Menopause & Hormone Therapy

ow safe is hormone therapy (HT) to treat menopausal symptoms?

The main indication for using HT is best therapy in symptomatic women for relief of menopausal hot flashes that are bothersome, disrupt sleep or adversely affect a women’s quality of life. Treating the symptoms of menopause is individualized and often based on personal philosophies for the various treatment options. Doctors got it wrong in 2002. More than 20 years later, further studies show that when HT is started within 10 years of menopause or <60year, the risks are few and generally outweigh the benefits. However, when HRT was started >60year, the reverse was true…the risks NOW outweighed the benefits. Dose and duration should be individualized and personal risk factors such as “the risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer should guide use of HT. You may not be a candidate if you have any of these risk factors.

HT is recommended when menopausal symptoms are disruptive and affect a women’s quality of life. For low-risk women, HT can safely reverse menopausal symptoms including hot flashes, sweating, insomnia, depression, anxiety, apprehensive feelings, fatigue, poor concentration, memory loss, vaginal dryness, and heart palpitations. It can also protect against bone loss.

When should I start taking HT? Do I need it during perimenopause?

Everyone has a different journey when it comes to starting, stopping and taking HT all together. Depending on how disruptive and unmanageable peri-menopause or menopausal symptoms become will determine when you start taking HT. Perimenopause refers to those years in the reproductive life cycle where the ovarian function becomes irregular. It occurs up to 10 years before menopause with the average of being 51yrs. Estrogen production from the ovaries is erratic and unpredictable causing menopausal symptoms. The same disruptive symptoms occur during peri-menopause and hormone therapy can ease these symptoms even before menopausal begins. Some women will start a low dose birth control pill or HT to improve their quality of life as they cross over into menopause. Starting and stopping is common, acceptable and completely safe depending on your needs and preferences.

Here’s something to keep in mind, menopause is the next chapter of a woman’s life, not a phase that you go in and out of like puberty. Many women believe that once the obvious and most common symptoms of menopause lessen—such as hot flashes, sweating, insomnia, depression, anxiety, apprehension, weight gain or loss, fatigue, poor concentration, memory loss, heart palpitations, exacerbation of migraines and vaginal dryness—menopause is done. Not so, rather, it may be just the beginning of your new “normal.” Yes, many of these symptoms do improve over time, but knowing that doesn’t help when you’re at the height of discomfort. All of these symptoms can disrupt the quality of life, but they can be lessened and, in some cases, eliminated with simple medication, lifestyle modifications and HT-albeit oral, transdermal and vaginal.

Why did the FDA remove the “Black Box” warning for hormone therapy to treat Menopausal women?

The FDA has recently removed the misleading “black box” warning for hormone therapy to treat menopausal women. By doing so, the FDA now supports all the benefits that hormone therapy affords women for healthy aging and longevity. Initially, the “black box” warning cautioned women and healthcare providers that hormone therapy would increase their risks of blood clots, breast cancer and strokes, which was based on the notorious and faulty WHI study done in 2002. After over 20years of waiting, we now have a restored trust and confidence in safely using hormone therapy for menopausal women as a recommended medication for quality of life and healthy aging.

For the 6,000 women entering menopause every day, hormone therapy not only gives relief from the disruptive symptoms of menopause including hot flashes, night sweats, sleep disturbances, depression, anxiety, fatigue, poor concentration, memory loss, and vaginal dryness, but will also have a reduced risk of heart disease, cognitive decline, Alzheimer’s disease, bone fractures, colon and endometrial cancers, especially when starting hormone therapy within the first 10 years of being diagnosed with menopause. Starting hormone therapy is an individualized process that should be discussed with a qualified healthcare provider weighing the benefits versus the risks.

How safe is hormone therapy (HT)?

Treating the symptoms of menopause is individualized and often based on personal philosophies for the various treatment options. Doctors got it wrong in 2002 when the largest Women’s Health Initiative study looking at HT safety, was abruptly stopped when the risks appeared to outweigh the benefits. More than 20 years later, further studies show when HT is started within 10 years of menopause or <60year, the risks are few and generally do not outweigh the benefits. However, when HT was started >60year, the reverse was true…the risks NOW outweigh the benefits. Dose and duration should be individualized and personal risk factors such as “the risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer should guide use of HT. You may not be a candidate if you have any of these risk factors.

For low-risk women, HT can safely reverse menopausal symptoms including hot flashes, sweating, insomnia, depression, anxiety, apprehensive feelings, fatigue, poor concentration, memory loss, vaginal dryness, and heart palpitations. It can also protect against bone loss.

The benefits of HT generally outweigh the risks when a woman is, prescribed and cared for, by a menopause healthcare practitioner. The health concerns of HT include increased risk of breast cancer and uterine cancer if taken too long or incorrectly.

How does hormone therapy (HT) work?

Hormone therapy (HT) is most effective in treating disruptive hot flashes, insomnia or any menopausal symptoms negatively affecting a woman’s quality of life. HT increases the body’s estrogen levels which nicely treats hot flashes and night sweats. There is no medical evidence that HT positively or negatively affect a woman’s weight. A woman may gain weight regardless if she is taking HT or not.

Does hormone therapy cause breast cancer?

Some types of hormone therapy can raise breast‑cancer risk a bit, but how much depends on the hormones, dose, and how long you take them. Combined estrogen‑plus‑progesterone (used if you still have a uterus) has the strongest link to a small increased risk that grows with longer use, while estrogen‑only therapy (for those without a uterus) shows little or no increased risk in many studies. The absolute increase for most women is small, and your personal risk will also depend on age, family history, genetics, weight, alcohol use, and other factors. Hormone therapy can greatly help menopause symptoms and bone health, get regular breast screening as recommended, and revisit the decision with your clinician based on your symptoms and risk.

Does hormone cancer increase the risk of any other cancer in women?

There is no increased risk of ovarian, colon, lung or skin cancer for women using hormone therapy.

What are the difference types of HT?

Treating the symptoms of menopause is individualized and often based on your philosophies for the various treatment options. Working with your healthcare provider on optimal dosing will vary and allowing your body 3 to 6 months making necessary adjustments is normal and should be expected.

Thanks to your BFF, social media, celebrity testimonials and Dr Google, there are many myths and misinformation when it comes to HT. The experts agree that for women younger than 60yr and within 10 years of being in menopause, the benefits of HT outweigh the risk. We now know using HT beyond 10years is safe and recommended to relieve symptoms of menopause, bone, cognitive, vaginal, bladder and other organ symptoms that happen with aging and menopause.

Estrogen can be prescribed orally or transdermal, either as a patch, gel, cream or spray and progesterone is given orally, if a woman has a uterus. You can take H T continuously or daily where a woman will not get a period or you can take them “cyclically” where you will get a period. There is not a health benefit, more of a woman’s preference of getting a period or not, in the way she takes H T. If you don’t have a uterus, you would take estrogen daily by itself. Estrogen and progesterone that Western doctors prescribe are FDA approved and have been properly tested in reliable medical studies, proving their safety and efficacy. (The FDA is an independent and trusted group that regulates medication prescribed by medical doctors for patient safety.)

Compounding bioidentical estrogen and progesterone hormones. Compounded bioidentical H T-creams, drops and pellets- have not been tested in clinical trials in the same manner as hormone replacement therapy and are not FDA approved. They are marketed as being “more natural, safer and better” for your body but there are no medical studies to support these claims. It’s true that they are made from plant products such as soy and yams, but they still need chemical processing to become active in the body. In truth, many estrogen pills, patches, gels, creams and sprays are also bioidentical, so just because hormones are termed bioidentical, it doesn’t mean that they are more natural or safer to use.

Who should NOT take HRT for menopausal symptoms?

Those who should not take HRT include those with a personal history of breast, ovarian or endometrial cancer, a strong family history of breast cancer, a history of blood clots, stroke, heart disease, liver disease or untreated high blood pressure. Ideally, it is best to use HRT for the shortest amount of time at the lowest dose, under the guidance of a menopausal specialist.

What are the pros and cons of hormone therapy?

Main indication for using oral hormonal replacement therapy is best therapy in symptomatic women for relief of menopausal hot flashes that are bothersome, disrupt sleep or adversely affect a women’s quality of life. Treating the symptoms of menopause is individualized and often based on your philosophies for the various treatment options. Discuss the treatment choices with your health care provider to understand what is best for you.

In 2002, the famous Women’s Health Initiative study studies 27,347 women aged 50 to 79 who took Estrogen only or Estrogen/Progesterone. The WHI study was prematurely stopped three years ahead of schedule when researchers found a higher risk of breast cancer, blood clots, stroke and heart attack in women on hormone therapy. When this information was given to the public, I think all women who took HT stopped taking it!

More than 10 years Further studies showed that when HT was started within 10 years of menopause or <60year, the risks are few and generally were outweighed by the benefits. However, when HT was started >60year, the reverse was true…the risks NOW outweighed the benefits. Dose and duration should be individualized and personal risk factors such as “the risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer should guide use of HT…you may not be a candidate if you have any of these risk factors.

Quality of life is everything. Menopause and its disruptive symptoms can be manageable. The benefits of hormone replacement therapy often outweigh the risks when it comes to your quality of life.

When do I stop taking hormone therapy (HT)?

There is now no general recommendation in stop taking hormone therapy at any specific age. In fact, taking hormone therapy beyond age 65years has continued health benefits for low-risk women. Continuing estrogen therapy alone (for those who do not have a uterus) beyond the age of 65years also showed a significant reduction in mortality, breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction and dementia. Taking combined hormone therapy, estrogen and progesterone, showed a reduced risk in endometrial cancer, ovarian cancer, ischemic heart disease, congestive heart failure and venous thromboembolism. Using a combination estrogen and progestogen therapy was found to increase the risk of breast cancer, but such risk can be minimized by using low doses of transdermal estrogen and progesterone. Reducing the estrogen dose (0.025mg for the patch and 0.5mg for the pill form of estrogen) to a lower dose is often recommended beyond the age of 65yr.

What is the link between declining sex hormones and symptoms we typically associate with aging, like low energy, brain fog and aches?

In perimenopause, sex hormones, estrogen, progesterone and testosterone, levels fluctuate and, in menopause, they plummet, negatively affecting the body in several disruptive ways.

The most common symptoms of perimenopause and menopause include irregular periods, hot flashes, sweating, insomnia, depression, anxiety, feeling apprehensive, weight, fatigue, poor concentration, memory loss, muscle and joint aches, vaginal dryness and low libido.

Aging causes many natural changes in the body including fatigue, muscle loss, brain fog, memory loss, weight gain and immune system weakness.

The combination of aging and normal hormone changes often make these overlapping symptoms more noticeable and challenging to handle.

How can HT help prevent or reverse these symptoms?

Hormone therapy has many health benefits for the disruptive symptoms of menopause including relief of hot flashes, night sweats, sleep disruption, brain fog, fatigue, muscle and joint aches, mood swings, depression, anxiety, vaginal dryness, libido, less pain with sexual intercourse and sexual activity.

Testosterone replacement therapy can also improve bothersome symptoms of aging and the menopause transition. Testosterone replacement not only improves libido but can also help with fatigue, muscle tone and stamina, mood disorders, sleep issues, cognitive functioning, bone strength and heart health.

Are bioidentical hormones the more safer HT than traditional HT?

First of all, the FDA, an independent group that regulates and tests for safety and efficacy of medication, has not approved bioidentical hormones, and many health insurances companies do not cover them. In contrast, medications that Western doctors prescribe have been properly tested in reliable medical studies, proving their safety and efficacy as per the FDA. Compounded bioidenticals have also not been tested in clinical trials in the same manner as hormone replacement therapy. Then there’s the question of what is “natural?” Are biodenticals more “natural?” They’re made from plant products such as soy and yams, but they still need chemical processing to become active in the body. In truth, many estrogen pills, patches, gels, creams and sprays are also bioidentical, so just because hormones are termed bioidentical, it doesn’t mean that they are more natural.

My point is that if you do choose to use bioidentical hormones, it’s important to understand that they are not proven to be any safer than hormone replacement therapy.

How can women manage their mental health during menopause?

Mental health awareness during the menopause transition should never be minimized or not taken into consideration during this hormonal rollercoaster time of life. Women must empower themselves to speak openly, without shame or embarrassment, if they notice concerning or disruptive mental health symptoms during the menopause transition.

Prioritizing mental symptoms, along with the physical symptoms, of menopause, must be a part of the routine screening process during perimenopause and menopause. Unfortunately, a woman cannot wait for the healthcare provider to ask mental health questions, it may be on you to advocate for yourself.

There are many viable treatment options for mental health challenges including antidepressants and antianxiety medications, psychotherapy, cognitive behavioral therapy, hormone therapy and support groups, that can ease the frightening symptoms during the menopause transition. Women need to understand that it is normal to experience worsening mental health symptoms during perimenopause and menopause.

Should affects on cognitive decline be considered when prescribing HT to women experiencing adverse effects of menopause?

Brain fog and cognitive decline are common symptoms in menopause and with aging. While there are many factors, including lifestyle habits and genetic influences, affecting the decline in cognitive health, hormone therapy may also help to slow cognitive decline in menopause.

The more stable and efficient transdermal estradiol has benefits of a first-pass metabolism, bypassing the liver, which may also support the area in the brain dependent on memory. Since oral estradiol is metabolized in the liver, estradiol is converted to estrone, which impacts the memory areas of the brain less effectively than transdermal estradiol. The effects of transdermal versus oral estrogen on these areas of the brain ultimately have different effects on cognition. Transdermal estrogen proves to be more beneficial in the areas of the brain responsible for memory compared to oral estrogen.

Will HT will make me fat?

No, HT will not make you fat.

Look, weight gain in menopause is a reality for many of us, but it is not the HT that will make you fat! Many women over 50 and on HT tend to blame their weight gains on the therapy, but that is not the cause. Plain and simple, as we age it is harder for us to lose weight. The hormonal upheaval of menopause tends to make weight gain in the usual places—abdomen, thighs, hips and buttocks—a common complaint. That upheaval, along with aging, genetics and lifestyle choices, makes losing weight all the more challenging. Some believe that you need to eat 200 to 300 less calories to maintain your current weight once you hit fifty, but the main focus for women should be on eating a healthy, well-balanced diet, regular exercise and limited alcohol consumption.

What’s with the debilitating vaginal dryness of menopause?

Genitourinary syndrome of menopause (GSM) is the newer term that describes vaginal dryness, burning and irritation and sexual symptoms including lack of lubrication, discomfort or pain with sexual intercourse and urinary symptoms including urgency, pain and frequency with urination. Only 25% of women with GSM talk about their symptoms with their healthcare provider. 33% of women don’t discuss GSM at all. Skin dryness involving any part of your body is uncomfortable and annoying, especially when it comes to the sensitive skin of the vagina. Persistent vaginal dryness causes itching, burning and pain can create emotional and physical disruptions in your daily life activities.

GSM does not have to ruin a sexual relationship with your partner if you start using vaginal estrogen or vaginal hyaluronic acid regularly. Keeping the vulva and vagina hydrated and moisturized with products designed specifically for this sensitize pH balance area must be a priority. I have always said that women need to treat their vulva and vagina like their face, using specially designed products to clean, hydrate and moisturize these delicate areas every day.

What can be done for vaginal dryness during menopause?

Vaginal dryness is a common and disruptive symptom of menopause. It’s a hallmark sign of genitourinary syndrome of menopause (GSM), formally known as atrophic vaginitis. The tissue of the vagina becomes thin, dry, irritated and tears easily with vaginal penetration with the loss of estrogen.

It’s important to remember to moisturize the vulva and vagina in the same way your take care of your face. Ideally you want to start moisturizing your vulva and vagina at an earlier age.

Helpful remedies for vaginal dryness and painful intercourse caused by GSM include vaginal estrogen, which is the most effective treatment for GSM. Non-hormonal prescription Ospermifene (Osphena), DHEA suppositorie and laser therapy are also treatment options . Other over the counter vaginal moisturizers, hyaluronic acid, and lubricants can be effective if you are looking for more natural remedies.

The old adage, “if you don’t use it, you’ll lose it” can apply to GSM.

Regular sexual activity and vaginal stimulation — with or without a partner —helps maintains healthy vaginal tissues in women after menopause.

Will hormone therapy (HT) help my symptoms of premature ovarian failure?

HT is recommended when early menopausal symptoms are disruptive and affect a women’s quality of life. For low-risk women, HT can reverse early menopausal symptoms and protect against bone loss and vaginal and bladder problems. It’s always about weighing the benefits versus the risks of HT. It’s best to use HT for the shortest amount of time and at the lowest dose under the guidance of a menopause specialist.

I believe quality of life is everything, so it’s important to try and manage the infuriating symptoms of menopause especially when it comes early!

What can I do for my shrinking and collapsing vagina-in menopause?

Shrinking and collapsing vaginas need a voice too! Many women suffering from vaginal shrinkage or atrophy usually do not had regular vaginal penetration. Lack of penetration, combined with GSM, can result in a shrinking of the vaginal opening which I have coined the Collapsed V. A survey found that 45% of women have never actually had an honest conversation about their vaginal dryness with their health care provider. They may have resigned themselves to sexual intercourse only once or twice a month or on “special occasions,” giving the term “birthday sex” a whole, new despairing meaning.

The good news is these disruptive vagina changes can be reversed. To begin the process of opening up again, literally (and perhaps figuratively), vaginal dilators may be employed to stretch the vaginal opening. Usually the process involves use of a dilator for 20-30 minutes, three to five times weekly, gradually increasing the size, with the goal of making vaginal penetration easier on the tissue. I created the first and only award-winning vaginal dilators that you can wear (compared to traditional dilators where you need to be lying down to use them) which has improved comfort, compliance and faster results, at keeping the entrance of the vagina more accommodating and less painful during vaginal penetration. Used in combination with twice weekly estrogen cream therapy, symptoms related to vaginal atrophy may be reversed, allowing painless (and, with luck, enjoyable) intercourse. As long as you’re 100% committed to improving dryness, you might try soaking in an extra virgin coconut oil bath for 20-30 minutes a day as a pampering addendum to treating dry skin, not only in genital area, but for your entire body. Using my silky serum vulva skin moisturizer also keeps this delicate area moisturized since menopause causes thinning of this area as well.

Alternatives to conventional dilators can be found not only at a local sex toy store in the form of dildos or vaginal vibrators, I don’t care if you use a cucumber or zucchini (of course covered by a condom) but traditional vaginal dilators are recommended. If you do however choose a ubiquitous form of produce, make sure you use a condom on it to avoid unwelcome bacteria. A pea-size dollop of topical lidocaine applied to the entrance of the vagina also helps in avoiding pain when introducing anything into a sensitive vagina, be it vegetable or mechanical. Because some of my less adventurous patients don’t know where to begin, I have gone online in my office with them, in order to scroll through dildos on goodvibrations.com, a great, accommodating online sex store that caters to women. While we’re perusing the endless array of toys, I ask these shyer patients of mine to try and approximate their husband or partner’s “size.” I tell them to decide on a favorite color, choose a special lube and pick a vibrator.

I’m proud to say that most of these patients report back with promising results after conventional vaginal estrogen therapy combined with a little fun (perhaps in the form of a classic purple dildo). Realize that when you enter menopause it’s not just the vaginal pain and dryness that can ruin a perfect date night, it’s the worry of vaginal collapse from infrequent intercourse. If you are having problems not only with dryness, but vaginal shrinkage and pain, please talk to your health care provider. Many doctors are not comfortable talking about sexual issues and if that is the case, find one who is comfortable doing so. Keep in mind that creative strategies are not only fun, but may be a necessity. The perimenopausal and menopausal women deserve sexual enjoyment in the bedroom but you have to be an active participate in this area.

Can vaginal estrogen treat recurrent UTI’s in menopause?

It’s true, vaginal estrogen saves women from recurrent urinary tract infections (UTI). It’s been found that women who use vaginal estrogen regularly, decrease their incidence of recurrent urinary tract infection by over 50%. Most women associate UTI’s with sexual intercourse but for women in menopause who have GSM they are more prone to UTI’s.

In a ground breaking study, 5638 women were studied for recurrent UTI’s. For those women who had close to 4 UTI’s a year, there was a 52% decrease in UTIs after using vaginal estrogen regularly for one year.

These results showed a significate reduction in recurrent UTI’s when vaginal estrogen was used regularly. This study proved that vaginal estrogen can treat women with recurrent UTI’s.

Vaginal estrogen is the first step in treating women with symptomatic GSM and, especially those suffering from UTI’s. There is no downside to this safe and effective treatment option.

How do antidepressants help with menopausal symptoms?

Some antidepressants have been found to lessen menopausal symptoms including hot flashes, night sweats, mood swings, depression, and anxiety. Unfortunately, some of the side effects of antidepressants, such as low libido and weight gain, can discourage their use. As long as the benefits outweigh the risks, it’s a viable treatment option worth exploring.

What are other non-hormonal alternatives in treating menopausal symptoms?

There are medications including Gabapentin and Clonidine which are not FDA approved for menopausal symptoms but can help minimize hot flashes. Side effects of both include dizziness, headaches which drowsiness may feel more disruptive than hot flashes.

Acupuncture and relaxation techniques including mindfulness, biofeedback, hypnosis, cognitive behavior therapy, yoga and Tai Chi may be helpful in controlling mood swings, depression, anxiety, hot flashes, and other mild symptoms of menopause.

There are many safe alternatives and supplements to use to treat common symptoms of menopause. You may be surprised to know that there are many scientific studies showing certain herbs to be helpful in managing the symptoms of menopause. Passionflower extract, L-Theanine, Chasteberry, Royal Jelly, Ashwagandha, Rhodiola, phytoestrogens, Ginseng, Black Cohosh, Evening Primrose oil, Hops, Lemon balm, Red Clover, Shatavari, Tribulus, Valerian, Wild Yam, Dong Quai root, St. John’s wort, Chromium, Fenugreek, Ginkgo Biloba Leaf Extract, Chamomile, Maca Root and CoQ10 are some of the better researched herbs shown to combat symptoms and improve your life. Although herbs are not FDA approved like pharmaceutical medications, well-regulated supplements can be as effective as, if not safer than, prescription medication.

Can Cannabis/THC help with menopausal symptoms?

Despite up to 80% of peri-menopausal and menopausal women using medical marijuana to help alleviate common symptoms including hot flashes, mood swings and insomnia, there are no long-term medical studies to support benefits versus potential risks. Medical research often lags behind new treatment options for disruptive hormonal symptoms, yet use with caution until science can prove its safety.

How do antidepressants help with menopausal symptoms?

How to navigate depression, brain fog, and fatigue — this is the first time I have experienced this in my life?

We always hear about hot flashes, night sweats, irregular periods and insomnia classically linked to menopause but there are other symptoms equally annoying but less talked about. Menopausal symptoms occur as a result of low estrogen levels which can also cause a drop in serotonin and dopamine levels leading to cognitive changes including memory loss, poor concentration, brain fog and depression. Normal aging also contributes to memory and brain fog issues so the overlap makes these symptoms seem more pronounced.

Vyvanse and other ADHD medications can be helpful with menopausal symptoms related to staying focus, organized, managing time, improving concentration, forgetfulness, and memory, also known as “foggy brain”. Even if you have not been officially diagnosed with ADHD in the past, menopause can throw you into an ADHD-like state.

A woman’s natural estrogen supply is protective against developing depression. Hormone replacement therapy can be helpful with some of these symptoms, especially if it is a new onset of depression. Menopause can worsen a woman’s depression or can bring out a depression a woman did not know she had. Talking to your healthcare provider or therapist can help you navigate these symptoms and consider starting a new antidepressant or increasing the dose of one that a woman is currently taking.

What are other non-hormonal alternatives in treating menopausal symptoms?

What type of doctor should I talk to if I am considering HT?

Recommendations and guidelines surrounding HT in menopause are very confusing, not only for patients, but also for healthcare providers. Finding a healthcare physician who is updated on current guidelines by the North American Menopause Society (NAMS) and well trained in caring and treating women experiencing hormonal changes caused by peri-menopause and menopause is so important. I cannot emphasis this enough. Gynecologist, Endocrinologist, Family and Primary Care Doctors are all medical doctors that can be considered, depending on where you live and how easy access you have to healthcare. Telemedicine and virtual consultations are an easy, cost-friendly and helpful way to now manage disruptive peri-menopause and menopause while sitting at your home computer. Women should do their research, ask others going through the same hormonal challenges, read YELP and other independent reviews on the doctors and patients experiences.

One reputable telemedicine site to get easy and well-priced consultations on menopause is https:quickmd.com

For women who can’t use hormone treatments, are there non-hormone remedies that can help with these kinds of symptoms (low energy, brain fog, etc.) that you recommend?

Not every person is a candidate for hormone therapy nor may want to take them for personal reasons. Those who should not take hormone therapy include those with a personal history of breast, ovarian or endometrial cancer, a strong family history of breast cancer, a history of blood clots, stroke, heart disease, liver disease or untreated high blood pressure.

For women experiencing the vaginal dryness and pain with sexual activity, low dose topical vaginal estrogen can offer relief from dryness and thinning tissue.

Fezolinetant (Veozah) is one of the newer kids on the block as a nonhormonal treatment option for hot flashes in menopause. It works by targeting and blocking the body’s temperature receptors (TRPV1) in the brain responsible for hot flashes.

Elinzanetant (Lynkuet) is the latest nonhormonal option in the medication arsenal in treating hot flashes. Lynkuet works in the brain, similarly to Veozah, by blocking the body’s temperature regulator receptors (NK1 and NK3), that trigger hot flashes. Lynkuet reduces hot flashes by blocking the chemicals in the brain responsible for causing disruptive vasomotor symptoms.

Selective serotonin reuptake inhibitors (SSRI’s) include Paroxetine (Paxil), Escitalopram (Lexapro) and Citalopram (Celexa), help relieve menopausal symptoms including hot flashes, night sweats, sleep issues, depression and anxiety, by controlling serotonin in the brain.

Selective serotonin-norepinephrine reuptake inhibitors (SNRI’s), include Venlafaxine (Effexor) and Desvenlafaxine (Pristiq) help to relieve the same symptoms that SSRI’s do by controlling serotonin and norepinephrine in the brain.

There are other medications including Gabapentin and Clonidine which are not FDA approved for menopausal symptoms but can help minimize hot flashes.

Despite up to 80% of peri-menopausal and menopausal women using medical marijuana (THC) to help alleviate common symptoms including hot flashes, mood swings and insomnia, there are no long-term medical studies to support benefits versus potential risks. Medical research often lags behind new treatment options for disruptive hormonal symptoms, so use with caution until science can prove its safety.

A healthy lifestyle goes a long way at any time in your life, but especially in this later chapter of life. Inactivity, unhealthy diet (fast food!), smoking, obesity, excessive alcohol consumption…if you are still waiting to remedy any of it, now is the time! All these factors only make menopause worse than it needs to be. There are simple adjustments you can start to make as soon as you put this book down.

A diet focused on fresh fruits, vegetables, whole grains, and fish, with limited alcohol intake and little red meat not only benefit your heart, it improves cognitive function. The Mediterranean diet is associated with the highest life expectancy and lowest heart disease rate and is proven to help menopausal symptoms.
Ditching the fast food, fast! The saturated fats and excessive sodium in fast food gives you no “value” whatsoever, in fact, depression is more common in those who eat fast food regularly. Within weeks of removing this food, you will show a decrease in cholesterol levels and even a decrease in weight gain.
Removing or decreasing “sweets” in your diet will not only limit your calorie intake; it will often reduce your intake of fat. A reduction of sugary foods will immediately reduce blood sugar, which will help in decreasing the bloating and water retention so common in menopausal women.
Limiting Alcohol Consumption. Alcohol increases your risk of heart disease, liver disease, high blood pressure, diabetes, colorectal and breast cancer, and, now we know (drum roll please), worsens hot flashes—and, by the way, one five-ounce glass of wine is equivalent to 1½ ounces of hard liquor, which may surprise and depress many of you. It is recommended that you consume no more than three to four servings of alcohol a week. Removing alcohol, even one or two drinks a few times a week, has immediate effects on blood sugar levels, water retention, blood pressure, weight loss, energy level, emotional stability, sleep changes and pulse rate.
Staying hydrated. About 55% of adult, female bodies are made of water. A good goal is to never feel thirsty as thirst is your body’s way of telling you that you need more fluid. Dehydration requires your body to work harder to perform even the most basic functions which can lead to fatigue. Dehydration can also cause nausea and difficulty concentrating. Choose water or caffeine-free tea or coffee and avoid sugary or high calorie drinks.
Avoiding hot and alcoholic beverages and avoiding hot and spicy foods also help prevent mild to moderate symptoms of menopause.

Harmful lifestyle habits include smoking, inactivity, eating an unhealthy diet, obesity, excessive alcohol consumption, stress and not sleeping well all contribute to making menopausal symptoms worse.

Nonhormonal therapy is a viable option with successful results, for those who prefer not to take hormone therapy or have taken hormone therapy with negative side effects or no symptomatic relief. There are safe alternatives when combating disruptive symptoms of menopause, many are worth exploring!

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