Question: Are there any risks to taking hormone replacement therapy (HRT) during menopause?
Answer: Yes. HRT use has been associated with higher rates of breast cancer, heart disease, stroke, and dementia (progressive memory loss).
These risks were revealed to the world in 2002 with the publication of the Women’s Health Initiative (WHI) study1. A more recent WHI study analysis reported at the 2008 San Antonio Breast Cancer Symposium confirmed that the risk for developing breast cancer doubles after 5 years of HRT use and returns to baseline 2 years after stopping HRT.
After the WHI results were made public in 2002, prescriptions for hormones plummeted by 66%2. Over the next 2 years, there was a dramatic decrease in the number of new cases of breast cancer in the US3. During the 1990’s breast cancer rates were actually increasing by about 0.5% every year. From 2001 to 2004, breast cancer rates dropped by an astounding 8.6%! This drop was only seen for women 50 years old and older; that is, the exact age group of women who decreased their use of HRT by 66%. It is believed by almost all experts that this unprecedented decrease in breast cancer rates was due to the large drop in HRT use triggered by the 2002 WHI study results.
Since the WHI study enrolled women around 63 years old, it was later theorized that HRT may be safe in younger women soon after going through menopause and more likely to be experiencing hot flashes. After reviewing the WHI results for these younger women, there did not appear to be an increased risk for heart attacks (heart disease) but there still was a significantly increased risk of stroke4.
Thus, it does not appear that HRT use is safe for women at any time after menopause. There also is no evidence that “Bioidentical Hormones” or “natural” human hormone medications are any safer than traditional HRT.
However, HRT remains the only therapy approved by the US Food & Drug Administration (FDA) for treating hot flashes. Because of this, many doctors still prescribe low-dose HRT only for women with severe flashes and only for a short period of time. The problem is that most women who try to stop taking HRT find that their hot flashes return5 forcing them to resume HRT.
You should not feel forced into taking HRT. There are safe and effective non-hormonal hot flash treatments available right now.
There is another hormone-type drug that is approved for treating this condition in Europe, but not in the US, called tibolone. Tibolone is a synthetic hormone that is only slightly less effective than HRT for treating hot flashes6. The question is: is it safe? This question was recently answered to be “no”. Tibolone use, like HRT use, is associated with higher rates of stroke7. (updated 01/2009)
Non-hormonal Hot Flash During Menopause
You deserve to know the truth about which non-hormonal hot flash and night sweat treatments are effective during menopause. Currently, there are 2 non-hormonal hot flash and night sweat treatments available that have been consistently shown in well-designed medical research studies to provide long-term relief; they are gabapentin and oxybutynin. (updated 01/2009).
Because these effective treatments are not hormones, they do not have the risks of breast cancer, heart disease, stroke, and dementia that are associated with using hormones. Most impressively, one of these non-hormonal treatments appears to be as effective as hormones for reducing hot flashes.
Both of these effective non-hormonal hot flash treatments are only available by prescription (medical research shows that the all-natural, over-the-counter hot flash supplements are ineffective). These prescription medications are approved by the US Food & Drug Administration (FDA) and have been widely prescribed since 1994 for treating conditions other than hot flashes. Both of these medications are available in relatively inexpensive generic forms.
Unfortunately, most doctors are not aware that these medications are effective non-hormonal hot flash treatments and are, therefore, reluctant to prescribe them. If you were able to provide your doctor with a professionally-written report of the supporting medical evidence and prescribing information for these effective treatments, your doctor would then have the complete information necessary in order to offer you a prescription.
Question: Which all-natural, over-the-counter hot flash supplements have been shown to be effective in medical research studies?
Not only have the all-natural hot flash supplements been shown to be ineffective but they may not be safe. Many all-natural supplements contain plant-derived hormones called phytoestrogens. We know that use of prescription hormones is associated with increased rates of breast cancer, heart disease, stroke, and dementia. Plant-derived hormone use may also have these risks as well as other undesirable side-effects
It may come as a surprise to you that the over-the-counter supplements such as black cohosh, flaxseed, evening primrose oil, wild yam, vitamin E, dong quai, and red clover have all been clearly shown in well-designed medical research studies to be no more effective than taking a placebo (sugar pill) in reducing your hot flashes. In addition, the vast majority of medical research on soy and isoflavones has also shown these supplements to be ineffective hot flash treatments.
Then why do so many internet sites and over-the-counter supplements’ labels say otherwise? The overwhelming majority of evidence used to support the use of all-natural hot flash supplements rely on results from poorly-designed medical research studies and on testimonials from individual women praising the benefits that they have received.
Testimonials do not substitute for well-designed medical research. What works for some women offers very little hope that it will also work for you. Only well-designed medical research can tell you how likely it is for a treatment to provide benefit for you.
Menopause and Hot Flashes Tips To Stay Cool
Do you want to rip of your clothes ,stick you head in the freezer, jump in the pool ,the pond, the river, the creek, the bath, just anywhere to get cool? Its those hot flashes they drive you nuts, they appear when least expected and, like an unwanted guest, stay for as long as they like.
Tips To Stay Cool
1. Wear layers of clothing which can be quickly removed when you feel a flash coming on, and try to wear only natural fabrics. (cotton/wool)
2. I purchased a number of thin cotton face washers which I soak in water with a few drops of my favorite perfume,or aromatherapy oil, I then pop them into plastic bags and put them in the freezer, they are so lovely and cold when I need them,and they smell so good. If you play sport or spend time in the garden they are fantastic.
3. Exercise. A must if you can ladies, apart from anything else exercise helps to prevent osteoporosis which occurs due to the lack of hormones. Exercising just 4 times a week for 20 -30 minutes can help to reduce the severity of hot flashes, and has a long lasting calming effect.
4. Have plenty of cold water handy. If I was in the kitchen and felt a flash about to happen, I would stick my head in the freezer. It worked a treat.
5.Take supplements, every time you have a flash you deplete levels of vitamins B and C as well as magnesium and potassium, these are very important to your overall health.
I hope these tips help and have a flash free day.
- Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. Jama 2002;288:321-33.
- Hersh AL, Stefanick ML, Stafford RS. National use of postmenopausal hormone therapy: annual trends and response to recent evidence. Jama 2004;291:47-53.
- Ravdin PM, Cronin KA, Howlader N, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 2007;356:1670-4.
- Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. Jama 2007;297:1465-77.
- Ockene JK, Barad DH, Cochrane BB, et al. Symptom experience after discontinuing use of estrogen plus progestin. Jama 2005;294:183-93.
- Hammar M, Christau S, Nathorst-Boos J, Rud T, Garre K. A double-blind, randomised trial comparing the effects of tibolone and continuous combined hormone replacement therapy in postmenopausal women with menopausal symptoms. Br J Obstet Gynaecol 1998;105:904-11.
- Cummings SR, Ettinger B, Delmas PD, et al. The Effects of Tibolone in Older Postmenopausal Women. N Engl J Med 2008;359:697-708.