Welcome to No Sweat, Jenny’s semi-regular advice column (it’s monthly, like a period in perimenopause is monthly), where we get experts to answer all your burning perimenopause questions (submit them here). This month, Rebecca Blake, a registered dietitian and nutritionist who specializes in women’s hormonal health, takes a turn in the hot seat.
Dear Jenny,
Yesterday, I broke into a sweat and needed to rip off my sweater immediately, and I wasn’t even moving a muscle. I am desperate for something to help with these ridiculous hot flashes! Every time I open up Instagram lately, it seems as if everyone, from actual medical doctors to nebulously credentialed “wellness experts,” says I should get hormone replacement therapy to combat my perimenopause symptoms, but I’m not sure I want to go down that road yet. Is there anything else I can do to help with hot flashes?
– Stephanie, 47
Dear Stephanie,
There is no one right way to manage perimenopause and menopause symptoms, and you may be in for some trial and error until you find what works for you. First, a few words about “diagnosing” menopause: Menopause is, by definition, the cessation of periods for a full 12 months. However, most of us experience the symptoms we associate with menopause during the many months, and even years, leading up to full menopause. During this time, hormone levels fluctuate enormously and we experience not only those hot flashes and night sweats, but also changes in body fat distribution (hello, cute belly pooch!), mood, energy levels, libido, and brain fog—to name just a few.
Many OB-GYNs have not had advanced training in the treatment of menopause, so it is a good idea to look for Menopause Society certified providers (MSCPs), who are well versed in perimenopause treatment options. MSCPs will also be up-to-date on the most current treatments (such as bio-identical hormones and new hormone delivery systems) which is critical, since the menopause research and treatment space is exploding right now. (It’s about time!)
Hormone replacement therapy (HRT) is considered safe and effective for most women, and recent large scale studies have confirmed that the risks associated with HRT are low for women who are healthy, less than 60 years old, or within 10 years from menopause. The benefits are largely considered by the medical community to outweigh the risks. Furthermore, HRT can help prevent osteoporosis and cardiovascular disease, which become more prevalent in menopausal women due to the drop in estrogen.
Women who are not appropriate candidates for HRT include those who have a history of breast cancer or other hormone sensitive cancers, women with clotting disorders, and women over 60 years old.
For anyone who cannot take HRT, or who prefers to go the herbal route, scientific studies have shown that phytoestrogens (plant estrogens), particularly soy isoflavones, can reduce hot flashes. In fact, compared to placebo treatments, research shows that consuming an average of 54 mg of isoflavones per day can reduce hot flashes by 20 percent.
Below are some robust food sources of isoflavones:
| Food | Serving Size | Total Isoflavone content* |
|---|---|---|
| Soy based sausage | 3 links | 11 mg |
| Boiled soybeans | ½ cup (shelled) | 16 mg |
| Soft tofu | 3 oz | 19mg |
| Tempeh (cooked) | 3 oz | 30 mg |
| Soy yogurt (non-dairy) | 3.5 oz | 33 mg |
| Dry-roasted soybeans | 1 oz | 42 mg |
* isoflavone content varies among different brands, so these are estimated values
If you prefer to take a supplement to up your soy isoflavone intake and minimize your hot flashes, I recommend Theralogix IsoRel. They’re certified by the NSF, an organization which evaluates supplements in lieu of a governing body like the Food and Drug Administration (FDA). The supplement market is not overseen by the FDA, so it’s important to exercise caution when buying supplements. Ones that do not have such a certification may not actually contain what they claim they do.
The Theralogix Isorel capsules are 250 mg; the dose is one capsule daily for women. Keep in mind that won’t be the case for all brands, since the ingredients and blends may differ.
While new products pop up every day claiming to reduce menopausal symptoms, soy isoflavones have the strongest body of evidence to support their effectiveness when it comes to hot flashes. A lack of research does not necessarily mean a lack of effectiveness, but it does mean we don’t yet have enough information to claim that it does. It’s worth mentioning that bee pollen and red clover extract both have some research to support their use for reducing some of those bothersome menopausal symptoms.
One final note: Some supplements may even be harmful, or interfere with other medications you are taking. It is always best to consult with your doctor or a registered dietitian (RD or RDN) with expertise in this area before starting a new supplement.
— Rebecca Blake, MS, RD, CDN
The content in this article is provided for informational purposes only and does not intend to substitute professional medical advice, diagnosis, or treatment.
Don’t miss our previous installments of No Sweat, on perimenopausal brain fog, weight gain, and how to know you’re in perimenopause. Got a perimenopause question? Submit it here.
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