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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? Since taking estrogen is associated with increased risk for breast cancer, most doctors recommend not taking it or if a woman takes it, to take it in the lowest dose for the shortest time. Several reports show that hot flushes possibly may be reduced by eating yams, whole grains or soybeans (1a, 1,2,3,4,5,6,7,8,9). A male-like estrogen called tibolone may help, but tibolone is not available in North America, even though it has been available in other countries for many 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 four 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.

Plant Estrogens Not Effective for Hot Flushes or Bone Loss
Estrogen pills taken after the menopause help to prevent excessive sweating, vaginal dryness and bone loss. Many women now take plant estrogens because of the data showing that animal estrogen taken after menopause increases breast cancer risk. However, a recent summary of studies shows that plant estrogens (usually from soybeans or red clover) do not prevent hot flashes or the bone loss that occur after menopause, even when taken in large doses (The Journal of Steroid Biochemistry and Molecular Biology, January, 2014;139:294-301).

Plant estrogens are much less potent than animal estrogens, but they can bind to human estrogen receptors. Some women report that plant estrogens reduce the frequency and severity of their hot flashes.

Noreinephrine
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, but this treatment is no longer recommended because of increased cancer risk. 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.

Updated 1/14/17

April 14th, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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