How to Survive Menopausal Mayhem
Menopause gets a bad rap with its threat of hot flashes, mood swings, sleep trouble, and other symptoms. But this time in your life can be more than just wonky hormones and night sweats: “Lots of women feel a new freedom in life,” says Sarah de la Torre, M.D., an obstetrician-gynecologist in Seattle. After all, she notes, your kids may be grown, you may have less responsibility towards others, and you can finally pay attention to your own wants and needs. That can begin with your health as you go through the hormonal changes of menopause. Consider these nine strategies a jump start.
Don't Dismiss Hormone Replacement Therapy
Hormone replacement therapy (HRT) in menopause is not without its controversy, which has brought with it plenty of confusion. Doctors used to prescribe it frequently, but after a series of large studies found an increased risk of heart disease and breast cancer in some patients, guidelines shifted. “This (decision) needs to be individualized for each woman,” says Dr. de la Torre. “However, HRT can be considered in a healthy woman with no personal history of hormone-related cancers at the lowest dose and for the shortest time possible.” So talk to your doctor; she’ll consider your personal family history as well as the severity of your symptoms.
Give Herbal Supplements a Whirl
The jury’s out on how much herbal supplements can ease your hot flashes or other menopause symptoms, says ob/gyn Joy’El Ballard, M.D., author of Loving Me, Myself and Her: Through Perimenopause and Beyond. Still, herbal remedies’ popularity among menopausal women makes them worth noting. Black cohosh is probably the most studied, says Dr. Ballard, but the results are mixed. One supplement that does have good data behind it is ginseng: Research shows it may help with menopausal mood issues and sleep problems, but alas, not hot flashes. Before you take any herbal supplement, be sure to talk to your doctor.
Give Your Vagina Some Love
Good news: You don’t have to worry about getting pregnant! Bad news: Sex may be uncomfortable, thanks to a decrease in estrogen, which regulates blood flow to vaginal tissue. Without estrogen, the tissue can become dry, says Lauren F. Streicher, M.D., medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago. About 60% of women will experience vaginal changes, including dryness, she notes. Your first line of defense? Lube. Choose one that’s pH balanced and preservative-free, recommends Dr. Streicher. If lubrication doesn’t do the trick, your doctor may prescribe low-dose vaginal estrogen, notes Dr. de la Torre.
Turn on Your Bedroom A/C
Even if you don’t wake up, hot flashes and night sweats can disturb your sleep and lead to brain fog and fatigue during the day. That’s why the National Sleep Foundation recommends that menopausal women keep their bedrooms cool, avoid heavy blankets, and wear lightweight pajamas. Sleep-medicine physician Jeffrey Durmer, M.D., co-founder of the FusionHealth sleep-management program, also recommends a temperature-control mattress pad such as the chiliPAD, which uses water to keep your mattress as cool as 55°F.
A lot of menopausal women have trouble falling asleep and staying asleep, says Dr. Ballard. Mindfulness-Based Stress Reduction, an eight-week program of meditation and relaxation training, has been shown to improve sleep and help some women cope with hot flashes. To find a workshop near you, Google “mindfulness-based stress reduction” and your city; it’s offered by many psychotherapy practices, medical clinics, and individual licensed practitioners.
Try Peppermint Oil
Leann Spofford, 51, a marketing advisor in Lakewood Ranch, FL reaches for peppermint oil as soon as a hot flash hits. “I mix about two drops into some coconut oil, and rub it on both arms from the elbow up towards my shoulder; it cools my whole body,” she says. The menthol produces a cooling sensation that may comfort some women, says Dr. Ballard. The use of essential oils is ever popular, but they should be used with caution and never be applied to the skin undiluted.
Take a Deep Breath
The next time a hot flash hits, try this meditation trick. Inhale for a count of four seconds (one mississippi, two mississippi …) and exhale for a count of six seconds. The key is to make your exhalation at least as long as your inhalation. The North American Menopause Society recommends you practice this “paced breathing” at the first sign of a hot flash — and even 15 minutes a day when your body is at normal temps. Paced breathing and other deep-breathing practices slow your heart rate and engage the body’s relaxation response and has been found to reduce frequency of hot flashes.
Try CBD Oil
“I was forced into menopause after having my uterus and ovaries removed,” says Stephanie Johnson, 46, a mass communications specialist in Dallas. She swears by CBD (cannabidiol) tinctures, a dietary supplement in liquid form: “It’s reduced my hot flashes, and they’re not as debilitating as they were before. I also feel more focused and not like I'm in a fog.” There isn’t sufficient research to support CBD’s effects on menopause symptoms, says Dr. Ballard. “But I have a few patients who say it works well for the hot flashes and insomnia. So, if I have an otherwise healthy patient who is interested in trying it, I support it.”
Be Open to Antidepressants
If you feel like you’ve tried everything for your hot flashes without relief, talk to your doctor. There’s one non-hormonal prescription treatment that’s approved by the Food and Drug Administration: low-dose Brisdelle (paroxetine), an antidepressant. A review of research published in the International Journal of Women's Health found that paroxetine led to a 33% to 67% reduction in the frequency of hot flashes. Some other antidepressants are also used off-label for hot flashes, including Effexor XR, and Prozac, according to the Mayo Clinic. Ask your doctor if one of them could work for you.
- HRT studies: Cleveland Clinic. (2019). “Estrogen & The Heart.” my.clevelandclinic.org/health/articles/16979-estrogen--hormones
- Herbal supplements info: North American Menopause Society (NAMS). (n.d.). “Natural Remedies for Hot Flashes.” menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/natural-remedies-for-hot-flashes
- MBSR history: University of Massachusetts Medical School. (n.d.). “History of MBSR.” umassmed.edu/cfm/mindfulness-based-programs/mbsr-courses/about-mbsr/history-of-mbsr/
- Paced breathing technique: Menopause. (2012). “Paced Respiration for Hot Flashes?” menopause.org/docs/professional/tfppaced0712.pdf
- Paroxetine Reducing Hot Flashes Study: International Journal of Women's Health. (2015). “Critical appraisal of paroxetine for the treatment of vasomotor symptoms.” ncbi.nlm.nih.gov/pmc/articles/PMC4476484/
- Effexor for Hot Flashes: Mayo Clinic. (2018). “Hot Flashes - Diagnosis and Treatment.” mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795