Menopause Symptoms: Tips for Survival -- Christiane Northrup, MD -- 05/13/03

By Christiane Northrup
WebMD Live Events Transcript

Menopause symptoms making you miserable? Menopause is not a time to suffer; it's a "mind-body revolution that brings the greatest opportunity for growth since adolescence," says women's health expert Christiane Northrup, MD. But if annoying or painful menopause symptoms are making life hard, take a look at her expert opinions on what you can do to feel better.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome back to WebMD Live Dr. Northrup. First off, can you explain the news that has been released claiming that HRT helps no one?

Northrup: This information and this study result was actually released to the press before it appeared in The New England Journal of Medicine.

Based on the Women's Health Initiative data, researchers found that after being on Prempro, a combination of Premarin and synthetic progestin known as Provera, women on the hormone did not have a significantly improved quality of life compared with those who received placebo. This information was interpreted to mean that HRT doesn't help anybody. So I would like to go on record with a more balanced and individualized approach.

First of all, the Women's Health Initiative study on Prempro chose healthy women who were not having any symptoms and put them on Prempro versus placebo in the belief that the use of Prempro would drastically reduce the risk of heart attack and stroke. This did not turn out to be the case. In fact, the study was stopped prematurely because of the increased risk of heart attack and breast cancer in those who were on Prempro.

The problem here is that hormone replacement is not, nor should it ever be seen as a fountain of youth solution to the lifestyle problems so often associated with aging. We can all keep our hearts healthy and our brains working well through the right diet, the right relationships, the right exercise, and the right supplementation. That said, there are thousands of women who feel better and do, in fact, have an improved quality of life when they take small amounts of individually prescribed bioidentical hormones for a few years, and sometimes for longer, depending upon the individual.

So if you are one of those women who have felt better on hormones than off hormones, then trust your own experience. Chances are good that if you're feeling better, you're going to do better in an overall health sense. The pendulum swung way too far in the direction of hormone replacement for everybody, and then last summer it swung all the way back with the news that one specific kind of synthetic hormone was not right for everybody. Now we're finally coming back to some sanity. And that sanity is individualized medicine, where everybody is treated as the unique individual that she is instead of having a one size fits all approach that is really unscientific and always has been.

Member: Hello, Dr. Northrup. Thanks for all your good work. I have followed your teachings for years. Twenty-five years ago, when I was 26, I took  birth control pills and they almost killed me -- really. Pulmonary emboli. My then doctor said I could never use HRT. I am having hot flashes now, at 51, and just cannot ingest Revival soy daily. What else might I do to get relief? Bioidentical hormones -- or are they also risky? Thank you for taking my question. Lead on!

Northrup: The first thing I would try in a situation like yours is 2% progesterone skin cream, one-quarter to one-half teaspoon on your skin every day. Studies have shown that this helps relieve hot flashes in 80% of the women who try it after a month or two. Another modality that helps some women is the herb vitex and/or black cohosh. If you log on to my web site,, you can find more in-depth information about these herbs.

But don't give up on Revival soy altogether. It's the one menopausal approach I really swear by and I use it every day. They now have meal replacement bars that are available in a wide variety of flavors, including the new one, apple cinnamon, and I find that people who don't like the powdered drink often do fine eating the bars. If you notice any digestive problem it's probably because your system is not used to the legume base, so just use Beano as a supplement until your body gets used to the increased bean proteins. You can log on to to learn more about Revival. It also decreases breast tenderness and PMS symptoms in many women who are not yet through menopause, or not even close.

And now for the big news about hot flashes: They really do respond beautifully to diet, but here's what you have to do. You have to eliminate all caffeine, even decaffeinated coffee. It personally took me approximately five years to come to grips with that in my own behavior, and no chocolate, no wine, and no sugar.

It's worthwhile to go on Ann Louise Gittleman's fat flush diet plan, which is spelled out in her book The Fat Flush Diet, because this diet is designed to cleanse the liver. All hormones have to be processed and metabolized by the liver. So when you support your liver through diet and the right condiments, like lemon juice, you will find that the hot flashes often decrease dramatically, or are eliminated entirely.

Once you've experienced this, then you can decide what piece of chocolate is worth the ensuing hot flashes, because they'll only be there a little while and then they'll go away when you get back on a stricter dietary plan. And after a year or two, depending on your metabolism, your hot flashes will simply go away permanently, no matter what you eat.

Member: Thank you so much. I will try the cream and herbs, then. Are they all OK taken together?

Northrup: Yes, absolutely. Just one more thing: If you have access to somebody who does acupuncture with traditional Chinese herbs, that often works wonders with all menopausal symptoms.

Moderator: FYI, Ann Louise Gittleman has been a guest on WebMD Live. Look for archived transcripts of her visits on our site for more information about The Fat Flush Plan and other helpful information for dealing with menopausal symptoms.

Member: What does cause those hot flashes? I know so many women that their major complaint is the hot flashes and it was the reason they went onto the HRT therapy, but since the new findings about the negative aspects of HRT, everyone I know has gone off it and "hot flashes" are driving us all crazy.

Northrup: Nobody knows for sure what causes hot flashes. It appears to be a change in neurotransmitters in the brain (the chemicals the brain makes when it syncs) and rapidly changing hormone levels, not the levels per se, but the change in the level, will trigger hot flashes. Stress of all kinds, whether emotional, physical, or nutritional, always makes hot flashes worse. Sometimes you can find yourself thinking stressful thoughts that result in hot flashes, and if you keep a journal, you can actually track the conditions that result in hot flashes.

I've created a wonderful, secure online journal for a variety of different life situations on my web site,, that you can easily use if you want to keep an online journal that nobody will be able to see except you.

Member: I can vouch for the coffee; it took me only one month to see the difference no coffee made to my breasts!

Member: Why no decaf coffee?

Northrup: Because decaf still contains not only a little caffeine, but also substances known as methylzanthines, and that combination can trigger a hot flash. I personally resisted this information for years, because I really love coffee and decaf coffee, but once you stop it (and that doesn't need to be a permanent thing) you'll have a chance to see the difference.

Member: I'm from Canada and can't find the progesterone cream. I do have a prescription for Prometrium. How can I mix up my own cream? Thank you.

Northrup: Progesterone is progesterone, and Prometrium is an oral capsule of progesterone that comes in 100 and 200 milligram sizes. I've had a few patients actually break open the capsule and put a little bit of the oil on their skin. Now the one-quarter teaspoon of progesterone cream contains 30 milligrams of progesterone. So if you were using the contents of a capsule as a skin cream, then you'd need to use about one-third of the contents of one capsule to get the same results.

The only concern here is that in Prometrium, the progesterone is suspended in peanut oil, and for some women this will absorb through the skin well, and for others it doesn't work as well, but you could certainly experiment. The good news is that some newer research has found that progesterone used on the skin does, in fact, protect the lining of the uterus from over stimulation, so it's a good balance for those who are on various forms of estrogen. Of course, you'll always want to check with your own doctor about this if you are on estrogen, and make sure that everything is monitored.

Member: There is a school of thought that soy can suppress thyroid function, and consuming it may be dangerous for thyroid disease patients. What are your thoughts on this?

Northrup: There's a great deal of controversy surrounding soy. Some studies show that soy does not adversely influence thyroid function, and some older studies suggest that it does. I have never seen a single documented case of soy being the proven substance that caused hypothyroidism.

The fact is that many women are first diagnosed with hypothyroidism during perimenopause, which is a time they're often drawn to begin using soy; therefore they feel that the soy is causing the hypothyroidism, but I don't believe this is the case. I personally developed fleeting hypothyroidism myself during perimenopause, and the emotional stress associated with that time frame, though I continued to use whole soy daily, my thyroid function tests went back to normal on their own.

The key is that one should not use soy supplements in pill form, because these contain purified chemicals derived from soy that do not contain the balancing substances associated with the whole soybean. So for instance, you can take purified chemicals from broccoli or carrots that have been found to have cancer-causing properties. That's not the way food was designed to be eaten. So when you're taking soy, make sure that you're using soy that contains the goodness of the entire soybean, and then there is almost no chance of problems.

Member: What do you think of Effexor being prescribed as an alternative for hot flashes? It seems they don't know a lot about these antidepressants yet, so isn't it sort of from the frying pan to the fire in a way?

Northrup: I couldn't agree with you more. We now have data showing that the antidepressant drugs, such as Effexor, actually increases the risk of osteopororsis by 30%, so just when women need a very holistic approach we are still finding ourselves in the position of looking for the next magic bullet. I feel the same about the bone-building drugs given to women, such as Fosamax.

The key here is that there are so many natural effective remedies for menopausal symptoms that there's no good reason to put yourself at risk by taking an SSRI drug. You do much better to make sure you're getting enough Omega 3 fats in your diet. These help mood immeasurably. Also exercise helps mood immeasurably.

Perimenopause is like a rebirth, but like your original birth you have to go through labor, and labor can be uncomfortable and be associated with symptoms. The symptoms do not necessarily need medication. On the other hand, women should never suffer in silence when there is so much that can be done to help that carries no risk.

Member: I'm taking both progesterone and bi-est for approximately 15 months. Many negative symptoms have disappeared and I'm feeling great, except my sex drive is close to ZERO and my doctor does not recommend I take any form of testosterone. Are there any other recommendations?

Northrup: The first thing I would wonder is why your doctor doesn't recommend a little dusting of testosterone. Some women at midlife can form plenty of testosterone from their ovaries and adrenal glands and some aren't able to. It's always helpful to have a free testosterone blood level drawn first thing in the morning, or have a salivary testosterone level tested, so you know if you need a little supplement. You can find out how to get the salivary hormone tests on my website,

If your testosterone levels are completely normal, then chances are very good that you're going through a time when you need to recharge your batteries on your own time and in your own way. Many women go through a period of time when they don't have any sex drive, and that is their body's natural way to recharge instead of being available for the sexual pleasure of others.

If a marriage is good and if the couple truly loves one another, they can get through this time. But one of the main tasks of the midlife transition is for a woman to come home to herself and to discover, perhaps for the first time in her life, what she wants, what she needs, what she likes to eat, what she likes to do. She's coming into her wisdom years, and she can't afford to leak her life force energy into any relationship, sexual or otherwise, in which she doesn't get back what she gives.

While this transition is going on, one's natural libido often goes deep inside, like the sap of the tree goes deep into the roots in the wintertime. It will come back, as long as she honors herself during this time with a lot of good nutrition, rest, and all the activities associated with true self-love that she has no doubt been brainwashed into thinking are selfish.

Member: Do you think that bioidentical progesterone taken orally can exacerbate depression in menopause and if so, do you think that a suppository will alleviate the symptoms?

Northrup: That is a great question. There is a subgroup of women in whom bioidentical progesterone will exacerbate depression. It is because their brain substrate, usually from some kind of childhood or adult trauma, is actually predisposed to depression, and the bioidentical progesterone will actually enhance that effect.

My experience is that the vaginal progesterone, or even the skin cream progesterone, may still have a depressant effect, and it may well be best to stay away from it altogether. While we're on the subject, synthetic progestin, in the form of Prempro or Provera, is far worse, in terms of causing symptoms, such as depression, irritability and so on.

Member: Dr. Norththrup, thank you for taking the time to help us. I have already gone through the breast swelling and that has stopped. I am on not on any kind of therapy for menopause. Do you think if I could go without any therapy and not have any difficulty. It would be better for me all around?

Northrup: The various natural approaches, such as herbs or supplements, generally don't do any harm, but my approach is always, if it ain't broke, don't fix it. There is no biologic reason why women need to suffer during perimenopause. Hundreds, perhaps thousands of women go through this transition without even noticing that anything is happening. One day, it occurs to them that they haven't had a period, and that's the end of it. It's very, very important for women to know that it's perfectly normal to not need a thing during menopause. The body just sails through.

Member: I had a hysterectomy at 35. I am now 42. My mother died of breast cancer and she has three sisters who have it. I am taking estrogen now but I worry if I should still take it and for how long. When I asked my doctor he just tells me it is my decision if I should say on or go off it. I am so confused! What do you think?

Northrup: I don't blame you for being confused. With that family history of all your mother's sisters having breast cancer and your mother having breast cancer, that creates a major fear factor. In your case, I would consider getting off the estrogen very, very slowly, but adding some natural progesterone as a skin cream, and perhaps some kind of whole soy supplement, such as Revival, and maybe even some traditional Chinese medicine with acupuncture and/or herbs.

We've never had a medical study that actually showed that it's dangerous to give estrogen to women who've had breast cancer, believe it or not. Still, we know that hormones, such as Prempro, are associated with an increased risk for breast cancer, albeit, very small. The most important thing for you, in my opinion, is to take the supplements that support your adrenal glands fully, wean off the estrogen when you can, very, very slowly, but most importantly, look at all the ways that self-sacrifice may have been modeled for you by your mother and your aunts.

Please read the breast section in The Wisdom of Menopause and Women's Body, Women's Wisdom, and also the breast material on my web site,, so that you can get an idea about how to build health in the fourth emotional center, which includes the heart and the breasts and the shoulders.

If you are shouldering more of the responsibility for any of your relationships, then the other people you are involved with know that that may be as much of a health risk as estrogen. This approach, though very difficult to do, is life-saving, because it will free you and your daughters, if you have them, from the martyr archetype. I remember reading Audre Lorde's book, Burst of Light; she had breast cancer that spread to her liver. Though this usually means you have only six months to live, Audre lived another eight years. When asked how she had done it, she wrote, "I have come to see the difference between overextending myself and stretching myself. There's a crucial difference. I have learned that caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare." Audre Lorde was the poet laureate of New York state, and for me, embodies the path to freedom through confronting our desire to be loved, even at our own expense.

Member: I still have a memory of your statement on a PBS special about the planet's need to experience the "rage" of a mass of menopausal boomers -- do you still support this notion (I DO!)?

Northrup: We don't need to experience the rage directly. The comment was about taking the rage and transforming it from anger to empowered action. If we see our anger as life force, as energy, then we can use it the way you use the fire to cook food. You can use a fire to burn down your house, or you can use it to warm you and to cook and to become comfortable. Our job is to take our righteous indignation, no matter how justified it seems, and transform it into uplifting, forgiving, beneficial action to change our own circumstances first and foremost, and then from a place of strength, to reach out and help others.

Moderator: Dr. Northrup, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Northrup: These were the most intelligent, fun to answer questions that I've received in a long time. Thanks to this audience today for making my afternoon so uplifting.

Moderator: Our thanks to Dr. Northrup for joining us. For more information, please read The Wisdom of Menopause by Christiane Northrup, MD.

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