Hormonal Imbalance; Menopause; 051015


I am 56 and have terrible hot flashes, especially at night. I have tried black cohosh, to no avail. What do you think of Prempro.


You have made one mistake, and you are about to make a second. Black cohosh is a selective estrogen receptor blocker, and it really does not do you very much good; the problem that you have is estrogen dominance. Black cohosh is very difficult to use, and that would not be what I would recommend.

In order to deal with the hot flashes, the first thing I would do in my practice would be to get blood work and find out what the progesterone level is. Hot flashes, more times than not, do not come from estrogen excess, but from progesterone depletion. It is a problem with the ratio of estrogen to progesterone. The ratio should be 80:1.

What you can do in the meantime is increase your Vitamin D3 level. Vitamin D3 is a selective estrogen receptor blocker. Doing this will help you with the hot flashes and other ways as well, but I would also be investigating progesterone replacement.

Prempro is a mixture of Premarin with progestin, which is the exact opposite of what your body needs, and it is about the worst way to approach your issue.

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.