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In a (Hot) Flash Hormone-replacement therapy isn't the only method of surviving the change.  Image courtesy Edwin Stemp The sensation feels like being thrust into a tropical rainforest at the height of summer. That’s followed by a wave of clammy cold. A hot flash is an absurd euphemism for the experience, say menopausal women. Yet, despite the discomfort, fewer women are seeking relief through hormone-replacement therapy (HRT), which has been shown to be effective. That’s unfortunate and unnecessary, according to health experts. “Some women suffer greatly when hormones are eliminated,” says Elizabeth Lee Vliet, M.D. and author of “It’s My Ovaries, Stupid” (Evans and Company, 2003). “Women may have sleep problems or severe joint pain. They clearly need to be on hormones because their quality of life is bad without [the drugs],” says Vliet, who practices medicine in Tucson, Ariz. One major cause of women’s anxiety was the Women’s Health Initiative Study, (WHI), on the theoretical benefits of HRT. The long-term investigation was abruptly halted in 2002 when researchers noted higher risks of breast cancer, heart attacks and strokes in volunteers taking hormones. Since then, many physicians report their patients dropping the common drug combination of estrogen and progestin. However, the dangers of HRT for short-term use may be misunderstood or exaggerated. Hormones still have a place in preventing hot flashes, night sweats and other menopausal symptoms, say physicians. Of the options, women may benefit from using HRT patches or gels, or taking lower dosages than researchers used in the WHI study. “If menopausal symptoms are affecting a woman’s life, she should discuss this with her physician. She should base her HRT choices on the best estrogen and the best route,” says Dr. Elena M. Kamel, who teaches obstetrics and gynecology at Northwestern University in Chicago. “There’s a role for lower doses, and physicians should use the lowest dose [of HRT] possible,” says Kamel. She also advises women to use HRT treatment for five years or less, and re-evaluate their course of action after that. The form of HRT can have an impact on a woman’s overall health. Patches and gels may offer some advantages over a pill. Pills are processed through the liver. Patches and gels are absorbed through the skin and bypass the liver. Some physicians feel this is safer, although there hasn’t been a lot of research on the issue. Researchers do know that HRT pills can raise a woman’s triglyceride levels; patches don’t have this effect, says Vliet. The start date for HRT may also determine whether it’s beneficial or detrimental to a woman’s overall health. Previous studies on hormone therapy used an older group of women, some of whom already had signs of heart disease, says Vliet. “The WHI study didn’t address the question of whether starting HRT at the beginning of menopause reduces the risk of heart disease. There are some animal studies suggesting that HRT at the beginning of menopause may be beneficial,” Vliet says. Bioidentical hormone products that claim to contain the same balance of hormones in the human body are compounded by pharmacies and are being marketed as an alternative to the horse estrogens in popular HRT drugs. Exercise caution, say physicians. A product won’t necessarily cause fewer side effects if it’s “natural” or “bioidentical.” “These new hormones the pharmacies are compounding have no studies behind them,” Kamel says. Some brands of bioidentical hormones have received approval from the U.S. Food and Drug Administration and these are the products women should choose, Vliet says. The other estrogen therapy Although many women are being advised to use hormone-replacement therapy for as short a time as necessary to alleviate menopausal symptoms, they should continue with vaginal estrogen to prevent atrophy, dryness and irritation. Topical vaginal creams are risk-free says Dr. Wulf Utian and executive director of the North American Menopause Society in Cleveland. Post-menopausal health Before the conclusions of the Women’s Health Initiative studies as well as more recent research, hormone-replacement therapy was touted as a magic bullet that might protect women from heart disease, stroke or Alzheimer’s disease. “The evidence wasn’t there to support all of that,” Utian says. He and other physicians recommend women use the occasion of menopause to look at their risk factors for various diseases of aging and take steps to improve their health. “This is an opportunity for women to focus on themselves and their own health care,” Kamel says. Your first step should be to reach a normal weight, if necessary, increase your exercise and change your diet to emphasize fruits, vegetables and whole grains. Your second step may be to discuss drug therapy for specific diseases with your physician, Utian says. Hormones and your waistline When you hit menopause you may notice a pinch at your waistband. Your waistline may be expanding even if you’re not gaining weight. As women stop making estrogen their weight distribution changes, says Dr. Michelle Warren and medical director of the Center for Menopause, Hormonal Disorders and Women’s Health at Columbia University in New York City. Before menopause, women tend to accumulate fat around their thighs and buttocks; after menopause they pack fat around the abdomen, developing an apple shape. The thickening waist may also signal fat build-up around the intestinal organs. Visceral fat leads to an increase in bad cholesterol (LDL) and insulin resistance, which could result in adult-onset diabetes. Women who continue to take hormones may see the apple shape later in life, Warren reports. She isn’t suggesting using hormones for vanity’s sake, however. “You don’t have to give in to the apple shape. Exercise can make a huge difference,” she says. “And if you have a genetic tendency to a thick waistline, exercise even more.”
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Bev Bennett, a veteran food writer and editor, is the author of "Dinner for Two: A Cookbook for Couples" and "30-Minute Meals for Dummies"
