Menopause - Hot flushes

Dr. Thi Vo

 

Menopause is the time in a woman''s life when she stops having periods. The average time for this transition period is between 49 to 51 years of age.  Around the time of menopause, a woman''s ovaries slowly stop making the female hormones.

At menopausal period, a woman may experiences several symptoms: hot flushes, irregular periods, the periods may be lighter or heavier, headache, back pain, mood swings, anxiety, depression, difficulty sleeping, concentration problems, leaking urine, vaginal dryness.

Hot flushes occur in about 75% of menopausal women, most often in the peri-menopausal period.

Hot flushes typically begin as a sudden sensation of heat centered on the face and upper chest that rapidly becomes generalized. This sensation lasts between two to four minutes and may occur several times per day. Other associated symptoms include: profuse sweating and palpitations, and is followed by chills and shivering.

More than 80% of women who have hot flushes will continue to have them for more than one year. Often, hot flushes stop spontaneously within a few years of onset in most women. However, it is estimated that 9% of women continue to experience hot flushes beyond the age of 70 years.

There are many different methods to relieve the unpleasant symptoms of menopause. One of the effective treatments is hormone replacement therapy (HRT).

HRT replaces the hormones that the ovaries stop making at menopause. HRT can be in the form of tablets, skin patches, gels, slow release pellets, nasal spray, vaginal tablets or vaginal creams.

Research has proven the benefits of HRT tablets including: relieving hot flushes, night sweats, sleep disturbance and decreasing the risk of bowel cancer and bone fractures. However, HRT can also increase the risks of breast cancer, stroke, serious blood clots and irregular bleeding.

The Australian Drug Evaluation Committee advise that women to consider using HRT only to relieve serious hot flushes and for no longer than is necessary to achieve this. For long term use and for women without severe symptoms, the risks of HRT appear to outweigh the benefits.

There are several non hormone treatment options for menopausal symptoms:

Behavioral interventions: Lifestyle changes, stop smoking and alcohol intake, keeping the core body temperature cool, regular exercise but not excessive exercise, relaxation therapy and stress management interventions.

Complementary and alternative therapies: soy foods, black cohosh, vitamin E, ginseng, dong quai, or acupuncture. However, research data do not support the efficacy of these treatments.

Selective serotonin reuptake inhibitors (SSRI): such as venlafaxine has been proven to be effective for menopausal symptoms.

Tibolone: may help to reduce menopausal symptoms as well as increasing the bone mineral density.

Clonidine: is also a treatment of high blood pressure. Some clinical studies shown that clonidine is effectively relieved hot flushes.

In summary, for women with moderate to severe menopausal symptoms, and no history of breast cancer or cardiovascular disease, short term HRT is the treatment of choice. HRT should not be used for more than five years. For women who have contraindications to HRT or not responding to HRT, it is worth to try SSRI and behavior interventions.