MENOPAUSE: Relief of Hot Flashes, Irritability and Anxiety Is Key To Improved Sleep

100+ year old medical treatment is safe and can restore balance menopausal women as well as those suffering from chronic stress. The Stellate Ganglion Block has been termed “The God Block” because of its amazing effects on many Veterans with PTSD. The Sphenopalatine Ganglion Block has been termed “The Miracle Block” because of the incredible effects it has on a wide variety of chronic pain. The book “Miracles on Park Avenue” was based on the work of Dr Milton Reder and the phenomenal relief his patients received from Sphenopalatine Ganglion Blocks (SPG Blocks).

MENOPAUSE_ Relief of Hot Flashes, Irritability and Anxiety Is Key To Improved Sleep

Hot Flashes and other menopausal symptoms are largely the result of the Autonomic System changes during menopause. The autonomic nervous system has two systems that need to be in balance. The Sympathetic Nervous System controls our “Fight or Flight Reflex”. It prepares us acutely for immediate action in the event of threat to life or safety. The Sympathetic System is also in control of our stress hormones and in chronic stress can lead to a system that is out of balance. This lack of balance is seen in stress related disorders and includes anxiety, feelings of anxiousness and lack of ease. We call these conditions of “Sympathetic Overload”!

Treatment of the Sympathetic Overload often restores normal patterns of sleep and helps optimize circadian rhythms in patients in addition to treatment of specific complaints.

The Parasympathetic Nervous System balances the Sympathetic System and is responsible for the “Feed and Breed” reflex or “Rest and Digest” Reflex. The Parasympathetic System is responsible for feelings of love, satisfaction and the bonding that occurs between mothers and their children. This system can often be turned on by exposure to puppies, kittens and especially babies. Feelings of Stress and Anxiety are quickly pushed aside as the Sympathetic Nervous System decreases output and the Parasympathetic System begins to predominate.

Hot Flashes are extremely destructive to a women’s  quality of life and there are many approaches to treating them. This article will focus on resetting the balance between the Sympathetic and Parasympathetic divisions of the Autonomic Nervous System. The Stellate Ganglion Block produced headlines like “A Single Shot Eases Menopause Hot Flashes!”.  This is not new material, in fact there are 30 citations on PubMed on the efficacy of treating Hot Flashes with Stellate Ganglion Blocks!  These studies are listed at the bottom of this article.

The use of Sphenopalatine Ganglion Blocks to treat hot flashes of menopause has only andetotal evidence but this procedure is extremely safe compared to Stellate Ganglion Blocks and also has excellent evidence for treating a wide variety of chronic stress related disorders including Migraine, Cluster Headaches (treastment of choice), Sinus Headaches, TMJ Disorders, Trigeminal Neuralgia, and many other disorders.  SPG Blocks are also utilized for treating stess disorders and PTSD.

The anatomy of the Autonomic Nervous System is important to understand.  There are four Parasympathetic Ganglia of the head the largest being the Sphenopalatine Ganglion or Pterygopalatine Ganglion for its position inthe Pterygopalatine Fossa.   The other Parasympathetic Ganglia are the ciliary ganglion, the otic ganglion , pterygopalatine and the submandibular ganglion.

The Sympathetic Cervical Chain consists of several Sympathetic Ganglia in the neck.  The Stellate Ganglion is at the botton of the Sympathetic Chain but sympathetic fibers run from the Stellate Ganglion up the sympathetic cervical chain and into and through the Superior Cervical Sympathetic Ganglion and into the Sphenopalatine Ganglion.  The Sphenopalatine Ganglion is located in the Pterygopalatine Fissure along with the maxillary division of the Trigeminal Nerve and the maxillary artery.

From the SPG the sympathetic and Parasympathetic nerves than travel along all of the branches of the Trigeminal Bervos Systemalong with the Somatosensory nerves and innervate a wide variety of structures.  The Trigeminal Nerves account for over 50% of all input into the brain after amplification in the Reticular Activatine System.  These nerves control the blood flow to the anterior two thirds of the brain and feed into the Limbic System which controls pain and to the Hypothalamus where homeostasis is controlled.  Hot Flashes are a symptom of unbalanced activity in the Hypothalamus.

Sphenopalatine Ganglion Blocks were first described in 1908 by Greenfield Sluder MD who described Sluder’s Neuralgia now thought to have been Cluster Headaches, Atypical  Trigeminal Neuralgia or TMJ Disorders.   Transnasal SPG Blocks were used to treat these problems very successfully.  Dr Sluder wrote two medical textbooks on the subject, the second book Nasal Neurology was groundbreaking.  Dr Sluder was Chair of the Department of OtoRhinoLaryngology at Washington University School of Medicine in St Louis.  He named the book Nasal Neurology because he felt this information was vital to Neurologist and opthamologists as well ans any other doctor treating head and neck pain and discomfort.

The use of Trans-nasal Catheters to block the Sphenopalatine Ganglion have been utilizer since 1908  and there are thousands of case studies and papers on their effectiveness for a wide and varied group of medical symptoms and conditiions.  Learn more about SPG Blocls at:

The utilization of Self-Administered Sphenopalatine Ganglion Blocks or SASPGB is a game changer allowing patients take control of their own conditions with a Cotton-Tipped Nasal Catheter thru their nose to the tissue covering the medial wall of the fossa holding the Sphenopalatine Ganglion often with remarkable results:  This link leads to dozens of testimonial videos of patients utilizing SASPGB or Self-Administered SPG Blocks.

These are well described in the following paper:  The following link will take you to the full article   ->

doi: 10.1080/08869634.2019.1592807.

Neuromuscular dentistry and the role of the autonomic nervous system: Sphenopalatine ganglion blocks and neuromodulation. An International College of Cranio Mandibular Orthopedics (ICCMO) position paper


The Sphenopalatine Ganglion (SPG) is known to play an integral role in the pathophysiology of a wide variety of orofacial pains involving the jaws, sinuses, eyes and the trigeminal autonomic cephalalgias. It supplies direct parasympathetic innervation to the trigeminal and facial nerves. Sympathetic innervation from the superior sympathetic chain passes thru the SPG to the trigeminal and facial nerves.This paper reviews relevant and significant literature on SPG Blocks and Neuromodulation published in peer reviewed medical and dental journals. Neuromuscular Dentistry employs ULF-TENS to relax musculature and simultaneously provide neuromodulation to the ganglion.Conclusion: The effects of ULF-TENS on the autonomic nervous system acts on the Limbic System and Hypothalamus (H-P-A) to address Axis II issues during neuromuscular dental procedures. It also directly affects the autonomic component of the trigeminal nerve involved in almost all headaches and migraines as well as the Myofascial and Joint disorders of TMD.

Keywords: Neuromuscular Dentistry; Sphenopalatine Ganglion (SPG) Block; Sphenopalatine Ganglion (SPG) Neuromodulation; Trigeminal Autonomic Nervous system; ULF-TENS.

Comparison of the effects of stellate ganglion block and paroxetine on hot flashes and sleep disturbance in breast cancer survivors.

Rahimzadeh P, Imani F, Nafissi N, Ebrahimi B, Faiz SHR.Cancer Manag Res. 2018 Oct 26;10:4831-4837. 
BACKGROUND: The incidence of menopausal symptoms, including hot flashes and sleep disturbance, caused by drug treatment is a common problem in breast cancer survivors. …The aim of this study was to investigate and compare the effectiveness of Stellate GanglionBlocks……

Pilot evaluation of a stellate ganglion block for the treatment of hot flashes.

Pachman DR, Barton D, Carns PE, Novotny PJ, Wolf S, Linquist B, Kohli S, Smith DR, Loprinzi CL.Support Care Cancer. 2011 Jul;19(7):941-7. doi: 10.1007/s00520-010-0907-9. Epub 2010 May 23.
Based on recent pilot data from a single group supporting the use of a stellate ganglion block for the treatment of hot flashes, the present pilot trial was done to further evaluate the hypothesis that a stellate ganglion block …

Effects of stellateganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study.

Lipov EG, Joshi JR, Sanders S, Wilcox K, Lipov S, Xie H, Maganini R, Slavin K.Lancet Oncol. 2008 Jun;9(6):523-32. doi: 10.1016/S1470-2045(08)70131-1. Epub 2008 May 15.PMID: 18485819 Clinical Trial.
METHODS: 13 survivors of breast cancer (in remission) with severe hot flushes and night awakenings were treated with stellateganglion block at the anterolateral aspect of the C6 vertebra on the right side under fluoroscopy. …Five patients had only o …

Anesthetic Injections Into the Stellate Ganglion for the Treatment of Hot Flashes in Women: A Review of Clinical and Cost-Effectiveness and Guidelines.

[No authors listed]Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Apr 14.PMID: 25577932 Free Books & Documents. Review.
Hot flashes, or hot flashes, are sudden and transient periods of feeling hot and sweating, with possible co-occurrence of palpitations and anxiety. …Stellate ganglion block (SGB), a procedure aiming to selectively block …

A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD).

Lipov EG, Joshi JR, Sanders S, Slavin KV.Med Hypotheses. 2009 Jun;72(6):657-61. doi: 10.1016/j.mehy.2009.01.009.

A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD)


The mechanism of action of the stellate ganglion block (SGB) is still uncertain; however it has been used successfully in treatment of chronic regional pain syndrome (CRPS) for many years. Our new insights in to the mechanism of action of the stellate ganglion block were first reported in 2007 in our publication detailing the control of hot flashes with the use of stellate ganglion blockade. We have demonstrated very significant results in the treatment of hot flashes and our most recent application of this block has been for the treatment of posttraumatic stress disorder (PTSD). Stellate ganglion has been demonstrated to have second and third order neurons connections with the central nervous system nuclei that modulate body temperature, neuropathic pain, the manifestations of PTSD, and many other areas. We believe that the commonality between the CRPS, HF and PTSD is the trigger of increased nerve growth factor (NGF) leading to the increase in brain norepinephrine (NR), which in turn is affected by the SGB leading to a prolonged reduction of NGF and eventually a decrease in NR. This, in turn, leads to a reduction or elimination of many of the symptoms of CRPS, Hot flashes, and PTSD.

Stellateganglion block as a treatment for severe postmenopausal flushing.

van Gastel P, Kallewaard JW, van der Zanden M, de Boer H.Climacteric. 2013 Feb;16(1):41-7. doi: 10.3109/13697137.2012.709889. Epub 2012 Sep 27.PMID: 23017097 Clinical Trial.
Unfortunately, its use is often contraindicated. A limited amount of uncontrolled data suggests that stellateganglion block (SGB) may be useful for the treatment of hot flushes. …This mean daily hot flush score was calculated as the product o …

Stellate ganglion block for the management of hot flashes and sleep disturbances in breast cancer survivors: an uncontrolled experimental study with 24 weeks of follow-up.

Haest K, Kumar A, Van Calster B, Leunen K, Smeets A, Amant F, Berteloot P, Wildiers H, Paridaens R, Van Limbergen E, Weltens C, Janssen H, Peeters S, Menten J, Vergote I, Morlion B, Verhaeghe J, Christiaens MR, Neven P.Ann Oncol. 2012 Jun;23(6):1449-54. doi: 10.1093/annonc/mdr478. Epub 2011 Oct 29.PMID: 22039079 Clinical Trial.
BACKGROUND: We studied the stellate ganglion block (SGB) recently suggested for the treatment of severe vasomotor symptoms and sleep disturbances in breast cancer survivors. …Although sleep quality was maintained out to 24 weeks the efficacy of SGB for h …
Lipov EG, Slavin KV.Med Hypotheses. 2013 Jul;81(1):146. doi: 10.1016/j.mehy.2013.04.018. Epub 2013 May 6.PMID: 23657137 No abstract available.

Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society.

[No authors listed]Menopause. 2015 Nov;22(11):1155-72; quiz 1173-4. doi: 10.1097/GME.0000000000000546.PMID: 26382310
Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are warra …

Risk factors, pathophysiology, and treatment of hot flashes in cancer.

Fisher WI, Johnson AK, Elkins GR, Otte JL, Burns DS, Yu M, Carpenter JS.CA Cancer J Clin. 2013 May;63(3):167-92. doi: 10.3322/caac.21171. Epub 2013 Jan 25.PMID: 23355109 Free PMC article. Review.
Hot flashes are prevalent and severe symptoms that can interfere with mood, sleep, and quality of life for women and men with cancer. …In addition, although the pathophysiology of hot flashes has remained elusive, these symptoms are likely attributab …

Effects of stellate ganglion block on vasomotor symptoms: findings from a randomized controlled clinical trial in postmenopausal women.

Walega DR, Rubin LH, Banuvar S, Shulman LP, Maki PM.Menopause. 2014 Aug;21(8):807-14. doi: 10.1097/GME.0000000000000194.PMID: 24496086 Free PMC article. Clinical Trial.
OBJECTIVE: Uncontrolled intervention studies, including studies involving breast cancer survivors, have demonstrated improvements in vasomotor symptoms (VMS) after stellate ganglion blockade (SGB) with a local anesthetic. This study presents the first randomized sha …

Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions.

Pachman DR, Jones JM, Loprinzi CL.Int J Womens Health. 2010 Aug 9;2:123-35. doi: 10.2147/ijwh.s7721.PMID: 21072305 Free PMC article.
They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. …Another promising nonpharmacolo …

What can be done about hot flushes after treatment for breast cancer?

Kontos M, Agbaje OF, Rymer J, Fentiman IS.Climacteric. 2010 Feb;13(1):4-21. doi: 10.3109/13697130903291058.PMID: 20067430 Review.
Breast cancer survivors frequently experience severe hot flushes as a result of their treatment. This can adversely affect their quality of life, compliance with treatment and overall survival. To relieve vasomotor symptoms, a variety of drugs have been used including clon …

Stellate ganglion blockade and verbal memory in midlife women: Evidence from a randomized trial.

Maki PM, Rubin LH, Savarese A, Drogos L, Shulman LP, Banuvar S, Walega DR.Maturitas. 2016 Oct;92:123-129. doi: 10.1016/j.maturitas.2016.07.009. Epub 2016 Jul 17.PMID: 27621249 Free PMC article. Clinical Trial.
OBJECTIVES: In a pilot randomized clinical trial of active stellate ganglion blockade (SGB) versus sham control, SGB significantly reduced the frequency of reported moderate to severe vasomotor symptoms (VMS) and the frequency of physiologic VMS measured using ambul …

[Management of hot flushes for breast cancer survivors].

Boutet G.Gynecol Obstet Fertil. 2012 Apr;40(4):241-54. doi: 10.1016/j.gyobfe.2012.02.015. Epub 2012 Mar 30.PMID: 22464746 French.
Hot flushes experienced by breast cancer survivors present specific issues due to their frequency, severity and difficulty to treat. …Prescription of progestin or of a menopausal hormone therapy should remain exceptional and limited to cases where all other treatments fa …
Walega DR, Maki P.Menopause. 2014 Sep;21(9):1027-8. doi: 10.1097/GME.0000000000000268.PMID: 24937028 No abstract available.

Neck injection may offer new treatment for hotflashes.

[No authors listed]Mayo Clin Womens Healthsource. 2008 Nov;12(11):3.

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