Plenty of options to offset hot flashes

When menopause graces your doorstep and you have banished your sleep partner to the far side of the bed, you may be considering your options for relief. As I wrote last week, hormone therapy works better than anything out there for getting rid of those pesky symptoms. Every menopausal woman knows what I’m talking about: hot flashes, night sweats, vaginal dryness, disturbed sleep and the occasional urge to scream at everyone within a 10 mile radius.

But how about if you can’t, or don’t want to, take hormones?

The first thing to try is “lifestyle changes” (Don’t you just love that euphemism?)

I am a personal believer in the portable fan. I have one on my desk and switch it on when I feel the flush. If you don’t have a fan at hand, grab a magazine and start fanning yourself.

If someone gives you a hard time, just say “hot flash” and move on. Make menopause part of the mainstream – that’s my motto.

Regular exercise makes for better sleep. And just like when you exercise, dressing in layers means you can adjust your clothing for your own personal climate.

I often wake up in the morning and find my nightie on the floor, having stripped it off in the middle of the night. I don’t recommend stripping at work, but pulling off a sweater is perfectly acceptable.

There are triggers that sometimes set off hot flashes. If you know yours, try to avoid them.

Hot drinks, caffeine and alcohol are among the more common triggers. Stressful situations can set off the flush mechanism. The old-fashioned Lamaze breathing can help here – paced, deep, slow abdominal breathing.

Some nonhormonal, prescription drugs can help with hot flashes. Selective serotonin reuptake inhibitors (SSRIs) like Paxil, Zoloft and Prozac have proven effective in several studies. Clonidine, a drug used to treat high blood pressure, can be helpful.

Relaxation techniques like yoga, meditation and a nice long bath can help relieve the irritability that comes with menopause and help promote better sleep.

Unfortunately, alternative therapies, readily available over the counter, have not been well studied for effectiveness and safety. They are government regulated as dietary supplements and are not held to the same strict standards as medications regulated by the Food and Drug Administration.

Not only are there concerns about efficacy and safety, but dietary supplements vary wildly in the amount of “active ingredient” they contain; some have been found to contain none at all.

“Natural” does not necessarily mean safe or that they won’t interact with any other medications you may be taking.

OTC hormones (progesterone, DHEA) may be contraindicated for breast cancer survivors. Some botanical therapies (dong quai, evening primrose oil, ginkgo, ginseng, ginger, garlic and feverfew) may increase bleeding and can be especially dangerous for women on blood thinners like Coumadin and even baby aspirin.

Some botanicals may interfere with drugs being used for serious illnesses like epilepsy and diabetes. Women using cyclosporine should speak with their doctor before taking any other medications, including botanicals.

Black cohosh (found in Remifemin), Vitamin E (800 international units/day) and increasing the intake of soy products may be helpful for hot flashes and are probably safe. We don’t know about the safety of isoflavone supplements (from soy) in women with a history of breast cancer.

Another bothersome symptom of menopause is vaginal dryness, which can make sex mighty uncomfortable. Vaginal lubricants are great, and there are lots out there.

Our office favorite, judging by how fast the samples left the office in our employees’ purses, is Astroglide. But experiment!

Your lubricant should be water based – no Vaseline or baby oil. Sex (and masturbation) increases the blood flow to the vagina and helps promote vaginal health.

If vaginal dryness is troublesome at other times, a product like Replens, used two to three times a week, may be helpful.

Finally, while you’re coping with all this, remember: This, too, shall pass.

Check out menopause.org and acog.org for more information.