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Hormone users take the chance

A major study prompted many menopausal women to toss their estrogen pills, but for some, the quality of life with the drugs far outweighs the benefits of quitting.

March 31, 2003|Shari Roan | Times Staff Writer

Since women stopped taking hormones in droves -- sales of the popular hormone product Prempro are down 50% since last summer, according to its manufacturer, Wyeth Pharmaceuticals -- many have experienced hot flashes, even women who did not have hot flashes before going on hormones. The emergence of hot flashes, especially in older, post-menopausal women, may be a temporary withdrawal from estrogen, says Dr. Gail Greendale, a professor of medicine at the David Geffen School of Medicine at UCLA.

"I think, and many others think, women are getting hot flashes from the abrupt discontinuation of [hormone replacement therapy] rather than the fact that taking them off the hormone is allowing their own hot flashes to [reemerge]," says Greendale. "It has made a new syndrome come to light."

Still, said Greendale, the lack of research on the phenomenon leaves both doctors and women guessing about what to do.

Paula Golden, a Century City woman in her 50s, said she experienced profound hot flashes after stopping hormones abruptly last summer. However, she was resolved to stay off hormones and instead increased her exercise levels and improved her diet. Whether it was those lifestyle changes or simply time, Golden's symptoms faded away.

"I sweated buckets of water for a month," says Golden. "I was so fearful this was going to be my life. But then I decided to get real about exercise and nutrition. It has taken me six months, but I've never felt better in my life."

The withdrawal syndrome suggests that hot flashes may be related to abrupt changes in estrogen levels, Greendale says.

More information on menopausal symptoms, including research on why certain women get hot flashes and how hot flashes are linked to estrogen levels, will be released later this year as part of another major women's health study, the Study of Women's Health Across the Nation. The SWAN study, a $17.5-million study led by the federal National Institute on Aging, follows women from pre-menopause through the menopausal transition.

"What the hormone debacle has ended up doing is shining the light on the fact that we need to know a heck of a lot more on menopausal symptoms," says Greendale, a SWAN investigator. "Having hormone therapy around made the need to develop alternatives very much of a back-burner issue. But now the need and motivation to develop alternatives will be greater."

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Other treatments for the symptoms of menopause

Many women are exploring alternative therapies for relief of hot flashes and other menopausal symptoms. Little research exists, but doctors say some therapies seem to help more than others.

Black cohosh: This herb is a key ingredient in the over-the-counter menopausal remedy Remifemin. Studies show it may be helpful for six months or less.

Isoflavones: These estrogen-like plant compounds are found in certain nuts, beans and soy and are available in supplement form.

Also, some studies have shown a 40% to 45% reduction of symptoms from soy protein.

Flaxseed oil: A few studies suggest modest relief, but the data is unconvincing overall.

Other herbs: Dong quai, evening primrose, wild yam, valerian root and chasteberry are often used to combat hot flashes, but the actual benefit is unknown because adequate studies have not been done.

SSRI antidepressants: Small studies show that SSRIs can reduce hot flashes in many women. The drugs cause side effects in some patients.

Lifestyle changes: Dressing in layers to cool off quickly or sleeping in a cool room may have a modest effect in lessening the severity of hot flashes.

Diet: Avoiding spicy foods and alcohol may help reduce the number of night sweats.

Exercise: Normal body mass index (neither too thin nor too heavy) was associated with fewer night sweats in one study.

Stopping smoking: Smoking is linked to more severe hot flashes.

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