What Menopause Advice Can You Trust?
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For many women perimenopause isn’t just about sweating through hot flashes for a few years—it can bring on a range of puzzling symptoms that sometimes stump even gynecologists. Whether the problem is anxiety or insomnia, finding relief can be hard, especially when research into this hormonal transition isn’t as robust as it could be. But at least talking about it isn’t quite as taboo as in years past. Today, even strangers seem more comfortable sharing their stories online. These sisterhoods can be powerful, says Amanda Thebe, a personal trainer and nutrition coach in Houston and the author of the book Menopocalypse. When Thebe’s doctor dismissed her depression, nausea, and vertigo as unrelated to perimenopause, she felt helpless. Eventually, she started the Facebook group Menopausing So Hard so women like herself could find solidarity and share tips and tricks.
But while forums can be validating, not everything you hear through them is sound advice, says Jackie Thielen, M.D., director of the women’s health clinic at the Mayo Clinic in Jacksonville, FL. So we asked women to dish on the advice they’d received and then asked health specialists to weigh in. After reading this, you’ll be more confident going forward, whatever options you hear about.
How to Handle Hot Flashes
“My flashes started seriously last fall. I’ll sense one coming on and within seconds my internal temperature flares. It begins in my lower back and radiates through my torso until all I want to do is strip off my pants and shirt and run outside. At night I retreat to another room, away from my husband’s warm body, where I can blast the fan high.” — Lucy Montgomery, 51, a pet sitter in Grass Valley, CA
Advice from other women
Watch your diet. Lucy’s flashes decreased when she gave up hot chai tea and instead sipped cold water and pressed cucumber juice.
Place an ice pack under your pillow. When she wakes up on fire at night, Lucy flips her pillow to chill her neck and head.
Dress in layers. Often Lucy dons a yoga top or a sports bra under her shirt: “Before I go out, I think, What can I strip down to without getting arrested?”
What the experts say
These suggested lifestyle habits are great for cooling down when you’re experiencing a mild hot flash, says Dr. Thielen. Avoiding triggering things like hot drinks, spicy food, alcohol, and caffeine can help too. And some women may try herbal supplements, but here’s the thing: The ones often said to ease hot flashes (black cohosh, red clover, evening primrose) have not been clinically proven to be effective, says Nanette Santoro, M.D., chair of obstetrics and gynecology at the University of Colorado School of Medicine in Denver.
If your hot flashes are moderate or severe, the best treatment is hormone therapy, as it can decrease their frequency and intensity, says Dr. Thielen. The common worry about hormone therapy is that it may increase the risk of breast cancer and heart disease. However, it’s generally safe for most women if started at or just before the onset of menopause and used for a limited time, adds Dr. Thielen. You should always discuss your personal risk with your physician before starting hormone therapy. If your doctor gives you the green light, avoid using “compounded bioidentical hormones.” These are natural plant-based hormones similar to the ones produced in your body—sounds harmless, right? But according to the American College of Obstetricians and Gynecologists, there is no scientific evidence that compounded bioidenticals are safer or more effective than standard versions, and since they are not regulated by the FDA, they may have added risks.
Facing Down Anxiety
“In my first massive anxiety attack, I woke up with nausea, sweating, heart palpitations, and overwhelming fear. These episodes struck daily for six months, then tapered off.”—Nicole Chartrand, 60, a retired business owner from Quebec, Canada
Advice from other women
Find a good hypnotist. Nicole has found that she relaxes after sessions with her hypnotist or listening to guided visualizations.
Consider hormone therapy. While she hasn’t tried it, Nicole has heard that estrogen and progesterone therapy has helped some women reduce their anxiety.
Try CBD. Nicole used this nonpsychoactive cannabis-derived compound and found it calming.
What the experts say
Anxiety and depression are known to increase throughout perimenopause, often worsening in the months before periods permanently cease, Dr. Santoro says. Mind-body methods like hypnosis and deep breathing are great ways to cultivate peace, as is therapy, which can help you manage your mood, says Dr. Thielen. Hormone therapy can also help curb anxiety, Dr. Santoro says, though remember that the treatment isn’t a great long-term solution, because the risk of breast cancer has been shown to increase after five years unless a woman has had a hysterectomy.
As for CBD, it’s regularly touted anecdotally for its anxiety-reducing effects, but there’s not much science to back up these claims. Another remedy your friends may share with you that may not work: magnesium. Dr. Thielen wasn’t thrilled when she heard that Nicole’s friends had told her to take it. There’s no evidence that magnesium is effective against anxiety, and some supplement doses exceed 500 mg, which, if taken daily, can lead to nausea, diarrhea, and irregular heartbeat.
Dealing with Headaches
“During ovulation and menstruation, I get a tightening in my lower neck, followed by a tension headache. It starts as a dull pain but quickly builds to a pounding sensation, as if someone’s beating on the back of my head and neck.” —Karen E., 55, a teacher in
Parkland, FL
Advice from other women
Take Tylenol or another drugstore pain reliever ASAP. Karen aims to take acetaminophen within 30 minutes after she realizes a headache is coming on. Any later than that, and the drug doesn’t dull the pain.
Place a heating pad on your neck. This is most effective when used immediately, Karen finds, since the warmth relaxes the muscles and stops the progression to more severe pain.
What the experts say
Hormone fluctuation (the gradual drop in estrogen levels during perimenopause) can cause headaches, says Dr. Thielen. Once menopause is over, the headaches tend to improve, but while you’re in the thick of it, pain meds can help, as might massages, heating pads, and stretching, which can relieve tension. But women with a history of migraines may need Botox injections or prescription medicines, says Dr. Thielen.
Surviving Insomnia
“Several times a week, I jolt awake at 2 a.m. and can’t fall back to sleep for hours. While I’m lying there, my mind starts worrying about my kids or work. Thankfully I have a flexible work schedule and I’m the queen of power naps; otherwise these nights would debilitate me.” — Stacey Greer, 51, owner of an in-home senior care business in Northfield, MN
Advice from other women
Turn to a book. Reading or audiobook listening distracts Stacey from her racing thoughts, she finds.
Try melatonin. Taking this hormone supplement a few hours before bed has helped Stacey sleep better, but she doesn’t like taking something every day.
Look into prescription medicines. Stacey hasn’t tried an Rx; she prefers to see if natural treatments work first.
What the experts say
Lack of sleep is a major complaint of perimenopause, Dr. Santoro says. Reading can calm the mind, but sleep experts advise taking your book away from bed if you don’t doze off after 20 minutes, because you want your body to associate your mattress with sleep. Keeping to a regular bedtime and blocking out light in the room (as from your clock or cable box) can also help your mind settle, says Dr. Santoro. But if you find your brain racing, a cognitive behavioral therapist can help teach you how to deal with unwanted thoughts.
As for melatonin, some studies show that supplements can reduce the time it takes to fall asleep, but Dr. Santoro says that the right dose is crucial: Less than 1 mg taken three to four hours before bedtime should do the trick, and some products can have as much as 10 mg. Too much melatonin can cause headaches, drowsiness, vomiting, and blood pressure issues. If you need a prescription sleep aid to get you through a rough patch, don’t be afraid to ask for one, Dr. Santoro says: “In the short term it can be helpful, and [luckily] today’s medications have less potential for addiction.”
Dealing with Brain Fog and Memory Lapses
“About a year ago I’d suddenly stop at work, unsure what I was supposed to do next even though I’d done it a thousand times. Or I’d forget the word I was about to say. The scariest was when my husband held a clothespin and for the life of me I couldn’t name it. I worried I had a brain tumor or early-stage Alzheimer’s. Fortunately, over time it’s gotten better.” — Jodi Philippon, 55, a registered nurse in Lisbon Falls, ME
Advice from other women
Just know that it’s normal. Learning that this was a common symptom of menopause soothed Jodi’s worry. “It was reassuring to know it’s not because I have a serious medical condition,” she says.
Eat nourishing food and exercise. Jodi began eating more nutritious foods and walking about 5,000 steps a day, not just to manage her menopause symptoms but also to relieve gastroesophageal reflux disease (GERD). This boosted her health across the board as well as reduced her brain fog and recall blips.
Try hormones. While this was a suggestion from many women, Jodi’s family history of breast cancer and heart disease ruled this treatment out.
What the experts say
Many women in midlife suffer from small but noticeable declines in cognitive skills, says Dr. Santoro. How long this lasts is unknown: In the famous SWAN study of women in midlife, brain function improved after periods ended, while more recent research involving low-income women has shown that the problem can persist even longer. Still, knowing that brain fog and occasional memory lapses are common during perimenopause can save you further stress, Dr. Santoro says. Hormone therapy might help, while eating healthy foods and exercising regularly may clear your mind. Another way to stay sharp, according to the Centers for Disease Control and Prevention: Get involved with people in your community, such as by auditing a college class, volunteering at a nonprofit, or joining a group with a shared passion. But if you find that you’re consistently having trouble holding a conversation or completing your usual tasks and it’s not getting any better, go see your primary care doc—those can be signs of a more serious condition.
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