You've asked a complex question plaguing a lot of women seeking a safe alternative to HRT. Unfortunately there is really nothing as effective as estrogen for decreasing hot flashes, night sweats, and vaginal dryness and every individual woman must evaluate the cost/benefit ratio of all treatments in consultation with her physician or PCP.

Having said that, there are some presciption meds that have been reported to provide some relief for women with menopausal symptoms:

1. Some SSRI's (selective serotonin reuptake inhibitors) commonly known as a class of antidepressants have been shown in some clinical studies (in low doses) to reduce hot flashes. Keep in mind that SSRI's (such as Effexor, Paxil, Zoloft, etc.) may have their own sexual side effects including decrease in libido, alterations in lubrication, and delayed orgasm -- so you may be substituting one group of concerns for another. If an SSRI is the appropriate choice for you, and it improves your hot flashes but not the dryness, you can look to a lubricant (water or oil-based) that will coat the vagina to make penetration more comfortable. Only Estrogen, however, will penetrate the vagina and improve the "ruggation" or elasticity -- other lubricants only "coat" the area. There are some forms of Estrogen (e.g. Vagifem) that are reported to have a lower systemic absorption, but again -- discuss with your physician.

2. Other medications such as Clonidine and methydopoa are also reported by some sources as being helpful with hot flashes -- again, these tend to dry the mouth (and the vaginal mucosa)!

3. Many of us are hesitant to suggest over the counter (OTC) herbal remedies because of the paucity of good clinical research and the lack of quality control from batch to batch in productes that are not FDA approved. These supplements are categorized as "food supplements" and there are many creams, lotions, and oral supplelments on the market. Many of them have varying amounts of l-arginine, menthol, black cohosh, and other ingredients that have had mixed reviews. Recognize when you're evaluating their effectiveness, that there is a placebo effect with ALL medications and that even though something advertized to be "natural" doesn't mean it is "safe" for you. Some herbal supplements can raise blood pressure or be irritating to the sensitive vaginal mucosa.

4. Other products that are often mentioned as alternatives to Estrogen replacement are soy, 400IU vitamin E, Dong Quai, and Black Cohosh. Again, there is individual to individual variation in the degree to which these are helpful. Some women are consuming a variety of soy products assuming it is hormone-free -- Past research had shown that women from countries that consumed large amounts of soy products had lower rates of breast cancer. There are now some reports that soy consumed in large amounts may be associated with the mutiplication of breast cells?? - so the jury is still out.

So find a reputable well-informed practitioner who will take the time to review and evaluate your specific family history and risk factors before making appropriate recommendations that are individualized for your needs. Remember that anything you can do to improve circulation in your peripheral vasculature will improve your arousal and your sexual enjoyment! Avoid any vasoconstrictors (smoking, antihistamines) -- exercise and keep your cholesterol at a healthy level and make time to have fun with your partner by expanding your romantic repertoire to include other pleasurable sexual forms of touching!

Dr. Sandy Scantling
Author of Extraordinary Sex Now.
Visit Dr. Sandy's Web site at: www.drsandy.com