February 19, 2018


hot flashes ›   menopause ›  

Normalizing Menopause in the Workplace

For our mothers, pregnancy was the workplace unmentionable. Once a married woman began to “show,” she was expected to leave her job and begin her new life as a stay-at-home wife and mother. Now, our daughters often have family leave time, breastfeeding rooms at work, sometimes even on-site daycare.  

Still, we have a long way to go. Despite progress on many fronts, menopause remains the workplace unmentionable. It makes people uncomfortable. It can be embarrassing; it isn’t well-understood; it is the butt of stereotypes and jokes; it is inevitably linked to being old, infertile and irrational. Heck, too often, we don’t even understand it ourselves.

In the workplace, the universal approach to menopause seems to be “don’t ask; don’t tell.” If you can’t see it, it ain’t happening.

There are, however, a few problems with this approach.

In our mother’s time, women over 50 were a rarity in the workplace. Our mothers didn’t talk about menopause. They didn’t discuss it with their doctors, spouses, or with us, by and large. There weren’t many options for treatment, anyway.

Now, however, while menopause is still in the closet, a lot of valuable employees at the peak of their careers are going through it. Now, most (75 to 80 percent) of women of menopausal age are working. If menopausal symptoms affect job performance and satisfaction, and if many of these problems could be addressed with more flexible policies and a supportive environment, then why isn’t it happening? Why are so many women struggling through the workday when fairly simple solutions could be implemented?

Menopause is prolonged and unpredictable. There is no handbook; it isn’t over in nine months—it can, in fact, last anywhere from four to eight years! Some women sail through without missing a beat while others struggle mightily with emotional swings, sleep issues, brutal hot flashes and night sweats, and a severe hit to self-confidence. Most of us fall somewhere in the middle, and most of us would appreciate a little understanding on the job.

Because we are numerous and at the peak of our career, one would think that accommodation, or at least conversation, would be happening in the workplace. But alas, in the US we are far behind our Western counterparts overseas. In Europe, awareness may be in its infancy, but at least it’s on the radar.

A lot of people are afraid to say what they want.For example, a poll of just over 1,000 women between 50 and 60 conducted by BBC Radio in Great Britain found that over 70 percent of women didn’t discuss their menopausal symptoms with their employer and about 33 percent hadn’t talked about it with their doctor, either. Half of the women surveyed said that menopausal symptoms had affected their mental health and one-quarter said that it made them want to stay home.

"It was such a waste of all that talent and experience that these women had in serving the public,” said Sue Fish, the former police chief who established the force’s first menopause policies in this article. "I was horrified to find out women were leaving early because of the severity of their symptoms. Some had been rebuffed by line managers or they'd chosen not to talk about what they were going through.”

It’s a touchy issue, to be sure. Most of us wouldn’t want to be singled out for special treatment, and most of our colleagues and bosses wouldn’t want to draw attention to our difficulty or make suggestions about fixing it. Yet, competent, productive women still struggle through work situations that could be made bearable with some awareness and a few, simple adjustments.

A web entrepreneur says in this article, “I have friends in senior roles who have had to attend meetings with closed windows where they were almost expiring from heat and drenched in perspiration, fearing that wet patches might appear – but this does not prevent them from continuing to work effectively.”

So, what’s the balance, and how do we begin to move the needle so our daughters don’t have to sweat it out (pun intended) in an oblivious workplace?

The Faculty of Occupational Medicine (FOM), the educational body of the Royal College of Physicians in the UK, has put together some fairly commonsensical suggestions in its “Guidance on Menopause in the Workplace” that were adapted from the European Menopause and Andropause Society.

The guidelines are addressed to both employers and to menopausal-aged female employees, since both sides share ownership of a solution. Guidance for employers emphasizes an atmosphere of openness and dialog, along with training for management. It also suggests that employers provide some access to ventilation and temperature control, some flexibility in work hours, choice in types of fabrics and the ability to layer clothing when a uniform is required, and some ability to move around for sedentary workers.

Menopausal employees are encouraged to learn about this transition and to reach out to their doctors for help and information, to develop techniques, such as note-taking and using a calendar, to compensate for memory lapses, to reach out to colleagues, sympathetic managers and HR personnel for help and camaraderie when possible rather than trying to suffer in silence. The guidelines also suggest using mindfulness techniques to reduce stress and to consider lifestyle changes that are known to ease symptoms: weight loss, not smoking, reducing alcohol use, and exercise.

Working toward a workplace that is accepting and open to menopause is a worthy goal, and now, given our numbers, is an opportune time to crack that resistance. We did it before, and for our daughters’ sake, we can to do it again.

Q: Will vitamins be effective for hot flashes and other symptoms?

You mention joint pain, weight gain, and food cravings in addition to hot flashes as symptoms of menopause. Menopause has such a variety of symptoms, depending on each individual. Lifestyle matters more; exercise is more important; adequate sleep and good nutrition—all of these have a greater impact to quality of life now than they did previously.

I wish I could tell you there is good data suggesting vitamins have a favorable impact on menopausal symptoms, but the trials looking at the specific supplements you mention and others suggest no benefit greater than placebo. But, hey, placebo has about a 30-percent response rate in any trial, so there is certainly no harm in using them. They provide some general vitamins that will not be harmful, and may help if you aren’t getting them in your diet.

The symptoms you mention could all potentially benefit from hormone therapy (HT). The loss of estrogen is huge for most women, and the loss of progesterone to some extent as well. For many women the only way to address symptoms adequately is to consider HT. More and more data suggests that HT is beneficial for women specifically with weight gain; that was a lead article in one of my journals just this week.

It’s a complicated journey that is nuanced, and each woman needs to assess her own symptoms and goals and determine the best approach to managing through menopause. It’s difficult to address all of the treatment options in a single Q&A. You might find the North American Menopause Society (NAMS) website helpful: menopause.org. They cover many issues related to menopause.

Good luck!


Soy: The Royal Bean for Symptom Relief

Previously, we examined several herbal remedies that are commonly taken to relieve hormonal symptoms. Plants have been used since time immemorial for treating health conditions, and I have the utmost respect for plant-based medicine.

Except for three caveats: 1) botanical (plant-based) treatments can have side effects and drug interactions just like any other medicine; 2) their use, dosages, and efficacy in treating specific illnesses haven’t been rigorously studied; and 3) the manufacture of these products isn’t held to federal standards for safety or consistency.

So my general approach to botanical therapies has been to proceed with caution. Always tell your doctor what natural remedies you’re taking, buy products from reputable manufacturers, and pay attention to how they’re affecting you.

Except for soybean products. I withdraw most of my qualifiers for soy.

While soy has gotten a bad rap in some quarters, especially since most of the US-grown beans are from GMO seedstock, soy still comes close to being a superfood in my (and others’) playbook.

Another tick in the plus column is that soy has been subjected to numerous rigorous scientific studies. (Not to mention that it’s been consumed for millennia in Asian countries.)

My approach to botanical therapiesRecently, new studies have shed light on how soy might work to relieve menopausal symptoms, such as hot flashes and even vaginal dryness. Its effects aren’t always straightforward, as in “eat more soy, have fewer hot flashes” (although sometimes, it is just that straightforward), but it does clarify how soy is broken down in our systems and under what circumstances it seems to be effective.

When we consume soy products, such as tofu, soy milk, tempeh, edimame, it’s metabolized in our gut into two main isoflavones: daidzein and genistein. These compounds have phytoestrogenic properties, meaning that they mimic estrogen in some ways. (However, seem to carry less risk than estrogen,  related to estrogen, and in fact, some research suggests they may have some protective qualities.)

Some women (about 30-40 percent of North American and Europeans; significantly higher percentages of Asians) carry a gut bacteria that can metabolize daidzein into a substance called S-equol. And this, according to at least one recent study, is the bit that is strongly linked to relieving hot flashes and other good stuff.

Among the women who produce equol, those who ate the most soy and had the highest levels of daidzein, reported far fewer vasomotor symptoms (VMS--or hot flashes in common parlance) than equol producers who ate less soy. “Among equol producers, higher equol availability attributable to higher soy consumption contributes to decreased VMS,” the researchers concluded.

Among women who didn’t naturally produce equol, there was no link between higher levels of daidzein and fewer hot flashes. Either you could produce equol and reap the benefit of soy or you couldn’t. Until recently, the only way to find out, says North America Menopause Society executive director, Margery Gass, was to conduct your own personal experiment: Eat soy foods for 4 to 6 weeks, and if it didn’t help, you probably couldn’t metabolize equol.

You either had the right gut flora or you didn’t.

Recently, however, a Japanese pharmaceutical company, Otsuka (Pharmavite in the US) has developed an S-equol dietary supplement made from fermented soybean germ, so whether you are among equol-producing women or not, you have access to the same VMS-busting possibilities.

Studies are fragmentary and scattered, but the consensus seems to indicate that S-equol, either produced naturally or taken as a supplement, is a viable and safe way to reduce the frequency and severity of hot flashes. It also may have positive effects on skin health, including regeneration and thickening of vaginal tissues without the risks associated with hormonal supplements.

Theoretically, you can take 10-40 mg. of S-equol supplement per day for relief of hot flashes. Since it’s metabolized quickly, you should take it in several 10 mg. doses at different times. S-equol has no negative interactions with drugs or supplements, and its side effects are minimal, although research is contradictory, so women with a history of breast cancer are advised to avoid it.

So there you have it. No guarantees, but with very little risk or expense you can conduct your own naturopathic experiment in taming menopausal symptoms. Let us know how it goes.


September 14, 2015


hot flashes ›   menopause ›   sexual health ›  

Menopause Awareness Month: Let’s Start Something

My car’s license plate reads “HOTFLAS.” I take it for granted, until someone rolls down his window to talk to me at a stop sign.

“Hey, I like your license plate,” he says. “You must be about 50. Wow, my wife is going through that. It’s really tough. It’s been a real challenge.”

Only a few days later, I was meeting with a colleague from a nonprofit for whom I volunteer. “Remind me what you do,” he said. It took about half a sentence from me (“I’m a doctor specializing in menopause care…”) to strike a nerve with him. “It’s like a stranger is living in my house,” he said, of his wife’s journey through menopause.

It’s Menopause Awareness Month. These men—among so many others who regularly cross my path—are aware of menopause. Now. I think it’s safe to say that the experience has taken them—and their wives—somewhat by surprise. I can’t think of another medical condition that affects so many of us—directly and indirectly—yet about which we have so little advance education.

Six thousand American women become menopausal every day (defined as not having menstruated for a year). In the U.S., the average age of menopause is 51; that’s the age the youngest of the Baby Boomers are now. We have the highest proportion of menopausal women in our population we’ve ever had—and may ever have again.

And yet, women I meet in all areas of my life—and the men who are living with them—are surprised by the range of effects from the change in estrogen in their systems. While lots of jokes (and T-shirts) circulate about hot flashes, women don’t realize that they may also have

  • Difficulty with memory and cognition
  • Increased joint pain
  • Urinary urgency and frequency, including susceptibility to bladder infections

About half of women have pain with intercourse five years after menopause. For whatever reason, many women don’t associate that symptom with menopause. Too many of us think it’s just “what happens.” Too many of our doctors don’t ask about our sex lives, so women don’t tell about their experiences. While there are a range of treatments—both over the counter and prescription—that would help, too many of us are unaware of them.

Avoiding the topic doesn’t make menopause go away. I’ll keep talking—to patients, to colleagues, to men and women on the street. I encourage you to learn everything you can, pay attention to your own health, and to join the conversation! We midlife women are indispensable resources to our families, our companies, our communities. We deserve to have this natural phase of our lives understood!

September 04, 2015


hormones ›   hot flashes ›   menopause ›  

Let’s Not Grin and Bear It

I’m an optimist by nature.

And that’s a good thing. I saw an article this week headlined “Women are not getting treated for menopausal symptoms.” It outlines the research behind the statement, research done in Australia but believed to be indicative of the reality elsewhere, including the U.S. and the U.K.

The researchers surveyed nearly 1,500 women who were 40 to 65 years old. Some of the results:

  • Up to half experience “vasomotor symptoms,” which include hot flashes and night sweats.
  • Seventeen percent said their vasomotor symptoms were moderate to severe.
  • Eighteen percent reported moderate to severe sexual symptoms.
  • Only 11 percent of respondents said they were using any hormone therapy.
  • Less than one percent were using non-hormone therapy.

Shop Comfort and Vaginal Health ProductsThis is, sadly, in line with other research I’ve seen over the past few years. Too many of us are taken by surprise by menopause symptoms. Too many of us expect the symptoms to pass in a month or two, when in actuality they may last for years. Too many of us suffer in silence (in one study, only 14 percent of men and women over age 40 had talked to their doctors about sexual health). And too many of our doctors lack either the information or the confidence to help us navigate these years.

And there are options available. The initial “alarming” findings from the Women’s Health Initiative regarding systemic hormone therapy have been largely disproved, put into a broader context of the trade-offs between quality of life and symptom management. The North American Menopause Society points out that breast cancer risk associated with systemic hormones doesn’t usually rise until “after 5 years with estrogen-progestogen therapy or after 7 years with estrogen alone”—which is likely long enough to weather the worst of menopause symptoms.

Localized hormones are an option for some symptoms; because they’re applied directly in the vagina, very little is circulated throughout the body. That limits or eliminates the risk of side effects, while still offering benefits in maintaining or restoring vaginal tissues.

New nonhormonal options for menopausal symptoms are also available, approved by the FDA. Osphena is a “selective estrogen receptor modulator” (SERM) that targets the vagina and uterine lining. Duavee is another medication in the SERM category that can be effective for hot flashes, with potential benefits for bone density. Brisdelle is an antidepressant that’s been prepared at a dosage that can help with hot flashes while minimizing its occasional side effects of weight gain and loss of libido.

Those are all prescription options, and there are plenty of steps women can take on their own, as well. That’s really our entire message, but if you’re looking for a place to start, these are the products women find most immediately helpful:

  • Lubricants make uncomfortable sex immediately more comfortable.
  • Moisturizers have longer-lasting effects, and can be used with lubricants to counter vaginal dryness.
  • Vibrators, as I tell women in my practice, are the reading glasses for diminished genital sensation.
  • And Kegel exercise tools help women keep their pelvic floors in shape, which is good not only for sexual response but for managing incontinence.

See how many things we can do? We don’t need to “grin and bear it,” as researcher Dr. Susan R. Davis, from the Monash University in Melbourne, fears we think. Step one is to believe—share some of my optimism!—that something can be done.

And then learn what you can, talk to your health care provider about your history, symptoms, preferences, and risks. Feel free to experiment until you find some options that make you smile.

Q: No-estrogen options for symptoms of surgery-induced menopause?

You describe hot flashes and night sweats that began after a hysterectomy to reduce breast cancer risk. You're right that the symptoms can be prompted by your sudden entry into menopause (through surgery) as well as by the prescriptions intended to deplete estrogen in your system. You are, as you know, not alone in facing this challenge!

I always start with lifestyle factors, which can lessen symptoms for anyone. You may be able to identify triggers (like caffeine, alcohol, spicy foods, or sugar) that you can avoid in your diet. Dressing in layers is a must for many of us. Now is the time to exercise regularly; women who do so may have fewer and/or less intense hot flashes.

Reducing stress—or learning new tactics to manage it—is helpful if you can do it (I know life doesn't always cooperate). Paced respiration is a technique to ease the intensity of a hot flash when one occurs: Breathe deeply and slowly, inhaling through your nose and exhaling slowly through your nose or mouth. There's also a biofeedback technique to slow the heart rate, which may lessen the hot flash intensity and duration (because an elevation of heart rate is part of the physiology of a hot flash).

Acupuncture has been very helpful to a number of my breast cancer patients in managing hot flashes.

Beyond that, we haven't seen a lot of success with alternative medications and complementary therapies. Those that have been tried include isoflavones (found in soy but not recommended for breast cancer patients), black cohosh, chaste tree berry, ginseng, dong quay, red clover, yarrow and others. For those that have been investigated and undergone careful scrutiny, the results are disappointing; there is limited scientific evidence for most herbal options. That being said, placebo has at least a 25 to 40 percent response rate in nearly every study, so if you can determine that an herb is not harmful (check with your physician) I do not discourage women from trying herbal preparations. I wish we could make a recommendation knowing we are in fact offering beneficial outcomes, but that just hasn’t been so for these options.

There are some non-hormone prescription options that have favorable effects. Just in the past year the FDA approved Brisdelle specifically for the treatment of hot flashes. It cannot be used with Tamoxifen, but as a very, very low dose of paroxitene (generic for Paxil), Brisdelle is well tolerated with minimal side effects. The anti-hypertensive medication clonidine has been shown to reduce hot flashes for some women, as well as gabapentin (generic for Neurontin). Other antidepressants can reduce hot flashes as well: venlafaxine (generic for Effexor), paroxetine, and fluoxitene (generic for Prozac), and escitalopram (generic for Lexapro). All of these have a modest benefit to hot flashes. They each have the potential of side effects, so a discussion with your provider is helpful in determining an option best suited for you.

Good luck, and the good news is that time will work to your advantage for the hot flashes. This too shall pass—really!

The Wrong Kind of "Hot"

Now that the FDA advisory panel has pulled the plug on two nonhormonal drugs to treat hot flashes and night sweats, what’s a grumpy, sleep-deprived, sweaty, menopausal woman to do?

For most of us, hot flashes are uncomfortable and inconvenient. For some of us, hot flashes are debilitating and make it hard to sleep or function normally. And except for hormone therapy, no treatment regimen is guaranteed to alleviate them.

So, chalk up yet another inhibitor to sex (as if we needed one). It’s hard to feel “in the mood” when your nightie’s soaked and sweat is running down your back—and this is pre-foreplay.

It may be possible, however, to manage the frequency and intensity of hot flashes with some simple home remedies. For some women, these techniques work well; for others, not so much. As in so much of life, it’s a matter of experimenting until you discover what works for you.

These more natural approaches fall into four categories: lifestyle changes, identifying the triggers, controlling your environment, stress management, and botanical remedies. If you’re bothered—or handicapped—by hot flashes, a combination of these might help. Even if the cure isn’t perfect, your overall health should improve. In the long run, that’s a whole lot better than popping a pill.

Lifestyle changes

A generally healthy lifestyle goes a long way to making you feel better all over. You’ll mitigate other problems, like diabetes and obesity, and you just might find your hot flashes are less frequent and intense as well.

A healthy lifestyle includes

  • A diet of high-quality, fresh fruits and vegetables, whole grains, low in fat and processed foods
  • Regular exercise that gets your heart-rate up and doesn’t injure your joints: brisk walking, swimming, free weights, yoga, tai chi
  • Losing weight, if necessary. You may have put on some menopausal baby fat (haven’t we all?), but be aware that a higher body mass index is related to more frequent hot flashes, according to the North American Menopause Society (NAMS).

Identifying triggers

While hot flashes are maddeningly unpredictable, they often seem associated with certain triggers, which are unique to every woman. Try to identify yours. Common triggers include

  • Caffeine, alcohol, and cigarettes (even passive smoke may be trigger one)
  • Anxiety, stress, and stressful situations
  • Hot drinks and spicy foods. If you’ve ever watched someone eating a habanero pepper, well, that’s enough to give you a hot flash right there.
  • Stress
  • Hot, stuffy, or crowded rooms
  • Activities that produce heat—ironing clothes, washing dishes, strenuous exercise
  • Did we mention stress?

Managing stress

Stress is linked in several studies to more frequent hot flashes, and you can bet they’ll happen at the most inconvenient times. When you’re heating up at a stressful moment, remember that, while embarrassing and uncomfortable, hot flashes aren’t life-threatening or even particularly noticeable to others. A few inconspicuous comfort measures will help you get through the moment, even in tense situations:

  • Breathe. Instead of panicking inwardly, consciously take deep, relaxing breaths.
  • Get up and walk around.
  • Open a window.
  • Try meditation, massage, yoga, relaxation or other therapy.
  • Maintain a sense of humor. You have to admit, the whole thing is kind of funny.

Controlling the environment

Because the hormonal changes you’re experiencing have temporarily (or not so temporarily) messed with your body’s temperature-regulating mechanism, you can compensate (in part) by controlling the ambient temperature. Some easy ways to do this include

  • Keep the house, especially the bedroom, cool and well-ventilated.
  • Cotton (or fibers that wick moisture away from your skin) is your friend. Use cotton bedclothes and keep a spare pillowcase handy. Or, check out cooling bedsheets like those at DriNights. Keep a clean, cotton t-shirt beside the bed.
  • “Keep a frozen cold pack under your pillow, and turn the pillow often.” (From NAMS)
  • Check out the Dry Babe website for a line of “absorbent sleepwear for hot mamas.” These could lead to a little heated action of their own.
  • Wear clothes in layers that you can shed or add as necessary.
  • Carry a pretty Oriental fan in your purse.

Botanical remedies

Finally, a few botanicals have been associated with relief of hot flashes. Again, research is inconclusive: Some women are helped while others aren’t. But the remedies are relatively safe and free from serious side effects. You could try:

  • Black cohosh. Already commonly used in Europe, this member of the buttercup family may be the most promising herbal treatment for hot flashes.
  • Soy and red clover contain plant-based estrogen, which isn’t as effective and doesn’t work the same way as the estrogen synthesized for hormone treatments. Still, some women say they help.
  • Vitamin E. Again, scientific evidence is scant, but some women say these supplements work for them.

Just because a supplement is “natural” doesn’t mean it’s automatically safe for everyone. Some herbal supplements are quite potent, and others could interact with medication you’re taking or exacerbate a physical precondition you already have. So consult with your doctor or pharmacist before taking botanical remedies.

If you discover a remedy that works for you—please share!

Nonhormonal Drugs for Menopausal Symptoms Nixed by FDA

So much for WISHes.

Following the approval of Osphena, a nonhormonal drug for vaginal pain, or dyspareunia, an advisory panel for the Food and Drug Administration (FDA) just voted against approving two nonhormonal drugs for the treatment of hot flashes.

Hot flashes, night sweats, and the sleep disturbance that accompanies them affect about 75 percent of perimenopausal women. Often, they are merely inconvenient, but for some women, they are severe enough to affect sleep, sex, and overall well-being. And they may continue for years—long after menopause is over.

However, based on the results of several rounds of clinical trials for gabapentin, a drug already used to treat seizures and nerve damage from shingles, and other trials for paroxetine, an antidepressant (the active ingredient in Paxil), the FDA panel voted overwhelmingly to deny approval.

The panel’s objection to both drugs was that their effectiveness didn’t outweigh the risks and side effects associated with their use. The most common side effects of gabapentine are dizziness and drowsiness. The most common side effects of paroxetine are nausea, sweating, drowsiness, and headache.

According to a recent New York Times article, women in the gabapentine trial experienced an average of 11 hot flashes a day. At the end of 12 weeks, they were down to about 4 per day. But the women on placebos saw almost as much relief—their hot flashes had dropped to about 5 per day. Thus, “women taking placebos in the trials experienced a substantial reduction in hot flashes that the drugs could not beat in any pronounced way.”

Women in the paroxetine trial fared slightly better, but the FDA panel decided that it still hadn’t cleared the bar for approval.

Voices on both sides of the debate are intense.

“They don’t work and cause dangerous side effects,” the consumer advocacy group Public Citizen testified before the FDA panel.

On the other hand, Linda Keyes, one of the panel members who voted to approve the drugs, said that the need for nonhormonal treatment “is high enough that I feel that a very modest reduction [in hot flashes] is still acceptable, assuming the risks are known and carefully watched, which I believe they can be,” according to an article on WebMD.

Obviously, these results are disappointing for women who are looking for a safe, federally approved, nonhormonal treatment for hot flashes and sleep disturbance. Currently, the go-to treatment for these menopausal symptoms is hormone therapy, and many women either can’t take hormones or choose not to because of the risk of stroke and breast cancer.

Both gabapentine and paroxetine are available off-label, and doctors have been prescribing them for menopausal symptoms for years. They, and other off-label options, can still be considered for treatment of menopausal symptoms—yet another reason for a detailed discussion with your health care provider so you’re making the best—and best informed—choices for you.

Herbs to Manage Menopause. Maybe.

Humankind has relied on medicinal plants for thousands of years. From that perspective, treatments like estrogen therapy (ET) are a flash in the pan.

And with insecurity about prescription oral ET because of rumored links to breast cancer and heart disease, are we back to leaves and roots?

Well, that’s an option. Maybe.

Many people choose nontraditional therapies, such as acupuncture, massage therapy, and homeopathy, either exclusively or in addition to traditional medicine. Botanicals—herbs and other plants—is just another of those nontraditional approaches. In fact, botanicals are still used in about half of the prescription drugs we take, according to an article in WebMD.

If you’re interested in trying botanicals for menopausal symptoms, like hot flashes, night sweats, and mood swings, here are a few options.

But first, a few caveats:

  • Herbs are drugs, just like pharmaceuticals. Don’t think that because they’re “natural” that they’re somehow safer or more pure. I often remind women that marijuana and cocaine are botanicals, too, so “botanical” does not always equal “healthful.” Botanicals can interact with other drugs, and they can cause side effects. If you have any medical conditions or are taking other medicines, do your homework and check with your doctor before taking any botanical.
  • Botanicals aren’t regulated. Dosages might vary and so might the quality and the efficacy of the remedy, depending on the manufacturer. So be sure to check the dosage you’re taking and buy botanicals from a reputable source.
  • There isn’t much credible research on the efficacy and long-term safety of most botanicals, so a lot of information is conflicting or based on hearsay from less-than-credible sources. For solid, current information, check out the National Center for Complementary and Alternative Medicine (NCCAM) website, which is maintained by the US Department of Health and Human Service.
  • No drug or botanical remedy replaces good health habits, like weight control, exercise, and a well-rounded diet.

So here’s the lowdown on the top botanicals for relieving some menopausal symptoms.

Black cohosh

Native Americans have used this member of the buttercup family to treat “female troubles” for hundreds of years. More recently, Germany’s Commission E, which is similar to our FDA, approved black cohosh for relief of menopausal symptoms. Remifemin is the commercial (and standardized) version of black cohosh. It’s also the version of black cohosh that’s been used in several studies.  As with most botanicals, however, the research is contradictory. It’s used to relieve hot flashes, night sweats, vaginal dryness and “other symptoms.”


While not an herb, per se, soy is one of those few plant-based substances that can only do you good. As a source of isoflavone—an estrogenlike hormone—it might relieve menopausal symptoms, although the North American Menopause Society stops short of recommending it due to inconclusive evidence. However, soy is known to control cholesterol and to help prevent osteoporosis, besides having several other health benefits. In any of its many forms—tofu, soy milk, roasted soybeans—it’s safe and good for you.


Fruit of the chaste tree, which is native to central Asia and the Mediterranean, chasteberry has been used for menstrual and menopausal symptoms for millennia. While it might be more effective in treating menstrual problems, the jury is still out on how it works and how effective it is on menopausal issues. While it doesn’t have serious side effects, it might affect hormone levels. It might also suppress sexual desire (thus the basis of its quaint name), so if you’re experiencing that side effect of menopause, this isn’t the herb for you. It’s also knows as “monk’s pepper” for its libido-suppressing qualities.

Dong quai

Sometimes called the “female ginseng,” dong quai is another of those ancient remedies with conflicting and unproven results. Some sources unequivocally praise its ability to relieve hot flashes and night sweats; others that it has no benefit beyond placebo.

But everyone agrees that one side effect is increased sensitivity to sunlight, so be more vigilant about using sunblock if you take it.

Evening primrose

Evening primrose is a pretty North American plant with yellow flowers that blooms, as its name suggests, in the evening. Oil from its seeds is extracted to make the botanical remedy. It has few side effects, but it apparently isn’t very effective at treating menopausal symptoms. Maybe plant the seeds in your garden and enjoy the pretty flowers?


Not long ago, ginseng root was touted as an herbal tonic for everything from memory problems to erectile dysfunction to a general energy booster. It would be hard for any substance to live up to such hyperbolic claims, and ginseng doesn’t. “Research results to date do not support health claims associated with the herb,” states the NCCAM fact sheet.

As a magic bullet for menopause? Not so good.

It’s fairly innocuous, and might have some health benefits, but it isn’t the miracle cure it was cracked up to be.

St. John’s Wort

Another of those old-time remedies that has recently made a comeback as a sedative and treatment for mood disorders, such as anxiety and depression. While it may—or may not—be beneficial (a large NCCAM study found it no more effective than a placebo), it definitely has some powerful side effects.

St John’s Wort interacts negatively with a host of medications, including other antidepressants. It has a long list of side effects, including sensitivity to sunlight and sexual dysfunction. Yikes!

Have you tried any of these or other botanicals? How have they worked for you?

Bad News for Smokers: More Reason to Quit!

About one in five women smoke. If you’re part of that 20 percent, I'm sure you've heard all the warnings and finger-wagging about the health hazards of smoking. Maybe you’re tired of hearing about all that bad stuff.

Well, unfortunately, here’s more bad news.

Just view this post as informed consent rather than yet another attempt to scare the bejeesus out of you. You can ignore it—just don’t say we didn’t tell you.

Several recent studies on smoking and menopause have found that not only do smokers enter menopause early by about a year or two, but also that menopausal symptoms, such as hot flashes, are more intense.

The more you smoke, the greater your chances of early-onset menopause. (Your odds are more than double, according to a 2007 study of 2,000 women in Oslo, Norway.) Researchers think that smoking may affect hormonal levels or the secretion of enzymes related to hormones. It may also activate certain genes that trigger the onset of menopause.

Early menopause is troubling because it’s linked to heart disease and osteoporosis. In fact, a team of researchers in Boston have hypothesized that smoking rather than early menopause may be to blame for the rise in heart disease they see in post-menopausal women.

In addition to entering menopause early, women who smoke have more severe menopausal symptoms, and now a group of researchers from the University of Pennsylvania have specifically linked the severity and frequency of hot flashes to smoking and to genetic variations that control the metabolism of estrogen and the body’s response to environmental toxins.

In a 10-year study of 300 women, half of whom were African-American, smokers overall were about twice as likely to suffer from more severe and frequent hot flashes than nonsmokers. But with certain genetic predispositions, the African-American smokers were 84 percent more likely to suffer from intense and frequent hot flashes, while the white smokers were 56 percent more likely.

In an article for WebMD Health News, Dr. Margery Gass, executive director of the North American Menopause Society said, “I don't think most women who smoke know that they are at risk for earlier menopause and more severe menopause symptoms.”

But now you know.

So if you suffer from hot flashes, and you smoke, you have one more reason to consider quitting.