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

Eileen Durward

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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  • Anne charrett's photo avatar
    Anne charrett — 19.02.2018 18:52
    I've being going through menopause For 6 years and had hot flushes on and off but the last 6 months my symptoms seem to be awful hot flushes,anxiety,palpatations and my brain is foggy.Is it normal to have had more severe symptoms later in the menopause??


  • Anita's photo avatar
    Anita — 05.02.2018 16:09
    Hi Eileen, I'm 50 and still have regular periods. However, for the last 7 months I've been having brown mucus discharge exactly when I'm ovulating and it lasts for 2 -4 days and then it's gone. I also tend to get quite bad ovulation pain down the right side. I've been to GP and am having various tests done but have read that this discharge can be a normal symptom of perimenopause ? It doesn't happen during any other time of the month, just bang on ovulation time.


    • eileen's photo avatar
      eileen — 06.02.2018 15:57
      Hi Anita Yes, this may happen. As your hormones start to get a bit more erratic this can affect the level of friendly bacteria in the vagina at certain times of the month which in turn may lead to a discharge. You may find a vaginal probiotic can help - a company called Optibac do one. It may also be due to a sudden spike in oestrogen at ovulation causing a surge of mucus. Ovulation pain can sometimes be eased with a magnesium supplement, I would suggest approx. 200mg of magnesium citrate once a day with food.


  • Nyree 's photo avatar
    Nyree — 30.01.2018 05:47
    Hi, I am 42 and about a year ago suffered from hot flushes during the day but mostly at night! I throw the covers on and off all night and constantly go to the bathroom. My Doc said I was too young for perimenapause but couldn’t find any other explanation. After a month or two the symptoms went however they have now come back in the last month and it’s starting to get me down. Alcohol and stress can bring them on and make them worse. I have a mirena coil fitted so I don’t know if I’m missing periods as I don’t have any. I also get aniexty and dryness. Do you think it could be perimenapause?


    • eileen's photo avatar
      eileen — 30.01.2018 15:30
      Hi Nyree The age you start the menopause can be hereditary, so maybe ask other close female relatives when they started and you may get a clue! The problem with having the Mirena coil (which gives you progesterone) is that it can unbalance your own natural hormone levels. If you have started the menopause your level of oestrogen maybe beginning to fall but your progesterone level will be kept artificially high with the coil so the 'gap' between the two hormones can get wider and wider. This can then give you low oestrogen symptoms that you experience with a natural menopause such as flushes, joint pains, low mood etc. So you may be experiencing menopausal developments or just the side effects of the Mirena coil! Unfortunately, I can't recommend any of the hormonal remedies whilst you have the coil but you may find sage helpful for the flushes/sweats, I would suggest one tablet with your evening meal. Anxiety can be a big issue and also makes your symptoms worse so you may find adding in Passiflora Complex or AvenaCalm helpful. Remember to drink lots of plain water every day as sweats can dehydrate you quickly and this can make all symptoms worse!


    • Nyree 's photo avatar
      Nyree — 30.01.2018 19:42
      Thank you for your advice, that’s great. I will try the sage tablets. A nurse told me that it can be a good idea to keep the Mirena coil in even through Perimenopause or menapause as it can help with the symptoms due to the added progesterone I presume but from what you say would you suggest otherwise? Many thanks


    • Nyree Ellis's photo avatar
      Nyree Ellis — 31.01.2018 08:54
      Would it be better to try the combined pill maybe?


    • eileen's photo avatar
      eileen — 01.02.2018 11:09
      Hi Nyree This is one of those situations where the coil can help some women through the menopause with out any problems but for others it can make symptoms worse the further through the menopause they go. Unfortunately, it is impossible to tell which way it could go so I would suggest staying with it, but if you start to get severe symptoms then you may need to re-evaluate. Again with the Pill it may go either way too.


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