Dear Doctor: I’m 53 years old, officially in menopause -- and officially miserable. I’ve got hot flashes, headaches, insomnia and crazy mood swings, and it’s making me depressed. My doctor means well, but he doesn’t really listen and keeps suggesting hormone therapy. Is this really my only option?

Dear Reader: Although we tend to talk about menopause in terms of the physical changes and symptoms that occur during this time of life, the experience affects us emotionally and psychologically as well. Like it or not, there’s long been a stigma attached to the ending of a women’s fertile years, which can make going through menopause an isolating time. The good news is that there are a number of approaches for managing menopausal symptoms.

Menopause is the stage of life when a woman has stopped having a monthly menstrual period. The ovaries have stopped releasing eggs, and the body is no longer producing the hormones estrogen and progesterone. Production of testosterone drops at this time, too. These hormonal changes often cause a range of physical symptoms.

From what we see in our practices, up to 80% of patients experience some degree of symptoms during menopause. These include hot flashes, flushing and night sweats, which are known as vasomotor symptoms, and they can cause great discomfort and distress. Additional symptoms can include the insomnia and mood swings that you have been experiencing, as well as urinary incontinence, vaginal dryness, changes to skin tone and elasticity, and a drop in sex drive. Anxiety, depression, headache and changes to the ability to concentrate can occur as well.

When it comes to hot flashes, hormone replacement therapy -- which can be oral, topical or vaginal -- is certainly effective. If this seems the best route for a particular patient, we always focus on using the lowest dosage for the shortest amount of time. Studies have shown that low doses of the antidepressants Paxil and Effexor can also offer relief. Their use in menopause treatment has been approved by the U.S. Food and Drug Administration. Other medications may provide some women with relief from hot flashes are gabapentin, an antiseizure medication, and clonidine, a high blood pressure medication. Although black cohosh, an herb sold as a dietary supplement, can be effective in relieving menopause symptoms, it can have adverse effects that range from mild -- stomach upset and headache -- to severe, including liver damage.

We help our patients explore nonpharmacological lifestyle interventions before moving to hormone replacement therapy. Acupuncture and yoga can improve sleep, concentration and mood. Mindfulness, relaxation, hypnosis and cognitive and behavior therapies can relieve stress, anxiety and fatigue. Foods like soybeans, chickpeas, lentils, flaxseed, grains and beans, which contain plant estrogens, may help. There is also evidence that sugar and sugary foods can worsen hot flashes.

Post-menopausal women are at higher risk of osteoporosis and heart disease, so a balanced and healthy diet becomes even more important. We are fans of MenoPro, a free app offered by the North American Menopause Society, which is designed to help you and your physician identify problems and make treatment decisions.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Is it true that eating ultra-processed foods raises your risk of cancer? I really don’t want to give up my comfort foods, like a handful of potato chips or an order of chicken nuggets every few weeks.

Dear Reader: If those chips and chicken nuggets make it onto your plate only occasionally and in limited quantities, you’re probably OK. But for people whose diets are high in ultra-processed foods, there’s no end to the bad news. Not only have recent studies tied these foods to an increased risk of cancer, they have been shown to play a role in heart disease, stroke and Type 2 diabetes.

So what is ultra-processed food? Cooking, canning, drying and freezing are ways to process various foods to make them edible, enhance flavor and preserve them for future use. But ultra-processed foods go several steps further. These are foods that have been repeatedly manipulated to alter their appearance, shape, flavor and texture, and that have been amped up with lots of added sugars, salt, hydrogenated fats, modified starches and artificial flavorings. Ultra-processed foods include everything from the packaged sweet and savory treats in the snack aisle, to convenience foods like canned soups and frozen entrees, to canned and bottled beverages, to much on the menus in fast-food chains.

The ingredient labels of these products start with recognizable foods like corn or wheat or potatoes, but quickly veer into the world of inorganic chemistry with a list of preservatives, colorings, stabilizers and additives. The nutritional information, meanwhile, is long on fat and sodium, and short on vitamins, minerals and fiber.

With an entire branch of food science dedicated to making these foods irresistible and addictive flavor bombs, it’s little wonder that studies show that up to half of calories consumed in the U.S. come now from ultra-processed food. And consumers pay a steep price. Close to 40% of Americans are obese. Type 2 diabetes has become an epidemic. As you mentioned in your letter, a small study found evidence that this type of eating is associated with a rise in cancer risk. Specifically, researchers associated a 10% increase in the proportion of ultra-processed foods in the diet with a 10% increase in the risk of cancer. The same study found that diets high in minimally processed foods like fruits, vegetables, milk and lean proteins, including fish, were associated with a lower cancer risk.

When it comes to diet, we’re realists. We want our patients to commit to eating habits that they can maintain over the long haul. For those in good health, we think a split of 80% being good about diet and 20% “cheat” is OK. For those with diabetes, hypertension or any kind of cardiac issues, the ratio drops to a minimum of 90% healthful eating and a maximum of 10% treat eating. When eating less healthful choices, our advice is to opt for whole food versions of your favorite treats and steer clear of ultra-processed foods.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I just read that there’s a new mosquito virus being found in Florida that can harm the brain. What is it? I thought Zika was the one we’re worried about.

Dear Reader: Mosquitoes aren’t your typical predators, but they can be deadly. Mosquitoes carry and spread an array of diseases that result in more than 700,000 deaths worldwide annually. With 3,000 known mosquito species -- about 175 of them here in the U.S. -- it’s no surprise that new mosquito-borne illnesses keep making news.

The virus you’re asking about is the Eastern equine encephalitis virus, or EEEV. In July, health officials in Florida reported finding the virus in horses, chickens and other animals across the state, prompting a statewide alert.

Symptoms, which appear from three to 10 days after infection, come on quite suddenly. They include headache, which becomes progressively more severe, fever and body aches. The virus is fatal in about one-third of patients and puts survivors at risk of ongoing neurological problems. The virus can lead to encephalitis, which is inflammation and swelling of the brain.

Signs that the virus has begun to affect the brain include loss of muscle control, weakness or paralysis; changes to sensation, including tingling or numbness; decline in cognitive function; and the onset of seizures. There is no human vaccine for the virus at this time, and medical treatment focuses on managing symptoms and offering supportive care.

In the past, the number of reported cases of EEEV, which was first recognized in humans in 1938, has been extremely low. According to the Centers for Disease Control and Prevention, the number of reported cases of EEEV annually is fewer than 10. The actual number of EEEV cases may be higher because it’s likely that some cases of the rare disease are undiagnosed or misdiagnosed.

Zika virus, which is linked to severe birth defects in infants whose mothers became infected while pregnant, is still a problem. The only thing that has disappeared are the headlines addressing it. In the U.S., widespread use of screens, air conditioning and the presence of mosquito control districts have sharply limited the Zika threat. So far in 2019, there have been five confirmed cases of Zika in the U.S., each acquired during international travel. There have been no known cases due to local mosquito-borne transmission.

Limit exposure to mosquitoes with the use of screens, mosquito repellent and by covering bare skin. Remove standing water near your home. Be aware of the times of day the specific mosquitoes in your area are active. Mosquitoes are frail and fly best in still air. A fan can stir enough breeze to keep them from reaching their target.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)