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Many women look forward to menopause by the time they get there. It is often a relief to no longer have periods or worry about pregnancy. But for some, the transition is not as graceful as they would like. While no two women going through menopause are exactly alike, some common symptoms may be improved without requiring hormone replacement (HRT).

Hot flashes can range from mild warmth to drenching sweats, and some — lucky — women never develop them at all. While HRT can be used for severe hot flashes, there are some non-hormonal ways to treat them. For one thing, avoid or minimize alcohol and caffeine, which are notorious for triggering hot flashes. Other factors that increase the likelihood of developing hot flashes are sedentary lifestyle, being overweight and smoking.

Popular herbal remedies marketed for hot flashes (black cohosh, evening primrose oil) have not been shown to be more beneficial than placebo in most studies. In addition, black cohosh and soy products have potential estrogenic effects on the breast and thus are not advised for women who have had or are at higher risk of breast cancer. However, prescription antidepressants (like venlafaxine) and a medication used for nerve pain (gabapentin) interestingly have been proven to be effective for hot flashes. Mostly well-tolerated, these drugs are a good alternative to HRT.

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Insomnia is a common complaint even during perimenopause. Hormonal changes and hot flashes are culprits, but other causes that are often overlooked are anxiety, alcohol, caffeine, stress related to teenage or young adult children, and even a snoring bed partner. At any age, learning how to wind down before bed is valuable. So avoid screen time for an hour before bed and engage in a relaxing ritual during this time. Take a bath, meditate and write down your worries in a journal if you find yourself repeatedly thinking about them. Wear loose clothing to bed, choose sheets with lower thread counts, and use a fan to help control nighttime hot flashes. See your doctor for further help with management or to rule out other causes of sleep disruptions if insomnia persists.

Many postmenopausal women report gaining weight and a redistribution of weight from hips and thighs to the midsection. Decreased muscle mass and emotional eating during this period are possible causes. That being said, weight gain is not necessarily inevitable during menopause. Studies have shown that even compared to women who took HRT, the women who exercised regularly and watched their diet were more likely to maintain or even lose weight and keep it off. This is not to imply it is easy. Even women who exercised regularly previously will likely have to have to increase their level of exercise or decrease overall calories to see this effect.

No one said entering menopause would be easy. But the good news is that common sense holds true. Against your favor are things like being sedentary, overweight, smoking, drinking alcohol and sometimes caffeine. Maintain what is helpful (healthful diet, exercise and good sleep habits) and you’ll be off to a better start.

Linda Pourmassina, M.D., is an internal-medicine physician who practices at The Polyclinic in Seattle. She has a blog at and can also be found on Facebook and on Twitter (@LindaP_MD).

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