Archive for hormone replacement
I was recently contacted by the NIH regarding my thoughts on the use of HRT for treatment of menopausal symptoms. I was asked to review a brochure from NIH (National Institute of Health), to see if viewers may find some benefit from their information.
Hot flashes can can certainly be a very difficult symptom of the menopausal transition. They can interfere with sleep, affect our confidence at work as well as concentration. They are embarrassing, make us feel old; and can make coping with social situations difficult. Some of us have it bad, others not so much.
Now, according to a recent study, they are costing the companies we work for; in the form of lost time at work.
A recent analysis of data looking at the insurance claims of 500,000 menopausal women, all of whom were insured by Fortune 500 companies. Half suffered from hot flashes, and half did not. This analysis took place over the space of a year.
This analysis revealed a surprising 1.5 million more health care visits in the group with hot flashes compared to the control group. The cost of lost work by this group was estimated to be over 27 million dollars and the cost of this additional health care almost 340 million!
I am not sure that 250,000 hot flashing women could actually rack up this amount of cost to their employers and health insurers; but the point is noted. Hot flashes affect women and affect productivity.
This change has apparently been amplified since the Women’s Health Initiative findings of an increased incidence of stroke and heart attacks to users of HRT; resulting in more women opting not to use hormone replacement.
While hormone replacement therapy may carry an increased risk of breast cancer and cardiovascular events if you are in a high risk category for either of these, it can also be very safe to use for several years. This can be a life saver if you are someone suffering from hot flashes.
For my readers following me for the past few years, you are probably aware that I am a proponent of HRT if you are low risk. I feel they are safe to use for a limited time and can help ease the transition.
The following link to an NIH brochure containing information regarding Hormones and Menopause will allow you to review the position of National Institute of Health regarding the safety of hormone use for many women at low risk for cancer and heart disease. It contains some good information that I basically feel is sound. The brochure can be read online or ordered for free.
So check it out! Don’t be afraid to discuss possible use of hormones to ease your menopausal symptoms if they are interfering with work and social activities. As they did for me, they may help ease the worst of it for a few years, and help you establish some changes in your routine to accommodate the changes that menopause can bring!
ps. There is no financial incentive for me promoting this brochure, I receive nothing from NIH or any other organization; and the brochure is free.
A recent survey on use of female hormone therapy for treatment of menopausal symptoms yielded some surprising results. Over the past several years, there has been an increase of information on the safety of hormone therapy when different modalities are used. Researchers have speculated that this would change the use of hormones in a similar way that the Women’s Health Initiative caused a drastic decrease in overall use of hormone replacement therapy.
Researchers at Stanford University School of Medicine use data collected by the IMS National Disease and Therapeutic Index, where information on prescriptions written in the outpatient clinic setting was collected, to analyze trends in prescriptions for estrogen and progesterone hormone therapy. This data was collected between 2001 and 2009.
Researchers expected to see a trend of increased use of lower doses of estrogen, and use of estrogen patches instead of pills. Research in recent years has shown that:
- Up to 2/3′s of women respond equally as well to the lower doses of estrogens for relief of their menopausal symptoms.
- There is also some indication that use of a more natural form of progesterone called Prometrium may carry less cardiovascular risk over Provera. It also produces less side effects, but is more expensive.
- Estrogen patches bypass metabolism in the liver and reduces risk of blood clots.
The surprising results indicate that there has been a mild increase in use of low dose estrogen, but less than 1/3 of prescriptions reflect this trend. Additionally, there was no appreciable increase in the use of transdermal estrogen therapy.
Additionally, female hormone therapy is felt to be safest and most effective when used close to the onset of menopause instead of years later. The trend does not indicate that this change in initiation of therapy is being utilized.
While there are many concerns and risk factors for use of estrogen and progesterone hormone therapy, they are very effective in preventing menopausal symptoms as well as helping to prevent bone loss, and improving memory issues associated with loss of estrogen. Recent years have yielded information on maximizing safety in using these medications, to include different forms of estrogen and progesterone as well as lower doses.
So what do you do when you see your medical provider? Talk to them about using a lower dose of estrogen, continue to decrease the dose until you reach the lowest dose at which your symptoms are still controlled. Ask your provider about using an estrogen patch instead of pills. Encourage your provider to tailor your dose of medication to you.
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A reader recently posted a question:
What do you do when your health requires you to stop taking your hormone therapy?
Many specialists would simply say, stop your medication and in essence, deal with it. Your gynecologist or family practitioner could no doubt offer more advice than that. My first advice would be to contact your regular provider to ask their advice on controlling symptoms.
The time of menopause is also the time of increase risk of stroke, heart attacks, cancers, and blood clots or DVT ( deep vein thrombophlebitis). Estrogen and progesterone can cause inflammation of blood vessel walls, thus helping to cause stroke, blood clots, and heart attacks. Estrogens can fuel a breast cancer or other cancers of the female organs. Since having one cancer places you at risk for any other cancer, it makes sense to discontinue estrogen for any cancer a woman may experience.
So what do you do when you are told to suddenly stop the therapy which is helping you feel sane and in control?
There are many other therapies which are safe and can help control symptoms, but first you must check with you provider. One thing which will be vital for controlling the symptoms of menopause is a healthy life style. Because of how food is metabolized during this time, it is important to limit foods high in sugar as this can lead to fatigue and sometimes fuel hot flashes. It is also important to limit caffeine and alcohol as these items can trigger hot flashes both daytime and nighttime. Alcohol also causes difficulty with sleep mostly due to the sugar content.
We all know a bad night sleeping can lead to
- fatigue, which leads to
- low energy and avoidance of exercise,
- leads to convenient food choices for comfort and ease of preparation.
- lack of sex drive
- difficulty concentrating
- all of the above leading to low self esteem and possibly depression over lack of control
How do you gain control of all this?
A diet high in antioxidants helps. This means fresh fruits and vegetables, brightly colored or deep leafy green. Consuming less sugar, caffeine, and alcohol. If you are sensitive, a diet low in dairy. If you are not sure how dairy sensitive you are, stop all dairy for 1-2 months and see how you feel. You may have more energy, less respiratory problems and skin problems. Exercise of any kind that gets your heart beating faster and uses your muscles in a way not normally used in your average day.
For medical help when the above measures are not enough, there is clonodine or effexor (low dose) which can help with hot flashes. There are sleep aids which are generally safe for short periods of time. Doing cross word puzzles or other memory type games can help some with “brain fog”, as does some low dose antidepressants if applicable. Herbal products should be used with extreme caution if they contain soy or black cohosh; these products can theoretically be irritating to blood vessel walls as they are estrogen like in their action.
There are measures you can take to control your symptoms, nothing may be as completely relieving as hormone replacement therapy. Talk to your medical provider to get advice targeted to your health situation. Then, write us back and let us know what worked for you! Share your successes with our readers.
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In the previous article on hot flashes I mentioned a some lifestyle changes which can help with hot flashes. In this article I will discuss medications and supplements which can help with hot flashes. It is still important to remember that the life style changes you make will improve your health in many ways, not just in reducing hot flashes. I admit it is easier to take a pill to help a symptom, but most pills come with side effects and they can only accomplish part of the job. All of the supplements and medications mentioned in this article work one of two ways. They either provide the body and brain with synthetically made estrogen, as in the case of pharmaceutical and/or bio-identical estrogen; or provide a plant based estrogen-like product called phytoestrogens. Or, they change the way the body responds to the signal to cause a hot flash.
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This is what happens with a hot flash, other than you get hot, sweat and feel miserable and embarrassed. Lower circulating levels of estrogen trick the hypothalamus portion of the brain(the area which regulates body temperature as one of its’ jobs) into believing that the body and itself(the brain) is too hot. So it sends out a signal by way of its’ messengers to lower the body temperature by dilating skin blood vessels, triggering sweat glands to sweat, and causes the heart to beat faster to help all this happens quicker. These messengers are epinephrine, norepinephrine, serotonin and prostaglandins (haven’t we heard of these guys before? Oh yeh-in the weight gain article) All of this is an attempt to cool the body off, but as all of us menopausal women know, this isn’t what actually happens!
Enter in hot flash relief. Lets start with herbal products. All herbal products are available without a prescription, some are advertised as mail order. Most of these products contain a combination of soy isoflavones, black cohoosh and evening of primrose. Each of these different components have been looked at and studied, there is a wide variety of results. For as many women you find who have been helped by herbal products, just as many have noticed no benefit from them. Soy is probably the best known and perhaps the most effective herbal product. It contains isoflavones which have estrogen-like properties although it is plant based. Women taking between 50-100mg daily have had reduction in hot flashes. This is best taken in the diet in the form of soy, tempeh, soy mild and miso. Isoflavones are present to a much lesser degree in peanuts,peas, beans and flax seed. Soy is also available in pill form but it is not as effective in this form.
Also used and touted to reduce hot flashes is black cohoosh which is also plant based. There have been trials in the US as well as in Europe using black cohoosh root stock (Remifemin) which is showing very effective reduction of hot flash frequency and intensity, the product is felt to be more standardized as it comes from root stock. It has been unclear how black cohosh relieves hot flashes but is has been suggested it works through the thermoregulory center in the brain. Lastly, Evening of Primrose Oil has also been pro ported to help with hot flash relief. This claim appears to be more tenuous then black cohosh and soy. Close study has not shown any great reduction of hot flashes, although it does appear to help eczema. There are also claims it helps breast pain, premenopausal symptoms and arthritis. EPO(evening of primrose oil) is an essential fatty acid and also contains gamma-linolenic acid.It has been theorized to have anti-inflammatory effects as its mode of action in reducing hot flashes. EPO has some serious side effects and interactions with certain medications, and should only be used after discussing with you medical provider. These items come in pills, and can be effective in relieving hot flashes, although have not been found to be as effective as soy.
None of these preparations are regulated by the FDA, so active ingredients can vary. It is important to buy a brand which states on the label that there is quality control performed on each batch manufactured. With soy products, there is some controversy as to the potential risk of breast cancer and because soy is estrogenic in nature, there is the possibility that soy supplements have the same risk factors as estrogen products, but to a lesser extent. There are no studies to substantiate this, however it is now felt within the medical community that a women who has had a female cancer or cardiovascular event (stroke, blood clot, heart attack) should avoid soy supplements.
All of the above herbal products are not as effective as estrogen products. The decision to use estrogen products is often a difficult decision due to potential risks such as possibility of breast cancer, and cardiovascular events such as blood clots, stroke or heart attack. Estrogen products replace the estrogen that the body is not producing as much of anymore. It can quickly eradicate the symptoms of menopause, and is usually safe for a few years which is often enough to get through the worst of symptoms. It is usually taken in pill form and must be taken with progesterone if you have an intact uterus. Estrogen can be taken alone if a women has had a hysterectomy. By taking estrogen, the uterine lining will become thicker, just as when a woman is having regular menses. If this lining is not shed, an endometrial, or uterine, cancer can develop. If you don’t have a uterus, then you don’t need to shed anything and don’t need progesterone. Estrogen is prescribed by a medical provider and attempts at using the lowest possible dose should be made. Estrogen products were widely used until the publication of the long term study “The Women’s Health Initiative” which revealed an increase in breast cancer, stroke and heart attacks in women using estrogen and progesterone. This study continues to be re-evaluated but did cause a significant decrease in estrogen and estrogen/progesterone usage. This hormonal product comes in several forms and should be discussed at length with your provider before deciding or not deciding to take.
More recently there has been usage of certain blood pressure medications and certain antidepressants to lessen or relieve hot flashes. Clonidine, a blood pressure medication, works to reduce hot flashes by altering the degree of blood vessel dilation in the skin in response to the brains’ command to give off heat. Effexor, an antidepressant, works by altering how epinephrine and serotonin respond to the brain’s heat alarm. This medication showed significant relief of hot flashes in breast cancer patients, and is now being used in non breast cancer patients with menopause symptoms.
While there are many options now for hot flash relief, it is important to remember that it is difficult to completely eliminate hot flashes and as with everything in life, there is a balance between symptoms and relief of symptoms. When you try to tweek mother nature, there can be consequences. It is always important to consider how much you feel you need relief, and the potential risks therapy may bring. Menopause is a time of life that women must pass through, and it is inevitable that some changes occur that are unwelcome. The key is finding a balance that works for you and paying attention to what is happening to your body, and continuing to try to change your lifestyle to adjust to those changes so you remain healthy as you move through this change of life.
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