Menopause, Hot Flash Treatment Options
“Is it hot in here or is it me?” If you or someone you know is going through menopause, this question may be all too familiar. While menopause itself is a naturally occurring experience, many women choose alternatives to reduce potential symptoms such as hot flashes and night sweats.
Menopause is a period of physical change that most women go through between our 40s to late 50s. During this time, our body makes less estrogen and progesterone; ovulation, menstruation, and fertility gradually end. With these hormonal changes, a number of symptoms can occur such as hot flashes, night sweats, vaginal dryness and mood swings. A hot flash, or flush, is a feeling of warmth that spreads over the body and is often associated with perspiration.
Hot flashes are reported to be less common among Chinese women (10-25%) than western women (58-93%). Figure 2 on page 3 displays the prevalence of hot flashes in Swedish women between 38 to 72 years of age. Note that the incidence of hot flashes peaks at 60% of women at age 53, and reduces to 30% by age 60 but is still almost 15% by age 72 years. Hot flashes can occur once a month or as often as every 10 minutes. The magnitude, duration, and intensity of hot flashes vary considerably among women and severe hot flashes can significantly affect one’s overall quality of life.
Estrogen has been used as a hormone replacement for over 60 years to treat menopausal symptoms and is still the most effective modality over all other non-hormone treatment options in reducing hot flashes. Results of the 2002 Women’s Health Initiative study, revealed considerable side effects associated with the use of combined hormone therapy (0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteroneacetate) including an increased risk in breast cancer, stroke, and thromboembolism. Since then, the use of the lowest effective dose of steroids in Hormone Replacement Therapy (HRT) is recommended and many of these low dose preparations are available in oral, transdermal or percutaneous forms.3 To find out which option is best suited to you, check with your physician.
Due to concerns of estrogen and its side effects, there is much interest in women seeking out alternative therapies. Women with breast cancer who cannot take estrogen are also seeking alternatives.1 A summary of these alterative findings is listed below.
- Antidepressant medications including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) --paroxetine, venlafaxine, fluoxetine, citalopram-- veralipride, and moclobemide have been shown in clinical trials to reduce the number and severity of hot flashes. Additionally, studies using antihypertensive medications including clonidine and gabapentin have similar results.1 Although these medications are less effective than estrogen in reducing hot flashes, they may be worth considering as a treatment option. Unfortunately, adverse side effects and cost may prohibit use by some women.
- Clinical trials using soy and isoflavones have shown mixed results in reducing hot flashes. However, the data are certainly sufficiently suggestive to justify women trying soyfoods and isoflavone supplements for relief. These products may be especially beneficial in women who experience very frequent hot flashes. Efficacy may also be determined by isoflavone metabolism which varies markedly among individuals. Also, products that are especially high in genistein, a type of isoflavone, may be most effective.
- Recent studies on oral supplements containing trifolium pretense (red clover) isoflavones, may offer another alternative for treating hot flashes. Although the evidence is marginally significant, the long term effects are unknown.4
- Other alternative products that have not been shown to reduce hot flashes in clinical studies includevitamin E, dong quai, ginseng root, evening primrose oil, and wild yam. Black cohosh may be effective but it has some mild adverse effects and has not been studied more than 6 months duration.
In treating your hot flashes, discuss your treatment options, their side effects and your overall health status with your physician.
About the Authors
Elisabeth A. Trimarchi, R.D., L.D.N. is a dietitian at Beth Israel Deaconess Medical Center, Boston in the MNT clinic and the Cardiovascular Health and Lipid Center. She is also a clinical dietitian at the Hebrew Rehabilitation Center, Boston. Elisabeth received her B.S. in human nutrition at the University of Massachusetts-Amherst.
Patricia Samour, MMSc, R.D., L.D.N., is Director of Nutrition at the Beth Israel Deaconess Medical Center in Boston. Active in the ADA, she is a long-time member of The Soy Connection editorial board.
1) Nelson et al. Nonhormal therapies for menopausal hot flashes. JAMA, 2006; 295:2057-2071.
2) Haimov-Kohkman,R and Hochncer-Celinikier,D. Hot flashes revised: pharmacological and herbal options for hot flashes management. What does the evidence tell us?Acta. Obstet.Gyneol. Scand, 2005; 84:972-979.
3) Rozenbaum, H. How to evaluate the risk-benefit ratio of the low-dose hormone replacement therapy? J. Steroid Biochem. Mol. Biol., 2006;doi:10.1016/j.jsbmb.2006.09.013.
4) Thompson Coon J, Pittler MH, Ernst E. Trifolium pratense isoflavones in the treatment of menopausal hot flushes: A systematic review and meta-analysis. Phytomedicine 2007.