As many as 75% of menopausal women experience the sudden waves of body 1 heat known as hot flashes, Episodes can be mild, causing just a few moments of discomfort...or intense enough to make a woman drip with perspiration.
Hot flashes and night sweats (which come on during sleep) are triggered by fluctuating levels of the hormone estrogen, affecting a woman's inner thermostat and causing blood vessels near the skin's surface to dilate. Typically, a hot flash ends after several minutes, though it can last a half-hour or more. Episodes generally abate after a few years—but some women continue to have hot flashes for the rest of their lives.
Here's what you should know about which remedies help...which are of questionable value ...and which are downright dangerous.
Important: Before beginning any therapy, talk to your doctor about its pros and cons and how they relate to your individual risk factors.
Prescription Drugs
Estrogen is the only prescription medication currently FDA-approved specifically for hot flashes, but others can be prescribed off-label."
Most effective…
- Estrogen therapy. This reduces hot flashes by making up for a woman's own diminishing production of the hormone. It also eases other menopausal symptoms, such as mood swings, vaginal dryness, thinning skin and bone loss... and may reduce risk for hip fracture and colon cancer.
Caution: Estrogen therapy can increase risk for heart disease, stroke, blood clots, breast cancer and possibly Alzheimer's disease. The more time that has passed since a woman reached menopause and/or the longer she takes estrogen, the greater the risks may be.
Consider estrogen if: Hot flashes reduce your quality of life...you have additional menopausal symptoms. and your doctor says that you have no increased cardiovascular or breast cancer risk. If you have not had a hysterectomy, you also must take progestogen (a drug similar to the hormone progesterone) to guard against uterine cancer.
Sometimes helpful...
- Antidepressants. Selective serotonin reuptake inhibitors (SSRI), such as paroxetine (Paxil), and serotonin/norepinephrine reuptake inhibitors (SNRIS), such as venlafaxine (Effexor), may relieve hot flashes by stabilizing the body's temperature-control mechanism.
New: The manufacturer of the SNRI desvenlafaxine (Pristiq) has applied for FDA approval of the drug as a treatment for hot flashes.
SSRIs can cause weight gain, dry mouth and decreased sex drive...and may interfere with the breast cancer drug tamoxifen in some women. SNRIs can cause insomnia, dry mouth, constipation or diarrhea, and high blood pressure.
Consider an antidepressant if: You cannot or do not want to use estrogen therapy and/or hot flashes are accompanied by mood swings.
- Gabapentin (Neurontin). In one study, this antiseizure drug was as effective against hot flashes as estrogen. Side effects may include sedation and dizziness in addition to mild or widespread swelling.
Consider gabapentin if: You also have insomnia and do not have additional symptoms better treated by estrogen or antidepressants.
- Clonidine (Catapres). This blood pressure drug affects the central nervous system. In some small studies, it reduced hot flashes. Clonidine can cause dizziness, fatigue, dry mouth and constipation.
Consider clonidine if: Other therapies have failed to relieve hot flashes, and you also require treatment for high blood pressure.
Alternative Therapies
The FDA does not test herbs or dietary supplements, Nonprescription products labeled "natural" are not necessarily effective or even safe. If you try them, choose brands that have the United States Pharmacopeia (USP) seal to ensure purity.
Perhaps helpful…
- Supplements of soy, black cohosh or red clover. These have phytoestrogens, plant compounds with estrogen-like effects. Theoretically, they could ease hot flashes via the same mechanism as estrogen-but they also may carry similar risks.
Caution: Women who ought not take prescription estrogen (for instance, due to elevated risk for heart disease or breast cancer) should use these products only with their doctors' approval.
- Flaxseeds. One small Mayo Clinic study found that hot flash frequency was reduced by half in women who consumed two tablespoons of ground flaxseeds twice daily for six weeks.
Possible reason: Flaxseeds contain lignans, antioxidants with estrogenic effects. Get your doctor's approval before using. Drink lots of water with flaxseeds to prevent gas and constipation.
- Acupuncture. A few studies suggest that this is somewhat effective for hot flashes.
Best: Use an acupuncturist certified by the National Certification Commission for Acupuncture and Oriental Medicine (904-598-1005, www.nccaom.org).
Probably not helpful…
- Evening primrose oil...ginseng...vitamins B, C and E. These fared no better than placebos in studies.
Ginseng should not be used with blood thinners, stimulants or antidepressant MAO inhibitors...vitamins C and E can cause bleeding in people who take blood thinners.
- Magnets. Supporters claim that magnetic fields have healing powers. However, in an Indiana University study, sham magnets eased hot flashes better than real magnets.
Dangerous…
- Over-the-counter topical progestogen cream. Absorption varies dramatically from woman to woman. Using these without a doctor's supervision can lead to hormone imbalances.
- Dong quai. This herb can interfere with medications and it may also contain a potential carcinogen
- Kava. This herb is intoxicating and can damage the liver
- Licorice extract. In large doses, it can cause leg edema (swelling), high blood pressure and dangerously low potassium levels.
Hormone Therapy Is Hard on The Heart
Hormone therapy (HT) eases menopausal hot flashes but may raise heart attack and stroke risk.
New study: Women whose ratio of LDL (bad) to HDL (good) cholesterol was below 2.5 had no increased cardiovascular risk from HT. For women with ratios of 25 or higher, HT did magnify cardiovascular risk.
Recommended: Discuss your cholesterol ra tio with your doctor if you are considering HT.
