Diseases

Treatment, Hot Flashes (Hot Flashes) Information

Bioidentical hormone therapy for hot flashes

There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.Advocates of bioidentical hormone therapy argue that the products, applied as creams or gels, are absorbed into the body in their active form without the need for "first pass" metabolism in the liver, and that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.

Black cohosh for hot flashes

Black cohosh is an herbal preparation that is becoming more and more popular in the U.S., and the North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms, for a period of up to six months (because of its relatively low incidence of side effects when used over the short-term).Some studies have shown that black cohosh can reduce hot flashes, but most of the studies have not been considered to be rigorous enough in their design to firmly prove any benefit. There also have not been scientific studies done to establish the long-term benefits and safety of this product. Research is ongoing to further determine the effectiveness and safety of black cohosh.

Hormone therapy for hot flashes

Traditionally, hot flashes have been treated with either oral or transdermal (such as a patch) forms of estrogen. Hormone therapy (HT) or postmenopausal hormone therapy (PHT), formerly referred to as hormone replacement therapy (HRT), consists of estrogens alone or a combination of estrogens and progesterone (progestin). All available prescription estrogen medications, whether oral or transdermal, are effective in reducing the frequency of hot flashes and their severity. Research indicates that these medications decrease the frequency of hot flashes.However, long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving 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 hormone therapy. 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.More recently, it has been noted that the negative effects associated with hormone therapy were described in older women who were years beyond menopause, and some researchers have suggested that these negative outcomes might be lessened or prevented if hormone therapy was given to younger women (prior to or around the age of menopause) instead of women years beyond menopause.The decision in regard to starting or continuing hormone therapy, therefore, is an individual one in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with 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.

Hot flashes definition and facts

• Hot flashes are feelings of warmth that spread over the body and last from 30 seconds to a few minutes.
• Hot flashes may be accompanied by redness of the skin, known as flushing, and excessive sweating.
• Hot flashes are a characteristic symptom of the menopausal transition (perimenopause, menopause, and postmenopause) in women, but may occasionally result from other medical conditions.
• About 70% of women will experience hot flashes at some point in the menopausal transition.
• Hot flashes in men, young women, or during pregnancy may be due to medical conditions that interfere with the body’s ability regulate temperature.
• Hot flashes may be treated by hormone therapy or other medications if necessary.
• Natural home remedies for hot flashes have been proposed and may provide relief for some women; the effectiveness of other alternative treatments has not been adequately scientifically evaluated.

Other prescription drug treatments for hot flashes

• The selective serotonin reuptake inhibitor (SSRI) medications have been shown be effective in reducing menopausal hot flashes. These drugs are generally used in the treatment of depression and anxiety as well as other condition. Paroxetine (Brisdelle) is an SSRI approved to treat moderate to severe hot flashes associated with menopause.
• Clonidine (Catapres) is an anti-hypertensive drug that can relieve hot flashes in some women. Clonidine is taken either by pill or skin patch and decreases blood pressure. Side effects of clonidine can include dry mouth, constipation, drowsiness, or difficulty sleeping.
• Gabapentin (Neurontin), a drug primarily used for the treatment of seizures, has also been effective in treating hot flashes.
• Megestrol acetate (Megace) is a progestin that is sometimes prescribed over a short-term to help relieve hot flashes, but this drug is not usually recommended as a first-line treatment for hot flashes. Serious side effects can occur if the medication is abruptly discontinued. Megestrol may have the side effect of weight gain.
• Medroxyprogesterone acetate (Depo-Provera) is another progestin drug and is administered by injection to treat hot flashes. It may lead to weight gain as well as bone loss.

Other vitamins, herbs, and supplements

There are many other supplements and substances that have been used as treatments for symptoms of menopause such as hot flashes, including:

• vitamin E,
• licorice,
• evening primrose oil,
• dong quai,
• chasteberry, and
• wild yam.

Soy and other plant sources for menopause symptoms

Isoflavones are chemical compounds found in soy and other plants (such as chick peas and lentils) that are phytoestrogens, or plant-derived estrogens. They have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been determined to be much lower than true estrogens.Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy (HT) with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined.There is also a perception among many women that plant estrogens are "natural" and therefore safer than hormone therapy, but this has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.