BoomerGirl Diary

Dear Crabby,

What would you recommend for a teetering-on-menopause woman who's experiencing hot flashes of the intensely sweaty kind far too often for comfort? I have read so many conflicting articles about hormone replacement therapy, and as nasty as the hot flashes are, they seem preferable to breast cancer, heart disease, stroke and whatever else the wisdom of the day suggests HRT can provoke. I'd druther tough it out if I can, but this may go on for years, if my older sister is any sort of a model (and she thinks she is).

My mother is no help at all. She claims not to have had any hot flashes or other menopausal challenges, which is similar to the claim of my best friend's mother: She can't REMEMBER! Talk about your useless matriarchs - who could not REMEMBER this sweaty, moody rollercoaster of aging?

Adding to my challenge is the fact that my medical coverage does not extend to prescription drugs, even if I wanted to take them, and I'm not sure that I do. Do you know of any herbal supplements or other holistic helpers that offer the hope of relief? I'm a physically sensitive gal, and I'm not inclined to suffer in silence. Which makes this sleep-interrupting, face-flushing PASSAGE OF LIFE a problem for my partner as well.

Please help,

Suffering Loudly in Kansas City

Dear Suffering:

Ah, I know of what you speak. Hot flashes are the biggest complaint I see in my practice. They range from mild warmth to drenching sweats, and have an emotional component that runs the gamut from mildly flustered to the screaming meemies. Let me tell you, there is nothing more embarrassing as a health care provider than breaking into a flustered sweat and fanning yourself immediately after performing a hernia check on a 20-something male patient … I’m sure they think it’s their own hotness that’s got me so steamed up. They don’t realize the exact same thing occurs when I am removing a lesion from an octogenarian’s gnarly foot!

I appreciate your disinclination to take HRT (hormone replacement therapy), for the multiple reasons you listed, and so we’ll explore the options that are out there. Please also see my earlier column on menopause.

First, lifestyle changes. Are you wearing cool clothing, keeping a fan handy, minimizing caffeine, spicy foods, and alcohol? Uh-huh, I thought not. Crabby knows you are a wine lover, she can tell from your letter … (My psychic tendencies — which are powerful — aside, dear readers, I know this writer.) Put down the vino, doll, especially the reds. Now, stop crying, dear, it’ll just make you have another hot flash. Oh yes, don’t forget “thinking cool thoughts,” as those of us who grew up without A/C recall our mothers advising us. (Crabby snorts with derision. I refer back to your comment on useless matriarchs. Cool thoughts indeed!) Oh, and exercise. It seems to reduce the hot flashes too. PS, smokers also have more hot flashes—another good reason to quit. (I know, I know. It’s for the other readers.)

Anyway, I digress. The next thing you can try, if you are not doing this already, is two servings of soy products per day. A friend swears by the chocolate soy milk. Crabby is allergic to soy, so she wouldn’t know, but it seems to be everywhere now, so have at it. I think I even saw some soy-infested candy somewhere. Soy also protects your bone density to some extent, due to the estrogen-like isoflavone genistein. Some researchers are concerned that this isoflavone is so much like estrogen, it could increase cancer risk, so don’t go overboard. Too much soy can also give you diarrhea. And that’s sooo much fun along with the hot flashes.

Many people have tried Black Cohosh, and feel it helps them. It is an herb that also seems to be an estrogen-type precursor, but the clinical evidence is poor that it significantly relieves hot flashes. It is available under the brand name Remifemin, or by itself at most pharmacies and health-food stores. Similarly, dong quai and evening primrose oil, two other so-called “women’s tonic” herbs have poor evidence to support their use. There is some decent, though limited, clinical evidence that Red Clover extract works, and you can find it under the brand name Promensil,® or by itself as well. Remember that if you take prescription medication, your health care provider should know all of the herbs and supplements you take as well.

There are a couple of blood pressure medicines and antidepressants that are being used with mixed results for hot flashes, and those are available only with a prescription, of course. These would be most valuable for women who absolutely shouldn’t have estrogen or estrogen-like substances — women with blood clotting disorders or reproductive cancers, or estrogen-responsive breast cancers.

For most women, the hot flashes do taper off and come to an end, but for some, they will last for years. Years of sweaty freakouts and subzero thermostat readings. Sorry to pass on that news, but it had to be said.

There are some women who feel that the hot flashes are sort of “rewiring” their bodies for the later years. (See especially the fantastic book, “Elderwoman,” by Marian Van Eyck McCain at www.elderwoman.org) This is a perspective that embraces the changes of menopause as a powerful transition, one which prepares women for the “wise elder” phase of their lives. I think this is great, but if you are only in your 40s, it’s tough to embrace the idea that you are on the cusp of being a wise elder. But, as with many stressors, positive thinking and acceptance of the emotional state can be of help, so you might try this approach. Many holistic providers offer energy work or acupuncture that can ease your transition as well. Just be cautious about multi-herbal preparations, if offered. Herbs are drugs, and “natural” is not necessarily equivalent to “safe.”

Obviously, each woman is different and what works for one may not work for another. The degree of hot flash severity, the number you have daily, and your circumstances make a difference in treatment choices. If you have to change your clothes/wring out your hair each time you have one, and you work outside the home, you would probably be willing to do just about anything to stop the flashes, damn the consequences. On the other hand, if you are just mildly sweaty and irritable, I advise you to dress in layers, keep a steady supply of icepaks around, a fan in every room, and warn your partner to look out. You’re being rewired, and everyone knows that renovation is a bitch.