​Hot flashes, brain fog, sleep disturbances, mood changes- a common shared experience among women.
Common but different; shared yet unique. Some women sail through the perimenopausal and
menopausal times of their lives smoothly with little impact on the quality of their lives. For others, this
leg of the journey is tortuous. How to approach these experiences is as individualized as each woman
and there are many options to consider. All have risks; these must be weighed against the benefits to
reach a proper balance for achieving the goal of living our best lives.
There are many herbal remedies and complementary medicines that have been used for centuries
around the globe for the management of menopausal symptoms. Most require a combination of
products such as evening primrose, black cohosh, or red clover for hot flashes and maca, ginseng, or
fenugreek for mood and sleep issues. Other over-the-counter products available, such as Estroven, offer
a combination of supplements to treat multiple symptoms of menopause. There is very little scientific
data to support the benefits of herbal use in western medicine as they are not regulated by the Food
and Drug Administration. That is not to say, however, there is not a place for such products in our
approach to overall wellness and well-being.
Hormone therapy is another option for most women. Estrogen and Progesterone are most commonly
used for the treatment of hot flashes, mood changes, and other symptoms of menopause. The general
rule of thumb among Women’s Health providers is “the lowest dose for the shortest period of time” to
achieve the desired effect. Considering, also, that the average age of menopause is 51, hormone therapy
is rarely started or continued after the age of 60. Bioidentical hormones are another option available;
these are specifically tailored to each individual and compounded depending upon her specific hormone
levels. There is not, however, evidence of the safety and efficacy of bioidenticals.
Certain antidepressants (SSRI) as well as gabapentin are used with success in many women who are
unable to take hormones.
Pellets, patches, pills, creams…the options are numerous. And in most women, safe alternatives to
confronting the speedbumps of menopause exist. Do not suffer in silence. Your quality of life is worth
the investment of having a discussion with your healthcare provider. BE WELL! BE KIND! SEEK JOY!

​Menopause: a time of change; a point in a woman’s life that most have heard about and will eventually
experience. The time leading up to this point, however, is less known and not well understood by many
women. This transitional period is PERIMENOPAUSE and can last for a few months to several years. It is
during this phase that women begin to experience the full weight of reduced ovarian function, resulting
in hot flashes/night sweats, decreased sex drive, sleep disturbances, and mood changes as well as many
other bothersome symptoms. Let’s try to understand the “WHYs” of these symptoms.
Hot flashes and night sweats (hot flashes during sleep) are, perhaps, the most widely recognized
symptoms of perimenopause. Clinically known as vasomotor symptoms, hot flashes are experienced as a
sudden, intense feeling of heat, mostly in the upper body. These are the result of disturbances of
temperature regulation in the brain. Even though the episodes are brief, typically lasting only a few
minutes, they may be debilitating for some, often accompanied by intense sweating, chills, and rapid
heart rate.
The brain contains a wide distribution of estrogen receptors, including areas involving mood regulation.
Though not completely understood big swings in estrogen levels, like those that occur in the
perimenopausal phase, result in mood symptoms (irritability, anger, lability), “brain fog,” sleep changes,
and decreased libido. Lifestyle behaviors (nutrition, exercise, nicotine use), stressful life circumstances,
and the severity of perimenopausal symptoms also play a role in mood changes.
Decreasing amounts of estrogen also result in unwelcomed vaginal and urinary changes, such as vaginal
dryness and burning, pain with sex, pain with urination, and leaking of urine. As levels of estrogen drop
the tissue of the vagina becomes less pliable and less estrogen-produced lubricant is available, creating a
drier, tighter vagina and urethra. This makes sex less comfortable and, if pain is associated with sex, less
desirable. Peeing can become painful, more frequent, and less controlled as the moisture and stretch
are lost.
One begins to see the overlapping of brain and body changes which magnify the personal experiences of
the perimenopausal transition. But there is hope! Next time: To Treat of Not to Treat- What are the
Options? Until then, BE WELL! BE KIND! SEEK JOY!

Menopause…is not a four letter word, though it may evoke several!
Technically speaking, menopause is that specific time which marks the end of a woman’s reproductive years. It is another leg in the journey of a woman’s life when her ovaries stop making estrogen and her menstrual bleeding ceases. In the United States the average age of menopause is 51 years. For most, the journey does not start there; perimenopause is the transitional phase in the years preceding menopause. It is during this time when women typically experience the unwelcomed signs and symptoms related to menopause.
Hot flashes, sleep problems, decreased sex drive, “brain fog,” and vaginal dryness are among the common symptoms and changes experienced by many women. Knowing that perimenopause and menopause are well-worn paths eventually travelled by every woman brings little relief when you are the one on this journey. This transition through menopause is a unique journey, in a sense, and should be approached with a unique perspective based upon how bothersome your symptoms are. It is possible to enjoy this new chapter and savor all it has to bring.
Next time we’ll take a deep dive into the common symptoms of perimenopause and the many factors that affect them. Until then…BE WELL! BE KIND! SEEK JOY!