Women bothered by hot flashes or other effects of menopause have a number of
treatment options - hormonal or not, according to updated guidelines from the
American College of Obstetricians and Gynaecologists.
It's estimated that anywhere from 50% to 82% of women going through
menopause have hot flushes sudden feelings of extreme heat in the upper body
and night sweats.
For many, the symptoms are frequent
and severe enough to cause sleep problems and disrupt their daily lives. And
the duration of the misery can last from a couple years to more than a decade,
says the college, the nation's leading group of ob/gyns.
"Menopausal symptoms are common, and can be very bothersome to
women," said Dr Clarisa Gracia, who helped write the new guidelines.
"Women should know that effective treatments are available to address
Hot flushes and effective help
The guidelines, published in the January issue of Obstetrics &
Gynecology, reinforce some longstanding advice: Hormone therapy, with oestrogen
alone or oestrogen plus progestin, is the most effective way to cool hot
But they also lay out the growing evidence that some antidepressants can
help, said Gracia, an associate professor of obstetrics and gynaecology at the
University of Pennsylvania in Philadelphia.
In studies, low doses of antidepressants such as venlafaxine (Effexor) and
fluoxetine (Prozac) have helped relieve hot flashes in some women. And two
other drugs the anti-seizure drug gabapentin and the blood pressure
medication clonidine can be effective, according to the guidelines.
Hormone replacement therapy fear
So far, though, only one non-hormonal drug is actually approved by the US
Food and Drug Administration for treating hot flashes: a low-dose version of
the antidepressant Paroxetine (SA brand names Aropax. Deparoc, Parax or Paxil).
And experts said that while there is evidence some hormone alternatives ease
hot flushes, none works as well as oestrogen and oestrogen-progestin.
"Unfortunately, many providers are afraid to prescribe hormones. And a
lot of the time, women are fearful," said Dr Patricia Sulak, an ob/gyn at
Scott & White Hospital in Temple, Texas, who was not involved in writing
the new guidelines.
Years ago, doctors routinely prescribed hormone replacement therapy after
menopause to lower women's risk of heart disease, among other things. But in
2002, a large US trial called the Women's Health Initiative found that women
given oestrogen-progestin pills actually had slightly increased risks of blood
clots, heart attack and breast cancer.
"Use of hormones plummeted" after that, Sulak noted.
But research since then has suggested that hormone therapy is safer for
relatively younger women who start using it soon after menopause, the report
notes. Women in that landmark study were in their early 60s, on average whereas
US women typically hit menopause at around age 51.
Experts now say that women should not take hormones to prevent any chronic
ills. But when it comes to hot flushes, hormone therapy remains the most
Another ob/gyn agreed that doctors and women alike are often reluctant to
consider hormones. "Since the [Women's Health Initiative], we've been like
little fishes swimming upstream," said Dr Jill Rabin, of Long Island
Jewish Medical Centre in New Hyde Park, NY.
To help minimise any risks, she said, it's important to keep the hormone
dose at the lowest level needed to relieve a woman's symptoms.
Sulak agreed. "I'm an oestrogen minimalist," she said. "I'm
going to start you at a low dose, and that's enough for most women."
Women who should not try hormones, she noted, include those who've ever had
breast cancer or a blood clot.
Hot flashes and night sweats are the most common menopause complaint. But
vaginal dryness and pain during sex are also issues for many women.
Read: How to survive your wife's menopause
Benefits and risks of an individual
The guidelines say that oestrogen applied directly to the vagina in the form
of creams, tablets or rings is effective. "Very little" of that oestrogen
gets into the bloodstream, Sulak said, so the risk of side effects is
And just this year, the FDA approved a new option for treating painful sex
in postmenopausal women. It's a pill called ospemifene (Osphena), and it has oestrogen-like
effects on the lining of the vagina.
As for "natural" remedies, such as soy and black cohosh, studies
have failed to prove they're effective for hot flashes and night sweats, the
However, Rabin said that some women who try supplements do feel better even
if it's by a "placebo effect."
There are some "common sense" tactics any woman can use to help
ease hot flashes, the guidelines say. Those include dressing in layers, keeping
the thermostat lower at home and drinking cool beverages.
But for women who need more than that, Gracia advised talking to your doctor
about the benefits and risks of all your options. "Therapy should be
individualised, since one therapy may not be optimal for all women."Read more