Mackie answers your questions on hot flashes, joint pain and panic attacks in perimenopause, and coming off HRT

The first question is from Danielle, who’s 48:

“I still have periods but have hot flashes and panic attacks. Is this part of perimenopause?”

Yes! It’s quite interesting because a lot of women don’t realize that their hormones start to subtly change several years before they hit menopause, so you can be getting regular periods and also start to suffer from menopause symptoms.

Hot flashes, perhaps the most common menopause symptom, can very often be relieved quickly with sage. It comes in tablet form and is worth trying as a way to ease hot flashes. And remember that dehydration can make flashes worse, so drink plenty of water!

Then there are panic attacks, a very common problem as well. When perimenopause begins, your estrogen levels can start to fall or fluctuate quite dramatically, which can have a stressing effect on your nervous system, making it much jumpier and much more reactive—things that wouldn’t have bothered you a couple of years ago can start to really upset you. You might get far more panicky or weepy or upset about things, including things people say to you. Or you might start to panic about what you’ve got to do later on in the day or in a few days’ time.

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 flashes and panic attacks, it’s a very good indication that you’re dehydrated—drink lots of water! But you may also be running low on magnesium, a mineral that has a very calming effect. It’s your happy mineral, so it helps keep your spirits up, while keeping you calm and relaxed. Consider taking some kind of magnesium supplement, around 200 mg twice a day with food.

This one is from Jessica, who’s 51, and she says:

“I’m in perimenopause and experiencing a few symptoms. One in particular is joint pain, which gets much worse just before my period. Why is that?”

As I explained above, when you’re in perimenopause, your hormone levels can fluctuate dramatically, and one of your main hormones, estrogen, falls in the week just before your period. If this drop is exaggerated by what’s going on in perimenopause, it can affect your joints, specifically through dehydration. So I’ll say it again, water is very important.

You can also consider herbs, such as Devil’s Claw. If your joint pain lasts all month and gets slightly worse just before your period, then you might try Devil’s Claw.

You also might want to try supplements called phytoestrogens. These are natural plant estrogens that help to very gently raise and balance estrogen levels, which can help with these sudden dips. You may find that a combination of these two remedies, taken daily, will help ease your joint pain. And remember the water!

This one’s from Denise, who’s 59:

“Hi! I’ve been on HRT for the past 12 years and want to switch to something natural. Can I do it immediately, or do I have to wean myself off it? Will there be any adverse reactions?”

This is a question we get very regularly. Women have either come off HRT, or they want to come off it, and they’re wondering how best to do it. Just to be clear: HRT doesn’t stop menopause, it just postpones it.

HRT gives you a high level of hormones that will stop all those menopause symptoms, but your own natural hormone levels will still be declining in the background, and if you come off HRT suddenly, you’ll go from a very high, HRT-induced hormone level to your own, very low natural levels. This huge drop in hormone levels in a very short time, like natural menopause, will give you a whole range of symptoms and you’ll end up with hot flashes, joint pains, anxiety, palpitations and sleepless nights.

If you want to come off HRT, start by discussing it with your doctor to make sure you’re coming off it for the right reasons. Once you decide to go ahead with it, do it as slowly as possible. The slower you do it, the more it’s going to mimic natural menopause and your symptoms will be milder. Come off HRT very gradually, taking at six months to a year to do it. This hormonal change, like proper menopause, can stress your nervous system quite dramatically, so it’s important to strengthen your nervous system.

A good way to do that is with a really good magnesium supplement, maybe 200 mg once or twice a day, and a comprehensive vitamin B complex, maybe 50 mg once or twice a day. I would also include a zinc supplement. Make sure you’re supporting your nervous system by getting plenty of rest and relaxation. Drink plenty of water and really take it as slowly as you can.