Menopause is a natural transition in every woman's life. Peri and menopausal hot flashes vary greatly from woman to woman, ranging from annoying to challenging.
With as many as 80% of women experiencing hot flashes or menopausal vasomotor symptoms (VMS), interest in non-hormonal approaches has increased. Some theories suggest that VMS may be influenced by an estrogen-related neurotransmitter imbalance, and addressing this pathway might help support comfort for these women.
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CC: Hot Flashes and Night Sweats
Joan was 51 when she experienced hot flashes that were interfering with her work due to their frequency and intensity. At its worst, she would experience up to 10 hot flashes an hour, leaving her drenched in sweat and waking her from sleep. There was no clear pattern of food, stress, or activity level linked to the hot flashes, as she could go days without them before having a week-long occurrence. They began suddenly two months prior. However, her periods had been irregular for the past three years. She ate a well-balanced diet focusing on high protein, fruits & vegetables, and healthy fats.
She was working part-time as a preschool teacher and had a very healthy balance of self-care and exercise to help manage stress. She lived at home with her husband and two teenage children.
Initial Lab Work: Saliva Hormone Panel
When labs were collected, Joan had not had a menstrual cycle for 2 months before waiting till day 20 of her cycle to collect. These labs suggest that she is entering her perimenopausal transition, and her low estrogen may be contributing to her symptoms. A morning cortisol elevation was also noted, which she associated with the high stress of morning life during the school year getting her children on their way.
Interventions
Cimicifuga racemosa, or black cohosh, was introduced at 400 mg twice daily between meals. Although the exact mechanism of black cohosh is not fully understood, it is thought to influence serotonin pathways; decreased estrogen levels may affect serotonin production, which can be associated with vasomotor symptoms.
Due to elevated cortisol in the morning, which could be related to hormone output, she was advised to stop intermittent fasting and eat a well-balanced breakfast with optimal protein and fat for blood sugar management. She moved her coffee intake to 90 minutes after waking and always with or after breakfast. She was also advised to focus on walking, biking, and hiking instead of high-intensity morning workouts to help manage cortisol levels.
Flax seeds were suggested at 2 tablespoons daily as they are a rich source of isoflavones, a type of phytoestrogen, which is a compound similar to endogenous estrogen that may have both estrogenic and anti-estrogenic effects.
A pre-methylated B complex was suggested every other day to provide the necessary B vitamins for estrogen support and detoxification. These vitamins also help support the adrenals for ongoing cortisol management.
Magnesium glycinate at 500 mg was also introduced nightly to support overall well-being and help with sleep support for ongoing night sweats.
Follow Up 3 Weeks Later
Joan was pleased to report her hot flashes and night sweats began to reduce five days into the new routine, with the most noticeable changes starting around the second week. She was having 1-2 mild hot flashes a day and was only woken up once for night sweats in the last week. She was advised to continue this approach until the six-month mark when labs would be repeated.
Follow Up 6 Months Later - Labs
Lab Analysis
At the six-month follow-up, Joan was doing well. Her skin and hair looked healthier, and she felt "better than she had in years." Her menstrual cycle returned to a regular 30-day cycle two months into the new routine. However, her period only lasted 1-3 days, unlike her previous 4-5. She has not had a single episode of night sweats in the last four months and would get one "barely noticeable" hot flash a week at most. Her energy had improved so much that she resumed weightlifting three days a week and noticed how quickly she gained muscle mass and lost excess weight compared to previous years.
Due to the noticeable changes in her menstrual cycle, the black cohosh was reduced to 1 cap daily in the morning upon waking. The daily flax seeds were continued for ongoing support. Both B complex and magnesium were replaced with a multivitamin containing adequate levels.
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Summary
Although the exact mechanism behind menopausal hot flashes is still not fully understood, black cohosh may help support comfort. When combined with food-based support and nutrients that help maintain hormone and neurotransmitter balance, individuals may experience positive changes with a few essential supplemental interventions.
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