Reader suffers from severe, long-lasting menopause

Q: I am 57 years old and going through menopause. I have suffered for 10 years with hot flashes. I took Prempro for two years, which successfully alleviated 95 percent of the hot flashes. I currently take Levoxyl daily to suppress two goiters on my thyroid gland. My thyroid tests are always normal, but my doctor says that I need to take the medication for the rest of my life to avoid future problems caused by the goiters.

I stopped taking the hormone-replacement therapy in January 2006, as I had been taking it for two years. My gynecologist said it was up to me but advised that the medication was not good for extended use. I do not have any history of breast cancer in my family.

Since then I have tried, unsuccessfully, soy and black cohosh. I am tired of having hot flashes 24/7. Could they be caused by the thyroid medication, even though my levels are normal? I don't want to go back on hormones, but my quality of life just is not there.

A: You are apparently suffering from a severe and long-lasting menopause that I believe bears no relation to your thyroid problem or its treatment. Unless your levels are abnormal, I wouldn't worry about the thyroid hormone. Excessive thyroid hormone does not cause hot flashes; rather, it usually leads to hair loss, weight loss, nervousness, excessive perspiration and more. Too little can cause difficulty losing weight or weight gain, dry skin and hair, depression, feeling cold and more. If you want more information, go to the Web site www.thyroid.org.

Now, to your hot flashes: If you don't want to start hormone-replacement therapy again, you have several options.

Some women have seen improvement by making a few behavioral modifications. This includes wearing layered cotton clothing, sipping cool drinks, using ice packs and avoiding certain foods and beverages (notably coffee, alcohol and spicy foods). Stress is also a major contributing factor. A simple breathing exercise done two or more times daily can reduce hot flashes by 40 percent or more. The key is to relax and breathe deeply through the abdomen (six to eight breaths per minute).

Conclusions about soy have been deemed inconclusive and contradictory. Some studies claim little or no benefit, while others claim stunning success. One of the positive-results studies claims that women who consumed 60 grams of soy protein per day had a nearly 50 percent reduction of symptoms. The following items contain 35 to 50 grams of soy protein: 1/2 cup edamame (green soy beans), 1 cup soy milk, one-half tempeh (a grainy-textured "cake" made of fermented soybeans), 1/2 cup tofu and three handfuls (about 1 cup) of roasted soy nuts.

One study found that an isoflavone (plant estrogen) derived from red clover reduced the intensity and number of hot flashes. A later article discredited these findings, claiming that it was no more effective than a placebo.

Black cohosh is possibly the most common alternative treatment for hot flashes. Again, there is some controversy, with some studies claiming success and others, failure. Of note is that studies showed a decrease in excessive sweating in postmenopausal women. Black cohosh does rarely cause side effects of vomiting, nausea and stomach upset. It also lowers blood pressure, so those on antihypertensive medications or with naturally low blood pressure should not use it. Continuous use for up to six months is recommended.

Some women swear by vitamin E. However, placebo-controlled, randomized studies showed that it only minimally improved menopausal symptoms over a placebo. If you wish to try this therapy, however, the dose is 800 international units daily.

Acupuncture hasn't been researched significantly, but many women claim it helps. One Swedish study found that women who had acupuncture experienced relief that lasted several months.

Another option is exercise. Exercise is good for nearly every ailment. One study showed that 55 percent of postmenopausal women saw a reduction in the severity of their hot flashes simply by doing aerobic exercises (fast-paced, oxygen-related exercises such as running). Weight-bearing exercises can also improve bone density in menopausal and postmenopausal women.

A final option, and perhaps the tastiest, is ginger. Many women use this method because it is safe, easy, inexpensive and delicious. Most supermarkets carry crystallized ginger. Simply eat a few pieces a day. If you don't like the flavor, however, most health-food stores and pharmacies carry ginger capsules that have the same effect. It is also effective in preventing motion sickness for some people.

To give you related information, I am sending you a copy of my Health Report "Menopause." Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.