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Menopause without Estrogen

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Transitioning into menopause can be challenging for many women.  The most common complaints arise from the drop in estrogen such as hot flashes and night sweats, vaginal dryness, sleep disturbances, foggy thinking, incontinence and bone loss.

While bioidentical hormones may help many women deal with the symptoms associated with menopause they are not for everyone.  It is possible to treat the symptoms of menopause without the use of Estrogen.   Listed below are the three most common symptoms and alternative treatments to talk to your doctor about.

Hot flashes and night sweats:

Hot flashes are vasomotor changes that may accompany the drop in estrogen levels as women go through menopause.  It is caused by a change in the way the body regulates its temperature it is thought that the drop in hormones signals to the body’s thermostat (the hypothalamus) that it is overheating.  The brain then responds by signaling to the cardiovascular system that it needs to help dispel the excessive heat by dilation of vessels just like would happen if you were truly overheated.  Your skin becomes flush and your body starts to sweat in an attempt to cool itself.  This can become incredibly uncomfortable for some women and the most effective way to manage these is through the use of estrogen.  Many women are either not comfortable with the use of estrogen or cannot use it for other reasons.  Bioidentical estrogen has been shown to be safe and cardio-protective at the right dosages.  If you are concerned about the safety of hormone replacement therapy please discuss this with your doctor or consult with Dr. Schulz about your individual risks and benefits.

Natural treatment ideas for hot flashes:

1. Avoiding triggers.  The most common triggers can be alcohol, caffeine, spicy food, sugar, hot rooms, hot weather, smoking, high stress and some medications.  For more ideas on avoidance see NAMS recommendations. 

2. Exercise.  Women who work out regularly report fewer hot flashes than more sedentary women.  This is also great for weight management which can be difficult around menopause.

3. Manage stress effectively.  Practices such as yoga, meditation, tai chi, deep breathing, and other stress-reducing techniques can help decrease frequency and severity of hot flashes and night sweats.

4. Diet.  Adding phytoestrogens to your diet can help by binding to estrogen receptors and decrease symptoms of low estrogen.  Examples of healthy phytoestrogens include tempeh, miso, natto, edamame, and tofu.

5. Other hormonal options:

Progesterone can help to minimize hot flashes in women.

DHEA a precursor to estrogen and testosterone can also benefit women experiencing hot flashes.

6. Supplements that may help include vitamin E, B vitamins, and magnesium. Also, Evening Primrose Oil and hesperidin have been shown to decrease hot flashes due to their anti-inflammatory effects.

7. Herbs: Black cohosh can be helpful for some but must continue use for at least 4-12 weeks to see a therapeutic benefit.


Vaginal Dryness

As women age hormonal changes affect the amount and consistency of the moisture that normally protects the vaginal walls. Dryness is a common problem for women as they lose their natural estrogen.  Symptoms include itching and stinging around the vaginal opening and in the lower third of the vagina.  It can also make intercourse uncomfortable.  The most effective treatment of vaginal dryness is topical estriol in the form of a suppository or cream.  However, if I woman wishes to try a more natural solution vitamin E topically is also an option.  Some of the same treatments for hot flashes are also effective for treating other symptoms of low estrogen such as Black Cohosh, Evening Prime Rose Oil, B vitamins and ground flaxseed.

Of course, adequate hydration is important as well.  Women might also want to consider using vaginal lubricants during intercourse to decrease discomfort and protect the tissue.  Kegels have been proven to help maintain tissue tone and prevent as well as treat incontinence.  Avoiding harsh soaps and douching is also a good idea as they can irritate sensitive vaginal tissue.


Dr. Schulz specializes in supporting women through the transition into menopause.  If you have any questions about BHRT and its safety please contact our office to schedule a time to meet with Dr. Schulz and discuss options for natural symptom relief.

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