I had a patient named Mary Ellen, who was 57 years old when she came to me to get help with her insomnia (the menopause symptom that was causing her the most distress). She was always somewhat of a light sleeper—she’d have her good nights of deep restful sleep, but when she was under stress, she had more disturbed sleep. And as she got older, she began noticing a shift in her sleep cycle.

During the day, Mary Ellen was groggy and sleepy, which made it hard for her to function at work, and her quality of work was affected. But as the night came, she became more agitated and couldn’t settle down. Over-the-counter products didn’t work, and she didn’t want to get hooked on prescription medications.

I worked with Mary Ellen on some key sleep-inducing exercises. Specifically, a couple of hours before bed, she did some quieting exercises, meditation, peaceful visualization, and prayer, which was compatible with her belief system. In addition, I also recommended that she take low-dose melatonin (300 mcg–1 mg) and 5-HTP (50–100 mg) each evening before bed. She was happy to report a few weeks later that she really achieved great success from this program.

If you’re having similar sleep issues because of night sweats or other menopause symptoms, I urge you to try these two supplements!

If you have found that natural hormone replacement therapy isn’t strong enough to relieve your menopause symptoms, an herb called maca is a perfect option. By some estimates I’ve read about in research studies, approximately 80 percent of menopausal women find menopause relief with maca. 

Maca is most commonly used in traditional medicine to increase libido, promote fertility, and balance hormone levels. An added bonus is that it increases vaginal lubrication, which obviously can improve sexual activity and satisfaction. Because it increases energy, it helps create more vigor for sexual activity, which is why Peruvians have used it for centuries to increase sexual desire.

Dosages are unique to each woman, so you will need to determine the dosage that works for you. You can take it indefinitely—there have been no acute toxic effects, even at very high doses. If you are sensitive to herbs, start with the low end of the recommended dosage, as too much can cause increased menopause hot flashes, breast tenderness, or headaches. Also avoid maca if you have a hormone-related cancer, liver disease, or are pregnant or nursing.

I like the Whole World Botanicals’ Royal Maca brand, which is available at www.wholeworldbotanicals.com.

For my patients whose menopause symptoms do not respond to the various herbs and nutrients I recommend, I have frequently prescribed natural hormone replacement therapy using estriol and natural progesterone. 

Estriol (2–4 mg daily) is prescribed in capsule or cream form to reduce menopause hot flashes, vaginal dryness, and mood swings. Estriol is the weakest and safest type of estrogen and is less likely to promote tissue growth. Unlike conventional estrogen replacement therapy (replacement therapy using estrogen alone) that may cause fluid retention, headaches, nausea, and the buildup of uterine tissue, estriol has few, if any, side effects. You’ll need a prescription and then you or your doctor can contact the Women’s International Pharmacy (www.womensinternational.com) to fill the prescription. If used directly on vaginal tissues, not only will estriol cream rebuild vaginal cells, it can also help restore clitoral sensitivity and orgasmic intensity, and reduce bladder infections.

Many women call them “their own personal summer”—and for good reason. Menopause hot flashes—sudden, intense episodes of warmth and heat—are one of the most uncomfortable symptoms that menopausal women complain about. While the frequency, intensity, and duration of hot flashes vary greatly, they usually involve sweating—mild in some women and profuse in others. These episodes are the result of increased blood flow to the brain and other organs.

Menopause hot flashes are physically draining since the body loses fluids and minerals in the process of perspiring. When they take the form of night sweats, hot flashes may disrupt sleep, soak sheets, and leave a woman exhausted and cranky. If they occur at work or during a social function, they can be embarrassing.

There are several natural remedies for menopause hot flashes, including: 

• 80–160 mg of a standardized extract of black cohosh twice a day. This dose should contain 2 to 4 mg of the active components (triterpenes, calculated as 27-deoxyacteine);
• 400–1,000 IU vitamin E; and
• 50–100 mg of soy isoflavones daily.

These nutrients are available in most health food stores, nutrition centers, and some pharmacies.

With so much attention given to estrogen, many women don’t know what role progesteron plays in the body. In short, progesterone balances the effects of estrogen. Where estrogen is growth stimulating, progesterone is growth limiting. Estrogen is mood elevating; progesterone has a sedative effect on mood. One of progesterone's tasks is to prevent menstrual bleeding from becoming too profuse or long lasting and prevent the uterine lining from becoming too thick, which may lead to uterine cancer. This is the reason progesterone is often a part of hormone replacement therapy.

I suggest looking into progesterone supplementation if you have menopause symptoms or signs of menopause.  There are natural forms of progesterone, which has no known side effects at the usual dose of 20–40 mg daily. Be sure to consult a physician who is knowledgeable about natural progesterone before beginning treatment with it.

Although it's available in pill form, many women prefer natural progesterone in a skin cream base, which you can get without a prescription. Topically applied creams are absorbed into body tissues immediately. Oral progesterone is first metabolized by your liver and converted into three different compounds. You can also use a transdermal spray such as Progest-Ease, that can be applied to the skin and absorbed into the blood stream without going through the liver.

A typical dosage of natural progesterone cream is 20 mg a day or one-quarter to one-half teaspoon amounts applied to any clean area of the skin twice a day. Look for a product that contains 400–600 mg of progesterone per ounce like Pro-Gest or Fem-Gest.

Perimenopausal women can apply the cream from day 12 to day 26 of their menstrual cycle. Menopausal women not taking estrogen may use progesterone for two to three weeks each month. And don't buy products that list wild yam on the label. Unprocessed, wild yam can't be converted to progesterone in your body. This conversion from the plants can only be done in a laboratory. And don't buy progesterone products that are made with mineral oil, which blocks the progesterone from entering your body. You can find a good natural progesterone cream at the Women's International Pharmacy (www.womensinternational.com).

Who would have thought that you can ease menopause symptoms with what you eat! Normally, I tell my patients to avoid spicy or hot foods that an increase the incidence of menopause hot flashes. But there is one spice that can actually decrease symptoms: saffron. This bright yellow Indian spice has been used traditionally to reduce menopause symptoms, enhance calmness, and reduce irritability.

To preserve its medicinal properties, stir saffron into hot, cooked food. Use 1/10 of a teaspoon or less per day. (Higher amounts can be toxic, so be sure not to use more than this amount.)

As my patients and newsletter readers know, I recommend many different types of herbs and nutrients for the relief of menopause hot flashes and other menopause symptoms. But there’s one herb that often doesn’t get the attention it deserves: red clover. Red clover contains four phytoestrogens (estrogen-like plant compounds thought to have an effect on menopause symptoms such as hot flashes) called genistein, daidzein, biochanin A, and formononetin, and has become increasingly popular among menopausal women here in the United States.

Many studies have been done on red clover, and according to a review of five studies published in the American Journal of Medicine, red clover helps to significantly reduce the frequency of menopause hot flashes. Other research has shown that the herb is also beneficial for cardiovascular health. In one placebo-controlled study reported in the Journal of Clinical Endocrinology and Metabolism, red clover improved arterial compliance. Other known potential cardiovascular benefits of red clover isoflavones include the inhibition of platelet clumping or aggregation, which can clog arteries, and the herb’s action as a potent antioxidant, which also helps reduce buildup of “bad” low-density lipoprotein (LDL) cholesterol in arteries.

I recommend taking a standardized extract that contains 40 mg of total isoflavones.

Acupressure is an ancient Chinese treatment that involves the stimulation of certain points on your body. Unlike acupuncture, which uses needles to stimulate these points, acupressure uses finger pressure. The following acupressure exercise can help to relieve a wide variety of menopause symptoms, including menopause hot flashes, night sweats, fatigue, and emotional tension.

• Locate the points on the back of your neck, in the hollows about a finger-width to the right and left of the base of your skull. Hold these points simultaneously for one to three minutes.

• With the thumb and index finger of your right hand, press the point located in the webbing between the base of your thumb and pointer finger of your left hand, directly above the muscle. Hold for one to three minutes, then switch hands.

• With the index and middle fingers of your right hand, press the point directly between your eyebrows, where the bridge of your nose meets your forehead. With the index and middle fingers of your left hand, press the point at the top of your head. (There should be a slight indentation.) Hold for one to three minutes.

• Press the fingers of your right hand on the point three finger-widths above the bottom of your breastbone, in the center of your breastbone, directly over your heart. Hold for one to three minutes.

Tired?

You’re not alone! I can’t even begin to tell you how common insomnia can be during menopause. And menopause symptoms such as hot flashes and night sweats are some of the major reasons for insomnia, as well as stress, anxiety, and thyroid disorder, just to name a few.

If you are menopausal, I urge you to use a natural form of hormone replacement therapy to treat your symptoms. Acupressure is also a great remedy. The two acupressure points traditionally used to relieve insomnia are the Spirit Gate and the Inner Gate. The Inner Gate is located in the middle of the inner side of the forearm, two and one-half finger widths from your wrist. The Spirit Gate is located on the inside of the wrist crease, in line with the little finger. To promote sleep, apply pressure to one point and then the other. You’ll soon learn whether you get the most benefit from pressing both points or one in particular.

In my 30-plus years of practice, I've found that most women eventually see an end to menopause hot flashes and night sweats—even if it takes a few years. But unfortunately, some women never become completely immune to these symptoms, regardless of their age.

About half of menopausal women suffering from hot flashes see them disappear within a year, even without hormone replacement therapy, while another 30 percent experience these symptoms for up to three years. The last 20 percent of women endure menopause hot flashes for five to ten years or longer. I've worked with women in their 60s, 70s, and even early 80s who continue to have menopause hot flashes if they're not on some form of hormone replacement therapy. Luckily, safe, natural therapies for menopause such as vitamin E, black cohosh, and soy isoflavones (which I’ve talked about in other posts) are useful in eliminating menopause hot flashes, no matter what your age.

This combination not only eliminates menopause hot flashes, but also provides additional support to the cardiovascular system and bones. As a rule, I recommend taking the following daily dosages for menopause relief: 400–1,000 IU vitamin E; 80–160 mg black cohosh; and 50 mg–150 mg soy isoflavones.

Women always ask me if they should take hormone replacement therapy to alleviate their menopause symptoms. My answer is always the same, no matter what the situation: Choose bioidentical hormone replacement therapy over conventional.

Conventional hormone replacement therapy has been shown to have a wide range of risks, including increased risk of breast cancer and heart disease. Why take this risk? Instead, choose more natural forms of hormone replacement therapy, including estriol.

Estriol is produced in the lab from active steroid molecules found in soy. The resulting molecules are structurally the same as those produced in your body. Of the three types of estrogen produced within your body, estriol is the weakest and least potent. Several research studies have found that it is as effective as the stronger, more potent estrogens for treating menopause symptoms. And unlike conventional hormone replacement therapy that may cause fluid retention, headaches, nausea, and the buildup of uterine tissue, estriol has few, if any, side effects.

One study published in JAMA found that estriol was particularly effective in treating vaginal atrophy, mood swings, and hot flashes. Researchers selected 52 symptomatic, postmenopausal women and separated them into four groups, giving each group either 2 mg, 4 mg, 6 mg, or 8 mg of estriol per day for six months. On average, women in every group experienced a decrease in their menopausal symptoms after one month of treatment. Plus, in three of the four groups, women who had ranked their symptoms as severe now felt that their symptoms were very mild.

Talk to your doctor about this safe and effective option for menopause relief

So many women come to me looking for relief from such common menopause symptoms as night sweats, hot flashes, vaginal dryness, and insomnia. I tell all these women the same thing: One of my top solutions for menopause relief is an herb called black cohosh.

Right now in Germany, a special extract of black cohosh is the most thoroughly studied and widely used natural alternative to hormone replacement therapy. Clinical studies have shown that black cohosh extract not only relieves menopause hot flashes, but also depression and vaginal atrophy.

In one of the largest studies on black cohosh, women with menopause symptoms received 40 drops of liquid black cohosh extract twice a day for six to eight weeks. Within four weeks of treatment, a distinct improvement was seen in nearly 80 percent of the women. After six to eight weeks, all symptoms had completely disappeared in half of the women.

If you have signs of menopause or menopause symptoms, I suggest taking 80–160 mg of a standardized extract of black cohosh twice a day. This dose should contain 2 to 4 mg of the active components (triterpenes, calculated as 27-deoxyacteine). Black cohosh is available in most health food stores, nutrition centers, and even some pharmacies.

Do you know if you really are post-menopausal? Or are you in early menopause? Or is that wave of heat you experienced really a menopause hot flash or just a passing flush?

Here is a wonderful checklist you can use to determine if you are in menopause, and if the symptoms you are experiencing really are menopause symptoms. The more statements you check off as being true, the more likely it is that you are, in fact, entering this stage of life.

Potential Signs of Early Menopause

• My last period was six months ago or longer (true menopause).
• My periods are lighter, less frequent, and of shorter duration (late perimenopause).
• I’m in my early to mid-40s or older.
• I’m having hot flashes.
• Intercourse is painful.
• My desire for sex has faded.
• I have difficulty achieving orgasm.
• I have frequent vaginal or bladder infections.
• I have difficulty sleeping through the night.
• I’m frequently tired.
• I’m anxious and irritable.
• I forget small details.
• My skin is drier, thinner, and more wrinkled.
• My muscles are losing their tone.
• I leak urine when I laugh, cough, or sneeze.
• I’m gaining weight.
• My joints and/or muscles ache.
• I have itchy, crawly skin.
• I sometimes feel as if electric shocks were going through my body

As women, we always hear about menopause-this, menopause-that. But there’s another stage in the menopausal process that you may not be familiar with: perimenopause. Perimenopause refers to the time period preceding menopause, when your periods completely stop. Perimenopause can last one to two years, or as long as seven to ten years. During this time, progesterone levels are declining. In fact, if you’re in your 40s or early 50s, you may be experiencing a decrease or even cessation in progesterone production during many menstrual cycles, due to a lack of regular ovulation and aging ovaries.

Let me give you a little “biology lesson” to explain what happens. As ovaries age, they actually undergo physical and structural changes. They begin to shrink and become less responsive to signals from your hypothalamus and pituitary glands. Additionally, you have fewer eggs available to mature, and the eggs that are left are older and less functional. This situation often prevents a follicle from maturing enough to expel an egg. When this happens, the second-half of the menstrual cycle never kicks in, so progesterone isn’t produced. Meanwhile, fluctuating estrogen levels may range from unusually high to unusually low. The result is an almost constant state of imbalance known as estrogen dominance, which is often the cause of perimenopause symptoms. These include irregular menstrual cycles, breast cysts or breast tenderness, sleep difficulties, fluid retention, anxiety, weight gain, lowered sex drive, brain fog, endometriosis, fibroid tumors, and heavy, irregular menstrual bleeding.

Some of the nutrients I recommend to bring perimenopause symptom relief include:

• Chaste tree berry or Vitex (175–275 mg daily of a standardized extract) appears to have a progesterone-like effect on the body during perimenopause. It is useful in treating periods that are either too frequent or too heavy and helps normalize and regulate the menstrual cycle.
• Citrus bioflavonoids (750–2,000 mg daily) put a damper on overall estrogen activity by binding to estrogen receptor sites and blocking the body’s own high-octane estrogen. Many studies have shown that the combination of bioflavonoids and vitamin C reduces heavy menstrual bleeding by strengthening blood vessels.
• Quercetin (50–300 mg a day), a potent antioxidant, reduces the inflammation of endometriosis. It also helps reduce excessive estrogen levels, while helping maintain healthy cholesterol levels, good blood circulation, and proper digestion.