|For Some in Menopause, Hormones May Be Only Option|
For women hoping to combat the symptoms of menopause with nonprescription alternatives like soy and flaxseed supplements, recent studies have held one disappointment after another.
Last week, a clinical trial found that soy worked no better than a placebo for hot flashes and had no effect on bone density. That followed a similar finding about hot flashes from a clinical trial of flaxseed.
“We wish we could have told women that, yes, they work,” said Dr. Silvina Levis, director of the osteoporosis center at the University of Miami, who led the soy study. “Now we have shown that they don’t.”
Before 2002 women were routinely treated with the prescription hormones estrogen and progestin, which rapidly fell out of favor after the landmark Women’s Health Initiative study showed that older women who used them had a heightened risk of heart attacks and breast cancer.
But now some doctors are arguing that those risks do not apply to the typical woman with menopause symptoms, and even some longtime critics of hormone treatment are suggesting that it be given another look for women suffering from severe symptoms.
Study after study has shown that many nondrug treatments — black cohosh, red clover, botanicals, and now soy and flaxseed — simply don’t work. Prescription medicines, including antidepressants, the blood pressure drug clonidine and the seizure drug gabapentin may have some benefit, but many women cannot tolerate the side effects.
“There is no alternative treatment that works very well, whether it’s a drug or over-the-counter herbal preparation,” said Dr. Deborah Grady, associate dean for clinical and translational research at the University of California, San Francisco.
About 75 percent of menopausal women experience hot flashes. Depending on the woman, symptoms can be mild, occurring only a few times a week, or moderate, occurring several times a day. Many women with mild to moderate symptoms cope without needing further treatment. But about a third of women have severe symptoms, experiencing 10 to 20 hot flashes day and night that disrupt their workdays and interfere with sleep.
While doctors often reassure women that it will all be over in just a few years, a May report in the journal Obstetrics and Gynecology found that during one long-term study of women, menopausal hot flashes recurred for some women, for 10 years or more.
A hot flash is usually described as a sudden warmth first felt in the face and neck. Hot flashes can turn a woman’s face red and lead to excessive sweating and then chills. On the Web site MinniePauz.com, women describe feeling lightheaded and dazed, with heart palpitations and anxiety.
“Whoosh, a rush of heat originating from the core of your body,” is how one woman put it. “Hair goes lank and you know that even if you stripped naked and ran down the high street waving your arms to fan your body, well you still wouldn’t get cool because the heat is inside you, not outside.”
The exact cause of hot flashes is not known, but it is believed that menopause disrupts the function of the hypothalamus, which is essentially the body’s thermostat. As a result, even small changes in body temperature that would normally go unnoticed can set off hot flashes.
Among prescription drug treatments, the most effective may be antidepressants, including Effexor, Paxil and Pristiq, which have been shown to reduce hot flashes by as much as 60 percent, doctors say. Antidepressants are particularly useful for women with breast cancer or blood-clot disorders who do not have the option of taking a hormone drug.
But some doctors say they are frustrated by the message given to many women that they must seek an alternative treatment to prescription hormones. Dr. Holly Thacker, director of the center of specialized women’s health at the Cleveland Clinic, said that for many women the benefits of effective hormone treatment would outweigh the risks and that they should not be scared off from considering the drugs.
“It would be like telling someone with insulin-dependent diabetes that they should try to use other things besides insulin,” she said. “I see women look to alternative agents and coming in with bags of things, and they have no idea what they are putting into their body. There has been so much misinformation, and they are confused.”
Dr. Grady, a longtime critic of widespread hormone use, said doctors and women appeared to be less tolerant of risks associated with hormones than of those with other drugs, even though menopause symptoms can be just as intolerable as migraine pain or other health problems.
“Somehow we’re quite willing to take a migraine drug with its associated adverse effects because it works so well, but we’re not willing to take estrogen,” she said. “We worry about the adverse effects associated with estrogen, but the important adverse effects are reasonably uncommon.
“The question is whether a woman is willing to trade off that risk for a very effective treatment for symptoms that are otherwise ruining her life.”