Dry Eyes Symptom during Menopause

When you think about Menopause symptoms, what naturally comes to your mind? Most likely, it is hot flashes, insomnia, vaginal dryness, mood swings, fatigue, and headaches. Yet one symptom affects more than 60% of women and most of them don’t even know it is connected to menopause: dry eyes. And more often than not, other imbalances that affect the eye are also at work but only become evident when hormones begin to fluctuate.

Women are twice as likely as men to suffer from dry eyes; and for reasons scientists don't understand, Hispanic and Asian women are especially vulnerable.

Symptoms of dry eye

Temporary mild symptoms of tired, itchy, or red eyes that abate with sleep, a change in environment, or taking your contact lenses out can be chalked up to obvious culprits. But worsening or persistent symptoms should be taken seriously. They include:

• itchiness
• a scratchy or gritty feeling
• tears running down the cheeks
• increasingly tired eyes during the day
• irritation from smoke, wind, or air movement
• stringy mucus
• sensitivity to light
• blurriness
• problems wearing contact lenses

If dry eye is left untreated, the cornea can become scarred or develop ulcers. Infection can also become more common because eye fluids help carry away debris. Vision can be affected, and you may feel chronic eye pain. But getting to the real cause of the condition can take some sleuthing.

What causes dry eyes?

In dry eye syndrome, the lacrimal gland or associated glands near the eye don't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

Dry eye syndrome has several causes. It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills; or because you live in a dry, dusty or windy climate.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

Dry eyes also are a symptom of systemic diseases such as lupus, rheumatoid arthritis, ocular rosacea or Sjogren's syndrome (a triad of dry eyes, dry mouth and rheumatoid arthritis or lupus).

Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers. Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and evaporation of moisture from contact lenses worsens dry eye symptoms.

Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes. Tears are composed of three layers:

• the outer, oily lipid layer;
• the middle, watery, lacrimal layer;
• and the inner, mucous or mucin layer.

Each layer is produced by different glands near the eye. The lacrimal gland located above the outer corner of the eye produces the lacrimal layer, for example. So a problem with any of those sources can result in dry eyes.

With increased popularity of cosmetic eyelid surgery (blepharoplasty) for improved appearance, dry eye complaints now occasionally are associated with incomplete closure of eyelids following such a procedure.

There are other ertain lifestyle factors that contribute to dry eyes include:

• Living and working in dry places. Dryness is usually worse in dry weather, in desert climates, during the winter, and when the eyes are exposed to second hand tobacco smoke or air pollution.
• Having LASIK surgery, which cuts eye nerves, reducing impulses for blinking. If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until the problem is resolved.
• Diets that don’t provide sufficient essential fatty acids or anti-inflammatory foods

Conventional medicine generally stops here when it comes to identifying the cause of dry eye, but the root imbalances that lead to many cases of dry eye extend much deeper, particularly for women in perimenopause and menopause. Often it’s just the tip of the iceberg. That’s because hormones play an important role in tear production and lubrication.

Hormonal changes and dry eyes

The degree to which your hormones affect your eye health depends largely on your individual blueprint and lifestyle. However, studies have linked androgen (testosterone) and estrogen receptors on the cornea of the eye and on the meibomian gland. This indicates a correlation between the production of tears and our sex hormones.

Before menopause, the more testosterone you have, the fewer tears you produce, while an increase in estrogen means more tear production. However, this equation reverses during menopause — more testosterone means more tear production, while more estrogen means less tear production. And while we still need to learn more about how this mechanism works, it’s clear that hormones play a significant role in lubricating our eyes. It makes sense that dry eyes may result from estrogen deficiency, progesterone deficiency, testosterone deficiency or possibly from an imbalance of any of the three.

When your eyes stay dry for too long, the result is localized inflammation. This immune response releases all kinds of inflammatory substances which make your eyes red, itchy, and swollen. The appearance of dry eyes often coincides with other signs of “drying” in menopause, like sore joints and dry vaginal tissues. Restoring a natural internal balance between estrogen, progesterone and testosterone is an important remedy for dry eyes.

Relief for dry eyes

Everybody is unique so you may need to experiment to find a combination of changes that work for you.

Optimize your nutrition. Eat three balanced meals a day, consisting of whole foods in any nutritional gaps with a daily multivitamin. Eat less meat, fried foods and dairy products and more chunky white tuna and walnuts.

Balance your hormones. Gentle endocrine support can help the body generate its natural levels of estrogen, progesterone and testosterone. You may also notices that some simple dietary changes, like eating more whole grains and less sugar and processed foods can help control insulin levels and reduce chronic inflammation.

Include flaxseed in your diet. Flaxseed is one of nature's best sources of n-3 essential fatty acids, which are the essential fatty acids the body uses to make anti-inflammatory hormones. Brazilian clinical researchers have found that flaxseed oil is an effective treatment for the condition of dry, red, inflamed eyes known as keratoconjunctivitis sicca. Brazilian women taking one or two 1,000-mg capsules of flaxseed oil every day for six months experienced a dramatic reduction in the redness and inflammation associated with dryness.

Evaluate your medications. If you are on medication, speak with your doctor about the possibility of it contributing to your dry eyes. Keep in mind that many medications required by adults over age 40 may cause or worsen dry eye problems. Examples include diuretics (often prescribed for heart conditions) and antidepressants. There may be suitable alternatives that cause fewer side effects.

Avoid excessive pollution and other irritants. Here’s another great reason to quit smoking: smoke aggravates dry eyes. Also, try to avoid rubbing your eyes since it can disturb tear film, remove moisture, and introduce bacteria or irritants into the eye. Try to buy hypoallergenic make-up as well.

Hydrate and humidify. Dehydration can draw fluid from the eyes, so remember to drink plenty of fluids. Non-diuretic drinks like water, pure juices, milk and herbal teas are good choices for hydration. You may also try using a humidifier to reduce tear evaporation, but be sure to clean it daily with soap to avoid introducing more irritants into the air.

Blink! Try to blink at least every five seconds or so, particularly when looking at your computer screen. It may also be helpful to lower your computer monitor a bit so your eyelids cover more of your eyeballs while you look at it.

Avoid unnecessary touching eyes. Too much rubbing may cause a loss of moisture and can promote bacteria growth in the eye.

Practice care with contact lenses. Contacts can sap the eye’s fluid and collect proteins, irritating eyes further with roughness and an environment conducive to growing bacteria. Keep lenses very clean, consider wearing them less, or explore lenses designed for dry eyes. Not all drops can be used with contacts, so check the labels.

Optimize your computer experience. Rearrange your computer screen so that you are looking down on the monitor.

Avoid (or at least reduce) eye make-up whenever it is possible. Some of the make-up brands might cause severe irritation and other negative health consequences.

Get more sleep! Last but definitely not least: enjoy the anti-inflammatory benefits of regular sleep! Beyond giving your eyes a chance to rest and refresh, good quality sleep reduces stress that can contribute to hormonal imbalances. Our bodies detoxify and attend to much needed cellular repair while we sleep, which helps soothe inflammation in all systems.

Note that all these recommendations may provide temporary relief or might be insufficient to improve the dry eyes conditions significantly. If your symptoms are severe, you should visit your eye care professional. There are prescription tears available that are longer lasting and more effective than over-the-counter alternatives. Your eye doctor may recommend inserting punctal plugs - special silicone plugs placed into the tear ducts, preventing tears from draining out. This allows tears to lubricate the surface longer. There is also surgery available that can help stimulate tear production in the eyes of older women.

Sources and Additional Information:

http://www.womentowomen.com/womenshealth/dryeyes.aspx

http://www.dryeyesyndrome.net/herbal-remedies/dryeyesyndrome/menopause-and-dry-eyes

http://www.empowher.com/menopause/content/truth-behind-menopause-and-dry-eye-syndrome

http://www.eyedoctorguide.com/eye_problems/dry_eyes_menopause.html

http://www.allaboutvision.com/conditions/dryeye.htm

http://www.your-eye-sight.org/dry-eyes.html

How to Deal with Vaginal Dryness during Menopause?

One of the most common menopause symptoms is vaginal dryness. It often occurs quickly and without warning in perimenopausal, menopausal, and postmenopausal women. It affects more than 80% of women just entering menopause and continues to affect up to 50% of those completing menopause. If you haven't experienced it, menopausal vaginal dryness may seem like a minor annoyance, but in reality it can be quite devastating. Vaginal dryness can ruin sexual intercourse for some menopausal women and leave behind feelings of inadequacy and guilt. Fortunately, effective treatments are now available for menopausal women who experience this symptom.

Vaginal Dryness in Menopausal Women

Also called vaginal atrophy, vaginal dryness is defined as a lack of adequate moisture in the vaginal area. It can affect women of all ages but it particularly affects women between the ages of 40 and 65.

The body naturally lubricates the vaginal walls with a thin layer of moisture. This moisture layer is made of a clear fluid excreted through the blood vessel walls around the vagina. When a woman is sexually aroused, these blood vessels receive more blood flow, stimulating the secretion of fluids, thus increasing vaginal lubrication.

However, hormonal changes that occur with menopause and other female life events can disrupt this process, both during sex and in daily life. Symptoms of vaginal dryness can range in severity from mild and slightly annoying to significantly life impeding.

The lubricant also has a slight acidity level, which helps to protect your vagina from foreign bacteria, keeping it free from infection.

Estrogen is the key to maintaining vaginal health and elasticity. As estrogen levels decrease during female menopause, the mucous membranes (vaginal epithelium) near your uterus produce less mucous. As a result, the vagina becomes very dry and thin. The walls of your vagina will become weaker and more sensitive. Acid levels also begin to decline, leaving you open to invading microorganisms, which can cause yeast infections and urinary tract infections. As your estrogen levels decline, less blood will circulate to the tissues in the pelvis, causing your vagina to thin and sag. Your vulva and vagina will probably begin to look different than it did before. Tissue and fat around the vagina will begin to disappear.

Symptoms of Vaginal Dryness

The most common symptoms of vaginal dryness are itching and painful sexual intercourse. Without its natural mucus, the vagina becomes very dry and fragile and cannot handle rough penetration. Forceful penetration may rip or tear the vaginal walls. You may have been wondering why you are experiencing vaginal bleeding after menopause. Spotting or bleeding can occur after sex if the vagina is too dry. A lot of women cannot stand to have sex at all, because the painful intercourse in menopause is simply not enjoyable.

Menopause itching due to dryness can also become painful and annoying. Incontinence also often occurs with vaginal dryness. As estrogen levels decrease, the walls of your vagina become increasingly weak, and are unable to prevent urine from escaping. Women with vaginal dryness are also at increased risk for developing vaginal infections like yeast infections, which are characterized by a thick, odorous discharge.

Treating Vaginal Dryness

Fortunately for menopausal women, vaginal dryness is not a condition that needs to be permanent. There are self management techniques to cope with this symptom, and varying degrees of treatment. It is recommended to begin with the least invasive method and progress up to more drastic treatments if symptoms are unaffected.

Lifestyle Changes

Your doctor will probably recommend that you try to have sex as much as possible. This may seem strange, but sexual intercourse will help stimulate the mucus glands at the base of the uterus, making your vagina moist. Women who refrain from sex often find that their dryness becomes even worse.

There are other lifestyle changes that can be implemented into a woman’s life as well, such as dietary adjustments or a different exercise program. Stress reduction techniques such as meditation or yoga can help women to relax if the vaginal dryness is stemming from emotional causes. Communication with one`s partner is recommended.

One of the recommended yoga exercises to treat vaginal dryness is as follows. It sounds simple, but requires concentration. Squeeze the anal/pelvic floor muscles firmly while inhaling; hold. Breathe out, holding the root lock and add a chin lock. Hold for two seconds. Visualize the nectar of the universe flowing down your spine and between your legs. Relax as you inhale.

However, as the primary cause of vaginal dryness in menopausal women is the natural decline in estrogen that is typical of this age group, the most logical method of restoring vaginal lubrication is to address the fundamental hormonal imbalance. Natural supplements can be an easy, safe and effective treatment option.

Some natural supplements to consider:

• Bryonia: root chakra overheated and dry, dry vagina, dry stools/constipation.
• Lycopodium: lack of root stability, vagina very dry, self-confidence withered, skin dry.
• Belladonna: vagina painfully dry and too sensitive to tolerate touch.

Recent studies have shown that a diet rich in soy flour and flaxseeds promotes vaginal health and prevents vaginal dryness. Drinking lots of water also can help your whole body, including your vagina, stay hydrated.

Sexual Activity

Sexual activity is a healthful prescription for postmenopausal women who have a substantially estrogenized vaginal epithelium. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation. Women who participate in sexual activity report fewer symptoms of atrophic vaginitis and, on vaginal examination, have less evidence of stenosis and shrinkage in comparison with sexually inactive women. A negative relationship exists between coital activity, including masturbation, and symptoms of vaginal atrophy.

Because no positive relationship has been shown to exist between estrogen levels and sexual activity, coitus is not hypothesized to restore or maintain estrogen in postmenopausal women. The existence of a positive relationship between coital activities and both gonadotropins and androgens indicates the importance of these compounds to healthy vaginal epithelium when estrogen levels are decreased.

Lubricants

To ease physical symptoms, over-the-counter products such as vitamin E oil, vaginal moisturizers, or water-based vaginal lubricants may be a boon to sexual comfort. There are lubricants that you can use during sexual activity that will make you more slippery. These include K-Y Jelly and Astroglide.

There are also products you can use on a regular basis to eliminate vaginal dryness, such as Replens.

You can open vitamin E capsules and apply the oil inside your vagina daily for a week or two and then once or twice a week after that.

Drugs - Estrogen Replacement Therapy

Because the lack of circulating, natural estrogens is the primary cause of vaginal dryness, hormone replacement therapy is the most logical choice of treatment and has proved to be effective in the restoration of anatomy and the resolution of symptoms. Estrogen replacement restores normal pH levels and thickens and revascularizes the epithelium. Adequate estrogen replacement therapy increases the number of superficial cells. Estrogen therapy may alleviate existing symptoms or even prevent development of urogenital symptoms if initiated at the time of menopause. Contraindications to estrogen therapy include estrogen-sensitive tumors, end-stage liver failure and a past history of estrogen-related thromboembolization. Adverse effects of estrogen therapy include breast tenderness, vaginal bleeding and a slight increase in the risk of an estrogen-dependent neoplasm. An increased risk of developing endometrial carcinoma and hyperplasia is conclusively related to unopposed, exogenous estrogen intake. Factors that determine the degree of increased risk include duration, dosage and method of estrogen delivery. Routes of administration include oral, transdermal and intravaginal. Dose frequency may be continuous, cyclic or symptomatic. The amount of estrogen and the duration of time required to eliminate symptoms depend greatly on the degree of vaginal atrophy and vary among patients.

Systemic administration of estrogen has been shown to have a therapeutic effect on symptoms of atrophic vaginitis. Additional advantages of systemic administration include a decrease in postmenopausal bone loss and alleviation of vasomotor dysfunction (hot flushes). Standard dosages of systemic estrogen, however, may not eliminate the symptoms of atrophic vaginitis in 10 to 25 percent of patients. Systemic estrogen in higher dosages may be necessary to alleviate symptoms. Some women require coadministration of a vaginal estrogen product that is applied locally. Up to 24 months of therapy may be necessary to totally eradicate dryness; however, some patients do not fully respond even to this treatment regimen.

Other treatment options include transvaginal delivery of estrogen in the form of creams, pessaries or a hormone-releasing ring (Estring). Treatment with a low-dose transvaginal estrogen has proved effective in relieving symptoms without causing significant proliferation of the vaginal epithelium. The genitourinary pH level is also lowered, leading to a decreased incidence of urinary tract infections. Absorption rates increase with treatment duration because of the enhanced vascularity of the treated epithelium. The advantage of transvaginal treatment may be a decreased risk of endometrial carcinoma because a lower hormone amount is required to eliminate urogenital symptoms. Negative effects of transvaginal treatment include patient dislike of vaginal manipulation, less prevention of postmenopausal bone loss and vasomotor dysfunction, decreased control of absorption with vaginal creams compared to oral and transdermal delivery, and irregular treatment intervals that may cause patients to forget to administer the treatment.

Transvaginal rings offer convenience, constancy of hormonal concentration in the blood stream and a therapeutic value equivalent to creams without the need for frequent application. Control of hormone dosage is manipulated by changing the surface area of the ring. Atrophic vaginitis symptoms are relieved (with a dosage of 5 to 10 μg per 24 hours) without stimulation of endometrial proliferation, thereby eliminating the need to add opposing progestogen to the regimen. Rings may be removed and reinserted by most patients with little difficulty and can be worn during coitus.

In any case, consultation with a doctor is strongly advised with these options due to the possibility of complications.

Vaginal estrogen can be very effective in treating dryness. There are a number of methods currently available for taking estrogen vaginally. Two options are Premarin cream and Estrace. Both are very well absorbed. Some women think that because you apply the cream only inside your vagina, none of it will get into the rest of your body. This isn't the case. Some of the estrogen is absorbed into your blood. In fact, both Premarin and Estrace raise your blood levels of estrogen much the same as estrogen pills.

You only need a low dose of these products. One study found that a dose of 0.1mg provided effective relief from vaginal dryness. When you start using vaginal cream, you apply a small dab just inside your vagina daily for three or four weeks. Then you can reduce your use to once or twice a week. If you apply it daily for more than four to six weeks, it becomes less effective. It's important to remember that this is not a lubricant. You should use K-Y Jelly or Astroglide or another type of lubricant before having sex.

Easier and less messy are the new sustained release products, Estring and Vagifem. Estring is a low-dose estrogen ring that is placed in the vagina (much like a diaphragm) for three months at a time. It releases small amounts of estradiol over time. The estrogen dose is so low that it is not absorbed into the rest of the body. Newer products like Vagifem involve placing a tablet in the vagina rather than a ring.

Note to Women with Breast Cancer: Women who have had breast cancer can use Vagifem or Estring. Estrogen cream, such as Estrace is not recommended. Neither is Femring which is a form of hormone replacement therapy (HRT).

Sources and Additional Information:

http://www.epigee.org/menopause/vaginal_dryness.html

http://www.34-menopause-symptoms.com/vaginal-dryness.htm

http://www.dslrf.org/mwh/content.asp?L2=1&L3=3&SID=244

http://www.mayoclinic.com/health/vaginal-dryness/DS00550

http://www.menopause-metamorphosis.com/An_Excerpt-115-dry_vagina.htm

http://www.aafp.org/afp/2000/0515/p3090.html

Hot Flashes: Menopause Symptoms Relief

Hot Flashes Symptoms

Hot flashes feel as a sudden wave of mild or intense body heat caused by rushes of hormonal changes resulting from decreased levels of estrogen in female body. They are due to blood vessel opening and constricting and a symptom of menopause.

Hot flashes are episodes that are experienced by many, but not all, women undergoing menopause. A hot flash is a feeling of warmth, sometimes associated with flushing that spreads over the body and sometimes followed by perspiration. Menstruating women in their 40's may have hot flashes, and hot flashes may last for a decade or more in some women. There is no way to predict when they will cease in a given woman. They decrease in frequency over time.

During a hot flash, sensations of heat move up your waist, chest, neck, and face. Perspiration that you exude during your hot flash will soon cool you down, causing you to experience rapid chills all over your body. Typically, a hot flash last only a couple of minutes, however, some unfortunate women can experience hot flashes lasting up to 30 minutes. Women can experience as many as 15 hot flashes in one day, but typically hot flashes occur 2 to 4 hours apart during menopause.

When you're having a hot flash, you may experience:

• A feeling of pressure in your head as the hot flash begins
• A feeling of mild warmth to intense heat spreading through your upper body and face
• A flushed appearance with red, blotchy skin on your face, neck and upper chest
• Rapid heartbeat
• Perspiration, mostly on your upper body
• A chilled feeling as the hot flash subsides

Less common symptoms associated with hot flashes include:

• Weakness
• Fatigue
• Faintness
• Dizziness

Reasons for Hot Flashes

Exact cause of hot flashes isn't known, but the signs and symptoms point to factors affecting the function of your body's thermostat — the hypothalamus. This area at the base of your brain regulates body temperature and other basic processes. The estrogen reduction you experience during menopause may disrupt hypothalamic function, leading to hot flashes. So, hot flashes may have more to do with fluctuation of hormone levels as opposed to low hormone levels per se.  

Low estrogen alone doesn't often seem to induce hot flashes, as children and women with low levels of estrogen due to medical conditions usually don't experience hot flashes. Instead, the withdrawal of estrogen, as happens during menopause, appears to be the trigger.

As estrogen and progesterone levels drop during menopause, the body produces more of a brain hormone called gonadotropin hormone (GnRH) in order to force fertility. GnRH is also responsible for regulating heat sensors in the brain. When higher levels of GnRH are present, the body mistakenly thinks that it is overheating. It attempts to cool itself down by opening blood vessels in the head and neck, which causes perspiration.

Sweaty Side Effects

The most obvious side effect of hot flashes is the sweating! The amount of sweat that your body produces during a hot flash will vary depending on your stage of menopause, your diet, and any medications that you are taking. Some women get away with just a sweaty lip while others feel like they've run 10 miles in a fur coat! If your transition between perimenopause and menopause is fairly quick, you can probably expect your symptoms to be a little worse.

Hot flashes can cause you to feel more than just sticky though. It's not unusual to feel completely exhausted, as though all your energy has been zapped for as much as an hour after a hot flash. On top of that, hot flashes often occur at night, making it impossible to get a good night's sleep.

Hot flashes leave a lot of women feeling very anxious because they are hard to predict. Though you may feel embarrassed if you have a hot sweat at a restaurant, at a friend's house, or during that big board meeting, remember: most women will go through this at some stage in their life. No one will judge you over a little sweat.

Risk Factors

Not all women who go through menopause experience hot flashes. Although it's not clear why some women get hot flashes and others don't, the following factors increase your risk of hot flashes:

• Smoking. Women who smoke are more likely to get hot flashes.
• Obesity. A high body mass index (BMI) is associated with a higher frequency of hot flashes.
• Physical inactivity. If you don't exercise, you're more likely to have hot flashes during menopause.
• Ethnicity. More African-American women report menopausal hot flashes than do women of European descent. Hot flashes are less common in women of Japanese and Chinese descent than in white European women.

Lifestyle Tips

Here are some tips to help dealing with hot flashes:

• Know your triggers. Keep a daily record of your hot sweats, including how long they last and when they occur. Certain foods often exacerbate hot sweats especially spicy foods, hot drinks, and alcohol.
• Keep cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove outer clothing when you feel too warm. Open a window or use a fan or air conditioner to keep air flowing. Lower the room temperature, if you can. If you feel a hot flash coming on, sip a cold drink. Avoid hot baths, spring showers and steam baths, esp. before bedtime. Have cool showers, instead.
• Use cotton bed linens. Cotton is more breathable and absorbent than other fabrics. It will keep you cooler at night and help you get a great rest.
• Watch your diet. Drink lots of water and juice and keep a cool drink by your bed.  Many foods are thought to contribute to or worsen discomfort from hot flashes. Alcohol, caffeine, excess sugar, dairy products, meat products and spicy foods rank among the top aggravators of severe hot flashes as well as mood swings.
• Relax! Learn yoga, listen to music, or engage in quiet meditation.
• Breathe deeply. Deep, slow abdominal breathing (paced respiration) may decrease hot flashes. It takes some practice to perfect the technique, but paced respiration done for 15 minutes twice daily, or at the beginning of a hot flash, can be helpful. To practice paced respiration, begin by sitting comfortably. Breathe in deeply for five seconds, pushing your stomach muscles out. Exhale for five seconds, pulling your stomach muscles in and up. Repeat this cycle of breathing deeply in and out until you feel calm and relaxed.
• Stop smoking. Smoking is linked to increased hot flashes. By not smoking, you may reduce hot flashes, as well as your risk of many serious health conditions such as heart disease, stroke and cancer.

Medications

Menopause is a natural transition. If hot flashes don't interfere with your life, you don't need treatment. If it's necessary to ease your symptoms with treatment, periodically re-evaluate your need for continuing that treatment. For most women, hot flashes fade gradually within a few years.

Hormone therapy

For moderate to severe hot flashes, your doctor may recommend hormone therapy. Estrogen therapy is the most effective treatment for hot flashes, but in some instances, doctors might prescribe progesterone therapy instead.

• Estrogen therapy. If you've had a hysterectomy, you can take estrogen alone. But if your reproductive organs are still intact, you should take progesterone along with estrogen to protect against cancer of the lining of the uterus (endometrial cancer). With either regimen, current recommendations are to use the lowest effective dose for the shortest amount of time needed to relieve symptoms.

Before starting estrogen therapy for menopause symptoms, review your heart-disease risk factors with your doctor and weigh the benefits of symptom relief against the risk — remote but recognized — of developing heart disease as a result. It's likely that hormone therapy interacts with other factors — timing and length of hormone use, reproductive history and family history, for example — to increase this risk, but there's no way to know what's safest for you individually. Your doctor can help you weigh the pros and cons.

Estrogen therapy is not a good option if you've ever had a blood clot or breast cancer.

• Progesterone therapy. As an alternative for women who can't take estrogen, some doctors prescribe progesterone alone to control hot flashes. Two progesterone-like drugs, megestrol acetate and medroxyprogesterone acetate, have been found to provide some relief from hot flashes.

Other prescription medications

If you decide against estrogen or progesterone therapy, your doctor may suggest a non-hormonal medication for reducing hot flashes. These medications aren't approved by the Food and Drug Administration specifically to treat hot flashes, but they are approved for treating other conditions.

• Antidepressants. Low doses of certain antidepressants may decrease hot flashes. Antidepressants from classes of medications known as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — including venlafaxine (Effexor), paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), desvenlafaxine (Pristiq) and others — have been found to relieve hot flashes. However, these medications aren't as effective as hormone therapy for severe hot flashes and may cause unwanted side effects, such as nausea, dizziness, weight gain or sexual dysfunction. Talk with your doctor about whether the benefits outweigh the potential side effects for you.
• Gabapentin. Gabapentin (Neurontin) is a medication approved for treating seizures or pain associated with shingles. It's also increasingly used to treat various other types of pain. Gabapentin may be moderately effective in reducing hot flashes, particularly for women who have symptoms at night. Side effects can include drowsiness, dizziness and headaches.
• Clonidine. Clonidine, a pill or patch typically used to treat high blood pressure, may provide some relief from hot flashes. Side effects such as dizziness, drowsiness, dry mouth and constipation are common, sometimes limiting the medication's usefulness for treating hot flashes.

Diet, Vitamins, and Natural Remedies

Soy Products

Several researches suggest that soy may have some benefit for reducing hot flashes and other symptoms of menopause. However, it is strongly recommended that you get your soy from foods rather than from supplements. Foods that contain soy include tofu, tempeh, miso, soy milk, whole soybeans, texturized vegetable protein, and soy powder.

Vitamin E

A study published in Gynecologic and Obstetric Investigation found that Vitamin E may help reduce the occurrence and severity of hot flashes and night sweats during menopause. However, a placebo-controlled, randomized study evaluated vitamin E supplements (800 IU/day for four weeks) for 120 breast cancer survivors with hot flashes and found that vitamin E only marginally decreased hot flashes.

Black Cohosh (Actaea racemosa, Cimicifuga racemosa)

This herb has received quite a bit of scientific attention for its possible effects on hot flashes. Studies of its effectiveness in reducing hot flashes have produced mixed results. However, some women report that it has helped them. Recent research suggests that black cohosh does not act like estrogen, as once thought. This reduces concerns about its effect on hormone-sensitive tissue (eg, uterus, breast). Black cohosh has had a good safety record over a number of years. There have been some reports linking black cohosh to liver problems, but this has not been proven.

Red Clover (Trifolium pratense)

In five controlled studies, no consistent or conclusive evidence was found that red clover leaf extract reduces hot flashes. As with black cohosh, however, some women claim that red clover has helped them. Studies report few side effects and no serious health problems with use. But studies in animals have raised concerns that red clover might have harmful effects on hormone-sensitive tissue.

Chasteberry (Vitex agnus castus)

Similar to black cohosh, chasteberry appears to act like a progesterone and  has been used in Europe for many years to alleviate PMS symptoms as well as menopausal symptoms. It may help diminish both LH and FSH and appears to affect your pituitary function. Different studies have found that it reduced menopausal symptoms, particularly hot flashes and irregular bleeding. And it appears to be very helpful for breast tenderness, primarily because chasteberry suppresses prolactin production. Typically, it takes about three to four weeks notice results.  One note, however:  While chasteberry is widely used in Europe, there have been no double-blind placebo studies conducted on it.

Dong Quai (Angelica sinensis)

Dong quai has been used in Traditional Chinese Medicine to treat gynecologic conditions for more than 1,200 years. Yet only one randomized clinical study of dong quai has been conducted to determine its effects on hot flashes, and this botanical therapy was not found to be useful in reducing them. Some experts on Chinese medicine point out that the preparation studied was not the same as they use in practice. Dong quai should never be used by women with fibroids or blood-clotting problems such as hemophilia, or by women taking drugs that affect clotting such as warfarin (Coumadin) as bleeding complications can result.

Ginseng (Panax ginseng or Panax quinquefolius)

Research has shown that ginseng may help with some menopausal symptoms, such as mood symptoms and sleep disturbances, and with one's overall sense of well-being. However, it has not been found to be helpful for hot flashes.

Kava (Piper methysticum)

Kava may decrease anxiety, but there is no evidence that it decreases hot flashes. It is important to note that kava has been associated with liver disease. The FDA has issued a warning to patients and providers about kava because of its potential to damage the liver.

Evening Primrose Oil (Oenothera biennis)

This botanical is also promoted to relieve hot flashes. However, the only randomized, placebo-controlled study (in only 56 women) found no benefit over placebo (mock medication). Reported side effects include inflammation, problems with blood clotting and the immune system, nausea, and diarrhea. It has been shown to induce seizures in patients diagnosed with schizophrenia who are taking antipsychotic medication. Evening primrose oil should not be used with anticoagulants or phenothiazines (a type of psychotherapeutic agent).

Sources and Additional Information:

http://www.medterms.com/script/main/art.asp?articlekey=7322

http://www.epigee.org/menopause/hot_flashes.html

http://www.mayoclinic.com/health/hot-flashes/DS01143/

http://www.menopause.org/hotflashes.aspx

http://womenshealth.about.com/cs/hotflashes/a/nomorehotflashs.htm