Ask the Experts

By: Red Hot Mamas

Published: April 15, 2011


Our experts Dr. Mache Seibel, Karen Giblin and Dr. Michael Goodman field questions from our members. Submit your question.

Dear Red Hot Mamas Experts,

I am wondering since I have not had a period in 5 years, why am I now experiencing hot flashes, dryness and feeling irritable?

Thank you,


Dear L,

Good question! “Menopause” is the final menstrual period. More importantly, it is the cessation of ovulation, where you mature and ovulate an egg. An ovulating woman’s ovaries secrete estrogen in the form of estradiol (from the egg follicle) and estrone (from the ovarian tissue) and progesterone (only if the follicle ovulates) and, if you don’t get pregnant, you have your period ~ 2 weeks after you ovulate. Of course, you don’t ever know if any given menses is your last, so the “official” definition of menopause is no menses in a year.

So, it certainly sounds like you’re in menopause… Women’s reactions to the internal ups and downs of estrogen levels accompanying the peri-menopause and menopause vary according to many factors, including the degree of ups and downs in a given woman, her “sensitivity” to these changes, her mental state (anxiety and stress always make these symptoms significantly worse), her weight, and other factors. Women who are significantly overweight as a group seem to suffer less symptoms, as fat cells secrete estrogen-like substances, making symptoms milder (and risk of breast cancer slightly greater…)

Some women’s estrogen levels experience wild variations and/or plummet, producing more bothersome symptoms. Some women’s levels very gently diminish over time, so that it may be years after their final period that their individual estrogen levels reach a critical level (for them)… a “tipping point” if you will, where they become symptomatic. Also, the post-menopausal ovary (no more ovulation…) secretes a variable amount of the estrogen hormone “estrone.” The more estrone you have, the less your symptoms (and slightly greater increased risk of breast cancer, since estrone is stronger than estradiol, and stronger than most low-dose hormone replacement products.)

Sooo… You have been “…let down gently…” and now you’ve reached your own personal “tipping point.” Alternatives at this time include no therapy, herbs and botanicals, and low-dose transdermal (through the skin via patches, gels or creams) estradiol therapy. Low-dose transdermal is the safest way to take post-menopausal hormone replacement which, if started within ~ 5 years of menopause, can reduce your risk of cardiovascular death and cognitive decline by ~ 30%, and definitively protect your bones from osteoporosis.

Ask your gynecological menopause specialist (one can be found on the North American Menopause Society website, what path is best for you.

Good Health to You!

Red Hot Mamas Experts