What are alternatives to estrogen for menopausal insomnia?

If you have insomnia, the alternatives to estrogen are soy, the herbal extracts red clover and black cohosh, or small doses of drugs called "selective serotonin-reuptake inhibitors" ("SSRI's"), such as Celexa (citalopram), Paxil (paroxitine), Prozac (fluoxetine) and Zoloft (sertraline). Soy, red clover, and black cohosh all contain estrogen-like substances that affect some estrogen receptors. However, test-tube experiments report a wide variation from batch to batch in the ways and extent these substances affect estrogen receptors.

The variation is to be expected, as, for example, the average soy preparation tested in one study consisted of one hundred twenty-four different isoflavones, substances in soy that affect estrogen receptors. (I am careful to state "affect" as some isoflavones "turn on" specific receptors and some block the very same receptor from being "turned on"). The randomized controlled studies that have tested soy in women with menopausal symptoms have shown no consistent effect of soy on night sweats and insomnia.

Similarly, when the placebo effect was taken into account, the studies on red clover and its isoflavones also show no effect on hot flashes or night sweats. It is interesting to note that the placebo produced a benefit of approximately 35 percent in the studies with both soy and red clover. Similarly, black cohosh produces approximately the same data.

Thus, any one of these supplements may work (each works in about 35 percent of all tested women), but I can't say definitively what will work for you. For the patient who doesn't get relief from any of these supplements and is really suffering from hot flashes and night sweats, I recommend trying the selective serotonin-reuptake inhibitors or returning to estrogen replacement therapy. (She should work with her physician to make a rational choice for her.).

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