Treatment of Hot Flashes

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• 0:03Treating menopause symptoms
• 0:26Estrogen for hot flashes
• 1:37Forms of estrogen
• 2:45Risks and benefits
• 3:51Taking progesterone with estrogen
• 4:36Treatments without hormones

Full transcript

1. 0:03Treating menopause symptoms

   Hi, I'm Dr. Taz Varkey. Today I want to talk a little bit about the different treatment options for the symptoms of menopause. So as I mentioned in a prior video, the most common symptoms of menopause are hot flashes, night sweats, vaginal dryness. There are also some other symptoms that we call secondary or nonspecific because they might be due to other things or other medical problems, and those include joint pains, breast tenderness, skin changes, mood changes.

2. 0:26Estrogen for hot flashes

   So the treatments that I'm talking about today may also help you with some of those, but they will most certainly help you with the primary symptoms, which are hot flashes, night sweats, and vaginal dryness. So specifically for the hot flashes and night sweats that women experience, the most effective treatment is estrogen.

3. 0:50

   And that's because the reason women are getting these hot flashes and night sweats is because they have what we call vasomotor changes. Means the blood vessels are changing, they're dilating, and we're getting hot because it draws heat to our skin and around our body, and so women get these flushes of heat and they might even perspire.

4. 1:13

   And it's very commonly focused to the chest and the face, but they can experience it all over their body, and it happens at night and during the day. So if the cause of these symptoms is the lack of estrogen, that what happens to our body when we go through menopause, then the best treatment is estrogen, and the estrogen can be given in many different forms.

5. 1:37Forms of estrogen

   Most commonly it's given orally, but we now have many transdermal, which means through the skin, forms of estrogen, and we also have vaginal estrogen in the form of a ring that can be left in place. So which method you choose depends on your medical history and your personal preferences, but it tends to be that the transdermal options are a little bit less potent than the oral options.

6. 2:00

   So most doctors and patients prefer to start at the lowest possible dose of estrogen that will relieve them of their symptoms. So the transdermal estrogens are very popular. Sometimes they're not well covered by pharmacies or patients' insurances, and so it's not always an option for every patient.

7. 2:22

   And in that case a very low dose oral estrogen is also acceptable, but the transdermal hormones, estrogen, tend to be the preferred route nowadays because they tend to have less effects on the body. Some of the concerns with hormone replacement therapy, the risks of estrogen, include heart disease such as heart attacks or stroke, an increase in the risk of breast cancer.

8. 2:45Risks and benefits

   There can also, however, be a decrease in the risk of colon cancer and osteoporosis. So these increases in heart disease and breast cancer and decreases in osteoporosis and colon cancer are very tiny, approximately six to eight out of 10,000 more cases for any of those conditions I mentioned.

9. 3:06

   So we're not really focusing so much on these types of effects of hormones, but rather the benefit that it gives women. If patients don't have hot flashes or night sweats that they're trying to treat, then we don't feel the need to give the medicine, there's nothing to treat.

10. 3:28

    We don't give the estrogen just to reduce the risk, for example, of colon cancer or to strengthen the bone. We give it to treat women if they're symptomatic. So I mentioned estrogen for treatment of all the hot flashes and night sweats. It's important to understand that progesterone always has to be taken with estrogen.

11. 3:51Taking progesterone with estrogen

    Why is that? Because estrogen alone can cause uterine cancer. It can stimulate the uterine lining. But if you take progesterone at the appropriate doses, it will protect the uterine lining and you will have no increased risk of uterine cancer. So you can get the benefits in terms of prevention of hot flashes and night sweats without the risks of uterine cancer. And I'm emphasizing that because some patients have come back to me and said, "Well, Dr. Varkey, I'm trying to take less hormones, so I stopped taking the progesterone. I'm still doing the estrogen, but I decided to stop the progesterone."

12. 4:15

    And I almost fall out of my seat because I know that they then increased their risk of uterine cancer because that progesterone was there to protect them. So now I make it a habit to tell every patient that they have to take these together. So please spread the word on that one.

13. 4:36Treatments without hormones

    Okay, other possible treatments outside of hormones for your symptoms: supplements, black cohosh and soy, or over-the-counter remedies. They're very weak estrogens. As I mentioned with the other types of compounded hormones, we don't really have many FDA approved trials that show efficacy or what the risks are, complications of these medications.

14. 4:59

    But they're so weak that if patients really want to avoid the prescription medications, I don't necessarily discourage them. I just make sure they understand that if you can't take estrogen, maybe you were diagnosed with breast cancer or you have some other medical issue that makes it a contraindication for you to take estrogen, then the other options that are out there include a medication called clonidine, which is a blood pressure medication.

15. 5:23

    There's antidepressants, SSRIs we call them, so Paxil or Effexor are FDA approved. Actually, Paxil is the only one that's FDA approved for hot flashes, but Effexor, SSRIs, and other drugs in these categories work as well. And lastly, there's a drug called gabapentin. That's a neurologic modulator that also really helps with hot flashes.

16. 5:44

    And in terms of the non-medication options, one last thing to remember, exercise, acupuncture, mindfulness sometimes helps, and lifestyle modifications, putting a fan by your bedside, dressing in layers. So that's okay, and if that works for you and these hot flashes aren't affecting your daily function or your life, then again you don't need to take anything.

17. 6:07

    Menopause isn't a disease, it's just a change in state. You can embrace it, and as long as you're not too uncomfortable, don't worry about it. That's it for today. If you have any questions, please come in to see me if you're my patient or go to your doctor. Thank you for tuning in, and don't forget to subscribe.