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Surviving Menopause: Hormones, Herbs, and More

Woman practicing yoga for self-care

A common question from patients is: “Should I take herbs or hormones for menopausal symptoms, and if so, which ones?”

This is a huge topic and the truth is there is no “right answer.”

Treating menopausal symptoms needs to be based on each woman’s unique situation accounting for her personal history, family history, current health goals. Without question, estrogen replacement is the most effective treatment for hot flashes and other menopausal symptoms.

While hormone replacement isn’t for everyone, there IS a lot of buzz right now around bioidentical hormones. For you to make an educated decision, it’s important to understand the difference between bioidentical (often compounded) and non-bioidentical hormones (conventional), and when you might consider using them.  In my upcoming talk at Blum Center, and further down in this blog, we will review all of this information.

But, not everyone wants to take extra hormones or can’t take hormones for health reasons.  Well, hope is not lost!  I will review several herbal remedies and lifestyle changes that women can use successfully.  This is a meaty topic, so let’s dive in!

“Hot Flashes?  No Hormones?  No problem!”

Many women come to me seeking strategies to address things like hot flashes, vaginal dryness, sleep disruption, and mood changes without hormones. In this case we have SO much to offer. Conventional medicine offers several antidepressants that have been found to work for hot flashes: paroxetine and venlafaxine are some examples. Gabapentin is another option.  Unfortunately, these drugs do tend to have other unwanted side effects such as sleepiness, headache, nausea, dizziness, and more. Rest assured, this is NOT our approach at Blum Center!  You don’t have to take an antidepressant to get you through menopause!

Here are just a few of the options that we can offer you:

St. John’s Wort has been shown in multiple studies to improve women’s sense of wellbeing, decrease hot flashes, improve sexual wellbeing, and reduce overall menopause rating scores (Grube, 1999 and Abdali , 2010).  Studies show that improvement was seen after 2-3 months and dose is typically around 300 mg taken three times a day.  St. John’s wort is metabolized in the liver and can interfere with the metabolism of many other drugs, so always tell your doctor if you are taking it.

Panax Ginseng has been shown to improve menopausal symptoms of depression and well being, increase energy, decrease insomnia (Wiklund, 1999 and Tode, 1999).  The dose is typically a standardized extract of 200mg a day.

Sage has been shown to decrease sweating by up to 64% in women who have hot flashes (Bommer, 2011).  If you are using dried leaf in capsule or tea take 1000mg twice a day.

Soy, Red Clover, Kudzu all contain various isoflavones such as daidzein, genistein, and puerarin. These compounds act as weak estrogen receptor modulators. Data on isoflavones for hot flash relief is mixed. Some studies show a benefit, others do not.  The tricky thing about some of these compounds, like daidzein, is that it turns out your gut bacteria have to convert it into equol to have the biggest impact. But it is estimated that only 30-50% of humans are “equol producers.” This may account for why soy seems to help some women more than others when it comes to hot flashes.My suggestion is to try it for about a month and if you see no improvement then stop. For soy, I would rather see patients eat whole, organic soy foods such as edamame, tofu, soy milk instead of taking a pill. Food is always better than supplements and foods with whole soy proteins (not soy protein isolate) are better for you. As always, any food or herb that has estrogenic qualities, you must use with caution in the setting of an estrogen-related cancer. Additionally, soy in large quantities (three times a day) can impact your thyroid function, so ask your doctor if you need to limit it. Also, these could interact with platelet/anticoagulant medicines.

Black Cohosh has shown mixed results in studies for menopausal symptoms. Many studies look at Black Cohosh along with a few other herbs. This is common practice in botanical medicine, taking advantage of the synergistic effects that herbs can have when taken together. It does make it more difficult to know if individual ingredients are beneficial. Black Cohosh is generally well tolerated and I mention it because it shows up in a lot of supplements that are geared for women’s health, menopause in particular. It is unclear if Black Cohosh directly interacts with estrogen receptors in humans, but to be on the safe side, I would avoid this one if you are an estrogen receptor positive cancer.

Clinical Hypnosis can decrease hot flashes by 55% compared to 13% in one well designed randomized study of 187 women (Elkins GR, 2013).  Hypnosis also helped with improvement in hot flash interference, sleep quality, and treatment satisfaction.

Acupuncture has been shown in multiple studies to improve sleep disruption (Chiu, 2015).  Researchers did a summary review of 31 studies involving over 2400 patients and found there was significant improvement in sleep as well as changes in blood hormone levels of estradiol and follicle stimulating hormone. And the larger the hormonal changes, the bigger the improvement on sleep. Data on acupuncture for hot flashes, however, is mixed. It appears that when acupuncture is compared to no acupuncture, there is a significant improvement seen. But when researchers compare real acupuncture with sham acupuncture, they don’t see a difference. This indicates that at least for hot flashes, acupuncture probably has a strong placebo effect. In my opinion, when the placebo effect works in our favor, it is a wonderful thing and I think we should take advantage of it!

Yoga has also been shown to be beneficial for hot flashes and emotional symptoms like stress in multiple studies (Joshi, 2011 and Chattha, 2008). Yoga has so many health benefits that I recommend it to almost all of my patients. In this fast-paced world, the practice of yoga slows down our sympathetic nervous system which is integrally involved with hot flashes. One caveat: I don’t recommend hot yoga as that will most assuredly make hot flashes worse!

“I’m Fine with Hormones – Bring Back the Estrogen!”

There has been a lot of research in the past few decades looking at hormone replacement for menopausal symptoms and the field is constantly growing. As with most medicines, there are risks and benefits to consider when deciding if you want to take hormones and it is important to have that discussion with your healthcare provider, or come and see me to discuss, because your personal and family history influences this decision enormously. In general, we do believe that hormone replacement therapy, especially bioidentical therapy, in low dose for the first few years of menopause is safe for most women.

My approach?  I always use bioidentical hormones and aim for the lowest effective dose, and prefer topical or local estrogen to limit unwanted effects.

“Bioidentical, Synthetic, I’m Confused…”

Bioidentical hormones are compounds that exactly mimic the hormones that we have circulating in our bodies. Those bioidentical hormones may be synthetic, in the sense that they were made in a lab, and that is not necessarily bad. Two of the most common hormones prescribed in this country are not bioidentical: conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA). These compounds act similarly to our own estrogen and progesterone, but nevertheless, have actions in our bodies that are distinct.

Historically, we assumed that CEE and MPA would be equivalent to bioidentical hormones, but as researchers have begun to compare the two in head-to-head studies, we now know there are differences especially in the progestogens (Stanczyk, 2013). Consensus is now building that bioidentical progesterone is probably safer than MPA. Although CEE and MPA are the most commonly prescribed hormone replacement regimens in this country, there are plenty of FDA approved bioidentical options for us to choose from including estradiol pill, patch, or gel form as well as micronized progesterone in pill form.

“So What is Compounding?”

Compounding medicine is the practice of taking one or more individual ingredients and mixing them together in the lab and creating a new compound that isn’t otherwise sold as a brand name product. The new medicine can be specially formulated for an individual patient to avoid allergenic ingredients, create new doses, convert a pill to a cream, combine medicines into one, etc.

Having access to high quality compounding pharmacies is extremely valuable in expanding the range of pharmaceutical offerings to the public.  For example, one FDA approved bioidentical progesterone product on the market in the US. contains peanut oil which some women are allergic to. This is a prime example of when compounding progesterone is a life saver!

There are pros and cons to using FDA approved drugs vs compounding drugs. The advantage of using an FDA approved medicine is that the approval process is stringent in terms of demonstrating safety, appropriate dosing, and efficacy. Additionally, the FDA drugs and facilities are highly regulated. Also, since the majority of research has been done using FDA approved drugs, physicians feel more comfortable prescribing them as they have been thoroughly vetted in clinical trials.  [A side note: the drug companies are the ones that fund the bulk of research since they can afford to do so. It costs millions of dollars to carry out a large clinical trial and very few entities can fund those studies.] The disadvantage is that sometimes we might want to give a drug in a different form than is available. In terms of compounding, the advantage is the ability to tailor a medicine specific to the needs of an individual patient.  The downside is that there is not as much safety and efficacy data on individual formulas, nor as much regulation on the actual compounding pharmacies themselves.

My approach to menopause is to get to know my patient, figure out what her goals are for the menopause transition, determine her risk profile, and come up with the best treatment plan together.

Meet Dr. Fitz:  Bronwyn Fitz, M.D. is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine. In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.

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3-Steps to Finding Chronic Headache Relief

Find Chronic Headache Relief


Headache blogger Kerrie Smyre expresses the sentiments of many with migraines or other forms of chronic headache.  “Headaches steal so much of your life. The list is long, but includes jobs, relationships, having children, self-respect, ambition and identity”.

Headache symptoms can vary from a dull ache, to razor sharp pain that stops you in your tracks. Even the simplest headache can be life altering.  In making your way through treatment options, often there aren’t good choices– either the medications don’t work, or they work for a while. And then over time, you find yourself taking more and more medications, which can also end up paradoxically being the actual cause of (rebound) headaches themselves!

There are many different triggers for headaches, and uncovering the cause of yours is essential to finding the cure. Many of our headache patients come in thinking that their sinuses are the cause.  Usually they are not!

The 3-Prong Approach to Alleviating Chronic Headaches 


Could It Be Food?– There are many foods that can cause headaches. Unfortunately, they are not universal. For one person it may be raw onions, for another it could be vinegar, red wine and aged cheese. Just as every person is different, so are individual triggers. The good news is that a skilled practitioner can help identify your triggers and help you remove them.

Could It Be Non-Food Lifestyle Triggers? – There are a significant number of lifestyle triggers that are often overlooked as a cause of headache. For instance, do you get a headache if you don’t wear sunglasses? How about going in and out of air conditioning? Again, just as with food triggers, it is possible to figure this out and then help you make a personalized plan.

Could It Be Stress? (Particularly if you say you don’t have any!) – Stress and headaches often go hand-in-hand. It does not have to be acute stress (“Oh my gosh, I’m so stressed?”) It is also related to long-term, under-the-surface stress, like financial pressure, a troubled relationship, or putting off life decisions. It is important to work with a practitioner to learn mind-body tools to help you relax for headache prevention, and also for in-the-moment when-you-need-it-most stressful situations.

Could It Be Hormones? – Many women find that headaches are in some way related to their cycle. Once you and your practitioner determines that this is the issue, these kind of headaches can be treated easily with herbs that help balance your hormones.

Could It Be Toxins? – Toxins like pesticides, heavy metals, and plastic residues can build up in both your body and your brain, and trigger headaches. A skilled Functional or Integrative Medicine practitioner can evaluate your toxic load and then help you reduce the toxins in your body and treat your headaches with a detox program that provides supplements and a food plan to help support the liver in doing this important toxin-clearing work.

Could It Be A Structural Issue? – A common cause of headaches for many people is an issue in their musculoskeletal system. Problems like TMJ (temporomandibular joint inflammation), neck issues, myofascial pain syndromes (muscle pain in the scalp, shoulders and neck radiating up into the head) and others, can all be causes of headaches. Once we figure out this is the issues, we can treat it and the headaches can be gone for good!

Could It Be Sinusitis? – Of course it could be! But now you know that there are many other possibilities and we need to check for them all. However, sinusitis remains on the list and if it turns out this is the culprit, there are great herbal and alternative ways to treat this other than antibiotics. Also, food and environmental triggers are often an underlying issue, and these can be treated as well.


It takes skill and experience to create an individualized plan. At Blum Center for Health, while all the practitioners treat headaches, it is a particular focus of my practice. I work with my patients to uncover and treat the underlying causes. Remember, it is critical to find someone who will be your partner – if they are only throwing medication at the issue, walk away!


It takes vigilance and attention on your part and mine to discover all the triggers that contribute to your headaches, but it can be done and I can show you how. Most importantly, once this is sorted out, you will have the tools and strategies you need to remain headache-free.

Ready to take aim at your headaches? A great place to start is with our 10-Day or 30-Day HealMyGut program — it’s a total gut reset with a nutritional plan, recipes, just-right supplements, daily email support, and a private online community. Our 30-Day program includes the added bonus of a weekly chat with our Functional Nutritionist to answer all your questions. Find out which program is ideal for you: Take the Assessment

Meet Dr. Gereau: Dr. Gereau is an Allergy and ENT (Ear, Nose and Throat) specialist who uses an integrative and functional medicine approach to conditions such as chronic sinusitis, allergies, sleep apnea and headaches.

CLICK HERE to learn more about Dr. Gereau.