Ask a Doc: Menopause Symptoms: Help is available!

April 20, 2015

Dear Doc,

I am 49 years old and for the past 6 months I have been suffering from hot flashes. I have at least 4-5 during the day and at night I wake up soaked from sweats. My mood is suffering but I am not sure if it is from the lack of sleep or from these hormonal changes. I am snapping at my family and I avoid some of my normal activities simply because I don’t want to deal with the flashes out in public. I know that menopause is natural and I would like to avoid taking medication but what can I do to get my life back?


Menopause is defined as a woman not having a menstrual cycle for one year. The average age of menopause is 51 although smokers tend to experience menopause a little younger. It is caused by the ovaries making less estrogen. During the years before menopause, known as perimenopause, many women may have symptoms related to this decline in estrogen.

About 75% of women experience some hot flashes. While the severity and length of hot flashes can vary, in general, this is a feeling of heat to the upper body and face. It may cause facial blushing and body sweating. Some women will experience chills, anxiety and occasional heart palpitations during the hot flash. Hot flashes that occur at night are often referred to as night sweats and are a common cause of sleep disturbances. Other common symptoms include mood irritability, memory changes, and decreased libido.

The loss of estrogen can have other impacts on a woman’s health as well. Bone loss occurs more rapidly which can result in osteoporosis. This condition puts women at risk for serious factures in the hip, spine and wrist. There is also an increased risk of heart attacks and strokes after menopause.

While menopause is a natural part of aging, the symptoms for some women can seriously affect their quality of life. There are many interventions that can be utilized to minimize symptoms. These include a variety of non-medical treatments as well as alternative therapies.

Non-medical treatments include:
  1. Regular aerobic exercise
  2. Weight loss
  3. Quit smoking
  4. Lower the room temperature
  5. Use fans
  6. Dress in layers
  7. Avoid triggers (spicy food, stressful situations)
  8. Avoid caffeine and alcohol consumption
There are many alternative medical therapies marketed to treat menopause. Studies have not shown any of these therapies to be significantly more effective than placebo; however, some women may find these products helpful.
  1. Isoflavone or phytoestrogens found in the over the counter soy products
  2. Black cohosh (can have negative effect on liver function)
  3. Acupuncture and reflexology
  4.  Relaxation techniques

For women who have tired the non-medical or over-the-counter therapies without success, there are some medications, both hormonal and non-hormonal, that can be very useful. At this time compounded bioidentical hormone therapy is not recommended by the American College of Obstetrics and Gynecology (ACOG). There is no significant evidence that it is better than conventional hormone therapy and it is unregulated by the FDA.

Medications options recommended by ACOG include:
  1. Estrogen (oral, patch, ring or vaginal cream/tablet)
  2. Estrogen with progesterone (progesterone is needed for any woman with a uterus)
  3. Selective Serotonin Reuptake Inhibitors or Selective Serotonin-Norepinephrine Reuptake Inhibitors (such as Prozac and Effexor respectively)
  4. Clonidine
  5. Gabapentin (also known as Neurontin)

It is important to speak with your gynecologist or medical provider about the various treatment options. Each treatment has its own unique risks and benefits. This needs to be carefully considered when making a treatment choice. I am very optimistic that with a few lifestyle changes and a discussion with your gynecologist that you will be able to get your symptoms under control and get back to enjoying your life!

Tara Gellasch, MD, is the Associate Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions on women’s health, please email Dr. Tara Gellasch’ s assistant, Monica Decory with questions for Dr. Gellasch at and write “Ask a Doc” in the subject line. The Women’s Center at NWCH is located at 1250 Driving Park Avenue, Newark. Call (315) 332-2427 to schedule an appointment.