Editor's Note: Cathy Cram, M.S., is the resident maternal fitness expert on our sister site, BabyFit.com. She blogs monthly on the topics of menopause, health and fitness.
By Cathy Cram, M.S.
This is the third blog in the series on menopause hot flash treatments. In this blog, we’ll explore the medical treatments that can help reduce hot flashes, and the controversy surrounding one of the most effective treatments, hormone treatment (HT, also termed HRT for hormone replacement therapy).
Hormone treatment for menopause has been around for decades and has been used to treat premenopausal women after hysterectomy with oophorectomy (removal of the uterus and ovaries, respectively). In those women, without hormone replacement, they would go into a surgical menopause and experience increased bone weakening. HT has also been used in the treatment of menopausal symptoms and is one of the most effective treatments for reducing hot flashes.
The usual HT prescribed to menopausal women who have their ovaries and uterus is a combination of some type of estrogen plus progestin (a synthetic form of progesterone). The progestin is added because estrogen by itself causes the uterine lining to thicken, and without progesterone initiating the sloughing off of the lining, there’s an increased risk of uterine cancer. Women who have had a hysterectomy don’t need the additional progesterone and are given estrogen-only HT.
In 1993, the Women’s Health Initiative (WHI) was designed to determine the risks and benefits of treatments given to reduce heart disease, breast and colorectal cancer, and fractures in postmenopausal women. Among several sets of clinical trials within WHI was a study on the effect of HT on these diseases. There was an estrogen-only hysterectomy group, which took Premarin (conjugated estrogen-a combination of estrogen hormones), the Prempro group (conjugated estrogen plus progestin) and a group that didn’t take any HT.
The study included 161,809 women who were followed over time, with a projected first report on study results to be issued in 2006. Instead, the Prempo portion of the study was halted in 2002 because of a surprising increase in the number of breast cancers, strokes, heart disease and dementia in the estrogen and progestin arm of the study as compared with the other groups.
The halt in the study caused a large number of menopausal and postmenopausal women to stop taking HT, and many suffered from hot flashes and other menopausal symptoms that diminished their quality of life. There has been quite of lot of discussion about the WHI study results, and recent findings regarding possible breast cancer risk reduction in women who took estrogen only have been in the news, but it’s too soon to make any definitive conclusions about this recent finding. Most health-care providers recommend that menopausal women avoid HT if possible, although some are easing their recommendation for women who have severe hot flashes and are prescribing HT in low doses for short periods of time.
It’s important to note that there are several types and sources of estrogen and progesterone used in HT, as well as methods of delivery. There hasn’t been enough literature to conclusively say whether one type of hormone or delivery system is more effective or less risky than another. Whether HT is chemically derived, or from what’s termed “natural" source, there isn’t enough clinical data to support whether one is safer or effective.
There are varied methods of hormone replacement delivery methods, from oral to cream to patch. Oral HT requires that the hormones go through the digestive system, whereas patches and topical creams and gel HT treatments are absorbed directly into the blood stream. The wide variety of HT delivery systems are too numerous to list, so if you're interested in exploring this topic I recommend you check out the resources listed below, and discuss the options with your health-care provider. Some women find more effective relief and fewer side effects with one form of HT versus another, so it may take some trial and error to find a HT treatment that works for you.
I have first-hand experience with hormone replacement as I’ve used an estrogen patch (.025 microgram of estradiol) for the past two years. I had a hysterectomy at 48 and had experienced some perimenopausal symptoms prior to surgery. After surgery, I started to have more intense night sweats and noticed changes in my mood, sleep pattern and general energy level. My doctor recommended an estrogen patch to see if that would help with the symptoms.
Within several days the night sweats stopped, and I noticed a lift in my mood. It’s hard to know if the mood change was just a placebo effect, but either way, I’ll take it. Several other things I’ve noticed (in my study of one) were improvements over time with skin dryness, and reduced hair loss. The literature hasn’t shown a clear correlation between hormone replacement and skin and hair health, and those issues shouldn’t be a reason to start HR, but they are a welcome possible effect.
The current recommendations for HT are to take the least amount over the shortest period of time needed for severe menopausal symptoms. For some women, HR will help them during those turbulent first years of menopause, and they’re able to wean themselves off HT after several years. For other women, the return of severe hot flashes with HR discontinuation makes it a more difficult situation. As with all medical issues, each woman needs to assess her situation, go over all the pros and cons of a treatment, and work closely with her health-care provider.
Non-Hormonal Hot Flash Drug Treatments
There are several non-hormonal drug treatments available that have been shown in studies to offer varying levels of hot flash relief. SSRIs (selective serotonin reuptake inhibitors) include a group of antidepressant drugs that have been shown to be effective in treating hot flashes. Effexor, Paxil, and Prozac are three in this class of drugs that have shown a 40% reduction in hot flashes in clinical randomized controlled studies. The dosing for hot flashes is in most cases about half the amount as used for depression.
Another drug that has been used to treat hot flashes is the blood pressure medication Catapres. In a double-blind study using Catapres, women taking the drug had a reduced frequency and number of hot flashes as compared to those taking a placebo. The drug Neurontin, used traditionally as a seizure medication, has been used with some degree of success in the treatment of hot flashes. Two double blind randomized placebo controlled studies found that women who took Neurontin had up to a 46% decrease in hot flashes as compared with the placebo group.
As with all drugs, there are varying degrees of side effects (some quite severe) that can occur with the use of these medications and HT treatments. Before you decide to use a medication for your hot flashes, do some research on the side effects, and talk with your health-care provider about whether the degree of your hot flashes is worth risk of a drug treatment.
I have found a wealth of current, clinically based information at Dr. Susan Love’s website. She is a surgeon and breast cancer expert, and her research foundation is one of the leading sites for current breast cancer information. Also helpful is the website menopause.org, a comprehensive site that provides information on menopause and symptom treatments.
Have you used any of these treatments?
Catherine Cram, M.S. is the author of Fit Pregnancy For Dummies, and the owner of Comprehensive Fitness Consulting, LLC. Catherine’s company specializes in providing prenatal postpartum fitness information to health-care professionals.