  menopause...
what's the scoop?
Dr. Vanda
Discovery Health Online
Often when we hear the word
"menopause" we still, even in this modern age, conjure up a picture of a woman completely
out of her mind, driving her family wacky with her emotional instability.
We also may envision a sad, pathetic woman for whom life is just about over. And if we happen to be the one who has just hit this phase of life, neither
of these images is particularly uplifting.
Luckily, neither characterization
of menopause is accurate. Most women don't go thru any "significant & lasting emotional
changes" during menopause & if you’re 40 & healthy, you could have another 40 years
to live.
That’s a lot of time
to fill & many women report that once they make it to the postmenopausal stage of their
lives, they feel a sense of renewed energy & potential.
Biology vs. Attitude
Without a doubt there are biologically-based symptoms that go with menopause. And some women experience
more of them than others. It isn't true, as some authoritarian physicians of the past would have had us believe, that we're bringing these symptoms on ourselves because of a "neurotic" reaction to the changes that are occurring.
However, complicating these
very real symptoms are Western attitudes about aging. In a culture that idolizes youth, menopause becomes a dirty secret.
Educated, sophisticated baby-boomer
women, who have always kept up to date with their careers, the latest in child-rearing practices & techno wizardry,
may be woefully ignorant about menopause. This seems due to an unconscious denial that this "horrible thing" can ever happen to them.
Denial
The ignorance of many physicians doesn't help. When women present with symptoms of menopause in
their 30's & 40's, their gynecologists may deny that these symptoms could possibly indicate the onset of menopause since the woman isn't yet 50. The doctor doesn't know that it isn't uncommon for women to have symptoms
of menopause many years before 50.
The Stages
There are 3
stages of menopause:
- perimenopause
- menopause
- postmenopause
This Menopause
Guide describes each phase & discusses available treatments to alleviate, or at least lessen, symptoms.
source: click here
perimenopause
Am I there yet?
by Dr. Vanda
Discovery Health
The term "perimenopause"
is a relatively new one, which has only been in common usage since 1995.
Perimenopause is a time
of transition when the ovaries decrease the amount of hormones they produce & as a result, a woman’s periods become
less regular.
Despite the beginning
of perimenopausal symptoms, actual menopause may still
be 5, 8 or even 10 years away.
Age of Onset
Perimenopause usually begins
in the early to mid-40s; however, it's possible for it to begin as early as the 30s, or as late as the mid-50s.
Perimenopausal Symptoms
You may have none of the following
symptoms, some of them, or all of them:
- Fatigue
- Emotional turmoil
- Memory problems
- Weight gain
- Fluid retention
- Sore breasts
- Painful intercourse
- Migraine headaches
- Irritable bowel-like symptoms or food intolerance
- Sleep disruptions
More In-depth Discussion of Perimenopausal Symptoms
Fatigue
Fatigue is a common symptom
of perimenopause. Many women are already working so hard at careers & running households
that when the fatigue of perimenopause hits, they don’t recognize it as a symptom of anything.
Usually, this additional fatigue
is due to insomnia, which is caused by the decrease in estrogen in the woman’s system; however, some of this fatigue can also be caused
by the decrease in testosterone in a woman’s system that is occurring at the same time.
It's the hormone testosterone
that keeps women feeling energized. Once menstruation ceases completely, women often begin to regain their energy & feelings
of aliveness.
Emotional Turmoil
Many women experience mood
swings during perimenopause. These could be caused by the decreased amount of estrogen in
the woman’s system.
Research in Australia
indicates that depression is at its worst 2 years after the last menstruation, but starts to lift after that. On the other hand, studies indicate that
women are more likely to be depressed in their 20's & 30's than they're during menopause.
Weight Gain
Physical changes in the body include fat shifting from the lower to the central body without increasing the actual amount of overall
body fat.
During this time, it's harder
to lose weight, but easier to put it on. This is true for both men & women as they age, because of a decrease in the rate
of metabolism.
Still, women between the ages
of 45 & 50 put on significantly more weight than men, leading researchers to believe that perimenopausal weight gain can be separated from weight gain that is due to aging.
The extra weight actually
has an adaptive purpose. The extra fat cells convert androgen into estrogen. They also produce DHEA, an anti-aging hormone.
Women with a few extra pounds generally feel better than very thin women.
Painful Intercourse
40 to 60% of menopausal
women find that the amount of time & sexual stimulation needed to become lubricated is greater than it was previously.
When they do become lubricated,
the amount produced is far less than when they were younger. Decreasing levels of estrogen cause less blood to flow to the
vagina, which causes decreased lubrication during stimulation. This decrease in lubrication is what makes intercourse painful.
Migraine Headaches
Migraine headaches have an
unusual relationship to the menopausal transition. Some women who have suffered with migraines
their whole life find they no longer have them when they reach this phase, while other women who have never had migraines
begin to have them during perimenopause.
source: click here
Is it hot in here?
Dr. Vanda
Discovery Health Online
Menopause is the period of
time during which the ovaries stop working completely, so that menstruation no longer occurs.
Menopause Symptoms
You may have none of the following
symptoms, some of them, or all of them:
- hot flashes
- Night sweats
- Dryness of the eyes, mouth, nose, vagina
- Pain with intercourse
- Decreased sexual desire & diminished orgasm
- Dizziness
- Migraines
- Sleep disorder
- Fatigue
- Formication (an itchy sensation
that feels like insects are crawling under the skin; there is no rash or redness that goes with this sensation.)
More In-depth Discussion of Menopause Symptoms
hot flashes
A hot flash is the most common symptom of menopause.
Depending on which source you read, 70 to 85% of menopausal women in America have hot flashes.
A hot flash (called a "hot flush" in Great
Britain) is a feeling of heat that comes over the face, shoulders, head & upper torso. It's often accompanied
by sweating.
Some women, also may experience
rapid heartbeat, nausea, dizziness, anxiety, or a feeling of weakness. A hot flash can last a few seconds or a few minutes. In rare incidences it may last as long as an hour.
hot flashes are most common between 6:00 a.m. & 8:00 a.m. & between 6:00 p.m. & 10:00 p.m.
The cause of hot flashes
No one is really sure what causes
a hot flash, but the lessened estrogen makes the
hypothalamus go out of control. The hypothalamus regulates appetite, sleep cycles, sex hormones & body temperature. Like
a thermostat that has been pushed up too high, the hypothalamus, under the influence of the decreased estrogen, raises the
body's heat.
In response, the brain sends
out a red alert in an attempt to cool down the body. The heart pumps faster, the blood vessels send more blood thru the system
& the sweat glands release sweat.
Factors that trigger hot flashes
- Stress
- Heat
- warm clothing
- warm weather (There
are more hot flashes in summer than winter.)
- hot showers
- drinking hot beverages (Tea
& coffee are especially problematic because of the caffeine.)
- drinking alcohol
- certain medications (Sudafed
& other over-the-counter sinus remedies that contain the chemicals related to adrenaline, i.e., may be a trigger.)
- emotional upset
- an overactive thyroid
- high blood pressure that is out of control. (Consult a physician to be sure that hot
flashes are due to menopause & not to some other
underlying cause.)
- Loss of Sexual (Desire Research
indicates that 30 to 35% of menopausal women undergo some loss of sexual interest. This may be partially due to the lack of
vaginal lubrication & the resulting painful intercourse. However, it's primarily due to the decrease in hormones produced
in the woman's system. This reduction in hormones (both estrogen & testosterone) may also have an effect
on orgasm.
Women often find it takes longer
to reach orgasm & that orgasm may be reached less often &/or the orgasm may be less intense.
For the majority of women,
these changes aren't serious & don't alter the woman's level of sexual pleasure. (For
some women, the decrease in intensity actually leads to a deeper, "sexier" orgasm.)
post menopause
Now what?
by Dr. Vanda
Discovery Health Online
Post menopause is the final
phase of the menopausal transition, when the hormones have found a new balance. According to Dr. Michele Moore in The
Only Menopause Guide You’ll Need (Johns Hopkins University Press, 2000)," for
most women it's a time of quiet after the storm."
Symptoms of Post menopause
- Hot flashes diminished
- Night sweats diminished
- Dry vagina
- Burning, itchy vulva
- Decreased sexual desire
- Stress incontinence
- Hypertension
- Bone pain
- Fractures
- Foot & leg cramps
- Wrinkles & droops
- Memory improvement
- Emotional stability
More in-depth discussion of post-menopausal
symptoms
Stress Incontinence Stress incontinence is the involuntary leaking of urine when coughing,
sneezing, laughing or lifting. It can be treated thru Kegel exercises. The way to do a Kegel exercise is to draw the muscles
of your vagina upward & squeeze.
Turning your
urine stream on & off using this method is an easy way of doing the exercises regularly.
Fractures & Bone Pain
Every
woman over 50 needs a bone density test to check for osteoporosis, the cause of fractures & bone pain. Most insurers
& Medicaid now pay for this painless test.
Osteoporosis
is both preventable & treatable. Prevention begins with a calcium-rich diet that includes dairy products, calcium-fortified
orange juice, broccoli & deep-green leaf lettuces such as kale.
Tofu,
fortified breads & cereals are also calcium-rich. A calcium supplement is also necessary. Doctors usually recommend 1,500
mg. of calcium & 750 mg. of magnesium in combination. The magnesium helps the body to make proper use of the calcium.
There are a
number of prescription drugs that are useful in the treatment of bone pain & fractures. See your doctor for information
on these medications.
Certain herbs
have also been found useful for treating fractures & bone pain. See Treatment section.
source: click here
treatments....
What's best for me?
Dr. Vanda
Discovery
Health Online
On July 9, 2002, the federal
government halted a research study being conducted by the Women’s Health Initiative on the effects of HRT, stating that
the risks of long-term use of HRT outweighed its benefits.
The study found
that women using estrogen plus progestin had an increased risk of coronary heart disease, stroke, breast cancer & pulmonary
embolism.
Despite the above findings,
there are still some benefits to long-term HRT use that should be noted. These benefits include:
- A decrease in hip fractures
- A decrease in colon cancer
- A decrease in or an elimination of hot flashes
- A decrease in nocturnal wakefulness
- An increase in vaginal lubrication
In her best-selling book The
Pause, psychologist & sex therapist Dr. Lonnie Barbach states that a Yale University study found 90% of women who
had experienced less sexual interest prior to the study “reported an increase in desire and sexual activity after being
treated with estrogen for 3 to 6 months.” Barbach doesn't report the sample size of this study.
Natural Hormone Replacement Therapy (NHRT)
NHRT, or bio-identical hormones,
work like hormones found in the body naturally. Natural hormones are derived from the yam plant or soybean plant. Unlike synthetic
hormones, bio-identical hormones are manufactured to have the same molecular structure as the hormones produced in the body.
Testosterone
When the ovaries stop producing estrogen,
they also stop producing testosterone. Testosterone has been called the hormone of desire.
Therefore, if a woman's testosterone
level falls below her personal baseline, she'll likely experience a decrease in sexual desire.
Doctors can test the level
& prescribe the appropriate amount of testosterone. If the testosterone is going to work, it'll start taking effect immediately.
Taking more than is needed will not increase your sexual drive further & too much testosterone produces acne, oily skin
& hair.
It can cause hair loss
on the scalp & hair growth on other parts of the body. While taking testosterone it’s important to be monitored
by physician.
Herbs
Vitex (chasteberry) tends
to balance female hormones. It evens out mood disruptions, gets rid of hot flashes & restores vaginal lubrication. It
can also be used for PMS. You can take it as a tincture.
A tincture is an alcohol extract of an herb & is sold in
a bottle. The directions on the bottle will state how many drops you should take in a small amount of hot water. Vitex also
comes as a tea. The problem with Vitex is it takes 2 to 3 months to begin working & you must take it at least twice a
day.
It also comes in pill form, but this takes 6 months to become
effective.
Siberian ginseng reduces hot flashes. Like Vitex, it may take
a few months to start working.
Skullcap can be helpful for irritability or anxiety.
Passionflower, motherwort & valerian are natural sedatives.
Some sources recommend dong quai to reduce hot flashes; however,
others cite research that shows it's no more effective than a placebo.
Diet
Avoid or cut down on:
- Caffeine (including chocolate)
- alcohol
- spicy foods
They can increase hot flashes & cause fatigue.
Increase your intake of:
Soy products, such as tofu, miso, tempeh and soybeans, which
are rich in isoflavones. They reduce hot flashes.
Eat small meals: Large meals
dilate blood vessels & cause the body to grow warmer.
Cognitive Control Over Mood Swings:
There are certain cognitive things you can do for yourself while you're going thru this phase.
First, you can start by being gentle with yourself. You're going
thru something real. It isn't "all in your head," so take good care of yourself.
Often, just knowing that your mood is being affected by the
decrease in your estrogen levels can put you back in control. Before blowing your cool, take a deep breath, reminding yourself
to put your head in charge of your feelings.
Remember that this phase won’t go on forever. Once your
hormones have found their new level, you’re going to feel fine again.
It's important, especially during this time, to maintain a good
support network with family & friends. Research indicates that women who have a support group they can rely on experience
fewer symptoms.
Exercise
Exercise decreases stress. Lessening stress helps to lessen
all symptoms. Exercise is good for mood swings; it increases brain endorphins, blood flow & oxygen in the cells, which
makes you feel better. In one study done in Stockholm, Sweden, women who engaged in regular exercise had significantly fewer
menopausal symptoms, including less negative moods, when compared with women who did not exercise. Also, doing some form of
aerobic exercise three times a week for 30 minutes can prevent insomnia as well as reduce hot flashes.
Maintaining an active sex life also reduces hot flashes. A Stanford
research study showed that women who have intercourse regularly (one or more times a week) have fewer or less intense hot
flashes.
source: click here
hot flashes...
some older suggestions
No More hot flashes... 10
Ways to Relieve Menopausal hot flashes...
From Tracee Cornforth / about.com / 2003
Menopause & the dreaded
hot flashes - it's almost impossible to think of one without the other. hot flashes are probably the first symptom we think
of when we think of menopause or peri-menopause (the years before menopause).
Whether you already
experience hot flashes, or you're still waiting for your turn, here are 10 tips that can help reduce the severity of
hot flashes when they happen to you:
- Research
suggests that soy may have some benefit for reducing hot flashes & other
symptoms of menopause. However it's recommended that you get your soy from foods rather
than from supplements. Foods that contain soy include:
tofu
tempeh
miso
soy milk
whole soybeans
texturized vegetable protein
soy powder
- Black cohosh (20 mg to 60 mg 3 times daily) often provides effective relief of hot flashes, as well as other symptoms of menopause including:
headaches:
heart palpitations:
anxiety:
A German study of over 600 women
found more than 80% of hot flashes & other symptoms improved within 8 weeks of beginning treatment
with Black cohosh.
- Natural progesterone
cream available OTC, in compounded prescriptions, or as a traditional prescription called Prometrium provides relief for hot flashes & other
symptoms of menopause for many women.
- Taking 400 IU to 800 IU of Vitamin E daily significantly
reduces the occurrence & severity of hot
flashes & night sweats during menopause
or perimenopause & provides an additional benefit of strengthening the immune system & protecting the heart.
- Effexor is a SRNI and an antidepressant that has been
found to reduce hot flashes in women undergoing treatment for breast cancer. Because it works so well for breast cancer
patients, researchers believe it may be an option for women who don't want to use traditional hormone replacement therapy
during menopause.
- Exercise at least 30 minutes every day. You can walk,
run, ride a bicycle, or do another activity. Just don't exercise within 3 hours of going to bed to help prevent night sweats.
- Gabapentin is a drug currently used to treat migraine
headaches, however the June 13, 2000 issue of Neurology found an 87% reduction in hot flashes among a
small group of women who took the drug.
- Dietary triggers that can start a bout of hot flashes
include:
alcohol:
caffeine:
cayenne:
other spicy foods:
If your hot flashes seem to
be worse after consuming these foods, try eliminating the offenders & see if the hot flashes subside.
- Traditional hormone replacement therapy (HRT) that includes
estrogen replacement provides relief from hot
flashes associated with menopause. Before choosing
estrogen replacement therapy, be sure you understand the both the risks & the benefits & how their relevance to your
personal medical history.
- hot flashes are often worse during hot weather.
Wear all cotton clothes that allow your skin to breathe & keep a fan nearby during hot weather to reduce the number of
hot flashes you experience.
this is my take on that! I take Effexor
- I believe it's Effexor XR - if there's a difference & have taken it for 5 years. It
doesn't help me at all with hot flashes. Now that's just me, but if you're on Effexor too
& you'd like to add your 2 cents - click here - to send me an email about it! I'll post the results here!
The other thing about that from my brain...
I hate to be a baby, but I don't like the taste
of soy anything. So I'm going to start this week trying some soy things that I can enjoy.
This ought to be interesting!
And then, lastly for this article... I drink my weight in
coffee it seems everyday. I did start drinking "half caff" about a year ago when my husband
had his heart attack. That's a bit of an exaggeration, but I'm going to switch it over to only one cup in the morning starting
tomorrow until I can wean myself off it without dying of a headache. I'm switching to green tea!
kathleen !
9/10/07
Hormone replacement therapy: Benefits & alternatives
Hormone replacement therapy
benefits some menopausal women, but there are health risks. Understand the risks associated with hormone replacement therapy, when you should or shouldn't take it, & what other treatments
are available.
Until July 2002, hormone replacement
therapy had been the standard therapy in the US for treating menopausal symptoms.
Not only did hormone
replacement therapy relieve such discomforts as hot flashes & vaginal dryness, it also seemed to protect against several post menopausal conditions, such as osteoporosis & heart disease.
But in July 2002, the Women's
Health Initiative - a large, multi-tiered clinical trial sponsored by the National Institutes of Health - reported that hormone
replacement therapy actually posed more health risks than benefits for women in the clinical trial. And as the number of health
hazards attributed to hormone replacement therapy grew, doctors discontinued routine prescriptions for this popular treatment.
You might be wondering how
this shift in opinion over hormone replacement therapy, also known as hormone therapy for menopause, affects you personally.
In some cases, hormone replacement
therapy is still your best option for treating menopausal symptoms. In other cases, it's wise to consider alternatives.
A turning point for hormone replacement therapy
Concerns about hormone replacement
therapy stem from the results of both the combined estrogen-progestin & the estrogen-alone arms of the Women's
Health Initiative (WHI) clinical trial.
Combination estrogen-progestin
therapy (Prempro)For women taking the combination estrogen-progestin used in the study (Prempro), researchers found
an increased risk of:
In addition, researchers found
that women taking combination estrogen-progestin experienced an increase in mammography abnormalities.
The increased number of false-positives
- signs of possible breast cancer that ultimately prove inaccurate - was attributed to the increased breast tissue density
that estrogen induces. Women on combination therapy should be aware that they may require more frequent mammograms & additional
testing as a result of this therapy.
As for quality-of-life
measures, such as sleep, emotional health, general health, physical functioning & sexual satisfaction, the WHI found that for women taking combination hormone replacement therapy - most of whom didn't have troublesome menopausal
symptoms - combination HRT didn't provide meaningful improvement in symptoms.
Estrogen-alone therapy
(Premarin)
For women taking estrogen alone (Premarin),
the WHI found no increased risk of breast cancer or heart disease, as was found with women on combination therapy, but researchers did find a slightly increased risk of stroke.
In addition, researchers found
that, as with women on combination therapy, women taking estrogen alone were more likely to have abnormal mammograms than
were women not on HRT.
The increased number of false-positives
- signs of possible breast cancer that ultimately prove inaccurate - was attributed to the increased breast tissue density
that estrogen induces.
Women on estrogen-alone
therapy should be aware that they may require more frequent mammograms & additional testing as a result of this therapy.
Some HRT benefits still
valid
Researchers did note important benefits of hormone replacement therapy in the WHI study - including a decreased risk of osteoporosis-related hip fractures
& colorectal cancer. These benefits were valid for women whether they were taking combination therapy or estrogen alone.
It's all in the timing: Age is an important factor
The WHI's study population
consisted of older post menopausal women. Participants were an average age of 63 at the
start of the trial. What's less certain is whether the study findings can be applied to younger women, such as women who typically
start estrogen early in menopause.
A more complete analysis of
data from the estrogen - alone arm of the WHI suggests there's less of a risk of heart disease if you take estrogen early in your post menopausal years.
The data analysis
revealed participants age 50 to 59 who took estrogen experienced fewer heart attacks & deaths from coronary artery disease than study participants who took a placebo.
Many questions regarding younger
post menopausal women & hormone replacement therapy exist.
To address some of these issues,
a randomized, controlled clinical trial - the Kronos Early Estrogen Prevention Study (KEEPS) - exploring estrogen use &
heart disease in younger post menopausal women is under way, but it won't be completed for several years.
Who can benefit from hormone replacement therapy?
Despite the inherent health risks,
hormone replacement therapy still has a role in treating menopausal symptoms. For some women
- such as those who experience moderate to severe hot flashes or other menopausal symptoms
- the benefits of short-term therapy outweigh the potential risks.
"The absolute risk to an individual
woman taking hormone therapy is quite low & may be acceptable to you depending on your symptoms," says Sharonne Hayes, M.D., cardiologist & director of the Women's Heart Clinic at
Mayo Clinic, Rochester, Minn. "Talk with your doctor about your personal risks."
Hormone replacement therapy
might still be your treatment of choice if you have:
- Hot
flashes. Hormone replacement therapy is still the most effective treatment for troublesome
menopausal hot flashes & night sweats.
- Vaginal
discomfort. Hormone replacement therapy can ease vaginal symptoms of menopause, such as dryness, itching, burning &
discomfort with intercourse.
- Osteoporosis. Hormone replacement therapy continues to be an option for osteoporosis prevention, but it's recommended only when
other medications for osteoporosis prevention have been considered & determined not to be best for you.
If you're already taking
hormone replacement therapy, should you keep taking it?
If you're already taking hormone
replacement therapy to relieve menopausal symptoms, review its benefits & risks with your doctor.
"Consider the reason you started
hormone replacement therapy & whether the reason remains relevant," Dr. Hayes advises. "If you started hormone therapy
for hot flashes several years ago, you may no longer have hot flashes & could stop taking the drug."
Your doctor may periodically
advise modifications to your regimen. For example, if you're taking a particular dose of estrogen, you may be able to lower
the dose. Switching from an estrogen pill to a patch may offer certain benefits.
In treating isolated vaginal symptoms,
estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That's because estrogen
applied directly to your vagina remains localized to that area to treat your symptoms & doesn't circulate throughout your
body as does estrogen ingested thru a pill or absorbed thru a patch.
Women on hormone replacement therapy
should take the lowest effective dose for the shortest amount of time needed to treat symptoms.
Who should avoid hormone replacement therapy?
Women with breast cancer or
a history of blood clots shouldn't take hormone replacement therapy. Also avoid hormone replacement therapy for preventing
memory loss, heart disease, heart attacks or strokes.
Instead, talk to your doctor
about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.
Alternatives to hormone replacement therapy
You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you
try making changes to your exercise or eating habits before you try medication.
After adjustments to your lifestyle,
if you're still dealing with bothersome symptoms, you have several options besides hormone replacement therapy to help relieve discomfort.
soruce: mayo clinic
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hot flashes... the year 2007
hot flashes: Minimize discomfort during menopause
You have many options when
it comes to managing hot flashes, ranging from lifestyle modifications to prescription medications. Discover what works.
hot flashes can descend on you at any time, leaving
you sweaty & red-faced. But they're quite common - as many as 3 out of every 4 women experience hot flashes as they
go thru the menopausal transition.
You don't need to seek treatment for hot flashes, especially if you're tolerating them well on your own. If your
hot flashes are particularly bothersome, treatment options are available.
But finding the best way to
control your hot flashes can take time. Start by asking yourself how hot flashes are disrupting your regular life. Then
consider the benefits & drawbacks of the most common remedies, which range from lifestyle changes to prescription medications.
What are hot flashes?
When you're having a hot flash, you might
experience:
- A feeling
of mild warmth to intense heat spreading thru your upper body & face
- A flushed
appearance with red, blotchy skin on your face, neck & upper chest
- A rapid
heartbeat
- Perspiration,
mostly on the upper body
- A chilled
feeling as the hot flash
subsides
hot flashes vary in frequency - you may have several
a day or just a few a week. You could experience full-on sweating throughout the day & night, or you may just occasionally
feel warmer than you used to. hot flashes can last as long as 30 minutes, but most subside within a couple
of minutes. Nighttime hot flashes - or night sweats - can wake you from a sound sleep.
hot flashes are common during peri-menopause - the
period of time leading up to menopause - & tend to peak during the first couple of years after menstrual periods have
stopped.
For some women, hot flashes
last up to a couple of years. For others, hot
flashes may continue for several years or indefinitely.
For mild hot flashes:
Start with diet & lifestyle changes
If your hot flashes
are mild - you have just a few a day & they don't interfere with your normal activities - you may be able to manage them
with lifestyle adjustments.
For example:
- Keep
cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove
clothing when you feel too warm. Open a window or use a fan or air conditioner to keep air flowing. If you feel a hot flash coming on, sip a cold drink.
- Get
active. Daily exercise is important during the menopausal years. If you aren't already exercising regularly, now is the time to increase your physical activity & add regular aerobic exercise. With your doctor's OK, try brisk
walking - or a similarly vigorous exercise - for 30 minutes or more on most days of the week.
- Watch
what you eat & drink. Hot & spicy foods, caffeinated beverages & alcohol can trigger hot flashes. Learn to
recognize your own triggers & avoid those foods or drinks that bring on hot flashes.
- Relax.
Many women find relief from mild hot flashes thru yoga, meditation, relaxation or other stress-reducing techniques. Even if these approaches
don't quell your hot flashes, they may provide other benefits - such as easing the sleep disturbances that tend to occur with menopause.
-
Practice paced respiration.
Deep, slow abdominal breathing - known as paced respiration - can decrease hot flashes. It takes some practice to perfect
the technique, but paced respiration done twice daily or at the beginning of a hot flash can be quite helpful.
To practice paced respiration,
begin by sitting comfortably. Breathe in deeply for 5 seconds, pushing your stomach muscles out. Exhale for 5 seconds, pulling
your stomach muscles in & up. Repeat this cycle of breathing deeply in & out until you feel calm & relaxed - for 15 minutes twice daily, at the start of a hot flash, or for a minute or two in the middle of a busy day.
- Don't
smoke. Smoking is linked to increased hot
flashes. By not smoking, you may reduce hot flashes as well as your risk of many serious health conditions, such as heart disease, stroke & cancer.
What about dietary supplements?
Dietary supplements some women
use to curb hot flashes include:
-
Black cohosh.
Black cohosh has been used widely in Europe for treating hot flashes & has been popular among women with menopausal symptoms in the US. While its safety record
has been good, there's no longer much reason to believe that it's effective for menopausal symptom relief.
In a meticulously conducted yearlong
clinical trial funded by the National Institutes of Health (NIH) & published in late 2006, black cohosh was found
to be no better than placebo for relieving hot
flashes. Women with hot flashes were assigned
to take black cohosh alone, black cohosh in a mixed herbal supplement, hormone therapy or a placebo (inactive
pill).
The women given black cohosh -
containing supplements reported the same number of daily hot flashes as did women given a placebo.
-
Soy & red clover.
Scientists have observed that women in Asian countries, where soy is a regular part of the diet, are less likely to report
hot flashes & other menopausal symptoms than are women in other parts of the world.
One
reason might be related to isoflavones - estrogen-like compounds in soy, red clover & many other plants.
However,
studies giving soy to women with hot
flashes have generally found no benefit. And
studies giving selected isoflavones have shown mixed results for menopausal symptom relief.
Isoflavones
have some weak estrogen-like effects, so there's some concern about cancer risk. If you've had breast cancer, talk to your doctor before supplementing your diet with isoflavone pills
or red clover. Experts generally consider whole foods containing soy or isoflavones to be healthy & safe, when consumed
in moderation.
- Vitamin
E. Studies using vitamin E in doses up to 400 international units (IU) daily have found little benefit in relieving
hot flashes. Vitamin E is no longer recommended for treating hot flashes.
Take all herbal supplements
with a dose of caution. Just because manufacturers claim their products are natural doesn't mean they're safe.
All supplements have potentially
harmful side effects - & supplements may interact with medication you're taking for other medical conditions.
Always
review what you're taking with your doctor.
For moderate to
severe hot flashes: Prescription medication options
If you continue to have troublesome
hot flashes despite making lifestyle changes, your doctor may recommend hormone therapy or a different prescription
medication.
Estrogen therapy is the most
effective treatment for hot flashes, but in rare instances, doctors might prescribe progesterone therapy.
-
Estrogen therapy.
If you've had a hysterectomy, you may take estrogen alone. But if your reproductive organs are still intact, progesterone
should be taken along with estrogen to protect against cancer of the lining of the uterus (endometrial
cancer).
With
either regimen, current recommendations are to use the lowest effective dose for the shortest amount of time needed to relieve symptoms.
It's not easy
to assess whether the benefits of hormone therapy outweigh the risks in your particular situation - & the frequent revision
of expert recommendations hasn't helped.
For most women,
short-term hormone therapy is probably less risky than they've been led to believe since 2002, when a large clinical trial
of estrogen-plus-progesterone was stopped early due to higher than expected heart disease, stroke & breast cancer rates.
A new analysis
of data from the same trial found that heart disease risk, i.e., actually was reduced for women in their 50s who started estrogen
therapy within 10 years of the start of menopause.
Still, one
group of women - those who initiated hormone therapy more than 10 years after menopause - had increased heart disease rates
according to both analyses of the trial data.
If you experience
moderate to severe hot flashes & you haven't had blood-clotting problems, breast cancer or
ovarian cancer, estrogen therapy may be an option for you. Your doctor can help you weigh the pros & cons.
- Progesterone
therapy. Rarely, as an alternative for women who can't take estrogen, some doctors prescribe progesterone
alone to control hot flashes.
Two
such medications include megestrol acetate & depomedroxyprogesterone acetate, found to provide some relief from hot flashes among women with breast cancer or at increased risk of cancer.
If you decide against estrogen or
progesterone therapy, your doctor may suggest a different prescription medication. There are several non-hormonal medications that can be helpful for reducing hot flashes.
These medications aren't approved by the Food & Drug Administration specifically to treat hot flashes, but they're
approved for treating other conditions.
venlafaxine (Effexor):
paroxetine (Paxil):
fluoxetine (Prozac):
citalopram (Celexa):
& others:
have
been found to relieve hot flashes in some clinical trials.
Many doctors
now consider these antidepressants the treatment of choice if you have troublesome hot flashes & can't
- or choose not to - take hormone therapy.
However,
these medications aren't as effective as hormone therapy for severe hot flashes & may cause unwanted side effects,
such as:
nausea:
dizziness:
weight gain:
sexual dysfunction:
Talk with your
doctor about whether the benefits outweigh the potential side effects for you.
- Gabapentin. Gabapentin (Neurontin) is a medication approved for treating seizures or pain associated with shingles. It's also increasingly used to treat various other types
of pain. Some studies have found that gabapentin is moderately effective in reducing hot flashes.
Side effects can include:
drowsiness
dizziness
nausea
imbalance when walking & swelling
- Clonidine. Clonidine, a pill or patch typically used to treat high blood pressure, may provide some relief from hot flashes. Side effects such as dizziness, drowsiness, dry mouth & constipation are common, sometimes
limiting the medication's usefulness for treating hot flashes.
Re-evaluate your options regularly
Menopause is a natural transition.
If hot flashes don't interfere with your life, you don't need treatment. If you choose to take medication or a supplement to help ease your symptoms, periodically re-evaluate your need for continuing it.
For most women, hot flashes
fade gradually & require no treatment.
source: mayo clinic
Bioidentical hormones: Are they safer?
Are bioidentical hormones safer & more effective than traditional hormone therapy? They sound like they would be because they're customized to the individual.
Answer
There's a lot of interest in bioidentical
- or so-called "natural" - hormone therapy for menopause symptoms.
However, there's no evidence that
bioidentical hormones are safer or more effective than standard hormone replacement therapy.
Bioidentical hormones are custom-mixed
formulas containing various hormones that are chemically identical to those naturally made by your body.
These prescription & over-the-counter
products are marketed as being tailored to a woman's individual hormone needs, typically determined thru saliva hormone
testing.
Manufacturers claim that bioidentical
hormones are safer than standard, FDA-approved hormone therapy.
According to the North American Menopause
Society (NAMS), custom compounds may provide certain benefits, such as individualized doses & mixtures of products
& forms that aren't available commercially.
However, they may also pose risks
to consumers. These compounds haven't been approved by the Food & Drug Administration (FDA) & as a result haven't
been tested for purity, potency, efficacy or safety.
These products may even contain unknown
contaminants. For this reason, NAMS doesn't recommend these custom-mixed products over well-tested, government-approved commercial
products for the majority of women.
Also, bioidentical estrogen &
progesterone are available in FDA-approved hormone therapy products, including:
- Estradiol, such as Estrace, Climara patch & Vivelle-Dot patch
- Natural progesterone (Prometrium)
These products come in many different
doses & forms. So, you don't need to turn to unregulated, individually compounded products as your only source of "natural"
hormones.
source: mayo clinic
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