Flashes of frustration
The many women in menopause all wonder the same thing: Why hasn’t modern medicine figured out a manageable solution?
After a decade of hot flashes, Donna Anderson would like answers.
“I’ve tried different things,” says Anderson, a 63-year-old retired state worker who lives in Sacramento, Calif. “I can’t remember the names of all of them.
“There’s been a lot of creams I’ve used, and I’ve tried swallowing pills. … Sometimes, I think things work, and then they don’t.”
Is it hot in here?
Many of the 22 million American women already in their 50s think so. They want to know why modern medicine hasn’t managed to discover a way to cool down hot flashes, the abrupt changes in the body’s thermostat caused by hormonal fluctuations and plaguing up to 80 percent of women in menopause.
As the baby boom generation tapers to a close, another 11 million women will turn 50 within the next five years and enter prime hot flash territory, seeking answers and relief.
Scientists already know the most reliable remedy for hot flashes and other menopausal symptoms, but it’s one that scares many women: hormone therapy.
Amid wide publicity and alarming headlines almost a decade ago, the 2002 Women’s Health Initiative study was halted several years early after research showed that hormone replacement therapy – long considered a wonder cure for older women – actually raised rates of breast cancer, heart attack and stroke.
But new and more nuanced analysis of the WHI data indicates that low-dosage hormone therapy can be safe for many women in their 50s when used only a few years.
“I wonder why women with moderate to severe hot flashes suffer so much instead of using hormone treatments,” says Dr. Laurie Gregg, Sutter Medical Center chief of obstetrics and gynecology.
“It’s such a shame. Give me a couple of years, and I’ll be taking hormone therapy. That’s the most reassuring thing I can tell women.”
For most women, hormone therapy involves estrogen plus progestin, given in combination because estrogen alone can cause uterine cancer. Women who have undergone hysterectomies can take estrogen alone.
For several decades before the landmark WHI study, which involved 16,000 women with an average age of 63, hormone replacement therapy was considered something of a cure-all for women in their 60s, 70s and 80s.
“The trend was to give it to older women as a preventative therapy for a lot of things,” says Dr. Marjery Gass, a WHI principal investigator and executive director of the North American Menopause Society.
“Physicians were starting to prescribe hormones to older women not only to prevent osteoporosis but also heart disease and cognitive disorders.”
Over time, women’s health advocates raised red flags that hormones were being over-prescribed and could put older women’s health at risk. In broad strokes, the WHI results seemed to suggest they were right. And so the panic began.
“Primary care doctors got so frightened they had their front offices call every female patient they had on hormones and tell them to stop,” says Dr. David Plourd, a spokesman for the American Congress of Obstetricians and Gynecologists and assistant professor at San Diego’s Naval Medical Center.
“The repercussions of that scare continue today,” he says.
When researchers took a cooler look at the WHI data, they found that women in their 50s who took hormones had a 30 percent reduced chance of dying, while women in their 70s on hormones increased their risk of death by 14 percent.
It was the combination of age, hormones and length of time taking them, rather than just the hormones themselves, that caused the alarming spikes in other diseases.
Scientists found that birth control pills, which contain higher doses of hormones, have 10 times the risk of causing blood clots as hormone therapy. Pregnancy has 40 times the risk.
And a woman’s chance of developing breast cancer increases only slightly after five years on hormone treatment, researchers said.
Even so, doctors continue to caution against hormone therapy for younger women with a history of blood clots, liver disease and breast cancer.
“Low-dosage hormones are quite safe for women in their 50s who don’t have contraindications, and they can be taken for several years,” says Gass. “Hormones will definitely improve the hot flash situation.”
Does that mean the pendulum has swung back in the other direction for hormone therapy? Not so fast. For women at midlife, the choices remain complex.
As a result of the WHI study, millions of women continue to abandon hormones altogether, preferring to wade through hot flashes as best they can with alternative therapies, lifestyle changes and hope.
They lower the thermostat and carry personal fans. They cut out potential triggers – hot coffee, red wine and spicy food, for example – and hope that helps. They try acupuncture to ease the heat.
And they pray for a night’s sleep uninterrupted by hot flashes.
“I have friends who’ve sweated through their nightgowns and have to change the sheets in the middle of the night,” says Karen Huff, 53, who works for a Chico, Calif., nonprofit and writes “The Menopause Diaries” blog.
Recent studies have shown that some antidepressants can reduce hot flashes by up to 60 percent.
But researchers have found mixed results for a slew of alternative remedies – everything from soy to flaxseed to black cohosh – although as Gregg points out, a placebo effect of 30 percent means that a lot of women will find relief in them anyway.
“Yes, there are alternative treatments,” says Plourd. “But nothing rivals estrogen for being as effective in treating hot flashes.”
Meanwhile, other research suggests that women who have hot flashes early in menopause are less likely to suffer heart problems later in life. And scientists say that going through hot flashes in the 50s could halve a woman’s lifetime chance of developing breast cancer.
That’s a ray of good news for Anderson, who after 10 years of hot flashes still has at least one a month.
“It can happen washing dishes with my hands in the hot water,” she says. “I go to tai chi, and the instructor will tell the class, ‘Your body is getting warm.’ That will set it off for me, just the suggestion.”