By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

DOCTOR MAY HAVE NON-HORMONE TREATMENT FOR READER’S HOT FLASHES

Question: Are there any new medications or supplements that are available for the hot flashes of menopause? I don’t want to take hormones, but I need something to help me get through this.

Answer: Vasomotor symptoms of menopause -- hot flashes -- affect about 85 percent of all women in what doctor’s call the perimenopausal period. This is the phase before menopause actually takes place, when ovarian hormone production is declining and fluctuating, causing a host of symptoms. It usually occurs three or four years before menopause, but can start as early as 10 to 15 years prior to menopause.

Whenever the vasomotor symptoms of perimenopause begin, they typically last for several years. The symptoms usually consist of flushing and an unexpected feeling of warmth or heat that moves up toward the head, frequently associated with sweating. While generally only lasting a few minutes, such hot flashes can cause significant sleep deprivation if they occur frequently during the night.

Hot flashes can also be associated with palpitations and dizziness. For many women, using estrogen supplementation to lessen these events is not an option. The good news is that there is ongoing research into non-hormonal treatments. Here are a few tips that you can try on your own and a couple of things you may want to discuss with your physician.

Early research found that exercise lessened hot flashes, but some more recent studies provide evidence that this may not be true. Some women have found that practicing yoga, as well as various forms of meditation, can be quite helpful.

Caffeine, alcohol, nicotine and spicy food can make hot flashes worse. You should avoid these things. Niacin, Vitamin B-3, should also be avoided -- it can cause flushing even in those who are not menopausal.

Some non-hormone based medications are being used to lessen hot flashes. All are showing some promise, but not in everyone. One that has seen some success is venlafaxine (Effexor). This medication is classified as a selective serotonin reuptake inhibitor (SSRI). You may have heard of SSRIs as a treatment for depression. Why they help some women with menopausal symptoms is still not understood. Other drugs in this class are also being studied; these include paroxetime (Paxil) and sertraline (Zoloft). An older blood pressure medication called Aldomet is also being investigated as is the clonidine patch -- used for blood pressure as well as smoking cessation. These drugs are all commonly prescribed medications, but this doesn’t mean your physician should necessarily prescribe them for you. He or she will need to review your personal medical history and your current symptom pattern before deciding if any of them should be tried as a treatment for your menopausal symptoms.

A small study has recently been done using an antihistamine called cetirizine (Zyrtec) to decrease vasomotor symptoms. It has yielded some promising results, but more research will be needed before most physicians will feel comfortable using this medication for the treatment of hot flashes.

Herbal and over-the-counter products like Vitamin B, Vitamin E, evening primrose oil, and certain soy proteins may have some benefit in some women. However, I caution you not to try any supplement to treat yourself without first having an in-depth discussion with your physician.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., at Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.