Dealing with Hot Flashes and Other Bothersome Menopausal Symptoms as Women Age
Vasomotor (a.k.a. “hot flashes”) and vaginal symptoms are the most commonly reported menopausal and postmenopausal issues. Although these and other quite bothersome symptoms (especially sleep problems, memory issues and fatigue) are most debilitating during the first year or two of menopause in some women, they may persist much longer—sometimes indefinitely. Several recent studies estimate the duration of moderate to severe symptoms to be 5-10 years on average!
“Genitourinary syndrome of menopause” (formerly named “vulvovaginal atrophy”) is a direct consequence of the super-low estrogen state associated with menopause, which results in both anatomic and physiologic changes in vaginal and bladder areas. In contrast with hot flashes, which appear early and tend to dissipate over time (but not always), these changes develop progressively as time passes, and unless they’re aggressively treated, they do not go away.
Hormone therapy (HT) can help. So, why are so many women (more than 90% of U.S. women), not using HT?
Hormone Therapy and Cardiovascular Risk (Myth vs. Fact)
Poorly reported and erroneously drawn conclusions with regard to the risks vs. benefits of HT in breast and cardiovascular health which were hastily extrapolated from the Women’s Health Initiative (WHI) in 2002 lead to a wholesale exodus from HT. (See previous blog posts here for more on this.) This reaction negatively impacted the long-term cardiovascular and bone health of the women who’d been taken off HT and caused many adverse quality-of-life side effects as a result of estrogen withdrawal.
But the data from the WHI and other studies, both from the U.S. and abroad, when analyzed properly, all point to the same conclusion: starting women on estrogen supplementation early (within 7-10 years of the start of menopause) confers a degree of cardiovascular protection, while starting later (more than 10 years from the start of menopause) statistically increases cardiovascular risk. Note that there is a difference between “new starts” of HT for older post-menopausal women (risky) versus women who have been on HT continuously since their menopausal transition or shortly thereafter (not risky). Continuing HT well after menopause and into older age actually confers additional cardiovascular protection due to HT-induced changes in lipid lipoprotein levels.
Without a specific situation that mandates removal, there is absolutely no good science behind the common dogma that women should be removed from HT as they age. HT (especially estrogen therapy, and especially if given trans- or sub-dermally) can actually be considered “age-management medicine” as continuation appears to be a positive factor in delaying the signs and symptoms of the aging process in women. Trained menopausal medicine specialists rarely take their patients off of HT as they age. Menopause experts value the contributions of carefully formulated transdermal estrogen supplementation.
Alternatives to Hormone Therapy
With such a large percentage of women now not using HT, the search is on for effective interventions for hot flashes and other post-menopausal irritations that continue well beyond the time many practitioners have been telling their patients “it will stop.”
Hot flashes are distressing in many ways, and if they continue without the comfort of any relief on the horizon, they can lead to other issues such as depression, anxiety and low self-image. These, combined with the absence of HT to diminish/improve symptoms and more and more patients’ desire to “do something” about their symptoms, means other methods may find traction for the still-symptomatic woman not on HT. These alternate methods include mindfulness-based stress reduction (MBSR) and cognitive-behaviors therapy (CBT), both of which are readily available in most communities.
CBT has a long and well-documented history of success when it comes to treating distress, sleep issues and other psychological aspects of coping with life’s challenges (such as the menopausal transition). CBT intervention has been shown to reduce at least two of the results of bothersome hot flashes—namely, depression and anxiety.
While nowhere near as effective as estrogen supplementation or CBT and MBSR, other non-hormonal therapies include over-the-counter botanicals such as Remifemin™, “AM-PM Formula™,” I-Cool™, Estrovan™ and Promensil™. Eating whole, plant-based foods (vegetables, fruits, nuts/seeds, grains, etc.) rather than processed and animal foods can also lead to fewer menopausal symptom. Finally, extracted or synthesized soybean isoflavones have also been shown to reduce menopausal symptoms, according to several well-done evidence-based studies.
The Bottom Line?
There is no need to suffer after menopause. Safe, low-dose transdermal (delivered through the skin) or pelleted (sub-dermal delivery) estrogen replacement is available to treat your bothersome symptoms. Intra-vaginal estrogen, compounded vaginally applied DHEA, SERM Osphena or vaginal fractional CO2 laser therapy is available for vaginal symptoms, and both botanical and psycho-social therapies are also available. You don’t have to put with your symptoms; see a skilled menopause practitioner for assistance.