Joan's Remarkable Journey of How She Achieved a Dramatic Reduction in Menopausal Hot Flashes and Night Sweats: A Case Study

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 debilitating. 

With as many as 80% of women experiencing hot flashes or menopausal vasomotor symptoms (VMS), demand for non-hormonal approaches has increased. With many theories supporting the driving force behind VMS to be an estrogen-influenced neurotransmitter imbalance, modulation of this pathway can provide relief for these women. 

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CC: Hot Flashes and Night Sweats 

Joan was 51 when she presented with hot flashes that were interfering with her work due to the high 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 a dead sleep. There was no pattern of food, stress, or activity level linked to the hot flashes, as she could go days without them before having a week-long attack. They came on 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 keep stress low and well-managed. 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 indicate that she is heading into her perimenopausal transition, and her low estrogen is likely driving her symptoms. A morning cortisol elevated was also noted, which she correlated with the high stress of morning life during the school year getting her children on their way. 

Interventions

Cimicifuga racemosa, or black cohosh, was brought in at 400 mg twice daily between meals. Although the exact mechanism of black cohosh is unknown, it is theorized to reduce serotonin reuptake; decreased estrogen levels reduce serotonin production, which can drive vasomotor symptoms.  

Due to elevated cortisol in the morning, which could contribute to decreased hormone output, we had her stop intermittent fasting and eat a well-balanced breakfast with optimal protein and fat for blood sugar control. She moved her coffee intake to 90 minutes after waking and always with or after breakfast. I also had her stop doing high-intensity morning workouts and focus on walking, biking, and hiking to reduce cortisol spikes. 

Flax seeds were recommended at 2 tablespoons daily as they are one of the richest sources of isoflavones, a type of phytoestrogen, which is a compound similar to endogenous estrogen that exerts both estrogenic and anti-estrogenic effects.

A pre-methylated B complex was recommended every other day to provide the necessary B vitamins for estrogen formation and detoxification. These vitamins also support the adrenals for the ongoing cortisol demand. 

Magnesium glycinate at 500 mg was also brought in nightly to support estrogen formation and sleep support for ongoing night sweats. 

Follow Up 3 Weeks Later

Joan was thrilled to report her hot flashes and night sweats began to reduce five days into treatment, with the most significant benefits 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 recommended to continue treatment till 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 excellent. 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 treatment. 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 dramatic menstrual cycle returning, we reduced the black cohosh to 1 cap daily in the morning upon waking. We continued with the daily flax seeds for ongoing estrogenic support. We replaced both B complex and magnesium with a multivitamin containing adequate levels.

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Summary

Although the exact mechanism behind menopausal hot flashes is still unknown, black cohosh is an effective treatment to reduce severity and intensity. When combined with food-based support and optimized nutrients needed for proper hormone and neurotransmitter formation, you can get long-lasting results with a few essential supplemental interventions.