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Guide Health: Hormones for menopause. Yes or no?

Women need to balance the risks versus the benefits of treatment

Menopause symptoms like “hot flashes” and “night sweats” are a big problem for every woman who experiences them. Yes, the symptoms will pass, but in the meantime you’re just miserable.

Hormones like estrogen are involved in keeping your body temperature within a normal range, and when their levels decline in menopause, body temperature regulation is skewed.

Hot flashes are sudden intense increases in body temperature, and they affect about 75 per cent of menopausal women. Of these women, 80 per cent experience the symptoms for about two years.

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These symptoms can occur at any time during the day, and usually affect the face, neck, and upper torso.

Night sweats occur during sleep producing extreme perspiration, which drenches pajamas as well bed linens and disturbs sleep. About 70 to 80 per cent of women experience these symptoms.

If your body’s range in ability to regulate its temperature is small, then any change in temperature can produce a hot flash. Some common triggers are tight clothing, drinking alcohol, stress, caffeine, spicy foods, hot beverages, or even a hot environment like a sauna.

Your body cannot cope with the increased temperature and a hot flash is its attempt to rid itself of some of the excess heat. Often, hot flashes and night sweats are followed by a feeling of chilliness because your body has reduced its temperature too much.

If hot flashes and night sweats are the result of reduced hormone levels, then it would follow that taking hormones should treat the symptoms, and it does.

However, about 15 years ago the Women’s Health Initiative found the use of hormones increased the risk of breast cancer, cardiovascular disease, blood clots, and dementia in older women.

As a result, until recently hormone therapy was countraindicated for menopausal symptoms, but today for moderate to severe symptoms, hormone therapy can be useful with limitations.

If you have moderate to severe hot flashes and/or night sweats, are under 60 years of age, have had your last period no more than 10 years ago, and are healthy, then hormone therapy may be an option.

You need to balance the risks against the benefits. If you have a family risk for breast cancer or multiple risk factors for cardiovascular disease such as a stroke, heart attack, or a blood clot, hormone replacement may not be for you.

However, if you have either controlled diabetes or controlled high blood pressure, it can be used for severe symptoms.

Ideally, you want to use the lowest effective dose for the shortest possible time, usually five years.

Estrogens are available as both tablets and patches, with the patches seeming to have less of a risk for blood clots.

When you are stopping the hormone therapy, tapering it over several months will reduce the risk for rebound symptoms. And remember, low-dose estrogen creams are available and can be continued indefinitely.

Non-hormonal symptom treatments are focused on working through your nervous system to regulate your temperature. Low-dose antidepressant drugs and some seizure medications like gabapentin help your nervous system maintain the body’s temperature.

And, of course, you can use non-drug approaches to counteract symptoms. Keep physically active, eat a healthy diet, avoid triggers, get enough sleep, dress in layers which can be removed or put on, and keep cool by using a small fan and by drinking cool water.

Your hot flashes and night sweats will eventually diminish. Try to keep yourself comfortable.

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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