Q. Here I am – 20 years older – and back to the same problems which caused me to start taking hormonoe replacement therapy (HRT) in the first place. After consulting with my nurse/doctor in October, I phased off my regimen of Premarin and Provera (for at least 17 years I had been taking it during the week, not on weekends because of my fibroids).

She advised me to increase my B complex to 100, increase my total intake of folic acid, calcium to 1500, and vitamin E. I did all that, and after about 2 months realized that I was depressed (I thought it was just Christmas – I usually get depressed around then).

Figured out it was more than that, so started taking St. John’s Wort, which seems to be working.  But I am also having what I’ve been referring to as mini-hot flashes, mostly at night but also frequently during the day, and general sleep problems.

I heard a comment on your radio show about primrose oil possibly working for night sweats. Do you have any information about that? And I just read your information on black cohosh. Is there any problem with taking that? I noticed you recommend not taking it for a long period of time.

I plan to go back to my medical person, but am not anticipating much help with this kind of treatment. This is becoming a very common problem – I feel like medical science has let women down once again and returned to the time when I was going through menopause in the first place with no information as to what to do.

I am really not interested in starting with any of the other  prescription medicine (Fosamax, etc). 

A. You are so right that women have been treated rather shabbily when it comes to menopause. For decades doctors thought HRT in the form of Premarin and Provera or Prempro would be the ideal solution. When problems were revealed (cardiovascular complications, cancer, etc), millions of women were left out to dry (actually, left out to drip). 

Alternative approaches are not always the panacea many had hoped for. Studies have produced mixed results for black cohosh. A brand new investigation (not randomized, double-blind or placebo controlled) in the journal Phytomedicine (June, 2013) did demonstrate symptomatic benefit with black cohosh (Cimicifuga racemosa or CR for short):

“This observational study demonstrated that treatment with CR in unselected patients with climacteric complaints under the conditions of daily practice resulted in a significant improvement of menopausal symptoms assessed by the total KMI score and its sub-item scores with an effect size similar to that in a previous randomized, controlled clinical trial.”

A review of the scientific literature by the Cochrane Collaboration (an independent and highly regarded group of experts who analyze research data) concluded in 2012: 

“There is currently insufficient evidence to support the use of black cohosh for menopausal symptoms. However, there is adequate justification for conducting further studies in this area. The uncertain quality of identified trials highlights the need for improved reporting of study methods, particularly with regards to allocation concealment and the handling of incomplete outcome data. The effect of black cohosh on other important outcomes, such as health-related quality of life, sexuality, bone health, night sweats and cost-effectiveness also warrants further investigation.”

To learn more about the benefits and risks of hormone replacement therapy (and bioidentical hormones), black cohosh, Pycnogenol, progesterone, red clover, St. John’s Wort, Vitamin E, and other non-hormonal approaches to relieving sympptoms, we suggest Graedons’ Guide to Menopause. This 8-page pamplet can be downloaded from our website for $2 or your can get a printed version for $3. Our Guide to St. John’s Wort is free

Share your own strategies for dealing with hot flashes, night sweats and other symtoms such as vaginal dryness below. 

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  1. Shelley R.
    Reply

    I have been using soy isoflavonoids for several years to keep my flashes down to occasional warm flashes. I also take evening primrose sporadically, but the soy really seems to do the trick.

  2. mary
    Reply

    I need to know about night sweats after menopause. What are some other causes? It seems to be associated with eating sweets. I am not fat but do have a bit of a high hip to waste ratio. I am 66, weight 120 lbs. and am about 5 feet. It usually occurs in the early morning and wakes me up with my bed clothes literally wet from all the sweating. Help. Is this normal?

  3. Karyl
    Reply

    I had hf’s for many, many years after the end of menopause and found that Bellergal kept them at bay but when that drug was discontinued they resumed.
    I have been taking Morphine for pain control for several years and recently have cut back and this has intensified my HF symptoms. I noted in earlier comments that Evening Primrose has helped several people. Does anyone think I might benefit from this? I have just turned 74.
    Please do suggest options if you can.
    Thanks! Karyl

  4. JW
    Reply

    Each woman is different. My sister never had them. My mother had many. I had them occasionally, but they weren’t that bad. Many different causes. Many remedies. But, doctors, please don’t generalize about them. Just listen; you might learn something.

  5. TS
    Reply

    Well, the sexist comments about hot flashes are still out there … even from medical professionals. A Google search brought up a physician’s remarks that women who are “driven to act like men, who are ambitious and are out of shape, and nutritionally deplete” are more likely to suffer from hot flashes. What hogwash.
    In contrast, he opines, Asian women are much less likely to suffer from hot flashes than American women.
    Yikes.

  6. TS
    Reply

    I’m going to try boron, I had never heard of that. If I get any significant relief, I’ll be sure and post it here. Thanks, Amy.

  7. Amy
    Reply

    I don’t see anyone mentioning boron. I read about boron for menopause in Adele Davis’ wonderful nutrition books and began taking one little 3 mg. capsule a day when I was in my late 40’s. I am in my 70’s now and strangely enough I never had a single hot flash or weepy time.
    Many friends who also wanted a natural approach found that boron helped them when I shared that suggestion. I do not drink sodas or anything with artificial sweeteners, but I do drink coffee and tea and green tea. It is hard to know what will work as we are all individuals.

  8. TS
    Reply

    Evening primrose oil did nothing for my hot flashes. For me it was an expensive waste.

  9. TS
    Reply

    Darn straight, women have been treated rather shabbily when it comes to menopause. Even a woman, who ought to have known better, posted on another thread that it was all in people’s heads.
    One thing that does help…a bit!…is to cut back caffeine and soda pop and drink a lot of water. Look, it can’t hurt to try.
    My sincerest sympathies go out to everybody suffering hot flashes. I started getting them about a year ago, and since I live in a hot climate, it can be pretty near unbearable at times.
    I never realized how many sexist jokes abound about hot flashes, until I had them myself. I really regret that I didn’t take it so seriously before. I never belittled anybody for it, but I shudder to think that I probably didn’t help my mom as much as I could have.
    Thanks heavens for this blog, where we can get non judgmental (mostly) advice from our peers, and from Terry and Joe.

  10. JW
    Reply

    I forgot to mention I have severe sleeplessness problems. Remedies don’t work for me.

  11. Susan P.
    Reply

    I started having hideous hot flashes in my mid-forties. I tried black cohosh and primrose oil. Neither did a thing. My doctor finally agreed to give me Premarin. Only the highest dose worked, and it worked really well for 20+ years. My doctor didn’t like it, but I needed it just to function. Without it life was miserable. I didn’t sleep, and the hot flashes were actually painful.
    Now that I have ER+ breast cancer that is no longer an option. My treatment for the rest of my life is a drug that prevents my body from making estrogen, and the hot flashes returned with a vengeance. Initially I took Effexor, and that worked really well. I didn’t like the sexual side effects and became suicidal coming off it.
    I now use a Catapres TT3 patch that is normally prescribed for high blood pressure. That has helped a great deal but not enough. Now I’m getting twice weekly acupuncture and taking a prescribed Chinese herbal preparation in granular form similar to Zhi Bai di Huang Wan. The hot flashes are down to a minimal level. One generally alerts me in the middle of the night to get up to go to the bathroom. I have discovered that it is really important for me to avoid stress, because that seems to make them worse.

  12. Viki
    Reply

    I started taking Evening Primrose Oil about 25 years ago (in my late 30’s) because of heavy periods and severe cramps. Within a few months the cramps pretty much stopped and I went from 7-9 days of heavy flow to 3 -5 days of moderate flow. Fast forward to 50-ish when my periods began to be less frequent and my Dr. asked me if I needed something for hot flashes, etc. I was surprised that he asked because I had not experienced any of the usual menopausal symptoms at that point. He assured me I probably would and to let him know when I did so we could decide on a method to deal with them. Ten years later, he’s still waiting…. I did have one time where I felt a little warm and flushed for a minute or two, but don’t recall any other symptoms.
    BTW, my sister and mother both had the usual menopause symptoms – hot flashes, irritability, difficulty sleeping, etc. so I don’t think I had any hereditary “immunity” to those symptoms. Sis suggested that I try Black Cohosh for the cramps and heavy flow, but I had already started the EPO and didn’t seem to need anything else. The BC seemed to help her some, but not like the EPO did for me.
    About 3 or 4 years after my last period I decided that I probably didn’t need the EPO, so discontinued it. After a couple of months I began to experience some periodic breast tenderness and abdominal bloating, so I went back to taking a lower dose of EPO and have had no symptoms since then. (And yes, I did go to my GYN to be sure there was nothing else going on.) Pre-menopause I took 2 or 3 1300 mg capsules per day, I now take a 1300 and a 500 mg capsule each day. I will probably back down to 1300 eventually to see how I do.
    I have a young friend that struggled with PMDD (Pre-Menstrual Disphoric Disorder) for several years. I gave her a bottle of EPO and after a couple of months she was so much improved that her Dr. was able to reduce her anxiety meds significantly.
    I also give EPO to friends as gifts. It was a life saver for me.

  13. JW
    Reply

    I have been using pine bark capsules for several years with good results.

  14. DW
    Reply

    I also suffered from menopause symptoms until I heard Tyne Daly talk about using chinese herbs instead of Premarin. She said dong que? and black cohosh helped her and I took them. Saved my marriage and my life. Like other natural remedies, it takes a few months to get the effect. I had no side effects. Natural is better than chemical.

  15. AL
    Reply

    You may want to try two Tablespoons of ground flax seed once a day (I eat mine at lunch). Just sprinkle it on your food. I grind my seeds daily in a coffee bean grinder. After just a few days I notice a positive results in mood, and no hot flashes within 1 1/2 weeks.

  16. Anne
    Reply

    I had hot flashes for 3 years after menopause, worse at night. Acupuncture and chinese herbs really made a difference. At first I had the acupuncture weekly, now I’m down to 4 times a year. It also seems to have improved my libido which had been in a slump for a year or so.
    I just feel better on many levels.

  17. Mel
    Reply

    Someone on your site recommended 2 tablespoons of flax seed meal per day for treatment for hot flashes. It takes a week or so to take effect, but it seems to work for me. I just put it on my cereal in the morning. You need to be consistent about eating it, though.
    I also started taking Evening Primrose oil for PMS, and did not notice any benefit for hot flashes. It worked well for PMS (no PMS when I did get my period regularly), but also is helpful for hair loss. I noticed the hair at my temples was thinning quite a bit. EPO allowed that to fill back in. It isn’t long hair but I no longer look mostly bald there. I also grew eyelashes where I had never had any. I went from 2 eyelashes (yes, I could count them) to about 8-9.

  18. sarah w
    Reply

    I started taking Thai Kudzu with B12 supplements about a year ago for hot flashes. My doctor approved my choice, too. It has eliminated them during the day and I only get hot flashes occasionally at night. It doesn’t, however, do anything for the sleeplessness. I take a quarter does of sleep aide nightly for that. Now I am just waiting for them to end!

  19. Linda S., Nurse
    Reply

    An friend recommended Evening Primrose Oil several years ago and It was a miracle. Worked beautifully and I have actually given bottles of the capsules to friends as a gift, when they mention their frustration with Hot Flashes.

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