health & wellness
Hope For Hot Flashes
Local doctors offer varied solutions for minimizing symptoms.
Hormone Therapy
Ruthan Brodsky
I Contributing Editor
lushed faces, sweat beads on
foreheads, car windows open in
winter and the hum of the hand-
held fan — all signs of women having hot
flashes.
Hot flashes are symptoms of perimeno-
pause and menopause. These short and
recurring episodes of intense heat are
reported by 75 percent of premenopausal
and menopausal women in the United
States. That's 45 to 50 million women who
may be sticking their head and shoulders
in open freezer doors when a flash occurs.
Perimenopause generally begins when
a woman's menstrual periods are incon-
sistent.
"Perimenopause is an
extended transitional
state and can last for
years, but menopause is
an exact point in time
says Dr. Robert Robins, a
gynecologist/obstetrician
in Bloomfield Hills. "The
Dr. Robert
premenopausal phase
Robins
usually begins several
years before menopause
as the ovaries gradually produce less estro-
gen. This usually starts in the 40s, but
some women start in their 30s.
"The average of length of perimeno-
pause is four years. At that point, when the
ovaries stop releasing eggs and a woman
hasn't had a period in 12 months, is when
menopause actually begins"
F
Avoiding Hot Flashes
"Hot flashes are often brought on by spe-
cific triggers" explains Dr. Jeffrey Obron,
a gynecologist/obstetrician and certified
menopausal clinician in West Bloomfield.
"Avoiding triggers, such as stress, alcohol,
caffeine, spicy foods and hot showers, may
reduce the number of hot flashes and their
intensity for some women.
"Other natural behaviors
that work for some
women are keeping the
core body temperature
down by wearing clothes
made of wicking materi-
al, keeping cool water at
their bedside and using
Dr. Jeffrey
air conditioning or ceil-
Obron
ing fans" Obron says.
"Maintaining an ideal
weight also helps because obese women
tend to have a higher incidence of hot
flashes:'
46 October 31 • 2013
JN
Just over a decade ago, millions of
American women were using
combination hormone
replacement therapy (HRT)
to help manage their
menopausal symptoms.
That changed
in 2002, when
scientists at the
National Institutes
of Health (NIH) halted
the Women's Health
Initiative (WHI) study in
which women were taking
combination estrogen and
progestin. Data showed
that those women were
at increased risk of breast
cancer, heart attack, stroke and
blood clots. Millions of women
tossed their HRT prescriptions in
the garbage.
"Use of hormone therapy
changed when that large clini-
cal trial found that the treat-
ment actually posed more health risks
than benefits, especially when given to
older postmenopausal women" says Dr.
Robert Goldfarb, senior staff physician,
Women's Health Services at Henry Ford
West Bloomfield.
"Doctors stopped prescribing the ther-
apy as the concern about health hazards
grew"
Then, in 2004, NIH also stopped the
estrogen-only study for women who had
undergone a hysterectomy. Data showed
that this increased the risk of blood clots
and stroke and did not reduce the risk of
heart attacks for these women.
The WHI study is large and compli-
cated and often resulted in patient and
medical confusion. The saga of HRT has
gone from "hormone therapy is good
for all women" back in the 1990s to "it's
bad for all women" after 2002. After a
reappraisal of the study, the results are
now broken down by age and time since
menopause, positioning the benefits of
HRT somewhere in the middle.
"The recommendation is not to use
hormones for long-term chronic disease
prevention because of the increased risk
of clots and stroke Goldfarb says.
"However, they should be considered
for treating younger women with moder-
ate to severe symptoms of menopause
and whose quality of life has diminished
because of severe hot flashes and other
menopausal symptoms"
Hormonal Options
"There are several types of
estrogen therapy used in dif-
ferent forms" says Dr. Deborah
Charfoos, Michigan Women's
Health Staff, Beaumont Hospital
in Royal Oak. "The type used depends
upon the health, symptoms and per-
sonal preference of the individual.
"Oral medication, pills,
is the common form of
Estrogen Replacement
Therapy (ERT), reducing
hot flashes and other
menopausal symp-
toms" Charfoos
says. "However,
there's still the risk
of strokes and blood clots
when taken long term. Estrogen
patches pose most of the same risks.
Estrogen gels, creams and sprays
are absorbed through the skin
directly into the bloodstream
making them safer than pills
for people with liver problems.
"The key is balancing the risks of taking
hormone therapy against the benefits of
not taking a hormone she says. "Patients
and their doctors need to work together to
figure out which therapy works best"
Obron says, At times a good compound
pharmacy may be useful, especially when
a physician decides that a particular drug
is not appropriate for a patient or the
patient requires a medication tailored to
her special medical needs. They provide
custom products with individualized
doses and mixtures of products prescribed
by the doctor"
Robins adds, "Another option for
hormone therapy is the bioidentical
hormones therapy (estradiol and proges-
terone) approved by the FDA. These are
hormones biochemically identical to the
body's own hormones that are custom
compounded"
Nonhormonal Options
"The U.S. Food and
Drug Administration
recently approved the
drug Brisdelle for the
treatment of hot flashes
due to menopause
Charfoos says. "This is
•
the first non-hormonal
Dr. Deborah
treatment to be
Charfoos
approved by the FDA for
hot flashes associated
with menopause. Brisdelle contains a
selective serotonin reuptake inhibitor,
making it unique from
all other FDA-approved
treatment for hot flashes
that contain hormones"
Goldfarb says, "Another
option is the FDA-
approved drugs to treat
depression, which are
Dr. Robert
known to sometimes
Goldfarb
reduce hot flash symp-
toms in women without
depression. These include Paxil, Effexor
and Lexapro. Others find relief with
Neurotin, a drug to treat epilepsy and
migraine"
Alternative Medicine
"Some women also find relief from hot
flashes with nonprescription remedies"
Obron says. "My advice is to use only those
products that have been studied and are
manufactured at a reliable location for safety.
The problem is many of these products aren't
studied and we don't know their risks or side
effects"
According to Obron, women may also
want to consider consuming soy and soy
products such as tofu and soy beans, chick
peas, lentils, flax seed and red clover.
Acupuncture Treatment
"Many women look for a
more natural and less
risky treatment" says
Julie Silver, MSW and a
certified acupuncturist
in Farmington Hills. "I
use traditional Chinese
acupuncture to reduce
Julie Silver
the severity of hot flash-
es and other menopause
symptoms"
In 2011, a study was published in the
Journal of Acupuncture in Medicine sug-
gesting that acupuncture might help
reduce the severity of menopause symp-
toms. By the end of the 10-week treat-
ment, the group of women receiving acu-
puncture reported significantly fewer hot
flashes and less severe flashes.
"Integrating the acupuncture techniques
with custom Chinese herbal formulas and
a healthy lifestyle usually provides the best
results for women with hot flashes" Silver
says.
Individual treatment is key to deciding
whether a woman should enter HRT or
select another option for managing her
menopausal symptoms. Quality of life,
family history and lifestyle are all factors
in the problem-solving process between
patient and physician.
❑