An estimated 5.6 million Canadian women will enter menopause this year. As many as 80 per cent will experience hot flashes, not to mention night sweats, mood changes and difficulty sleeping. Having been thrown into menopause myself because of chemotherapy, I more than empathize with how this can have a negative impact on quality of life.
Normal menopause occurs around age 50, but might occur as early as 45 or as late as 55. Premature menopause is deemed to occur before 40. Perimenopausal women, those who are still menstruating but have declining levels of estrogen, can experience these symptoms as well.
While most women have hot flashes for up to two years, 10 per cent will experience the symptoms for more than 10 years - a daunting prospect, indeed.
Although we know that a decrease in estrogen levels can lead to these troublesome symptoms, it is not clear what, specifically, causes hot flashes and night sweats. One possibility is that the drop in hormone levels affects the brain's temperature centre. Small changes in core body temperature might cause the hot flashes, sweating and resulting shivering (as the body cools down).
In years past, millions of women around the world turned to hormone replacement therapy (HRT) to help lessen menopause symptoms. But in July, 2002, a major U.S. study, known as the Women's Health Initiative, raised concerns about the safety of HRT; it found that women on HRT drugs had higher rates of breast cancer, heart attacks and strokes. Since then, the search has been on for non-hormone alternatives to control hot flashes and night sweats.
Some women find it helpful to stay cool by wearing lighter clothing, especially natural fibres such as cotton and linen; and to sleep with lighter bedding. Regular exercise might be helpful as well.
Diet and supplements
Diet can also help. Many women report that avoiding hot or spicy foods, caffeine and hot beverages may improve both the severity and frequency of their symptoms.
There isn't enough evidence in the medical literature to know whether dietary supplements make much difference in controlling symptoms such as night sweats and hot flashes. Isoflavone supplements - such as soy and red clover, black cohosh (at 40 milligrams a day) and vitamin E (at 800 IU a day) - have all been used with varying degrees of success. It should be noted that the safety of isoflavones in women who have hormone-dependent cancer is unknown.
Non-prescription progesterone creams, such as wild yam, also have inconclusive results. Again, hormone-dependent cancers and the use of these creams have not been studied.
Acupuncture, reflexology, evening primrose oil and ginseng are also used to try to lessen the symptoms, but there have been no research trials to determine their efficacy.
Prescription therapies include the use of a variety of antidepressants (but in lower doses than are used to treat depression). Medications - such as venlafaxine, paproxetine, fluoxetine and gabapentin - have been used with varying success rates. Adverse reactions can include dry mouth, decreased appetite and nausea.
Anti-hypertension medication, such as clonidine, is also used, but it, too, can spur adverse effects.
Many women ask about so called "bio-identical" hormones - artificial hormones made from plant matter such as soybeans or yams, and chemically identical to hormones produced by the ovaries. Some are available in well-tested prescription drugs such as estrace, along with estrogen skin patches and topical gels. But they, too, have side effects. Bio-identical hormones were not studied in the WHI study, so conclusions cannot be drawn specifically about their long-term safety.
Many patients ask about pharmacies that make their own forms of estrogen creams. These custom-compounded hormones might have some benefit, but there may be risks to users. Many of these compounds do not have government approval and have not been tested, nor are there clear guidelines for their use.
For women with intractable hot flashes, low-dose hormone therapy is still used for short periods of time. Hormone-replacement therapy remains the gold standard in terms of alleviating symptoms because it is most successful in eliminating many of the troublesome vasomotor symptoms. Despite the risks, for many women "quality of life is more important," as one reader commented in a note to me. Earlier this year, the Society of Obstetricians and Gynecologists of Canada said hormone therapy should be recommended only for use in combatting moderate to severe menopausal symptoms.
If you are one of the many, many women whose life is made difficult because of menopause, don't hesitate to talk about it with your doctor or health-care provider. You may learn ways you hadn't considered to cool those hot flashes, stop those sweats and feel a little more comfortable in your changing body.
Dr. Marla Shapiro can be seen Tuesdays on CTV's Canada AM. Questions about general health issues can be sent to her at: firstname.lastname@example.org (Please direct queries about personal health issues to your doctor.)