How Your Gynecologist Can Help Manage Challenging Menopausal Symptoms
Posted on by Capital Women’s Carein Gynecology, Menopause
Oh the joys of going through menopause! You know, the night sweats, hot flashes, weight gain, and moodiness. Of course we are kidding, because every woman who has experienced menopause knows its no fun. Some women have it easier than others, but regardless of the severity of your symptoms, learn how your gynecologist can help manage challenging menopausal symptoms.
Buyer Beware: Unproven Nonscientific ‘treatments’ For Hot Flashes
You may have heard about black cohosh, DHEA, or soy isoflavones to treat hot flashes. These products are not proven to be effective, and some carry risks such as liver damage.
Phytoestrogens are estrogen-like substances found in some cereals, vegetables, and legumes , and herbs. They may work in the body like a weak form of estrogen, but they have not been consistently shown to be effective in research studies, and their long-term safety is unclear.
Always talk with your doctor before taking any herb or supplement. Currently, it is unknown whether these herbs or other “natural” products are helpful or safe to treat your hot flashes or other menopausal symptoms. The benefits and risks are still being studied.
Popular Medications For Hot Flashes
Hot flashes are one of the most common and most dreaded symptoms that is associated with menopause. While hot flashes can make things difficult for many women, there are also a number of ways to manage the problem. A large number of women decide to take medication for hot flashes in order to reduce the severity, or sometimes even eliminate hot flashes entirely. Learn about four of the most popular medicines for hot flashes.
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How Do I Know If A Product To Treat Hot Flashes Is Safe Or Legitimate
In general, its always a good idea to talk to your healthcare provider before starting a new medication or supplement. Sometimes, a product might seem safe on the surface, but it might not be a good option for you when you factor in other medications you take or other medical conditions you might have. Your provider will discuss each of these factors with you and make sure its a safe product for you.
Ask yourself a few simple questions when youre considering a new treatment for hot flashes:
- Whats the treatment?
- Ads disguised as valid news articles.
- Ads in the back of the magazines.
Additional red flags to look for can include:
- Big claims: If products claim to be a “cure” for your condition or give outrageous claims, be cautious.
- : Be wary if the product is only offered through one manufacturer or purchased only through a healthcare providers office.
- Ingredients: Make sure all of the active ingredients are listed and dont trust “secret formulas.”
- Testimonials: Remember that only people who are satisfied with a product give testimonials and that they may be getting paid for their endorsement.
The best and safest thing to do is talk to your healthcare provider before starting any new product for your hot flashes.
How Do I Cope With Mood Swings Fears And Depression
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Many people experience a wide variety of symptoms during menopause, not just hot flashes. Mood swings, depression, anxiety and fears are all possible symptoms you might experience throughout menopause. Its alright if you have these symptoms. Menopause is a time of extreme change and transition for your body. If you feel overwhelmed by any of these symptoms at any point, reach out to your healthcare provider. There are ways to help you feel better.
There are also a few ways you can cope with mood swings, depression and fear during menopause at home. These things include:
- Finding a self-calming skill to practice, like yoga, meditation or slow, deep breathing exercises.
- Avoiding tranquilizers, if possible.
- Engaging in creative outlets that foster a sense of achievement.
- Staying connected with your family, friends and community.
Another symptom of menopause that you might experience is painful intercourse. If you find that sex is uncomfortable or painful, there are things you can do to make it better. Try using a vaginal water-based moisturizing lotion or lubricant during intercourse. These are sold without a prescription. Common names include Astroglide® and KY liquid®. Its recommended that you avoid Vaseline® as a lubricant because it could lead to yeast infections.
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Can I Prevent Hot Flashes At Night
Hot flashes can also interfere with your sleep. You might hear this referred to as night sweats or even insomnia. There are a few environmental and lifestyle changes you can make that can help you sleep better each night. These changes include:
- Keep your bedroom cool to prevent night sweats.
- Avoid using sleeping pills.
Hot Flashes May Return After Ending Antidepressant
By Kerry Grens, Reuters Health
5 Min Read
NEW YORK – For about a third of women taking antidepressants to treat menopause symptoms, hot flashes and night sweats will return after discontinuing the drug, according to a new study.
Its important for people to understand that…the benefit of the treatment is related to the duration of the treatment, said Dr. Hadine Joffe, lead author of the study. But that shouldnt discourage women from trying an antidepressant if they want to, she added.
Just because symptoms come back after you stop it doesnt mean it didnt make a big difference when you took it, said Joffe, who is an associate professor of psychiatry at Harvard Medical School and director of research in the Center for Womens Mental Health at Massachusetts General Hospital.
Escitalopram, an antidepressant sold under the brand name Lexapro, is not approved to treat menopause symptoms, but physicians may prescribe it because some – though not all – studies have found it can reduce the number and severity of hot flashes.
It has a moderate effect, Joffe told Reuters Health. The drug does not eliminate hot flashes, but it can make a very meaningful improvement in somebodys life.
Antidepressants of the same type as Lexapro, called selective serotonin reuptake inhibitors , are also used to treat menopause symptoms.
To address the second question, she and her colleagues asked 200 women to take 10 or 20 milligrams a day of Lexapro for eight weeks.
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Can Menopause Cause Depression
Reviewed By:
Jennifer Payne, M.D.
The time leading up to menopause is a physical and emotional roller coaster for some women. The so-called change of life comes with a host of symptoms triggered by hormonal shifts hot flashes, insomnia, mood fluctuations and even depression.
When women go through sudden hormonal changes like those that come with perimenopause, puberty, postpartum and even their monthly cycle, theyre at a higher risk for depression, says Jennifer Payne, M.D., psychiatrist and director of the Women’s Mood Disorders Center at Johns Hopkins. In general, women are twice as likely as men to develop the condition.
Are There Any Lifestyle Changes I Can Make To Help With Hot Flashes
Making small changes to your normal lifestyle can sometimes help limit the number and severity of your hot flashes. Dressing in layers, reducing the temperature in your home, using a fan and drinking cold beverages can all be small ways to help with hot flashes. If you have obesity, you might have more bothersome hot flashes. Maintaining a healthy body weight may be helpful. Another lifestyle change that can help improve your hot flashes is not smoking or using tobacco products. Smoking contributes to the increased cardiovascular risks of being postmenopausal. People who smoke and/or use tobacco products also tend to experience more hot flashes.
Exercise is another lifestyle change that often helps menopausal people. This is not only a great way to maintain a healthy weight, but people who lead sedentary lives seem to experience more hot flashes. Just remember to watch the temperature when you work out. Getting overheated can trigger a hot flash, so its best to try and exercise in a cooler environment.
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Antidepressant Effective For Hot Flashes
Women taking a low dose of the antidepressant escitalopram had fewer and less severe hot flashes than those taking a placebo, a new clinical trial reports.
Menopause is a transition that affects many women as they approach age 50. It marks the end of menstrual periods and fertility. It can also bring hot flashes, trouble sleeping, mood changes and other symptoms.
Menopausal hormone therapy has long been the predominant treatment for menopausal symptoms. However, its use has greatly declined since 2002, when a large NIH-funded study concluded that the overall risks of menopausal hormone therapy likely outweigh the benefits. The therapy increases the risk in some women of heart disease, stroke, blood clots and breast cancer.
No other treatments for menopausal hot flashes currently have FDA approval. Recent studies suggest that certain anti-depressant medications may be effective for relieving hot flashes, but the results have been inconclusive.
Dr. Ellen W. Freeman at the University of Pennsylvania School of Medicine and her colleagues enrolled over 200 healthy menopausal or postmenopausal women. The women were given either a daily dose of escitalopram or a placebo for 8 weeks. The researchers tracked the number, severity and irritation of their hot flashes. The trial was funded by NIHs National Institute on Aging and several other NIH components.
by Amy Alabaster
The Role Of Genetics In Drug Metabolism
Paroxetine and venlafaxine are metabolized by the CYP2D6 liver enzyme. Escitalopram and citalopram are metabolized by a different liver enzyme called CYP2C19. Genetic variations in both genes can significantly affect the speed of medication metabolism, effectiveness and tolerability. A slow metabolism can dramatically increase the risk of side effects. Whereas a rapid metabolism clears medication too fast, resulting in lower antidepressant levels in the blood. For this reason, rapid metabolizers do not experience remission of menopause and depression symptoms.
Less than 35% of North American women are normal metabolizers for both CYP2D6 and CYP2C19 enzymes. Over 18% of women in Canada are rapid metabolizers . It helps to know your genetic profile and how it affects your drug-metabolism for different medication options. The majority of women will benefit from a pharmacogenetic test such as Pillcheck, to help select appropriate menopause and depression treatment.
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‘it Gave Me My Life Back’
It was only when Jo Caminiti watched a TV program about menopause that the penny dropped.
As soon as she joined an online support group for menopausal women, she got the information she needed and took it to her doctor.
Even then, she struggled to get her condition treated as a hormonal issue.
Instead, her doctor suggested anti-depressants.
She held her ground and her doctor agreed to try menopausal hormone therapy.
“It made an immediate difference, and it gave my life back,” she said.
“I had nearly ten years in the wilderness there where things were just getting worse and worse and if I had known earlier, I could have done something about it earlier.”
With her joint pain gone, her depressive moods under control and her drive restored, Ms Caminiti turned her back on her science career.
Instead, she took up metal sculpting and landed a public commission to create a four-metre metal sculpture of a cluster of red flowering gum blossoms.
“I can do stuff, I can live, and life is good,” she said,
“It’s like the weight’s lifted off. I’m not angry now.”
Citalopram Effective For Treating Hot Flashes
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For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flushes. However, after studies reported that estrogen may have an adverse effect on risk for cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors .
The North Central Cancer Treatment Group studied the use of the SSRI citalopram to decrease hot flashes in a randomized, placebo-controlled phase III trial as reported in a poster session at the annual meeting of the American Society of Clinical Oncology. This group found that citalopram performed twice as well as placebo in decreasing the frequency or severity hot flashes.
This study included 254 post-menopausal participants who had a history of breast cancer or who wanted to avoid hormones due to breast cancer risk. The participants needed to have at least 14 hot flashes per week for at least 1 month and could not be taking any other antidepressants or hot flash therapies. These participants were divided into 4 separate groups with 57 participants in each of the treatment arms and 83 participants in the placebo group. For week one, all the participants recorded their hot flashes prior to treatment. The groups received the following interventions during weeks 2-7:
Betty Wang, MD
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Newer Depression Drug Relieves Hot Flashes
May 22, 2000 — A newer type of medication typically used to treat depression has proven to be a useful treatment for hot flashes and may work for both women and men. Researchers discovered the effect while treating breast cancer patients who were experiencing the hot flashes due to their treatment.
“Hot flashes can be quite a problem in patients undergoing chemotherapy for breast cancer,” Charles Loprinzi, MD, tells WebMD. “This new class of medicines, called SNRIs, seems to be effective and the least toxic of the medicines we’ve tried, helping more than 60% of patients who took them in this study. We also believe they may be effective in men being treated for prostate cancer, in whom hot flashes may also occur, and in menopausal women.” Loprinzi is professor and chair of medical oncology at the Mayo Clinic in Rochester, Minn.
Women receiving chemotherapy for breast cancer often experience hot flashes because the drugs affect the ovaries. Ovaries produce estrogen, and when the body is deprived of estrogen, as it is in women going through menopause, hot flashes often develop. Cancer physicians and women with breast cancer are often reluctant to use estrogen replacement because estrogen may stimulate cancer growth.
Loprinzi and colleagues used an SNRI, known as Effexor, in a 4-week study of more than 180 women with breast cancer who were having hot flashes. Study participants were asked to record their experience of hot flashes in a diary.
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Fda Approves Antidepressant For Hot Flashes
The FDA has approved paroxetine , a selective seratonin reuptake inhibitor , to treat moderate to severe hot flashes in women with menopause.
Todays approval provides women with the first FDA-approved, nonhormonal therapeutic option to help ease the hot flashes that are so common in menopause, Hylton Joffe, MD, director of the division of bone, reproductive, and urologic products at the FDAs Center for Drug Evaluation and Research, said in a press release.
As many as three quarters of post menopausal women experience moderate- to severe- vasomotor symptoms, sometimes lasting five years or longer, the FDA noted, and as many as two-thirds of the 24 million affected by the condition choose not to treat their symptoms instead of opting for hormonal therapies.
The FDA approval of paroxetine addresses the unmet need for a clinically proven nonhormonal treatment option for hot flashes and night sweats, David Portman, MD, director of the Columbus Center for Womens Health Research in Ohio, said in a statement.
The FDA approval is based results from two randomized, double-blind, controlled studies examining paroxetines effectiveness against moderate to severe hot flashes in 1,175 postmenopausal women.
Headaches, fatigue and nausea/vomiting were the three most common side effects, although fatigue was shown to decrease as treatment progressed over time.
by Walker Harrison, an undergraduate student at Columbia University and editorial intern with Clinical Advisor.
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How Does Paroxetine Help With Hot Flashes
Paroxetine helps reduce vasomotor symptoms . When taken as prescribed, paroxetine decreases overall core body temperature by vasodilation, or by reducing blood flow in blood vessels.
SSRIs are shown to vasodilate and decrease blood flow to the skin, which lowers flushing.
Usually, the thermoregulatory zone, a temperature range the body processes, is narrowed during this phase of a woman’s life. SSRIs help reduce temperature ranges through central vasodilation, therefore decreasing hot flashes.
Paroxetine reduces hot flashes and night sweats in 50% of women, helping improve the quality of sleep and staying comfortable. Though not as effective as hormone replacement therapy, Paroxetine is a viable, proven, and FDA-approved option for women who cannot take estrogen.
The good news too is that the clinical response is much more rapid than the typical response to SSRIs for depression .
Clinical Presentation: Signs And Symptoms
TABLE 1 outlines the symptoms of hot flashesa subjective sensation of intense warmth in the upper body typically lasting 30 seconds to 5 minutes when these flashes manifest during the night, they are referred to as night sweats.6 Hot flashes vary in frequency .10 Persistent sweating may be experienced throughout the day and night, or patients may just feel occasional warmth.10 Hot flashes may alternate with other vasomotor symptoms such as chilly sensations and, less commonly, paresthesias.7
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Lifestyle Changes To Improve Hot Flashes
Before considering medication, first try making changes to your lifestyle. If hot flashes keep you up at night, lower the temperature in your bedroom and try drinking small amounts of cold water before bed. Layer your bedding so it can be adjusted as needed and turn on a fan. Here are some other lifestyle changes you can make:
- Dress in layers that can be removed at the start of a hot flash.
- Carry a portable fan to use when a hot flash strikes.
- Avoid alcohol, spicy foods, and caffeine. These can make menopausal symptoms worse.
- If you smoke, try to quit, not only for hot flashes, but for your overall health.
- Try to maintain a healthy weight. Women who are overweight or obese may experience more frequent and severe hot flashes.
- Explore mind-body practices. Some early-stage research has shown that hypnotherapy and mindfulness meditation could help with management of hot flashes.