- The Washington Times - Monday, March 19, 2007

Menopause can be a trying time in a woman’s life. Hot flashes and night sweats can be embarrassing and uncomfortable. While many doctors frown on post-menopausal therapy, women are left with few effective options to control the symptoms.

A healthy lifestyle is the best way to limit the effects of menopause, says Barbara V. Howard, a principal investigator for the Women’s Health Initiative, funded by the National Heart, Lung, and Blood Institute at the National Institutes of Health in Bethesda. Regular exercise, a healthy diet, sleep and reduction of stress are beneficial for a woman going through “the change of life.”

“The symptoms usually resolve over time,” says Ms. Howard, who holds a doctorate in microbiology. She is a senior scientist with MedStar Research Institute in Hyattsville.

“It is a transition period, like postpartum symptoms that diminish with time,” she says. “If symptoms are too much, a woman needs to see her own doctor.”

In July 2002, the Women’s Health Initiative halted its study on estrogen-plus-progestin post-menopausal therapy. Compared to the placebo group, it found a 41 percent increase in strokes, a 29 percent increase in heart attacks, a doubling of rates of blood clots, a 22 percent increase in total cardiovascular disease and a 26 percent increase in breast cancer.

Although it found a 37 percent reduction in cases of colorectal cancer, a one-third reduction in hip fracture rates and a 24 percent reduction in total fractures compared to the placebo group, the risks of the therapy outweighed the benefits, Ms. Howard says.

In April 2004, the Women’s Health Initiative found an increased risk for stroke and blood clots, 12 cases more and six cases more, respectively, for every 10,000 women with estrogen-only therapy, according to the National Heart, Lung, and Blood Institute.

“Estrogen was marketed as the fountain of youth until we did the trials, and we saw it didn’t help almost anything,” Ms. Howard says. “In fact, it was harmful for almost everything.”

If the menopause symptoms are unmanageable, a woman should ask her doctor if short-term post-menopausal therapy would benefit her, Ms. Howard says.

However, women with a family history of breast cancer, heart disease, diabetes and blood clots should be wary of taking the therapy, she says. Depression and mood swings, common symptoms of menopause, often can be treated with anti-depressants. Vaginal dryness often can be relieved with local topicalremedies.

No two women’s menopause experience is the same, says Pamela Boggs, director of education and development for the North American Menopause Society in Cleveland. In fact, some women have no symptoms. The length of symptoms is variable depending on the woman.

“There is no universal answer that is appropriate for all women,” Ms. Boggs says. “Menopause is associated with a whole constellation of potential symptoms. It’s very unusual for a woman to have all of the symptoms. How she chooses to treat each of those symptoms depends on a number of things.”

For instance, hot flashes often can be managed by doing simple things such as keeping a fan by the bed or a glass of water on the nightstand, she says. Some women sleep with a frozen cold pack over the pillow. Other women find that avoiding spicy food or alcohol diminishes hot flashes.

Though some women find that supplements such as soy, black cohosh and flaxseed help hot flashes, it’s hard to determine if they are better than a placebo. Estrogen is the only treatment that can help all the symptoms of menopause, Miss Boggs says. She hopes reliable clinical trials will test supplements in the future.

“What we do know is that with hot flashes there is a very high placebo effect,” Ms. Boggs says. “Women could be saying the truth: ‘I did this, and my hot flashes went away.’ ”

For those women who don’t want to take estrogen, there’s isn’t a good alternative, says Dr. Christine Colie, division director of obstetrics and gynecology at Georgetown University Medical Center.

Progestin alone can sometimes help night sweats, she says. Clonidine, an anti-hypertensive, gives relief to some women with hot flashes and night sweats. Neurontin, a fibromyalgia drug, sometimes has been shown to relieve menopausal symptoms.

Estring, a vaginal ring containing an estrogen replacement for vaginal problems associated with menopause, such as dryness, burning and itching, is another option, Dr. Colie says. With the device, the estrogen is applied just to the vagina and doesn’t spread to the rest of the body.

However, it has not been reported whether the unopposed estrogen could overstimulate the uterus, causing uterine cancer, she says.

Patients who choose to take post-menopausal therapy could be women in the work force who are trying to make it through the day, Dr. Colie says. However, when the estrogen is stopped, it doesn’t mean the woman will feel better. The body still will have to adjust to the withdrawal.

For patients delaying pregnancy, Dr. Colie reminds them that one in 100 women have premature menopause. Further, menopausal symptoms don’t appear to have a genetic component, she says.

“You can have people who are miserable and the mother was fine,” Dr. Colie says. “But years ago, most people at 50 weren’t working, and the kids were grown. Today, women have to function as though nothing is happening. We still have to keep going. More of those women may be electing to take the medication.”

Replicating post-menopausal therapy may take multiple medications and still not have the same effect, says Dr. Hunter Tashman, practitioner of obstetrics and gynecology and former chairman of obstetrics and gynecology at Inova Fair Oaks Hospital in Fairfax.

“If you have a woman who has severe osteoporosis and isn’t responding to other drugs, then you may be forced [into] a corner to give estrogen to prevent a hip fracture,” Dr. Tashman says. “Maybe better medication will be given down the line, and maybe we will still have to give estrogen to those women who feel like they need it.”

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