As many as 75% of perimenopausal women in North America experience hot flashes, and for a quarter of these women, hot flashes are so disturbing that they seek help.

There is no question that hormone therapy is the most effective treatment for bothersome hot flashes, but in many cases, hormone therapy is not appropriate, and some women simply choose not to try it. In fact, from 50% to 80% of perimenopausal women try nonhormonal therapies for hot flashes, but without any real guidance on what works (and what doesn’t), woman experiment with different products, often delaying their chance at finding effective treatment, wasting capital, or they suffer in silence.

A number of nonhormonal products and techniques are promoted for hot flashes, but they are often untested and unproven. To learn what really works, a NAMS panel of experts looked at the evidence and made recommendations in the Position Statement, “Nonhormonal Management of Menopause-Associated Vasomotor Symptoms.”

The NAMS panel found solid evidence that a few therapies do work, including two behavioral approaches (a combination behavioral approach and clinical hypnosis) and certain nonhormonal prescription medications. Other lifestyle and behavioral approaches, treatments, and a supplement under study (S-equol) look beneficial, but the evidence is not as strong.

Evidence for other lifestyle approaches, herbs, and supplements is insufficient, inconclusive, or just plain negative. The panel found no evidence that exercise, yoga, paced respiration, and acupuncture work on hot flashes, although they may offer other health benefits. They are not recommended as hot flash therapy. Over-the-counter and herbal therapies (such as black cohosh, dong quai, evening primrose, flaxseed, maca, omega-3s, pollen extract, and vitamins), relaxation, calibration of neural oscillations (a brain-training technique), and chiropractic intervention also were not found to work, and risk-free approaches such as stay-cool techniques and avoiding hot flash “triggers” have no studies testing their effectiveness, so these are not recommended therapies either.

The NAMS panel prepared this Position Statement to educate healthcare providers and menopausal women. With this careful, critical look at all the available studies, NAMS has highlighted the need for further research. In the meanwhile, women are better informed on how to handle hot flashes without hormones.

The Position Statement has been published online in the NAMS journal, Menopause.

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:

• Maintain an environment that promotes sleep. Think quiet, cool, and dark. A white noise machine may be helpful. If you have night sweats, try a bedside fan, light pajamas and bedding, and placing an ice pack under your pillow—turning the pillow over during the night so that your face rests on the cool side.

• Try relaxation techniques such as meditation or slow deep-breathing exercises. You can learn these techniques through books, videos, and classes.

• Avoid TV, computer screens, smart phones, and electronic readers for at least an hour before bedtime, because the light from these devices may disrupt sleep.

• Follow the 15-minute rule. If you do not fall asleep within 15 minutes, get up, leave the bedroom, and do something relaxing in another room, such as reading a book or magazine or listening to quiet music. Return to bed when you are drowsy.

 

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:

• Harmonizing your relationships
• Improving your personal health and fitness
• Focusing on your physical, emotional, and/or spiritual life
• Learning a new skill or pursuing a new interest
• Setting a new career or social goal
• Completing a specific project that has been on the back burner for a while
• Choosing a new, healthy habit to replace an unhealthy habit
• Supporting a worthy cause by volunteering/donating

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. 

Studies suggest that hormones may play a role in headaches. Women at increased risk for hormonal headaches during perimenopause are those who have already had headaches influenced by hormones, such as those with a history of headaches around their menstrual periods (so-called menstrual migraines) or when taking oral contraceptives. Hormonal headaches typically stop when menopause is reached and hormone levels are consistently low. Most headaches do not require treatment or can be treated with nonprescription pain medications. Some headaches, however, can be serious. More serious headaches, including migraines, may require prescription drugs; however, care should be taken to monitor the use of these drugs. If a headache is unusually painful or different from those you have had before, seek medical help promptly.

If you’re having hot flashes and other menopause symptoms but still getting your period now and then, there is a slight chance you could become pregnant, unless you have already taken care of that. If not, and if you would like to avoid pregnancy, birth control is recommended until one year after your last period. Many options are available for midlife women:

• Birth control pills, patches, or rings—added benefits include more regular cycles with perhaps lighter bleeding, perhaps fewer hot flashes and a reduced risk of cancer of the uterus and ovaries. Note that these methods are not recommended for women who are smokers over age 35, have high blood pressure, migraines or who have had a blood clot in their legs or lungs. 
• Progestin-alone pills, implants and injections—a potential option for those who smoke, have certain cancers,  high blood pressure, diabetes (without kidney, retina, or neurologic complications), history of blood clots, or obesity. These conditions should be discussed with your healthcare provider.
• Barrier methods (condoms, diaphragm, spermicide)—condoms are the only method than provides some protection from HIV and other sexually transmitted infections. Note that these methods depend upon one of the two partners using the method with intercourse every single time.
• Intrauterine devices with or without hormones—safe, highly effective, convenient, and long-term.
• Sterilization (Tubal ligation, fallopian tube inserts, or vasectomy for men)—very effective and permanent methods, but require a surgical procedure.
• Note that the last two methods, as well as progestin implants, require procedures that produce long-lasting contraception. They are highly effective, but they are more costly up front and in the short term. If you are quite close to menopause, they may not be worth the cost and the necessity of undergoing a procedure. 

For all of these methods be sure to review the pros and cons with your healthcare provider in order to be sure the method is a good choice 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.