Drug Treatments for Hot Flashes

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By: , SparkPeople Blogger
5/11/2011 5:33 AM   :  21 comments   :  8,775 Views

Editor's Note: Cathy Cram, M.S., is the resident maternal fitness expert on our sister site, BabyFit.com. She blogs monthly on the topics of menopause, health and fitness.

By Cathy Cram, M.S.

This is the third blog in the series on menopause hot flash treatments. In this blog, weíll explore the medical treatments that can help reduce hot flashes, and the controversy surrounding one of the most effective treatments, hormone treatment (HT, also termed HRT for hormone replacement therapy).

Hormone Treatment
Hormone treatment for menopause has been around for decades and has been used to treat premenopausal women after hysterectomy with oophorectomy (removal of the uterus and ovaries, respectively). In those women, without hormone replacement, they would go into a surgical menopause and experience increased bone weakening. HT has also been used in the treatment of menopausal symptoms and is one of the most effective treatments for reducing hot flashes.

The usual HT prescribed to menopausal women who have their ovaries and uterus is a combination of some type of estrogen plus progestin (a synthetic form of progesterone). The progestin is added because estrogen by itself causes the uterine lining to thicken, and without progesterone initiating the sloughing off of the lining, thereís an increased risk of uterine cancer. Women who have had a hysterectomy donít need the additional progesterone and are given estrogen-only HT.

In 1993, the Womenís Health Initiative (WHI) was designed to determine the risks and benefits of treatments given to reduce heart disease, breast and colorectal cancer, and fractures in postmenopausal women. Among several sets of clinical trials within WHI was a study on the effect of HT on these diseases. There was an estrogen-only hysterectomy group, which took Premarin (conjugated estrogen-a combination of estrogen hormones), the Prempro group (conjugated estrogen plus progestin) and a group that didnít take any HT.

The study included 161,809 women who were followed over time, with a projected first report on study results to be issued in 2006. Instead, the Prempo portion of the study was halted in 2002 because of a surprising increase in the number of breast cancers, strokes, heart disease and dementia in the estrogen and progestin arm of the study as compared with the other groups.

The halt in the study caused a large number of menopausal and postmenopausal women to stop taking HT, and many suffered from hot flashes and other menopausal symptoms that diminished their quality of life. There has been quite of lot of discussion about the WHI study results, and recent findings regarding possible breast cancer risk reduction in women who took estrogen only have been in the news, but itís too soon to make any definitive conclusions about this recent finding. Most health-care providers recommend that menopausal women avoid HT if possible, although some are easing their recommendation for women who have severe hot flashes and are prescribing HT in low doses for short periods of time.

Itís important to note that there are several types and sources of estrogen and progesterone used in HT, as well as methods of delivery. There hasnít been enough literature to conclusively say whether one type of hormone or delivery system is more effective or less risky than another. Whether HT is chemically derived, or from whatís termed ďnatural" source, there isnít enough clinical data to support whether one is safer or effective.

There are varied methods of hormone replacement delivery methods, from oral to cream to patch. Oral HT requires that the hormones go through the digestive system, whereas patches and topical creams and gel HT treatments are absorbed directly into the blood stream. The wide variety of HT delivery systems are too numerous to list, so if you're interested in exploring this topic I recommend you check out the resources listed below, and discuss the options with your health-care provider. Some women find more effective relief and fewer side effects with one form of HT versus another, so it may take some trial and error to find a HT treatment that works for you.

I have first-hand experience with hormone replacement as Iíve used an estrogen patch (.025 microgram of estradiol) for the past two years. I had a hysterectomy at 48 and had experienced some perimenopausal symptoms prior to surgery. After surgery, I started to have more intense night sweats and noticed changes in my mood, sleep pattern and general energy level. My doctor recommended an estrogen patch to see if that would help with the symptoms.

Within several days the night sweats stopped, and I noticed a lift in my mood. Itís hard to know if the mood change was just a placebo effect, but either way, Iíll take it. Several other things Iíve noticed (in my study of one) were improvements over time with skin dryness, and reduced hair loss. The literature hasnít shown a clear correlation between hormone replacement and skin and hair health, and those issues shouldnít be a reason to start HR, but they are a welcome possible effect.

The current recommendations for HT are to take the least amount over the shortest period of time needed for severe menopausal symptoms. For some women, HR will help them during those turbulent first years of menopause, and theyíre able to wean themselves off HT after several years. For other women, the return of severe hot flashes with HR discontinuation makes it a more difficult situation. As with all medical issues, each woman needs to assess her situation, go over all the pros and cons of a treatment, and work closely with her health-care provider.

Non-Hormonal Hot Flash Drug Treatments
There are several non-hormonal drug treatments available that have been shown in studies to offer varying levels of hot flash relief. SSRIs (selective serotonin reuptake inhibitors) include a group of antidepressant drugs that have been shown to be effective in treating hot flashes. Effexor, Paxil, and Prozac are three in this class of drugs that have shown a 40% reduction in hot flashes in clinical randomized controlled studies. The dosing for hot flashes is in most cases about half the amount as used for depression.

Another drug that has been used to treat hot flashes is the blood pressure medication Catapres. In a double-blind study using Catapres, women taking the drug had a reduced frequency and number of hot flashes as compared to those taking a placebo. The drug Neurontin, used traditionally as a seizure medication, has been used with some degree of success in the treatment of hot flashes. Two double blind randomized placebo controlled studies found that women who took Neurontin had up to a 46% decrease in hot flashes as compared with the placebo group.

As with all drugs, there are varying degrees of side effects (some quite severe) that can occur with the use of these medications and HT treatments. Before you decide to use a medication for your hot flashes, do some research on the side effects, and talk with your health-care provider about whether the degree of your hot flashes is worth risk of a drug treatment.

I have found a wealth of current, clinically based information at Dr. Susan Loveís website. She is a surgeon and breast cancer expert, and her research foundation is one of the leading sites for current breast cancer information. Also helpful is the website menopause.org, a comprehensive site that provides information on menopause and symptom treatments.

Have you used any of these treatments?

Catherine Cram, M.S. is the author of Fit Pregnancy For Dummies, and the owner of Comprehensive Fitness Consulting, LLC. Catherineís company specializes in providing prenatal postpartum fitness information to health-care professionals.



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Comments

  • RAHAB1SB4
    21
    I use to take Prempro, but decide to stop. I am now taking Estroven and it seems to help. The longer I take it the more benefit I get. I sleep better, and in a better mood. Hot flashes is still there, but not as bad as it used to be. It has only been 4 weeks. - 6/25/2011   10:34:12 AM
  • 20
    I have not used any of treatments mentioned above. I do use Evening Primrose oil in a gel cap form, and my hot flashes have been completely eliminated.

    Now if I could find something that worked as well at preventing migraines! - 5/17/2011   8:50:31 AM
  • 19
    After my hysterectomy and oophorectomy, I did without hormone replacement. My transition period wasn't bad at all. I suspect that I had enough hormone stored in my fat to supply any needed. - 5/12/2011   10:58:24 PM
  • 18
    I had a complete hysterectomy 6 months ago due to acute endometriosis. I was already perimenopausal and experiencing hot flashes and night sweats, but it was awful after surgery. I'm now on Evamist which is an estrogen spray...LOVE IT!!!!! I'm on the lowest dose and quite happy there. I tried black cohosh but I might as well have been eating candy...it did nothing to relieve my symptoms. - 5/12/2011   6:26:24 PM
  • 17
    I did use estrogel, and progesterone. I was on it, for about 4 years. I thank "the powers that be", everyday, that I had this option. It worked like a charm, for all of my symptoms. When I went off, I was still in menopause, but found that, if I drank soy milk, it helped as well. I did go back on the hormones, for a year, or so....am over it, and fine now! - 5/12/2011   5:29:16 PM
  • 16
    I am so thankful that I didn't have to depend on drugs to get me through to menopause. About the time I started, I also started eating healthy and exercising. The only time I had hot flashes was when I didn't eat healthy. That's what worked for me and I'm just thankful. - 5/12/2011   11:39:19 AM
  • 15
    HRT--nope, not with history of DVT and protein-S deficiency, which requires lifetime use of warfarin
    Other drugs--don't even want to go through the maze of what FAA will allow me to take among those drugs and still fly
    Bottom line--I toughed out the worst, the ones that actually seemed to be preceded by an aura. Now the hot flashes/night sweats are milder. - 5/12/2011   8:24:05 AM
  • 14
    I, too, am trying to use herbal remedies, and so far the difference is tremendous. Time will tell.... - 5/12/2011   5:47:14 AM
  • COMPFC
    13
    Thank you for your comments ARTGIRL and I'll see if a link to my prior blogs can be added to the resources section. For now, if you take a look at the upper right hand side of this page you should see my older blogs on menopausal hot flash treatments. Hope to have the link added to my next blog.
    Cathy - 5/11/2011   9:17:03 PM
  • 12
    I am glad to read that the author has written 2 articles that cover non-pharma approaches to a natural cycle in every womans life. Thankyou for the information but where are the links to your other articles/blogs Cathy? I feel that Sparkpeople is becoming more and more an advertising tool for big business. - 5/11/2011   7:10:59 PM
  • YEEGADS
    11
    I was on Premarin for four months and developed blood clots. Went to the ER last month with clots in my lungs. Spent three days in ICU and another three in the general wing. I am off HTR permanently. They started me on Cymbalta which is an anti-depressant and is supposed help with the hot flashes. Time will tell. - 5/11/2011   5:30:19 PM
  • 10
    Just living with the hot flashes. Not a candidate for HRT due to the type of cancer cells found when I had my hysterectomy. I am not bothered during the day but how I hate the nighttime. I sleep with the fan going all night long. Oh, well. I guess it could be worse. - 5/11/2011   4:50:26 PM
  • 9
    Just entering that horrible phase now. Wow, its like having my own personal summers every hour or so. The worst it the foggy brain, the sluggishness and change in sleep pattern. Going to have my annual physical next month and will chat with the doc about the sleep pattern issue. - 5/11/2011   3:55:36 PM
  • 8
    I went into menopause at the age of 40 because of my cancer treatments; I have stage IV breast cancer, so I cannot take Premarin or anything like that. I cannot take SSRIs either because of the side effects; I have tried them, and they made me feel like a zombie. So I just have to live with the hot flashes.

    I've also tried black cohosh and that didn't do a thing for me at all. - 5/11/2011   3:06:10 PM
  • 7
    Most people opt for Premarin, since that's what most drs are familiar with. However, Ogen is a soy-based HRT, which provides phytosterols which the body uses to create estrogen and/or progesterone, as needed. Much easier on the body, much better for you, and less likely to have any of the negative side effects down the road.

    Good thing I'm allergic to horses, so I was forced to take Ogen! (generic is Estropipate, if you want to ask you dr)
    - 5/11/2011   12:13:25 PM
  • COMPFC
    6
    Just as a reminder, my first two blogs cover non-drug and alternative treatments for hot flashes. Check those blogs out if you're interested in all the options available to help reduce menopausal hot flashes.
    Cathy - 5/11/2011   11:06:48 AM
  • 5
    I am currently experiencing symptoms of peri-menopause and I'll admit I'm wary of trying "drugs". It strikes me that the side effects of some drugs are worse than the symptoms they're trying to cure. Taking hormones kinda puts me off too. I'd like to be able to get through menopause with just a healthy diet and regular exercise. However, if my symptoms get too unbearable, I'll see what my doctor suggests.

    - 5/11/2011   10:53:42 AM
  • 4
    In the past year I began to expeirence intense hot flashes and night sweats. My Doctor discouraged HRT and recommended an herbal supplement that included black cohash. Initially, the hot flashes disappeared, but after a month or so they have returned, but they are far less intense... more like warm flashes now. I think I will stick with the supplement until/unless they again began to disrupt my life. - 5/11/2011   10:39:24 AM
  • 3
    After menopause (18 years ago) I started experiencing severe hot flashes and night sweats and began HRT. When the WHI study came out my doctor and I decided to stop the HRT, but sweats and flashes returned with a vengeance and we resumed hormones at a minimal dosage. This worked fine until last summer when I was diagnosed with invasive breast cancer which tested hormone positive. After surgery and radiation I began long-term Arimadex and the hot flashes became worse than ever. I tried natural (non-plant estrogen) treatments, but nothing did the job until I went on low-dose Effexor. It didn't do away with them entirely, but turned the hot flashes into warm waves which I can deal with. I've also noticed an increase in skin dryness and a return of psoriasis (gone the entire time of HRT) - will deal with that later.

    p.s. to MEATBALL44 - Guys also experience wicked hot flashes after many Prostate Cancer treatments - you're definitely not off the hook! - 5/11/2011   9:49:21 AM
  • 2
    No but I am so glad you post this information. - 5/11/2011   9:25:36 AM
  • 1
    Geez...Glad I'm a Guy..! - 5/11/2011   8:18:10 AM

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