Menopause Symptoms- What Can I Use for My HOT FLASHES?

ANYTHING NATURAL THAT I CAN USE FOR HOT FLASHES?

Relizen is a flower pollen that can be used for hot flashes. It is over the counter and ordered on line. Take two tablets daily by mouth on an empty stomach. Many women find this to be useful. It has no hormonal effects.

Estroven is a combination of Black Cohash and Soy Isoflavones that is non prescription and can be used for relief of hot flashes.

OK- WHAT IF THAT DOESNT WORK FOR MY HOT FLASHES?? ANYTHING ELSE THAT IS NON- HORMONAL?

If you are still plagued by symptoms there are many safe and effective medications that can be used for hot flashes.

A clonidine patch is a blood pressure medication that can help with hot flashes and is used in a weekly patch form. This is a safe and non hormonal product. Some patients get relief from this but others do not. I would not recommend this if you run a very low blood pressure because it can further drop your pressure and make you feel dizzy and rarely pass out if the blood pressure drops too low.

If you have cardiac issues and are on a lot of other medications you also may not want to use this. Ask your doctor about your specific situation and if the clonidine patch may be useful for you.

The antidepressant category of medications such as SSRIs can also be very useful in women with hot flashes. These medications are usually given in much lower doses than when they are prescribed for depression. They also tend to work a lot quicker than if given for depression. Brisdelle is a form of Paxil that is taken daily for hot flashes and can be very efficacious.

If that doesn't work I often go to a stronger medication such as Effexor XR. The problem with some of the stronger versions of antidepressants is that they can cause weight gain and a decrease in libido (which many women are already complaining about in the peri menopause and menopause).

Neurontin (gabapentin) is an anti-seizure medication that is often used for chronic pain syndromes and is also efficacious for hot flashes. Choosing a medication should be done with your doctor who knows your medical history best and can fine tune and tailor the medication for your specific situation.

WHAT IF NOTHING ELSE WORKS FOR MY HOT FLASHES AND I HAVE TO USE HORMONES- WILL I GET CANCER OR ANOTHER PROBLEM FROM THIS?

Some patients are not candidates for hormone replacement therapy.

Patients who have had blood clots in their lungs or legs, those who have had a stroke or heart attack in the past, and those patients who have had a personal history of breast cancer should not use hormone replacement therapy.

Most other patients are candidates for hormone use and can use it safely without significant untoward effects. Data from one of the biggest studies on hormone use called the Women’s Health Initiative Study show a very small increase in breast cancer, stroke and heart attack, in the range of an extra 7-8 cases per 10,000 women per year of use in those women who use combined estrogen and progesterone (you would need both if you have a uterus and have not had a hysterectomy- the progesterone is used to protect the lining of the uterus).

In those women who have had a hysterectomy, you would use estrogen alone without progesterone and there is no increased risk of breast cancer- only 7-8 extra cases of stroke/10,000 women per year of use. There are also about 15 cases per 10,000 women per year of use extra cases of blood clots in both groups.

The Women’s health initiative study was good because it looked at a very large group of women over time, but not so good because it only studied one type of hormone which is very synthetic and not used as widely these days (the estrogen in the study was premarin which is made from horse urine and the progesterone was provera which is synthetic).

In addition, the average age of the women in the WHI was 63 and in this age group de novo there are already increased risks of heart disease, stroke and breast cancer. Most women that we start on hormones who have symptoms are in their 40s and early 50s, so these risks may actually be lower with less synthetic medications, in lower doses and in younger women.

We can give hormones by transdermal skin patch, vaginal ring or orally. We use the lowest dose possible for the shortest amount of time and we continually re-evaluate the need to continue the medication. This is the recommendation by the North American Menopause Society and the American College of Ob/Gyn. 85% of women are done with vasomotor symptoms in 2-3 years and can be tapered off the medication. 5-15 percent of women will continue to have significant symptoms into their 70s and 80s and in some cases remain on hormones for decades.

Although the long term risk may be slightly increased for breast and cardiovascular issues for long term use, this becomes a very serious quality of life issue for many women, where continued hormone use is warranted and necessary. Talk to your doctor about the specific risks, benefits and alternatives based on your specific symptoms, concerns and history to come up with the best individualized plan for you.

HAVE QUESTIONS ABOUT MENOPAUSE or PERI-MENOPAUSE?

Schedule an in-office appointment to chat with us. We'd love to meet you! Call us at 516-365-6100 to set up a convenient appointment. We're located right off the Northern State Parkway here in North Hills, Long Island, just a few minutes away from North Shore University Hospital & Northwell Health.

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