For some women, miserable hot flashes may resemble Energizer Bunnies. They keep going and going and going well past age 60. But when these women want to keep using hormones, many Medicare plans, insurance companies, and healthcare providers say no because supposed safety concerns put hormones on a standard list of medications that older people shouldn’t have, called the “Beers list.” NAMS thinks there shouldn’t be a hard and fast rule against hormones after age 65. Yes, there may be safety concerns, and the Society does recommend that a woman use the lowest dose of hormones for the time appropriate to meet her needs. But NAMS has also stated that, under some circumstances, hormone therapy can be OK for women over age 65. They can be appropriate when the benefits for hot flashes outweigh the risks or when a woman has a high risk of bone fractures and can’t take other bone drugs or can’t withstand their side effects. In fact, that Beers list wasn’t meant to be a hard and fast rule, and it has changed. In 2012, it added a new category of medications that should be used “with caution.” And that’s just how to use them—knowing what the risks are and having your doctor monitor you closely for any problems. NAMS calls it “judicious use.” You can read the official statement from NAMS about continuing hormones after age 65 here.
NAMS has just released a new MenoNote on sleep. Here’s a sneak peek:
You have had enough sleep when you can function in an alert state during waking hours. Most adults need between 7 and 9 hours of sleep each night. During the menopause transition, you may find that you have more trouble falling asleep, staying asleep, or waking up feeling refreshed. These interventions may improve your sleep:
A new year is upon us. It is a great time to think about where we are and where we want to be. What are your personal priorities for 2015? If you're still trying to come up with a resolution or a new direction, here are a few options to consider:
At midlife, we generally have lot to reflect upon looking backwards and a lot to envision looking forward. The move from 2014 to 2015 provides yet another opportunity to be intentional about out life choices. Be sure to give yourself credit for all the good things you accomplished in 2014. Happy New Year!
It is really your choice. If your hot flashes are not bothering you that much, you may want to just wait them out. Hot flashes generally become milder and less frequent as time goes on, and for most women they totally disappear. However, there are some women who have a long experience with hot flashes for several years, maybe longer, and then an occasional hot flash forever. The challenge is that no one can predict how long your hot flashes will persist. Hormone therapy provides very effective treatment for hot flashes, but it is not always a permanent cure. About forty percent of women have a return of their hot flashes when they stop treatment—somewhat like a second menopause when the estrogen level drops again.
There are a number of low-risk coping strategies and lifestyle changes that may be helpful to you for managing hot flashes, but if hot flashes remain very disruptive then prescription therapy can be considered. Prescription hormone therapy (HT) approved by the US Food and Drug Administration (FDA) and by Health Canada include systemic estrogen therapy (ET) and estrogen-progestogen therapy (EPT; for women with a uterus). Some of these treatments have been around for 70 years. A newer FDA-approved hormone product, for women with a uterus, combines estrogen with bazedoxifene instead of a progestogen. Bazedoxifene is an estrogen agonist/antagonist, which means that it works like estrogen in some tissues while inhibiting estrogen activity in others. In this case, it helps to protect the uterus from cancer. There are reasons why some women should not use HT and the list includes such things as a history of estrogen-related cancers such as breast cancer, a history of liver disease, blood clots in the legs or lungs, cardiovascular disease, and stroke. A review of your health history with your healthcare provider is an important first step.
For women who prefer not to take hormones or cannot take them for other health reasons, nonhormonal drugs approved to treat depression, called selective serotonin-reuptake inhibitors (SSRIs), have been found to be effective in treating hot flashes in women who don’t have depression. The only SSRI the FDA has approved thus far for treating hot flashes is paroxetine 7.5 mg. It was shown to improve hot flashes and offers women a new choice. Discuss with your healthcare provider all of these options to see which ones are appropriate for you.
Are you bothered by menopause symptoms and wondering what to do about it? Try our free MenoPro app available in the iTunes store. You can also read about it here.
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JoAnn V. Pinkerton, MD, NCMP