Brief Answer: Mentioned a few more compounds Detailed Answer: hello and welcome, I understand that you had menopausal symptoms and used soy and koesh and were benefited. Now the symptoms have recurred. I understand the need to avoid HRT considering that you are on many medications and also have a mitral valve issue. Since you are looking for natural alternatives the commonest ones and those found beneficial are compounds containing isoflavones and lignanes. These include soy, flax seeds, red clover, whole cereals, whey proteins, legumes and green leafy vegetables. You can also use menopro powder 2 spoonfuls with milk twice daily. Other measure are regular light exercise like yoga or walking, use of evening primrose oil. Calcium supplementation is important to prevent osteoporosis. If the symptoms are severe then you may need SSRI's or SNRI group of drugs that modulate the estrogen receptors and prevent hot flashes. They need prescription and you may discuss their use and side effects with your doctor before using as they ultimately modulate the hormones. Most cause severe nausea and decrease libido. Having said all this, duration of perimenopause may be variable in different women. Some may experience the symptoms for a few days and then become menopausal while others may experience them for years. Hence maintain a healthy lifestyle, light but regular exercise, a proper diet and taking calcium and vitamin D are the most useful measures in the long term. Hope this helped you in the question. Thanks for using HCM and please go ahead and ask any queries that you may have. I am here to help. Dr Nilajkumar Bagde Consultant Obstetrics and Gynecology

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Brief Answer: Hormones are not recommended or you Detailed Answer: Hello and welcome back, Your medications suggest that you have cardiac issues and also high blood pressure. So hormone replacement is not a choice in your case as it is not to be prescribed in people with high blood pressure or heart issues. So just try the natural remedies. You are already on Welbutrin. You may ask your health care provider if it is possible to substitute it with another group of drugs called SSRI's as they are helpful in controlling the vasomotor symptoms of menopause like hot flashes as well as control depression and anxiety. This will help and alleviate the need for hormones. Other drugs are vitamins like vitamin E, C that are good antioxidants and help to detoxify the body. The B complex group of vitamins can also be taken intermittently every alternate day to help maintain well being. A healthy balanced diet mostly provides for everything. Life style changes go a long way in combating menopausal syndromes as many psychological changes are also going on that need management. Weight bearing exercises are also needed. But many women tend to do weight bearing exercise for an intensive phase and then give them up. This does not help. They must be done on a daily basis. Hence we recommend moderate exercises daily. Most likely you will experience this for 1-2 years. Do not take excess estrogen compounds. Just make them a part of your diet and that is enough. Once the hormonal fluctuations of menopause settle these symptoms will settle. Hope this provided an answer. I am always at hand for further queries. Dr Nilajkumar

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Brief Answer: Hormones not indicated... Detailed Answer: Hello and welcome back, It is good that you do not have a high blood pressure. However you have mitral valve problems and so HRT is not recommended. HRT leads to blood coagulation disorders. It leads to excess blood clots inside the body that may go in any organ [especially the lungs] and become life threatening. People with heart problems are more prone to this as abnormalities in heart rhythm and valve defect may produce areas of low blood flow that favor clot formation. So HRT is not recommended. This is not uncommon even in women not havong heart issues. So you will realize how many fold the risk is increased if there is any cardiac problem. Please remember that HRT is not the only way out. Also HRT is advocated only for short term for control of hot flashes etc. Long term HRT use is associated with blood clotting, decline in memory function, increased risk of breast and endometrial cancer and many other adverse effects. You have already surpassed the 3 years when HRT would have been used. So in any case, most likely it would have to be stopped now even if you had taken it. I understand that you are facing problems due to menopause and naturally are looking for a solution. Unfortunately as of now, the only possible measure for you is lifestyle and diet modification. I have explained some of the commonly used life style / diet changes. Those have worked wonderfully with my patients. I would suggest you to try those. However if you still want to try HRT, first discuss with your cardiologist about the associated risk and amount of compromise in the heart before starting it. Remember there are many women that do not take HRT and do well with other measures and a healthy diet alone. I hope this explains the matter. I am here for any further queries. Thanks and take care. Dr Nilajkumar Bagde

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