Eileen answers your questions on hot flushes, joint pain & panic attacks in the peri-menopause, and coming off HRT

Eileen Durward
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30 November 2015

Read the full video transcript below

Today's topic

Hello, and welcome to my weekly video blog. And today on A.Vogel Talks Menopause, I’m going to be answering some of the questions that you’ve sent in this week, so here goes.

Question 1: Hot flushes and panic attacks in the peri-menopause

Now the first one is from Michelle, who’s 48, and she’s saying:

“I still have periods but have hot flushes and panic attacks. Is this part of the peri-menopause?”

Yes! Now, it’s quite interesting because a lot of women don’t actually realise that their hormones can start to subtly change a good number of years before they actually hit the menopause, so you can actually be getting regular periods and also start to suffer some of the menopause symptoms.

Now hot flushes, which is probably the most common menopause symptom, can very often be sorted out quickly by the herb Sage. You can get this in a liquid form, and you can also get it in a tablet form, so it’s certainly worth trying, to ease the hot flushes. And with the hot flushes, remember that dehydration can make flushes worse, so do remember to drink plenty of water with that one.

We’re also talking about panic attacks. This is very, very common as well. When you start in the peri-menopause, your oestrogen levels can actually start to fall or fluctuate quite dramatically, and that can have quite a stressing effect on your nervous system. It can make your nervous system much more jumpy, and much more reactive, and what happens then, is that things that maybe you wouldn’t have bothered about a couple of years ago can start to upset you, you can start to get far more panicky, or weepy or upset about things, you know, even things that people say to you, or you can start to panic about what you’ve got to do later on today or things that might be happening in a few days time.

So with the panic attacks, it’s very important to do several things. Dehydration will make them worse, so if you’re getting a combination of hot flushes and panic attacks, it’s a very good indication that you’re low in water; but you may also be low in the mineral magnesium, and magnesium is very calming: it’s your happy mineral; it helps to keep your mood level; it helps to keep you calm; and it helps to keep you relaxed, so you could look at taking some kind of magnesium supplement, maybe 200 mg twice a day with food.

Question 2: Joint pain in the peri-menopause

Now, question number two. This is from Debbie, who’s 51, and she says:

“I’m in the peri-menopause and experiencing a few symptoms. One in particular is joint pain, and why does it get much worse just before a period?”

Well as I explained before, when you’re in the peri-menopause, your hormone levels can go up and down quite dramatically, and one of your main hormones, oestrogen, falls in the week just before a period, and if this fall is exaggerated by what’s going on in the peri-menopause, that can actually affect your joints, and the way it affects your joints is through dehydration, so again, water is very, very important.

You could also look at herbs, such as Devil’s Claw. If you’re getting the joint pain throughout the whole month and it’s getting slightly worse just before your period then you could try the herb Devil’s Claw.

You can also try supplements that are called phyto-oestrogens. Now these are natural plant-oestrogens that help to very gently help to raise and balance oestrogen, and that can help with these sudden dips, so you may find that a combination of these two taken on a daily basis will help to ease this joint pain, and remember the water!

Question 3: Coming off HRT

And question number three. This is from Cindy, who’s 59, and she says:

“Hi Eileen! I have been on HRT for the past twelve years and now want to switch to something natural. Can I do it immediately, or be weaned off slowly from HRT? Will there be any adverse reactions?”

Now this is a question that we get very, very regularly. Women have either come off HRT, or they want to come off HRT, and they’re wondering how, the best way to do it. Now, just to make something really, really clear, HRT does not stop your menopause, all it does is postpone it.

Now, HRT is giving you a nice high level of hormones that will stop all those menopause symptoms, but your own natural hormone levels will still be falling underneath this, and if you come off HRT quickly, you’re going from a very high hormone level to your own natural levels which will be very low, so you can have a huge tumble of hormones in a very short space of time, and this fall, like a natural menopause, will give you a whole range of symptoms. You can end up with the hot flushes, the joint pains, the anxiety, the palpitations and the sleepless nights.

So if you want to come off HRT, the really important thing is, first of all, discuss it with your doctor, make sure that you’re coming off for the right reasons. Secondly, you really need to do it as slowly as possible – the slower you can do it, the more it’s going to mimic a natural menopause, and therefore your symptoms are going to be less, so we would say, take at least six months to a year to come off, if you possibly can. Do it very, very gradually, and in the meantime, this hormonal change, like the proper menopause, can stress your nervous system quite dramatically, so it’s important to strengthen your nervous system.

So we would be looking at a really good magnesium supplement, maybe 200 mg once or twice a day, a comprehensive vitamin B complex, maybe 50 mg once or twice a day. I would also add in a zinc supplement as well to actually help. Make sure that you are supporting your nervous system by getting plenty of rest and relaxation. Drink plenty of water, again, and really take it as slowly as you can, and hopefully that will help.

Until next week...

Now, I hope you’ve found these questions and answers really helpful, and if you have a particular question, then please let me know. Next time I’m going to be talking about those intimate problems that you might not really want to discuss with anybody, and I do hope you can join me again next week for another edition of A.Vogel Talks Menopause.


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  • Tine Bartels 's photo avatar
    Tine Bartels — 19.04.2021 11:54
    Migraine help please: Dear Eileen, I find all your advice very helpful and reassuring - Thanks so much!! With a sage, magnesium, lady's mantle and hops supplement and evening primrose I manage my milder perimenopause symptoms (mainly frequent sweats and rare hot flushes) quite well, however I also suffer from horrible hormonal migraines now and when they're bad, I can't manage them with Paracetamol....Due to a blood clotting gene, Neurofen doesn't agree with me (and neither do most other meds....). Is there anything herbal/natural you could recommend please? (Nothing soya based, as there is family history of breast cancer, which on top of my Leiden VF clotting disorder forbids HRT as well!) Thanks a million, Tine


    • eileen's photo avatar
      eileen — 20.04.2021 14:29
      Hi Tine Menopausal migraines can be triggered by low magnesium so you may find a magnesium supplement, approx 200mg twice a day (I'd go with either magnesium taurate or magnesium glycinate) and see if this helps. Dehydration and low blood sugar levels are also common factors so remember to drink loads of plain water every day and eat little and often. Try to avoid caffeine and high salt and sugar foods as these can be an issue for some people as well. Great to hear that you find the advice helpful, thank you!


  • Anni's photo avatar
    Anni — 01.10.2017 19:01
    Hi. I've just turned 50 this year and believe I am going through the peri menopausal symptoms. These are more severe headaches, ankle joint pains, neck,back and shoulder aches, trouble sleeping, (having normally been a deep sleeper) claminess at night,more sweaty at times in the day, but not having a 'hot flush' as such,irritability and low sex drive, low moods bordering on depression, low self confidence. I have seen my gp about my frequent migraines and she wanted me to try amtriptyline..however I'm very reluctant as this can cause extreme tiredness/dizziness and would rather not take an antidepressant or any drug. Also as i work split shifts, earlys and lates I don't feel this will benefit my overall health. I dont like taking medication and would prefer a more natural alternative. I'm vegetarian and believe I have a healthy/varied diet eating pulses, nuts,seeds and plenty of veg,avocados etc and not eating any processed foods.I am pretty active. Walking daily with my dogs and my job requires reasonable amount of physical activity. I would really appreciate any advice as feeling at a loss if what i can do to feel better about myself. I will be rrturning to my gp as sge mentioned that when i had bloods taken regarding my headaches that my thyroid waa a little underactive but 'nothing to concerning' indicating thats normal for my age?


    • eileen's photo avatar
      eileen — 04.10.2017 09:48
      Hi Anni Just to let you know I have answered you privately.


  • Azz's photo avatar
    Azz — 05.09.2017 17:14
    Can you take the Menopause support when you are in the peri-menopause stage?


    • Eileen's photo avatar
      Eileen — 06.09.2017 14:28
      Hello Azz, What age are you and do you still have periods? Thank you


    • Azz's photo avatar
      Azz — 06.09.2017 15:38
      I'm 49 and yes but with 30 to 40 day gaps between them.


    • Eileen's photo avatar
      Eileen — 07.09.2017 14:29
      Hello The Menopause support tablets are helpful before, during and after the menopause. I often recommend them if periods become irregular, erratic or cease, so this would be fine.


A.Vogel Menopause Support tablets with Soy Isoflavones, Magnesium and Hibiscus for all stages of menopause, 60 tablets

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Menopause Support can be used to help you through all stages of the menopause.
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