By Dr. Andrea Hilborn, ND

Originally published in the Kingston Whig-Standard.

Some women go through menopause wondering what all the fuss is about — they feel fine. Others have moderate discomfort, and still others are catapulted into firey hot flashes and wild mood swings. Menopause sweeps through the entire body, making it capable of producing a wide range of symptoms, from brain fog to bone density loss.

Many seek relief for these symptoms, most often through hormone therapy. Formerly, women were on hormone therapy (HT) permanently — from peri-menopause to end of life. HT was thought to decrease risk of heart attack and osteoporosis, among other things. However, studies revealed that this was not the case.

Conjugated estrogen, plus medroxyprogesterone (the most common form of HT) taken over the long term increases the risk of heart attack and breast cancer, among other diseases. Short term use of HT is still considered safe; the reigning principal has become “the lowest effective dose for the least amount of time.” Generally, use of HT is now limited to a four- or five-year span.

In my practice, I suggest a holistic approach that looks at nutrition, stress and sleep. When needed, I recommend women try nutritional and herbal remedies before turning to hormone therapy. There are remedies I turn to again and again to decrease hot flashes, improve mood and restore libido.

Flaxseed contains something called a phytoestrogen, which is a compound that can activate estrogen receptors throughout the body. The activation of cells by phytoestrogens is weaker than by real estrogen. Naturopaths consider phytoestrogens to be estrogen modulators for this reason. When a woman has high estrogen, the weaker phytoestrogen signal displaces some of the stronger estrogen signal. When a woman has low estrogen, the phytoestrogens provide extra activation.

During the years leading up to menopause, there can actually be an excess of estrogen in the body, whereas afterward, estrogen is low and remains low for the rest of a woman's life. Taking ground flaxseed can decrease blunt estrogen’s highs and boost its lows.

Theoretically, some people believe that phytoestrogens are not safe for women who have or have had estrogen-receptor positive breast cancer. To take a conservative approach, eat phytoestrogens in your diet from legumes, sprouts and sunflower seeds, rather than as a supplement.

The last Nature’s Way column talked about sleep and the usefulness of melatonin. Menopause can cause poor sleep and poor sleep makes symptoms worse. Supplementing with melatonin can restore restful sleep and decrease not only hot flashes, but some other symptoms as well: brain fog, poor memory and irritability.

Some studies are showing that a magnesium supplement of 400-800 mg per day can reduce hot flashes. Magnesium and calcium complete for absorption, which is especially significant for women trying to prevent bone density loss. Take a combination calcium:magnesium supplement to make sure you get both, or take your calcium and magnesium at different times of day.

Many women, especially those with an interest in alternative therapies, have heard of black cohosh. There is one specific extract that has had the best results in studies; it is Remifemin from Enzymatic Therapies. I do not use it often, because I prefer a herb called maca. Unlike black cohosh, maca does not rely solely on activating estrogen receptors — it has a range of effects on various hormones. Maca is good for restoring libido and evening out mood swings.

Some unscrupulous people have succeeded in tricking many women into buying wild yam products. Don’t waste your money on them. Synthetic hormones are produced from wild yam in the lab. We do not have the capability to convert what’s in the wild yam into sex hormones.

A final word on hot flashes: weight management helps. If you are overweight, losing weight will also decrease your risk of breast cancer.

Every woman has a unique constellation of symptoms, hormone levels and lifestyle factors that make up her experience of menopause. These days, healthcare practitioners need to have a more multi-faceted understanding of the process than just chalking it up to a lack of estrogen. When you are looking for relief, work with someone who listens, and is willing to make adjustments until you are getting the relief you need. On the other hand, expecting your treatment to make you look like Suzanne Somers probably isn’t realistic! She promotes a very extreme form of HT, the longterm safety of which is a big question mark.