Sign up for our monthly newsletter and stay up to date on all things menstrual and ovarian health. Newsletter

Ask an Expert: Lucy McBride, MD

  • January 28, 2023
  • Doctor Lawrence

Q: What are some solutions to stiff joints and hot flashes – ailments associated with POI or menopause – for women whose clinicians advise them to avoid P-HRT due to health issues? 

A: Women with POI, as well as women transitioning into menopause or already there, can experience a range of varying symptoms, including hot flashes, night sweats, joint pains, muscle stiffness, vaginal dryness, urinary tract infections and frequency, low libido, pain with sex, fatigue, forgetfulness, moodiness, irritability, heart palpitations, dry skin — among others. 

Some women will experience these symptoms; others won’t. The most effective way to treat symptoms caused by declining or absent hormones is by taking hormones themselves. As is true for any medical intervention, however, P-HRT carries risk, yet the risks depend on the individual. Because some of the symptoms are subjective (i.e., quantifying stiff joints, hot flashes, or irritability is more difficult than measuring cholesterol), a decision about hormones should include quality of life issues in addition to measurable data. In short, there are risks of taking hormones, but there are risks of not taking hormones, too. (Click here for the most recent expert guidelines. And be sure to talk with your doctor.)

Here are some non-hormonal tips to treat the symptoms you described:

  • For stiff joints. The combination of strength training and stretching is critical. Our joints have to work harder when the surrounding muscles are weak or tight. Particularly as we age and change hormonally, women should include muscle tone and elasticity in their exercise routines.
  • For hot flashes. Behavioral changes such as limiting alcohol, caffeine, and spicy foods; wearing light clothing; and turning on fans can help. So can managing stress. You can also consider natural supplements (like black cohosh and vitamin E) or prescription medications (like Gabapentin or an SSRI medication like Effexor) which can provide some relief. These treatment recommendations are nuanced and depend on the patient. It’s always best to talk with your primary care provider about your specific needs and tolerance for symptoms vs. side effects from different therapies. 

Dr. Lucy McBride, a Washington, D.C.-based primary care doctor who’s been seeing patients for 20+ years, received her undergraduate degree from Princeton University, her medical degree from Harvard University, and completed her residency at John Hopkins University in Baltimore. Her straight-talking newsletter, Are You Okay? – and sequential podcast, Beyond the Prescription — which she began during COVID, has 20,000+ subscribers. Dr. McBride’s piece about hormone replacement therapy is here, and her conversation with menopause expert Dr. Sharon Malone is here. For more information, see her Substack or visit

Menstrual and Ovarian Health

Follow the Evidence

POI Fast Facts

POI is a hormonal deficiency. It is not menopause.

Read More

Know Your Numbers

Understanding estradiol deficiency begins with understanding ovarian hormones.

Read More

The Evidence

Research can help you make evidence-based decisions.

Read More

Think Again

Educate and advocate. Your doctor may not be an expert.

Read More