Hormonal Treatment of Hot Flashes Still OK for Some: Experts
TUESDAY Oct. 18, 2011 -- Women do have options when it comes to treating hot flashes and other symptoms of menopause, and these still include the short-term use of hormone replacement therapy using estrogen alone, experts conclude in a new consensus report.
"Hormone replacement therapy should be considered a very reasonable option for recently menopausal women who have moderate-to-severe hot flashes or night sweats," said Dr. JoAnn E. Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston and the current president of the North American Menopause Society (NAMS).
Hormone replacement therapy (HRT) was widely used up until 2002. That year, however, the estrogen-plus-progestin arm of the Women's Health Initiative (WHI) trial was stopped early after women who took the formulation were found to have an increased risk for heart disease, strokes, breast cancer and blood clots. Use of HRT plummeted soon after the news was announced.
However, analysis of the estrogen-only arm from the same trial showed that younger postmenopausal women who had had a hysterectomy -- could take estrogen for up to six years without significant risks.
As a result, the pendulum may be swinging back toward the use of supplemental estrogen -- in low doses and for short periods of time -- to relieve some of the symptoms of menopause. So concludes the new report, which is being released jointly by the International Menopause Society and the American Society for Reproductive Medicine.
The report was funded by the International Menopause Society and is published Oct. 18 -- International Menopause Day -- in the journal Climacteric.
According to Manson and colleagues, older women need to be more proactive when it comes to relieving the symptoms of menopause, and HRT provides the best results for treating hot flashes and night sweats. Fully 90 percent of women are symptom-free within three months of the therapy, the experts said.
Many women will see relief from symptoms and improved quality of life with estrogen, according to Manson, who is also professor of medicine at Harvard Medical School, in Boston.
However, "any woman who doesn't have symptoms of hot flashes, night sweats or other menopausal symptoms is not a candidate," Manson stressed. Other patients who would not be considered candidates for HRT are women with a history of hormone-sensitive cancers such as endometrial or breast cancer and/or a history of heart attack, stroke or blood clots in their legs, heart or lungs, she said.
In these cases, antidepressants -- such as the widely used family of selective serotonin reuptake inhibitors (SSRIs), which include Celexa, Prozac, Paxil and Zoloft -- might be used. Alternatively, the anti-seizure drug gabapentin may help relieve symptoms for some, Manson said.
"There are some non-hormonal prescription medications that are better studied now than they have been in the past and may be very reasonable options, especially for women who are not candidates for hormones or who would prefer a non-hormonal option," she added.
The report also looked at acupuncture, but found that the evidence to support its use against menopausal symptoms is mixed at best.
Dr. Lila E. Nachtigall is a professor of obstetrics and gynecology at New York University Langone Medical Center in New York City. She agreed that, when used on its own, estrogen can still be safe and effective in treating the symptoms of menopause.
"If a woman has symptoms and there is not an absolute contraindication, we should be using estrogen again," she believes. "We use the lowest dose for the shortest period of time that reaches the therapeutic goal." According to Nachtigall, that goal is typically the relief of menopausal symptoms.
Dr. Steven R. Goldstein, a professor of obstetrics and gynecology at New York University Langone Medical Center in New York City and the immediate past president of NAMS, concurred. "The estrogen-only arm of the WHI showed almost none of the harms that were seen with estrogen-and-progesterone arm," he noted.
However, that arm of WHI got very little attention, he said, and many younger women who could benefit from estrogen replacement therapy may not be getting it, Goldstein said.
"You need to look at an individual's family history and personal history, and make the most intelligent decision about their menopause treatments," he said. "There is no question that in general the harm that a lot of people associate with hormone replacement therapy is unfounded and overstated," Goldstein said.
He was much less supportive of so-called "bioidentical" hormonal therapies, which are made by compounding pharmacies and typically come from plant sources such as soy. "This is snake oil," Goldstein said, adding that, in his opinion, most bioidenticals do not have the proper ingredients in the correct amount.
Find out more about menopause at the U.S. National Library of Medicine.
Posted: October 2011