Going Through Menopause? There Are Many Therapies That Can Help Reduce Hot Flashes

By Susan Stevens Daily Herald Health Writer

If you are a menopausal woman who must face a board room – or a class of seventh-graders – hot flashes can be a major source of anxiety.

For years the best relief came from hormone therapy, but many women were turned off the pills when studies emerged showing they increased the risk of stroke, heart attack and breast cancer.

More recent research has doctors suggesting hormones again, but in lower doses. Women also have a host of other alternatives, from acupuncture to antidepressants. We asked a few experts to lay out the options.

Lifestyle changes

Anything that cools your body can help relieve a hot flash. Doctors recommend layered clothing, ice on your neck or wrist, fans, air conditioning or cool drinks. Regular exercise can be effective. You should also do your best to avoid triggers such as hot drinks, spicy food, stress and warm rooms.

Relaxing activities such as yoga, massage, meditation and leisurely baths might also help, said Dr. JoAnn Pinkerton, professor of obstetrics and gynecology at University of Virginia and a board member of the North American Menopause Society.

Paced respiration – deep breathing for about 20 minutes, three times a day – also has been shown to alleviate hot flashes, Pinkerton said.

Hormone alternatives

The placebo effect with hot flashes can be as much as 30 percent to 50 percent, which leaves a high threshold for treatments to prove effective.

Black cohosh (usually 20 mg three times a day) is probably the most effective herbal supplement for treating hot flashes, though it hasn’t been as successful in recent studies. It’s also not effective for long, said Dr. Barbara Soltes, a reproductive endocrinologist at Rush University Medical Center in Chicago.

“It’s really only effective about six months at a time,” she said. “Then the woman will have to stop and give the body a rest.”

Vitamin E supplements, at 400 to 800 IU a day, have been shown to eliminate one hot flash per day, Pinkerton said.

The evidence on soy is mixed. Soltes believes that’s because the American diet has so little soy compared to Asian diets.

“It’s not a regular part of our diet, and just taking a little supplement probably is not enough,” Soltes said.

Acupuncture has also been proven to alleviate hot flashes in menopausal women. In one study, women who had acupuncture went from an average of seven hot flashes a day to three per day, Pinkerton said. Women who took estrogen, in comparison, went from eight hot flashes to less than one. Neurontin, another drug sometimes used to treat hot flashes, reduced hot flashes by two per day.

Women who got no treatment didn’t get any better.

Nonhormone drugs

Neurontin, or gabapentin, is an antiseizure medication that can reduce hot flashes by 50 percent, Pinkerton said. Side effects include dizziness and drowsiness.

Antidepressants, including Effexor and Paxil, can shut down hot flashes in addition to improving mood, Soltes said.

Clonidine, which is usually used to treat high blood pressure, is effective in alleviating hot flashes, Soltes said.

“We see the body temperature go down and the changes in the metabolic rate go down,” she said.

Because it’s a hypertension drug, its side effect is obvious: low blood pressure, which can cause dizziness, drowsiness and constipation.

“We know that it has to be something going on in the central nervous system that has to trigger hot flashes,” Soltes said. “Certain medications act in this system, and that’s why we have found a few alternatives.”

Hormonal treatments

When scientists halted the Women’s Health Initiative in 2002, thousands of women quit hormone therapy. Hormones were supposed to protect menopausal women from heart attacks and bone loss; instead they increased the risk of blood clots, heart attacks and breast cancer.

But that study involved women with an average age of 63. Newer studies have found hormone therapy is safer for women just entering menopause, in their 40s and 50s. Lower doses also appear to be safer.

Instead of prescribing estrogen to all menopausal women to protect their health, doctors now use it judiciously.

“We found that lower doses may be equally effective, and the current recommendations are for the lowest effective dose for the shortest period of time,” Pinkerton said.

Estrogen is effective; studies show it works 85 percent of the time, compared to 65 percent for antidepressants. Choosing the right approach depends on a woman’s individual circumstances, doctors said.

“I think short-term use of a low-dose of estrogen may have some risks associated with it, but everything has risk, and it kind of depends on how disruptive hot flashes are to a woman’s life,” said Dr. Marcie Richardson, an obstetrician/gynecologist at Harvard Vanguard Menopause Consultation Service in Boston, Mass.

Bioidentical hormones are heavily marketed as a safer alternative, but there is no evidence to support that claim, Pinkerton said.

sstevens@@dailyherald.com

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