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POSTMENOPAUSAL HOT FLUSHES
What should a woman take for hot flushes after the start of the menopause now that large studies show that taking estrogen and progesterone increases risk for breast cancer, heart attacks and strokes? Until recently, the only effective treatment for hot flushes caused by the menopause was taking the female hormone, estrogen. Several reports show that hot flushes possibly may be prevented by eating plenty of whole grains and soybeans (1a, 1,2,3,4,5,6,7,8,9) or by taking a male-like estrogen called tibolone, which can be prescribed for women who cannot take estrogen, and it won't cause breakthrough bleeding (9). However, tibolone is not available in North America, even though it has been available in many other countries for the last five to ten years.
Many women suffer from hot flushes when they start the menopause. Their upper bodies, arms and faces feel hot, their skin turns red and they sweat. Hot flushes usually last about 4 minutes and are caused by a down setting of the temperature regulating part of their brain. When you have an infection and your temperature rises above 100 degrees, you sweat to cool off. However, postmenopausal women suffer hot flushes with any rise in temperature, even if it is a rise from only 96 to 97 degrees Fahrenheit.
Your body temperature rises and falls in a set pattern each day. Your body temperature is usually lowest at 3 in the morning, at around 96 degrees. It is highest in the early evening at at around 99 degrees. During the course of day and night, your body temperature rises and falls and with every rise, a post menopausal woman may suffer a hot flush. Sixty-five to 85 percent of women suffer from hot flushes which persists for five years in 60 percent and for more than 15 years for 10 percent.
A hormone called norepinephrine causes a woman to think that her body is overheating, even if it isn't. She then flips open the blood vessels in her skin, giving her the feeling of a rush of heat, and she starts to sweat (10). Yohimbine increases norepinephrine and causes hot flushes only in susceptible women. Clonidine, a blood pressure medicine, lowers norepinephrine and blocks hot flushes in some susceptible women (11). There still are not any good drugs to effectively lower norepinephrine levels in the brain, but here at least is a lead for future researchers.
The most effective treatment is to take estrogen which then raises the sweating mechanism of the brain to its normal level above 100 degrees. If a woman has had breast or uterine cancer and cannot take estrogen, she can try eating whole grains, beans such as soybeans, and other seeds such as flax seed; and root vegetables such as yams. Other choices are the male-like drugs, tibolone or Danazol (100 mg per day), progesterone injections (20 mg pill of Provera daily or an injection of MPA (Depo-Provera) 50 mg 11once a month) or she can take a protein extract from soybeans, a commercial preparation called Bellergal (ergotamine tartrate, belladonna alkaloids and phenobarbital twice a day) or clonidine (0.2 mg pills twice a day. Advertisements for dong quai are misleading because it does not have demonstrable effects of estrogen (12). No large, long term studies have been conducted on any of these alternatives.
1a) Alternative therapies for traditional disease states: Menopause. American Family Physician, 2002, Vol 66, Iss 1, pp 129-134. V Morelli, C Naquin. Morelli V, Louisiana State Univ, Hlth Sci Ctr, Family Practice Residency Program, 200 W Esplanade Ave, Suite 510, Kenner,LA 70065 USA.
1) P Albertazzi, F Pansini, G Bonaccorsi, L Zanotti, E Forini, D Dealoysio. The effect of dietary soy supplementation on hot flushes. Obstetrics and Gynecology 91: 1 (JAN 1998):6-11. 60 g of isolated soy protein daily. By the end of the 12th week, patients taking soy had a 45% reduction in their daily hot flushes versus a 30% reduction obtained with placebo (P < .01).
2) A Brzezinski, H Adlercreutz, R Shaoul, A Rosler, A Shmueli, V Tanos, JG Schenker. Short-term effects of phytoestrogen-rich diet on postmenopausal women. Menopause - the Journal of the North American. Menopause Society 4: 2 (SUM 1997):89-94. Address: A Brzezinski, Hebrew Univ Jerusalem, Hadassah Med Sch, Hadassah Med Ctr, Dept Obstet & Gynecol, IL-91120 Jerusalem, Israel.
3) S Barnes. The chemopreventive properties of soy isoflavonoids in animal models of breast cancer. Breast Cancer Research and treatment 46: 2-3(NOV-DEC 1997):169-179.
4) G Maskarinec, S Singh, LX Meng, AA Franke. Dietary soy intake and urinary isoflavone excretion among women from a multiethnic population. Cancer Epidemiology Biomarkers & Prevention 7: 7(JUL 1998):613-619.
5) PL Crowell. Monoterpenes in breast cancer chemoprevention. Breast Cancer Research and Treatment 46: 2-3(NOV-DEC 1997):191-197.
6) A Brzezinski, H Adlercreutz, R Shaoul, A Rosler, A Shmueli, V Tanos, JG Schenker. Short-term effects of phytoestrogen-rich diet on postmenopausal women. Menopause - the Journal of the North American. Menopause Society 4: 2 (SUM 1997):89-94.
7) P Albertazzi, F Pansini, G Bonaccorsi, L Zanotti, E Forini, D Dealoysio. The effect of dietary soy supplementation on hot flushes. Obstetrics and Gynecology 91: 1 (JAN 1998):6-11.
8) C Nagata, M Kabuto, Y Kurisu, H Shimizu. Decreased serum estradiol concentration associated with high dietary intake of soy products in premenopausal Japanese women. Nutrition and Cancer - an International Journal 29: 3(1997):228-233.
9) M Hammar, S Christau, J Nathorstboos, T Rud, K Garre. A double-blind, randomised trial comparing the effects of tibolone and continuous combined hormone replacement therapy in postmenopausal women with menopausal symptoms. British Journal of Obstetrics and Gynaecology 105: 8(AUG 1998):904-911. Address M Hammar, Linkoping Univ Hosp, Fac Hlth Sci, Dept Obstet & Gynaecol, S-58185 Linkoping, Sweden.
10) Obstetrics and Gynecology Clinics of North America. 1994(June);21(2):381-390.
11) P Albertazzi, F Pansini, G Bonaccorsi, L Zanotti, E Forini, D Dealoysio. The effect of dietary soy supplementation on hot flushes. Obstetrics and Gynecology 91: 1 (JAN 1998):6-11.
12) JD Hirata, LM Swiersz, B Zell, R Small, B Ettinger. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertility and Sterility 68: 6 (DEC 1997):981-986. Address B Ettinger, Kaiser Permanente Med Care Program, Div Res, 3505 Broadway, Oakland, CA 94611 USA.
Checked 8/9/05