging fennel and sage on your abdomen or lower back will help regulate estrogen production. Using a misting bottle, spray yourself with spring water and a few drops of clary sage to cool down your body during hot flashes.

Prior to menopause, sometimes even before the patient has any idea she is perimenopausal, a woman may experience anything from crying spells to periods of depression, often with no apparent reason. For some women, premenstrual syndrome will worsen. Some women also experience irritability, feelings of vulnerability, insomnia, or memory lapses.

Mood swings have been so prevalent in menopausal women, in fact, that menopause has become a convenient scapegoat for every show of emotion by women over the age of forty. But not all bouts of depression are related to menopause, and not all menopausal women experience these behavioral changes.

When depression and mood swings are related to menopause, experts disagree over the causes. Some say they are due to changes in the endocrine system; others argue that the changes are related to social issues, as women in this age group face significant upheavals in their lives during this time frame. Recent studies correlate these changes to already present physical problems, nutritional deficiencies, poor lifestyle habits, stress, insufficient sleep, and unresolved psychological issues.

Natural Lubricants Almond, coconut, or vitamin E will add moisture to the vagina. Vitamin E is most frequently recommended by alternative specialists; it’s available in either liquid or suppository form. Natural progesterone creams work well for women who cannot tolerate estrogen. Many experts advise limiting progesterone cream use to small amounts during three out of every four weeks over a six-month period, then gradually decreasing use until it ceases within the year.

Diet Dieticians suggest finding foods that encourage your body to produce extra estrogen when it needs it. Foods containing tofu, soybeans, and soy milk all help build estrogen in the female body.

Essential fatty acids (EFAs) lubricate tissues of the body, including the skin, hair, and vagina. If you have been on a strict low-fat diet, you may be not be eating enough essential fatty acids to accomplish this lubrication (the body does not produce them on its own). You can find EFAs in nuts, pumpkin seeds, sesame seeds, sunflower seeds, salmon, trout, and mackerel. You can also take essential oil supplements—such as evening primrose oil, flaxseed oil, black currant oil, and borage oil—in capsule form. If you are diabetic, do not take supplemental fish oils.

To lessen the drying out of vaginal and other tissues, cut out alcohol, caffeine, diuretics, and antihistamines, all of which are drying agents. Instead of coffee, drink plenty of water, at least one to two quarts per day.

Increase your natural intake of vitamin E by eating more asparagus, avocados, beans, brown rice, dried prunes, green leafy vegetables (such as broccoli or spinach), legumes, nuts, peaches, seeds, vegetable oils, wheat germ, and whole grains.

Nutritional Supplements Nutritionists suggest increasing your levels of vitamin E by taking it in capsule form. Begin with 30 IU daily, then gradually increase until you see results. Do not exceed 800 to 1,000 IU. If you are being treated for diabetes or high blood pressure, do not take more than 30 IU daily. It may take more than a month of vitamin E intake to be effective.

Herbalism Herbalists believe that Vitex will help stimulate hormone production, which will assist in lubricating your vaginal tissues. Take one capsule, one to three times per day, prior to eating (so that your stomach is empty).

Another herbal treatment is to take one Black Cohosh tablet two times a day, increasing if necessary to two, then three in the morning and two in the evening. Within three weeks, go back to one at night and one in the morning.

Other herbs believed to increase vaginal lubrication are Motherwort, Dong Quai, ginseng, Chinese Angelica, romania, peony root, and thorough-wax root.

Many herbalists and naturopaths suggest by taking an adequate amount of Imperial Gold Maca™ daily, usually no less than 3500 mg to assure adequate natural hormonal balancing to occur naturally as the endocrine system is properly fed so it can deliver adequate nutrition to the pituitary gland so thyroidal imbalances can be rectified by the body. Read more about maca here. 

Aromatherapy Aroma therapists suggest alendula flowers to help combat vaginal dryness.

Homeopathy Homeopathic practitioners suggest Bryonia (wild bryony) for helping to relieve a dry and thinning vagina.

For some women, very little change in the menstrual cycle occurs preceding menopause, with quite normal monthly periods occurring right up until their stoppage at menopause. But for many women, cycle changes can be dramatic, ranging from more frequent periods to skipped periods; from a lessening of menstrual flow to heavy bleeding and clotting; from spotting between monthly periods to months in which it does not occur. Such irregular menopausal bleeding results when ovulation does not occur because less estrogen is being produced by the ovaries. If heavy or continual bleeding continues for longer than a few months, it could be caused by uterine fibroids, polyps, or (rarely) even cancer. If you have any concern, be sure to consult your doctor immediately.

Cyclic Progesterone Progesterone's create a more regular monthly period and reduce excessive bleeding. However, the side effects of progesterone—depression, fatigue, bloating, and breast tenderness—discourage some women from using them.

Birth Control Pills A low dosage of birth control pills can control irregular bleeding for healthy nonsmoking women.

Diet Nutritionists recommend various foods, depending on a woman’s symptoms. To replace iron lost through heavy bleeding, eat almonds, beef, clams, egg yolks, liver, oysters, poultry, prune juice, raisins, red meat, shrimp, spinach, and split peas. Also good for heightening iron absorption is the inclusion of citrus fruits and drinking fruit juices with meals.

To normalize blood flow, eat foods containing vitamin A: butter, cantaloupe, carrots, cod liver oil, egg yolk, kidney, liver, papaya, pumpkin, spinach, sweet potatoes, watermelon, and whole milk.

To reduce heavy blood flow, eat foods rich in vitamin B: beans, brewer’s yeast, lean meats, peas, wheat germ, and whole-grain cereals.

Bioflavenoids, which together with vitamin C help reduce bleeding, can be found in soy products, buckwheat, grape skins, cherry skins, and the inner pulpy peel of citrus fruit.

Nutritional Supplements Nutritionists recommend various supplements, depending on a woman’s symptoms. Iron tablets of 100 mg per day have been shown to effectively treat excessive bleeding.

Vitamin C and bioflavenoids will decrease menstrual flow by strengthening capillary walls; start with 1,000 mg of vitamin C and 500 mg of bioflavenoids. If necessary, increase to 4,000 mg of vitamin C and 2,000 mg of bioflavenoids.

Vitamin A (25,000 to 50,000 IU per day) will normalize blood flow. If your periods are very heavy, take a B-complex vitamin tablet containing at least 50 mg of B1, B2, and B6.

Herbalism Herbalists suggest swallowing one capsule of dandelion leaves as many as three times a day to replace iron lost through excessively harsh periods. You can instead mix 10 to 30 drops of liquid dandelion extract with juice or water. Vitex and wild yam root have also been used to slow down heavy bleeding; take one capsule, one to three times per day.

Aromatherapy Aroma therapists recommend essential fatty acids, which can normalize heavy periods. They can be found in borage oil, black currant seed oil, flaxseed oil, and evening primrose oil. Use one to two tablespoons of them daily on salads and vegetables. They are also available in capsule form.

Many herbalists and naturopaths suggest by taking an adequate amount of Imperial Gold Maca™ daily, usually no less than 3500 mg to assure adequate natural hormonal balancing to occur naturally as the endocrine system is properly fed so it can deliver adequate nutrition to the pituitary gland so thyroidal imbalances can be rectified by the body. Read more about maca here. 

As hormone levels drop off, vaginal tissues begin to shrink and atrophy, and pelvic tissues weaken. If these supporting tissues weaken substantially, as most often happens among women who have had several children, the uterus may drop down into the vagina (known as a prolapse). At times, the bladder or intestines will break through the weakened vaginal lining, causing frequent urination, burning, lack of urinary control, and bowel problems.

Such tissue changes generally occur slowly over time and may not be apparent until many years after menopause.

Estrogen Creams Doctor-prescribed vaginal creams containing estrogen can restore diminishing hormone levels that lead to vaginal atrophy. As estrogen does spread throughout the body and may cause adverse effects, estrogen creams should be used sparingly and only for a short time (see page 119).

Pelvic Floor Exercises Kegel exercises (named for the pioneering California physician, Arnold Kegel) may strengthen supporting tissues. Place two fingers inside your vagina and tighten the muscles around your fingers, hold for a second, then release completely. Repeat this ten times in a row to make up one group of exercises. Add one group of exercises each day, until within a month’s time, you are doing twenty groups of exercises per day.

Nutritional Supplements Nutritionists find that vitamin E is helpful in reducing vaginal atrophy. Start with 400 IU per day, building up gradually to 800 IU.

While both men and women suffer from a gradual loss of calcium in their bones as they age, the loss during menopause of estrogen—which at proper levels helps maintain bone mass—speeds up the process in women. Half of all women in their fifties and sixties exhibit at least the beginnings of osteoporosis; by their mid-

seventies, 90 percent of women have osteoporosis to some degree. Inactive women, small-boned women, and smokers are especially susceptible to the disorder. Other factors increasing the risk of osteoporosis include early menopause, history of low calcium intake, regular use of antacids, and heavy coffee drinking.

Among osteoporosis sufferers, bones become more brittle. Minor falls can result in broken bones. In advanced cases, such ordinary movements as coughing may cause fractures. As the spinal vertebrae collapse, the body “shrinks” to a shorter height, and the spine frequently curves. Early signals of osteoporosis include sudden sleep problems, leg and foot cramping every night, persistent lower back pain, gum disease and loose teeth, and a gradual loss of height.

Estrogen Replacement Therapy Estrogen replacement therapy (ERT) can slow down the loss of bone, but it cannot replace what has already been lost. Because of its potential side effects, estrogen therapy is usually reserved for postmenopausal women who are in the high risk osteoporosis categories: Caucasian, Asian, blond or redheaded, calcium deficient, cigarette smoker, physically inactive, those with early surgically caused menopause, or a family history of osteoporosis.

Once begun as a treatment for osteoporosis, estrogen treatment cannot be discontinued. If stopped, the rate of bone loss accelerates. You will need to discuss thoroughly with your health care provider the potential risks against the possible benefits for your own particular situation before beginning this treatment.

Hormone Replacement Therapy According to some researchers, lack of progesterone is the real culprit in osteoporosis. They claim that applying natural progesterone cream or oil directly to the skin will not only increase bone mass, but reverse osteoporosis. Some experts suggest applying approximately 30 mg each day for three weeks, then none for one week, then maintaining the three on, and so on. You will want to check with your primary care physician before following any hormone regimen.

(Complimentary And Traditional)

Diet The major preventive against osteoporosis is calcium, which helps build and strengthen bones. You can cut down or eliminate calcium supplements if you eat three servings per day of green vegetables such as broccoli, spinach, snow peas, beet or turnip greens, kale, mustard greens, lettuce, kelp, or seaweed. Other good sources of calcium include: bone meal, sesame seeds, soybeans, cheeses, brewer’s yeast, sardines, yogurt, and carob.

For the most efficient calcium intake, other measures are advised. Vitamin D is important, as it helps bones absorb calcium. You can take calcium with vitamin D as a supplement, or through foods such as milk, sardines, tuna, and salmon.

To maintain the levels of magnesium necessary to keep the calcium and vitamin D working, eat peanuts, lentils, tofu, wheat germ, wheat bran, almonds, shredded wheat, bananas, apricots, whole grains, and oatmeal. To maintain boron, which is necessary to retain the calcium in your bones, eat apples, legumes, nuts, pears, leafy vegetables, prunes, raisins, almonds, peanuts, hazel nuts, dates, figs, and honey.

Reducing the amount of processed meats, packaged foods, soft drinks, and cereals—anything listing any kind of phosphate on its label—is also a good idea, as overabundance of phosphorus speeds up bone demineralization. High-protein diets, soda drinks, and antacids deplete calcium, so you will want to cut your protein intake if you are eating such a diet; either decrease or eliminate sodas and antacids.

Nutritional Supplements Nutritionists believe that calcium supplements can go a long way toward preventing osteoporosis in later life. If you’re not on estrogen replacement therapy, take 1,200 to 1,500 mg of calcium per day. Experts suggest calcium citrate as the best form for women over fifty because it is more easily tolerated. Instead of taking your calcium all at once, it is more effective if taken several times a day, preferably at mealtimes and at bedtime. Along with the calcium, you will need to take 800 IU of vitamin D per day in order to absorb the calcium.

utritionists also suggest the following supplements to counter osteoporosis:

• 1,500 mg of vitamin C twice each day

• mineral supplements, such as magnesium (500 mg prior to menopause, 1,000 mg after), and boron (1 to 3 mg)

• 500 mg of calcium, 3 alfalfa pills, and 3 kelp pills, twice a day, in the morning and at night

3500 mg Imperial Gold Maca™ daily to balance the body and increase calcium absorption

Exercise Exercising a minimum of three to four times each week for a period of at least twenty to thirty minutes each time will preserve calcium levels in your bones; a sedentary lifestyle can hasten bone deterioration. The best types of exercise are aerobic because they exercise the weight-bearing bones: brisk walking (especially when wearing wrist or ankle weights), running, dancing, tennis, and aerobics. Even basic household chores such as sweeping and lawn mowing help maintain bones. Lifting five-pound items ten times with each hand for four repetitions can be an easy way to maintain bone strength in the arms.

Herbalism Oatstraw (the whole oat plant dried and chopped) and horsetail (a plant) are high in silica, which herbalists find heighten the absorption of calcium. These are available in several forms, including fluid extract, decoction, juice, capsules.