Hi Dr. Jen, thanks so much for giving us the straight goods. I recommend The Vajenda and your books to all my friends, co-workers, random women at the gym, etc. My nurse practitioner has suggested Ashwaganda to help with sleep disruptions and hot flashes. I’d love for you to provide info on ashwaganda. Thanks so much!
Hi Dr. Gunter. I'm an ob/gyn and I read this paper too. I was taught that heavy women often have an easier menopause due to increased levels of circulating estrogen which comes from aromatase in their adipose tissues converting androgens to estrogen. This paper says the opposite. I think that's the first time I ever heard that losing weight helps HF. One of the risk factors for severe VMS is being thin.
Also, I might highlight that the super popular black cohosh had no benefit and can also cause rare liver damage. This is the worst case with many supplements. They don't work and some can cause potential serious harm!
The weight issue seems complicated, and I'm not sure it's completely sorted out. Higher adiposity is associated with fewer hot flashes after menopause, but in the perimenopause it may be associated with more. There is also data that suggests higher lean body mass is associated with fewer hot flashes. But for this position statement they were looking at studies that specifically addressed weight loss. The quality of evidence was lower, but some effect is apparently seen. This seems to be one of those areas that we don't know what we don't know.
Thank you so much for this. I get migraines with aura so estrogen is a no go for me and my estrogen levels are strangely fine; the night sweats and hot flashes still hit. The two different supplements I have tried are Amberen and Relizen by Bonafide, the latter of which is too expensive and I didn’t find helpful, but I would like to hear your thoughts on them. Amberen was recommended by a coworker and Relizen by my Menopause Specialist Gynecologist who referred me to read your stuff! Thank you for the work you do!
Dr. Stacy Sims out of Australia has been studying menopause in athletic women for years. She has lots of data to report, including tons of information on supplements, nutrition and exercise. I highly recommend everyone read both Roar and Next Level for more information.
The non-hormonal treatment that I have just been offered for hot flashes and night sweats was anti-depressants, specifically my choice between Effexor, something related to Effexor, or Paxil. I would love for you to talk about this. I said no. I've taken Effexor and I'm not up for a repeat. Also not a fan of taking Paxil (scored as 3 on that anticholinergic burden scale), whilst heading into my 60s with brain fog and other cognitive problems. But also, I'm suffering.
Hi Dr. Jen, I'm a little skeptical about adaptogens but also a little curious. I keep hearing about Schiasandra as a therapy for hot flashes. So curious to know if you have found any studies about this. Also, if one pursues this kind of therapy, how to feel confident that you're getting a bonafide product? Thank you for sharing your wisdom!
Hi, thanks for responding. I’m actually a physician but not gyn ( radiology)
I’ve had 2 kids vaginally with a bad tear after delivering a macrosomic pumpkin 😝
Now I’m post menopausal and have had a worsening cystocele ( now protruding just to the introitus) without uterine or rectal prolapse. I Had some urine leakage with coughing or jumping but that resolved when I started very low dose amitryptilline for migraine prophylaxis ( 25mg q day). It also makes me incredibly constipated but I wouldn’t go off it bc of the migraines and it let’s me sleep!
Anyway …probably way more info than you needed…
I have a good friend from my work who is not my personal doctor say that she always sends her pelvic floor weakness patients to PT and has good results with this.
However when I finally scheduled an appointment with my personal doctor she said “Oh, that never really works -you need surgery “ After she examined me though she ended up just fitting me with a pessary-which is working well, at least for the last week.
I guess my question is should I go ahead and try the PT? Can it get me back to not needing the pessary? Or can it at least help to prevent progression of the prolapse, etc?
Thanks again ( and yes I understand that you are not giving me personal medical advice-I just want to know if it’s a reasonable treatment)!
Pelvic floor therapy can definitely be helpful. Pessaries are also great when they are well fitted and the combination of PT and pessary is first line care. Whether it can get you to not need a pessary depends on your prolapse and the symptoms that are bothering you, but its absolutely worth a try. Just make sure your PT is giving you regular home exercises to do. If they are only treating you in the office you won't make any improvement in the same way if you only play the piano at your lessons!
I would love to have you talk about Estrovera in one of your posts (www.estrovera.com). I was advised to take this early in perimenopause six years ago by my (former) Ob-gyn. Its active ingredient is Siberian rhubarb. I was/am hesitant to take any kind of MHT because I am at high risk for breast cancer. The thing is, it seemed to help at first for my worst symptom, which was brain fog, not hot flashes. But now I am wondering if that was just placebo effect. It didn't seem to do much for my hot flashes one way or the other, but they weren't bothering me that much. The brain fog eventually went away (for the most part, lol) but it bothered me that I was only able to get Estrovera from her office, and it was costing me about $1/day because of course it was not covered by my insurance. I tried researching it but didn't come up with much. Eventually I dropped it, and her, and got a new Ob/gyn that I trust much more. My hot flashes are about the same, maybe a little less, now that I am fully menopausal.
Since you asked: please review the data on Equol. I'm actually surprised that it's not recommended, since I'd read positive things about it -- though I admit I didn't do the deep dive that you always do.
Pelvic physical therapy can be very helpful for incontinence, prolapse, and pain with sex! I've written about it pretty extensively in The Vagina Bible. Do you have a specific question about it or a symptom? That might help me frame the answer.
While I understand not all woman can take hormones, I wonder why they aren't considered the most "natural" remedy. Our bodies make estrogen and progesterone and we know that it's the depletion of these that are causing the symptoms we are trying to alleviate. It feels safer to me to take exogenous hormones than to try the newest thing.
It isn't natural to take a hormone by mouth and it isn't natural to have high levels of estrogen in menopause. In medicine we don't use natural because it really doesn't mean anything. Products found in nature can be very dangerous and they can be benign. As far as medications go, natural means found in nature, and the only natural hormone is Premarin, as it is extracted from horse urine. We also don't know that low estrogen is the cause of all the symptoms, it is more complicated than that. Many women can have severe hot flashes when their estrogen levels are normal, and of course 25% of women have no hot flashes at all. I think it's best to look at all interventions with an effective/non effective and safe/unsafe eye.
Thanks so much that’s really helpful!
Hi Dr. Jen, thanks so much for giving us the straight goods. I recommend The Vajenda and your books to all my friends, co-workers, random women at the gym, etc. My nurse practitioner has suggested Ashwaganda to help with sleep disruptions and hot flashes. I’d love for you to provide info on ashwaganda. Thanks so much!
OK let me take a look
Hi Dr. Gunter. I'm an ob/gyn and I read this paper too. I was taught that heavy women often have an easier menopause due to increased levels of circulating estrogen which comes from aromatase in their adipose tissues converting androgens to estrogen. This paper says the opposite. I think that's the first time I ever heard that losing weight helps HF. One of the risk factors for severe VMS is being thin.
Also, I might highlight that the super popular black cohosh had no benefit and can also cause rare liver damage. This is the worst case with many supplements. They don't work and some can cause potential serious harm!
The weight issue seems complicated, and I'm not sure it's completely sorted out. Higher adiposity is associated with fewer hot flashes after menopause, but in the perimenopause it may be associated with more. There is also data that suggests higher lean body mass is associated with fewer hot flashes. But for this position statement they were looking at studies that specifically addressed weight loss. The quality of evidence was lower, but some effect is apparently seen. This seems to be one of those areas that we don't know what we don't know.
Thank you so much for this. I get migraines with aura so estrogen is a no go for me and my estrogen levels are strangely fine; the night sweats and hot flashes still hit. The two different supplements I have tried are Amberen and Relizen by Bonafide, the latter of which is too expensive and I didn’t find helpful, but I would like to hear your thoughts on them. Amberen was recommended by a coworker and Relizen by my Menopause Specialist Gynecologist who referred me to read your stuff! Thank you for the work you do!
Hi; I'm a WHNP, and as Dr. Jen has pointed out, hormone levels are a useless waste of $$, so don't be surprised by your labs...
I would love for you to discuss Bonafide's Relizen!
two people have asked now, so will put up a post this week!
Dr. Stacy Sims out of Australia has been studying menopause in athletic women for years. She has lots of data to report, including tons of information on supplements, nutrition and exercise. I highly recommend everyone read both Roar and Next Level for more information.
The non-hormonal treatment that I have just been offered for hot flashes and night sweats was anti-depressants, specifically my choice between Effexor, something related to Effexor, or Paxil. I would love for you to talk about this. I said no. I've taken Effexor and I'm not up for a repeat. Also not a fan of taking Paxil (scored as 3 on that anticholinergic burden scale), whilst heading into my 60s with brain fog and other cognitive problems. But also, I'm suffering.
Hi Dr. Jen, I'm a little skeptical about adaptogens but also a little curious. I keep hearing about Schiasandra as a therapy for hot flashes. So curious to know if you have found any studies about this. Also, if one pursues this kind of therapy, how to feel confident that you're getting a bonafide product? Thank you for sharing your wisdom!
I don't think there is any good data here at all, but I'm happy to take a look for a future post!
Hi Dr Jen. Thank you so much for this wonderful piece. I love it. Keep on with your good work 👌💕
Also just wanted to fan girl you and say I am always forwarding your articles to friends and family!
Hi, thanks for responding. I’m actually a physician but not gyn ( radiology)
I’ve had 2 kids vaginally with a bad tear after delivering a macrosomic pumpkin 😝
Now I’m post menopausal and have had a worsening cystocele ( now protruding just to the introitus) without uterine or rectal prolapse. I Had some urine leakage with coughing or jumping but that resolved when I started very low dose amitryptilline for migraine prophylaxis ( 25mg q day). It also makes me incredibly constipated but I wouldn’t go off it bc of the migraines and it let’s me sleep!
Anyway …probably way more info than you needed…
I have a good friend from my work who is not my personal doctor say that she always sends her pelvic floor weakness patients to PT and has good results with this.
However when I finally scheduled an appointment with my personal doctor she said “Oh, that never really works -you need surgery “ After she examined me though she ended up just fitting me with a pessary-which is working well, at least for the last week.
I guess my question is should I go ahead and try the PT? Can it get me back to not needing the pessary? Or can it at least help to prevent progression of the prolapse, etc?
Thanks again ( and yes I understand that you are not giving me personal medical advice-I just want to know if it’s a reasonable treatment)!
Pelvic floor therapy can definitely be helpful. Pessaries are also great when they are well fitted and the combination of PT and pessary is first line care. Whether it can get you to not need a pessary depends on your prolapse and the symptoms that are bothering you, but its absolutely worth a try. Just make sure your PT is giving you regular home exercises to do. If they are only treating you in the office you won't make any improvement in the same way if you only play the piano at your lessons!
I would love to have you talk about Estrovera in one of your posts (www.estrovera.com). I was advised to take this early in perimenopause six years ago by my (former) Ob-gyn. Its active ingredient is Siberian rhubarb. I was/am hesitant to take any kind of MHT because I am at high risk for breast cancer. The thing is, it seemed to help at first for my worst symptom, which was brain fog, not hot flashes. But now I am wondering if that was just placebo effect. It didn't seem to do much for my hot flashes one way or the other, but they weren't bothering me that much. The brain fog eventually went away (for the most part, lol) but it bothered me that I was only able to get Estrovera from her office, and it was costing me about $1/day because of course it was not covered by my insurance. I tried researching it but didn't come up with much. Eventually I dropped it, and her, and got a new Ob/gyn that I trust much more. My hot flashes are about the same, maybe a little less, now that I am fully menopausal.
Since you asked: please review the data on Equol. I'm actually surprised that it's not recommended, since I'd read positive things about it -- though I admit I didn't do the deep dive that you always do.
Yes, I can tackle that. I think there is just one lower quality study. Possibly two, but I will put it in the cue!
Oh, I forgot to mention: I just recommended your books to my cardiologist who picked my brains on menop. issues. (:-)
Hi Dr. Jen,
Do you have any information on Pycnogenol for reducing hot flashes? Love your books and your Substack; thank you for all that you do!
Hi Dr. Jen
Can you please do an article about pelvic floor weakness treatments. My doctor said that she doesn’t think pelvic physical therapy works.
I also have a good friend who’s an obgyn and she says she always sends her patients for PT.
Pelvic physical therapy can be very helpful for incontinence, prolapse, and pain with sex! I've written about it pretty extensively in The Vagina Bible. Do you have a specific question about it or a symptom? That might help me frame the answer.
Thanks you for this.
While I understand not all woman can take hormones, I wonder why they aren't considered the most "natural" remedy. Our bodies make estrogen and progesterone and we know that it's the depletion of these that are causing the symptoms we are trying to alleviate. It feels safer to me to take exogenous hormones than to try the newest thing.
It isn't natural to take a hormone by mouth and it isn't natural to have high levels of estrogen in menopause. In medicine we don't use natural because it really doesn't mean anything. Products found in nature can be very dangerous and they can be benign. As far as medications go, natural means found in nature, and the only natural hormone is Premarin, as it is extracted from horse urine. We also don't know that low estrogen is the cause of all the symptoms, it is more complicated than that. Many women can have severe hot flashes when their estrogen levels are normal, and of course 25% of women have no hot flashes at all. I think it's best to look at all interventions with an effective/non effective and safe/unsafe eye.