Disease: Alternative Treatments for Hot Flashes of Menopause

Alternatives for treating hot flashes facts

  • Each woman experiences menopause differently. Treatment, if necessary, is directed toward  particular symptoms that are present.
  • Hot flashes are experienced by many but not all women undergoing menopause. A hot flash is a feeling of intense warmth, sometimes associated with flushing, that spreads over the body and may be accompanied by perspiration.
  • Often it is not simple to determine if a given symptom is due to menopause. A physician should be consulted regarding symptoms that are new or of unknown cause.
  • While "natural" menopause remedies may be effective, there is a lack of research on the safety and effectiveness of many of these remedies. Side effects of prescription remedies are generally better understood than those of over-the-counter medications and "natural" treatments or remedies.
  • The most effective treatment for hot flashes is estrogen. However, the risks and benefits of this therapy must be carefully considered by a woman and her physician.
  • Other prescription medications, including SSRIs and SNRIs, may also be effective in relieving hot flashes.
  • Non-prescription products that have been used to treat hot flashes include phytoestrogens (plant estrogens), black cohosh, and vitamin E. However, studies that attest to their effectiveness and long-term safety are incomplete or lacking.

Introduction to menopause and hot flashes

Women frequently ask what symptoms they can anticipate during menopause. In reality, each woman experiences menopause differently. Some women have changes in several areas of their lives. It is not always possible to tell if these changes are related to aging, menopause or both. While one woman is certain that insomnia is a menopause symptom for her, another feels joint aches are her primary menopause symptom. Doctors find it difficult to communicate to their patients about menopause and what could be a host of uncomfortable symptoms. For example, medical science cannot explain how declining hormone levels during menopause could cause joint pain.

Menopause is not an illness, but a natural transition when a woman's reproductive ability ends. Yet many of the menopausal symptoms may mimic signs caused by diseases. When do women undergoing menopause need treatment in the first place? The same pattern of hot flashes in two women can have a very different psychological impact. For one woman, they can greatly disturb her daily functioning, but for another, while another may hardly be bothered.

What are hot flashes?

Hot flashes are experienced by many women, but not all women undergoing menopause have this experience. A hot flash is a feeling of warmth that spreads over the body, but is often most strongly felt in the head and neck regions. Hot flashes may be accompanied by perspiration or flushing. On average, they usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, they are thought to be due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels. What is known is they can vary in severity, frequency, and duration.

"About 70 percent of women experience hot flashes, but their underlying physiology isn't well understood," said Rebecca Thurston, an assistant professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh.

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

How are hot flashes usually treated?

Traditionally, hot flashes have been treated with oral (by mouth) or transdermal (patch) forms of estrogen. Hormone therapy (HT), also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens or a combination of estrogens and progesterone (progestin). Oral and transdermal estrogen are available as estrogen alone or estrogen combined with progesterone. Whether oral or transdermal, all available prescription estrogen replacement medications are effective in reducing hot flash frequency and severity.

However, long-term studies (NIH-sponsored Women's Health Initiative, or WHI) of women receiving oral preparations of combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

The decision in regard to starting or continuing hormone therapy, therefore, is a very individual choice in which the patient and doctor must take into account the inherent risks and treatment benefits, plus each woman's own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

Which alternative prescription medications are effective in treating hot flash symptoms of menopause?

A few prescription medications, in addition to estrogen, can provide relief for hot flashes. While none of these drugs is as effective as estrogen, studies show that non-estrogen drugs may have up to 70% of the effectiveness of estrogen therapy when treating hot flashes.

  1. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs): This class of medication is used to treat depression and anxiety. In clinical studies, however, low doses of SSRIs and SNRIs have been shown to be effective in decreasing menopausal hot flashes. The SNRI that has been tested most extensively is venlafaxine (Effexor), although there is also evidence showing that the SSRIs paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac) can be effective in controlling hot flashes.
  2. Clonidine: Clonidine (Catapres) acts in the brain to decrease blood pressure. It has a long history of being used for blood pressure control, but it has potentially annoying side effects, such as dry mouth, constipation, drowsiness, or difficulty sleeping. Clonidine effectively relieves hot flashes in some women but is completely ineffective in others. Clonidine is available in pill or patch form.
  3. Megestrol acetate (Megace): This medication is a type of progesterone, a female hormone. It can be effective in relieving hot flashes, but can only be taken over the short term (for several months). Serious effects can occur if the medication is abruptly discontinued, and megestrol is not usually recommended as a first-line drug to treat hot flashes. Megestrol use can also lead to weight gain.
  4. Studies of another form of progesterone, medroxyprogesterone acetate (Depo-Provera), which is administered by injection, has also been useful in treating hot flashes. This drug can be used long-term but may have side effects that include weight gain and bone loss.
  5. Gabapentin: Gabapentin (Neurontin) is a drug that is primarily used for the treatment of seizures that appears to be moderately effective in treating hot flashes. The drug is well tolerated by most women, but often causes drowsiness.

Why are some doctors reluctant to recommend nonprescription therapies for menopause symptoms?

Nonprescription products such as herbal supplements are not controlled by the FDA because they are considered food supplements by law. Because they are not regulated like prescription medications, their ingredients and potency vary from manufacturer to manufacturer, and even from bottle to bottle from the same manufacturer. Also, careful testing and proof of safety is not required as it is with prescription medications. (The only way the FDA can recall a nonprescription product is by proving that it is dangerous.) Furthermore, there are so many nonprescription products available that a doctor cannot possibly know exactly what is in each preparation. Moreover, not one of these products has been scientifically proven to be safe or effective.

So, how well have the nonprescription alternatives to hormone therapy been tested? Not one study has adhered to all of the stringent requirements that are necessary for approval of prescription medicines.

  1. Specifically, sugar pills (placebos) have not been included in many studies of nonprescription alternative medications. Therefore, it is not possible to know if the product worked at all, since any effects seen with the product might have been seen with a placebo.
  2. Many studies evaluated women who were taking products without supervision. Obviously, these women were aware that they were taking something to improve their symptoms. Thus, the element of objectivity was eliminated, and bias was introduced.
  3. Most available studies have been carried out for only a few months. Physicians do not want to recommend a product that hasn't been proven safe over the long-term.
  4. Lastly, each study seems to have a different way of judging whether the medication helps. Some analyze hot flashes alone, while others evaluate a group of symptoms without specifically segregating out hot flashes. Other studies examine multiple but individual symptoms. Even the studies that evaluate hot flashes may record different factors; the number of hot flashes per day, the severity of the hot flashes, or the duration of the hot flashes, etc.

What are hot flashes?

Hot flashes are experienced by many women, but not all women undergoing menopause have this experience. A hot flash is a feeling of warmth that spreads over the body, but is often most strongly felt in the head and neck regions. Hot flashes may be accompanied by perspiration or flushing. On average, they usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, they are thought to be due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels. What is known is they can vary in severity, frequency, and duration.

"About 70 percent of women experience hot flashes, but their underlying physiology isn't well understood," said Rebecca Thurston, an assistant professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh.

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

How are hot flashes usually treated?

Traditionally, hot flashes have been treated with oral (by mouth) or transdermal (patch) forms of estrogen. Hormone therapy (HT), also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens or a combination of estrogens and progesterone (progestin). Oral and transdermal estrogen are available as estrogen alone or estrogen combined with progesterone. Whether oral or transdermal, all available prescription estrogen replacement medications are effective in reducing hot flash frequency and severity.

However, long-term studies (NIH-sponsored Women's Health Initiative, or WHI) of women receiving oral preparations of combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

The decision in regard to starting or continuing hormone therapy, therefore, is a very individual choice in which the patient and doctor must take into account the inherent risks and treatment benefits, plus each woman's own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

Which alternative prescription medications are effective in treating hot flash symptoms of menopause?

A few prescription medications, in addition to estrogen, can provide relief for hot flashes. While none of these drugs is as effective as estrogen, studies show that non-estrogen drugs may have up to 70% of the effectiveness of estrogen therapy when treating hot flashes.

  1. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs): This class of medication is used to treat depression and anxiety. In clinical studies, however, low doses of SSRIs and SNRIs have been shown to be effective in decreasing menopausal hot flashes. The SNRI that has been tested most extensively is venlafaxine (Effexor), although there is also evidence showing that the SSRIs paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac) can be effective in controlling hot flashes.
  2. Clonidine: Clonidine (Catapres) acts in the brain to decrease blood pressure. It has a long history of being used for blood pressure control, but it has potentially annoying side effects, such as dry mouth, constipation, drowsiness, or difficulty sleeping. Clonidine effectively relieves hot flashes in some women but is completely ineffective in others. Clonidine is available in pill or patch form.
  3. Megestrol acetate (Megace): This medication is a type of progesterone, a female hormone. It can be effective in relieving hot flashes, but can only be taken over the short term (for several months). Serious effects can occur if the medication is abruptly discontinued, and megestrol is not usually recommended as a first-line drug to treat hot flashes. Megestrol use can also lead to weight gain.
  4. Studies of another form of progesterone, medroxyprogesterone acetate (Depo-Provera), which is administered by injection, has also been useful in treating hot flashes. This drug can be used long-term but may have side effects that include weight gain and bone loss.
  5. Gabapentin: Gabapentin (Neurontin) is a drug that is primarily used for the treatment of seizures that appears to be moderately effective in treating hot flashes. The drug is well tolerated by most women, but often causes drowsiness.

Why are some doctors reluctant to recommend nonprescription therapies for menopause symptoms?

Nonprescription products such as herbal supplements are not controlled by the FDA because they are considered food supplements by law. Because they are not regulated like prescription medications, their ingredients and potency vary from manufacturer to manufacturer, and even from bottle to bottle from the same manufacturer. Also, careful testing and proof of safety is not required as it is with prescription medications. (The only way the FDA can recall a nonprescription product is by proving that it is dangerous.) Furthermore, there are so many nonprescription products available that a doctor cannot possibly know exactly what is in each preparation. Moreover, not one of these products has been scientifically proven to be safe or effective.

So, how well have the nonprescription alternatives to hormone therapy been tested? Not one study has adhered to all of the stringent requirements that are necessary for approval of prescription medicines.

  1. Specifically, sugar pills (placebos) have not been included in many studies of nonprescription alternative medications. Therefore, it is not possible to know if the product worked at all, since any effects seen with the product might have been seen with a placebo.
  2. Many studies evaluated women who were taking products without supervision. Obviously, these women were aware that they were taking something to improve their symptoms. Thus, the element of objectivity was eliminated, and bias was introduced.
  3. Most available studies have been carried out for only a few months. Physicians do not want to recommend a product that hasn't been proven safe over the long-term.
  4. Lastly, each study seems to have a different way of judging whether the medication helps. Some analyze hot flashes alone, while others evaluate a group of symptoms without specifically segregating out hot flashes. Other studies examine multiple but individual symptoms. Even the studies that evaluate hot flashes may record different factors; the number of hot flashes per day, the severity of the hot flashes, or the duration of the hot flashes, etc.

Source: http://www.rxlist.com

Hot flashes are experienced by many women, but not all women undergoing menopause have this experience. A hot flash is a feeling of warmth that spreads over the body, but is often most strongly felt in the head and neck regions. Hot flashes may be accompanied by perspiration or flushing. On average, they usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, they are thought to be due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels. What is known is they can vary in severity, frequency, and duration.

"About 70 percent of women experience hot flashes, but their underlying physiology isn't well understood," said Rebecca Thurston, an assistant professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh.

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

Source: http://www.rxlist.com

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