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Common-Sense Lifestyle Assists
By Michele Moore, M.D.
Hot Flashes, Night Sweats and Insomnia
I have great sympathy for every woman lying awake at night. During the day, it is easier to appreciate a hot flash as a “power surge” and to affirm your status as a new woman, but somehow resources wane in the depths of night.
Small practical things help many women: changing from synthetic fibers to all-cotton nighties, keeping a fan blowing obliquely on your side of the bed, keeping wipes or a cool, damp washcloth handy, and dividing your bedding or using separate beds. Visualization can truly help: my personal favorites were a waterfall, floating in a river, sliding on snow, and standing in the breeze.
For sleep disturbances not associated with night sweats or hot flashes, a nighttime dose of magnesium or a calcium/magnesium dose is often helpful. Melatonin may be helpful at doses of 1.5 to 3 mg. . . It is rare that I prescribe hypnotics, and usually before doing so I will suggest a trial of Benadryl, since this makes many women sleepy.
Again, it is the phytoestrogen-donating herbs that are most helpful. Black cohosh, motherwort, Dong Quai, and mixes of red clover and raspberry lead the pack, but oat straw, dandelion, and chickweed are also helpful. My patients have gotten relief by using Ostraderm, which contains aloe, licorice, soy, and wild yam. Sage contains thujones, which decrease sweating. Try a cup of sage tea at night. Prepare it by boiling one teaspoon of sage with two cups of water.
For insomnia, valerian alone or in combination with hops, skullcap, or passion flower can be helpful, taken about half an hour before bedtime. It is also very important to clear the last hour of your day from all “busyness” and to have a routine or bedtime ritual, much as we do with young children.
Homeopathic aids include belladonna, Pulsatilla, and Sulfur, plus many more. Belladonna is for the red faced, jerking out of a heavy sleep, nightmares, hot sweats. Coffea (with an “a”) is for mind racing, awaken at any sound, overstimulated. Ferrum metallicum for confused, vivid dreams, for restless sleep, difficulty falling asleep.
Lachesis is for hot flashes when falling asleep and awakening, sweaty during sleep, flushes of heat. Nux vomica for red, turgid face; sleeplessness with overabundance of ideas; awakens early and can’t return to sleep; awakens unrefreshed; nightmares. Pulsatilla for frequent need to urinate at night, discomfort lying down, awakens unrefreshed. Sanguinaria for burning heat; red, hot cheeks; flushes of heat into head and face; with headache, little sweat. Sepia for sweating easily or for weakness followed by anxiety and hot flashes.
Sulfur is for hot flashes; sweating in armpits and on hands and feet; itchiness, especially at night; hot feet; unrefreshing sleep. Sulphuricum acidum for hot flashes followed by tremblins and cold sweat-drenching, worse in evening. Valeriana for tightness in throat and chest on dropping to sleep; night cramp in left leg which awakens you; sudden gushes of sweat.
Dryness and Difficulty with Intercourse
When I was in medical school, we were told that frequent intercourse was the answer to the problem of dryness and difficulty with intercourse: “A well-worn path grows no weeds.” Although this may be true it is difficult to carry through when you’re never sure if it will hurt this time or not. You tense up and try to avoid intercourse or, at best, initiate activity less often. These signals are often misread or not understood by your partner, and distance grows. Yes, this is a common scenario.
Dry eyes, mouth and nasal passages are less commonly talked about, but they can also be quite troubling. Artificial tears, saline nose sprays and gels, and chewing gum are helpful for these symptoms. For eye dryness, placing freshly cut cucumber slices or wet chamomile tea bags on your eyelids feels very good. Drink lots of water and eat many high-water content fruits and veggies, such as lettuce, melon, cucumber, and spaghetti squash.
Start early (as soon as you read this) with a daily vaginal massage with any good dietary oil. Use oil as a lubricant for lovemaking. (I was once at an airport, scanning the incoming passengers for a family member, when a voice behind me said, “Thanks for the olive oil tip, Michele.” Why buy lubricants?) Caution: if you use condoms, don’t use oils that can break down the rubber. Ditto for diaphragms. Use KY Jelly or another lubricant designed to be used with condoms and diaphragms.)
Homeopathic remedies for dryness include Belladonna, Bryonia, and Natrum mur. Belladonna is for dry, hot mouth and throat, while Bryonia is for dry, parched, cracked lips; dry mouth; tongue very dry and rough and coated in the center; bitter taste; dry mucous membranes; and scanty sticky secretions. Cantharasis is for raw, inflamed, burning thirst but with an aversion to liquids; scalding urine; sexual irritation. Lycopodium is for sour taste, painful intercourse; dry skin and vagina; rawness in vluva and anus. Natrum mur (sea salt) is for dryness of skin, moth, rectum, and vagina; thirst; genital herpes; painful intercourse.
Decreased Libido
Use of estrogen or phytoestrogenic herbs – or both – may be all that’s needed to boost libido in many women, but for some women this is not enough. This where we consider androgens, or male hormones.
DHEA, the current popular “cure-all” is a mildly androgenic adrenal hormone, which in doses of 10 mg to 15 mg may be sufficient for the woman whose levels are low. (I measure by testing blood or saliva). Otherwise, the “hormone of desire,” to borrow a phrase from Dr. Susan Rako, is testosterone. I have reservations about the commonly p Everescribed oral preparations, like Estratest, because of the possibility of liver damage with prolonged use. Instead, I prescribe natural testosterone (generic) as a transdermal cream or gel or as a sublingual tablet or a trochee, or methyltestosterone (a synthetic testosterone that does not convert to estradiol) as a cream to be applied directly to the vulvae.
A wild card that needs to be considered when using natural testosterone is that some of it will be converted in the liver, skin, and fat to estradiol, and that each woman does this at her own rate. Because of this, I advocate monitoring levels of testosterone and estradiol when using these preparations. With methyltestosterone, this conversion is less significant and therefore less worrying.
Dizziness
Usually, the complaint of dizziness is really light-headedness rather than true vertigo, but occasionally episodes of true vertigo may be experienced.
Very often, on discussion, it becomes apparent that eating habits or lifestyle are causing this problem. Usually, remembering to go not longer than three hours without eating something, and making sure that you eat a combination of complex carbohydrate and protein (e.g., and apple wedge with a smear of peanut butter), will take care of the problem. Some busy and absent-minded souls (like me) may even need to set an alarm to remember to do this.
Being too busy and overcommitted can also lead to light-headedness. This is a time of intense inward activity physiologic change. Pace yourself. Match the rhythm of your life to your breathing: you cannot breathe in without breathing out, and vice versa. Yoga can help.
The herbal suggestions of the scent of lavender oil or drinking primula flower tea are offered in herbal books on menopause, but I have no experience with them. The suggestion to breathe into your cupped hands will, of course, help if you are hyperventilating at all.
I do have personal experience of using the homeopathic remedy Cocculus indicans and have found it usually very helpful, both for lightheadedness and for true vertigo.
Formication
Formication is an unusual symptom, experienced by approximately 6 to 10 percent of menopausal women. As I said in Chapter 1, formication is a sensation of ants crawling on your skin, or, more broadly, an itching or a crawling sensation, usually, but not always, confined to a single area of the body. There will be nothing to see unless you’ve scratched it raw! I had a six-inch strip on my left forearm that itched mercilessly for two months.
This is a high-class nuisance, but it is not an illness. All the suggestions given for dryness are helpful, as are topical anti-itch creams or gels. Cold helps, too.
Homeopathic aids are Caladium, which helps if the itching is in the genital area, and Rhus tox, which is reputed to be helpful for a crawling sensation on the skin.
Palpitations
Palpitations are actually fairly common at this time and usually do not imply illness, but, to be on the safe side, check with your physician. Most commonly, I find that tincture of reassurance and relaxation does much to alleviate this symptom, and I recommend fifteen to twenty minutes of meditation each morning and a relaxing bedtime ritual. Turn off the stimuli. Beyond this, supplemental magnesium is very helpful, and a dose of 250 to 500 mg usually does the trick.
Herbal preparations that are cardiotonic (soothing to the heart) are hawthorne, motherwort, valerian, and black haw. They have helpful relaxant properties.
Hawthorne appears to have a beneficial effect on minor arrhythmias by improving energy metabolism and the utilization of oxygen in heart muscle. It reduces the accumulation of lactic acid in the heart muscle. It is regarded as very low toxicity.
Motherwort (botanical name Leonardus cardiaca has a long history of use in treating hormonal-driven and anxiety-driven rapid heartbeat
Valerian brings to my mind the Victorian “vapors.” Pharmacologically, its effects help to normalize the nervous system and probably help palpitations through a sedative effect and perhaps by decreasing andrenergic drive. It is regarded as safe when using standardized extracts in recommended doses.
Black haw also acts as a sedative and relaxant.
Homeopathic remedies are Spigelia, which is reported to be helpful, especially when palpitations are combined with eye symptoms, such as left eye pain, radiating from the left side of the back of the skull, or swollen, aching eyes; and Rock Rose (Bach flower), which is useful when there is fear and anxiety.
Moore, Michele, M.D. The Only Menopause Guide You’ll Need. pp. 87-94. ©2000 The Johns Hopkins University Press. Reprinted with permission of The Johns Hopkins University Press
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