Menopause Symptoms Return When Hormones Stop
More Than Half in Study Had Recurrence of Hot Flashes, Night Sweats
Alternative Treatments continued...
Widely recommended strategies to cope with hot flashes and night sweats include:
- Wearing layered cotton clothing
- Avoiding coffee, alcohol, and spicy foods
- Reducing stress with deep breathing exercises, medication, or yoga
- Sipping cool drinks throughout the day and using ice packs
- Getting regular exercise
Aerobic exercise was found to reduce hot flashes in one study, and working out with weights also helps maintain strong bones.
Many women swear by other treatments such as vitamin E, soy, and a host of over-the-counter products that contain botanicals like black cohosh and red clover. But the research on these treatments is inconclusive.
"Unfortunately, most of these alternative treatments have not been well tested," says clinical psychologist Judith Ockene, PhD, who headed the newly published study on WHI outcomes.
Ockene has received funding from the NIH's National Center for Complementary and Alternative Medicine to study the impact of soy and meditation on menopause symptoms.
"It is important to look at the evidence scientifically," she tells WebMD. "The studies on soy, for example, have been small and have included many different formulations."
There is also no good evidence that a wildly popular alternative to traditional hormone therapy is any safer or effective, Wulf Utian says.
So-called "bioidentical hormones" are custom compounded formulations supposedly tailored to a woman's individual hormonal needs.
Promoters say this makes them safer, but Utian says there is no good clinical evidence to back up the claim.
"The fact is these are the same hormones in different combination and permutations, and they are therefore subject to the same risks and benefits," he says.
Smallest Dose, Shortest Time Revisited
Since the study, the conventional wisdom among women's health experts has been that hormone therapy should be used to treat menopausal symptoms -- hot flashes and vaginal dryness -- only and that it should be given in the lowest effective dosage for the shortest possible time.
But there seems to be little official guidance to help women and their physicians understand what that means.
In a 2004 task force report on hormone therapy, the American College of Obstetricians and Gynecologists recommended only that women taking hormones for menopause symptoms have an annual discussion with their doctor about whether they are ready to stop.
Ockene and colleagues concluded that short-term treatment, whether that means a few months or a few years, may not be enough for many women.
"Some women may not be able to follow the advice to take hormones for only a short time, because their symptoms will last for many years," Ockene says.
How Long Is Too Long for Hormone Therapy?
Utian agrees that women should use the lowest effective dose of hormone therapy. He adds that it is increasingly clear that the combination of progestin and estrogen may pose more health risks than estrogen alone. Progestin is recommended for women who have not had hysterectomies.
All the experts contacted by WebMD agreed that there is no clear answer to the question, "How long can a woman safely stay on hormone therapy?"
"It is a personal decision that has to be made by a woman and her doctor taking her individual risk factors into account," Ockene says. "Right now, medical science can't really say how long is too long."