Hot Flashes – A Personal Journey

The only good thing about having hot flashes in January is, well, it’s January.  It’s easy to go outside, open a window, take off my sweater or turn the heat down.  I haven’t worn long sleeve shirts since about 2000.  By now, you would think I would have this hot flash thingy down.  I have been having hot flashes off and on since the late 1990s.  Fortunately, I went on treatment.  Unfortunately, a medication I started yesterday restarted the hot flashes.  At least my cheeks are nice and rosy.

Hot flashes are much more common in women than men, and usually related to our “change of life” or menopause.  They can be caused by medications or other problems.  As a gynecologist, this is a common complaint in my office.  Some women tolerate them well.  Others become irritable because of sleep disturbances.  Usually there are other symptoms of low estrogen.  If a woman has not had a hysterectomy, menses will often be irregular or stop completely. 

Many women do not want to try hormones.  There are non-hormonal “over the counter” treatments.  Soy products sometimes help because they work like estrogen.    We also sometimes use some blood pressure medications or other prescription drugs.  But, in my opinion, and in my experience, the best medication is good old estrogen - with progesterone if needed.  Of course, you should consult your very own physician.  And there are reasons some women cannot take hormones.  You should at least discuss it. 

Here’s a great article from USA today about why most other treatments don’t work for hot flashes.  I hate to say it (not really), but “I told you so!”

http://yourlife.usatoday.com/health/medical/womenshealth/story/2012-01-16/Hot-flash-remedies-Estrogen-may-be-the-best-answer/52604096/1

“It could be for one of several non-hormonal drugs, including some antidepressants, which modestly reduce hot flashes. But the first choice — except for women with a history of breast cancer or other health conflicts — is still hormone therapy (estrogen, often combined with progestin).

It reduces hot flashes by about 90% and "it's actually very safe, but that's not getting across to the public," Warren says.”

National Prematurity Awareness Day

Today is National Prematurity Awareness Day.  This was passed on to me by MOST.  MOST stands for Mothers Of SuperTwins, an organization that supports parents of triplets and more.  Our pregnancies are at high risk for early delivery with all the problems that ensue. 

We end up on bedrest a lot.  We have premature labor.  There is a high risk of miscarriage and pregnancy loss.  As a general rule, the more babies, the earlier the delivery.

My triplets were almost 35 weeks.  They didn’t have any breathing problems.  They did have some feeding problems.  They came home when they were nine days old. 

Now is a good time to thank my doctors and friends for helping me through all of that.  My Mom was awesome.  I learned a lot from her.  My husband put up with all my moods, my hot flashes and my insomnia. 

My boys are now 17.  They show no sign of being 4 ½ pounds at birth.  They are seniors in high school.  Wow.  Who would have thunk it?

Hot flashes? Irritability? Night Sweats?

You’re Not Crazy, It’s Just Menopause!

Menopause is a natural time in a woman’s life when she stops having periods.  Most women stop between 45 and 55, with the average being about age 51.  It is normal to have some symptoms for a few years before and after this time.  Some women have no symptoms, while others have symptoms that are quite bothersome. 

Guys, you should pay attention, too.  This may help you understand your mother, your sister, your wife or your daughter.  You might apply this to the cranky teacher who is always opening the window, or the lady next door who sits on the porch in the winter.  We are everywhere!

Menopause is considered early if you quit having periods before age 40.  You should see your doctor if you are having problems with irregular periods before this time. 

Symptoms of menopause include hot flashes, night sweats, vaginal dryness, fatigue, irritability and changes in your period.  The irritability and fatigue may be from not sleeping well because of the hot flashes.  This may lead to depression.  Vaginal dryness can cause irritation of the bladder with more frequent bladder infections.  It may cause difficulty determining if you have a vaginal infection.  It can also cause difficulty with intercourse.

The period changes may be heavier periods, lighter periods, more frequent or farther apart periods.  It may be time to start keeping a record, like when you were a teenager.  Heavy bleeding can be treated by a variety of methods, and should be discussed with your physician.  Too much bleeding can cause anemia with other health problems. 

If you haven’t already thought about it, now is the time to get educated about hormone replacement.  You should discuss this with your doctor.  Menopause is the time when your estrogen drops.  Without hormones, your risk of heart disease starts to climb.  It eventually catches up to a man.  Not a thing you want to do. 

You also start to lose calcium from your bones when the estrogen drops.  Calcium replacement (with Vitamin D) helps a little, but this process continues after menopause.  The risk of breaking a bone gets worse as a woman gets older.  The hip, spine and wrist are the most common bones.  A large number of people die within 6 months of hip fracture.  Many never are as mobile as they were before.  You cannot reverse this by starting estrogen later. 

Many women are also concerned about the hair thinning, skin thinning and wrinkling that also occur as a woman ages.  These things seem to accelerate at the time of menopause.  They may also be somewhat hormone related. 

Some of these symptoms may be caused by other problems.  Remember that this is general advice.  You should consult your physician for specifics about your problems.  Don’t forget your mammograms and pap smears. 

September is menopause awareness month.  I hope this has given you some basic information.  Please use these thoughts to start a discussion with your doctor before you actually go through menopause.  This should help you stay healthy longer into your golden years. 

For Some in Menopause, Hormones May Be Only Option

From the New York Times by Tara Parker Pope

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.”

Comment by Dr. Lasermed
This is an issue that we discuss in my office frequently.  I think this article has a good point of view.  Discuss this with your physician.  If you are a peri-menopausal woman, you will be glad you did.