Avoiding Hot Flashes and Osteoporosis
with Kathryn Kostic, M.D., obstetrician/gynecologist with Advanced Healthcare
In 1991 the national bestseller, "The Silent Passage," was published. The book highlighted the choices modern women had for dealing with perimenopause and menopause. And what many women chose, with the blessings of their physicians, was hormone replacement therapy, referred to as HRT.
Today, women at a low risk for breast cancer or heart disease and troubled by the symptoms of menopause may still want to choose HRT. Others may look to natural or alternative solutions. And sometimes, women going off HRTs have a pleasant surprise. "I've taken a lot of women off HRT and many notice no change in their quality of life. I also have many women who immediately need to go back onto something," said Dr. Kathryn Kostic, an obstetrician and gynecologist with Advanced Healthcare.
Frequently the need for "something" stems from the more troubling symptoms of menopause - the hot flashes, night sweats and resulting lack of sleep that make lives miserable. Doctors also are more concerned about bone density loss and the possibility of osteoporosis as a woman ages. Here are some different ways to treat these problems.
Hot flashes
Hot flashes are no respecter of time or place. They strike at company meetings, at dinner parties and at home. Not only are they troublesome they also are a very public symbol that a woman, no matter how young looking, is going through the "change." Night sweats, similar in cause to the daytime flashes, deprive women of sleep, creating a new set of problems. Clearly, if HRT is not the answer for some women, something else has to be.
For those with occasional hot flashes, Dr. Kostic recommends some practical measures. "Dress in layers. Try not to do things that set you up for a hot flash such as eating hot, spicy foods or drinking red wine," she said.
And then, there is the promise of soy and its plant-based bioestrogen. Women in Japan who follow a traditional diet high in soy do not appear to have the problems with menopausal symptoms of American women. Aware of the relief some women get from soy products, companies have created dietary supplements.
"The problem is the pills don't seem to work as well as the food products. It appears there is something in the food that cannot be concentrated in a pill. When the supplements are studied head-to-head with soy shakes, they don't seem to deliver," Dr. Kostic said.
Women also are trying other nutritional supplements. Of these, black cohosh seems to help with some symptoms. Calcium is another, and it also is good for bones. Some women treat themselves with evening doses of valerian and kava, both of which have sedative effects and assist with sleep, though Dr. Kostic notes that some of these can be habit forming.
In the arsenal of other prescription drugs that treat hot flashes and other symptoms there are progesterone-only medications and the anti-depressants Paxil and Effexor. Better known for their treatment of social anxiety disorders, these two drugs have been found to cut hot flashes by up to 60%, the doctor said. She added that she often prescribes these for women who have troubling menopause symptoms but cannot take HRTs, and for those who also would benefit from a mood elevator.
The risk of supplements
"The biggest risk in most of these supplements is loss of money, but some do increase the risk of bleeding during surgery, so women must tell their doctor what supplements they are taking," Dr. Kostic explained.
The doctor added that use of supplements is new to many physicians, especially in more traditional areas such as the Midwest. "When I was practicing in Seattle, we actually hired an herbalist to help us understand these things. Now medical journals have almost monthly articles on alternative medicine," she said.
Preventing bone loss
Many symptoms of menopause are annoying, but osteoporosis is the one that poses a real danger. Women begin to lose bone mass as their estrogen levels decline. HRT delays this loss for as long as a woman is on the hormones, then the process begins again.
"My concern is that women who do not take estrogen at all will develop osteoporosis later in life. Twenty percent of older people will die within a year following a hip fracture. Fifty percent will be severely disabled," Dr. Kostic said.
Fortunately, doctors now have the bone scan, a diagnostic tool that allows them to establish a baseline for premenopausal women and a way to measure bone loss over time. For women at risk of osteoporosis, the benefits of a low dose of HRTs may far outweigh the risks. There also are bone-protecting medications such as Fosamax.
There are practical things women can do to protect their bones. The first is to be sure to get adequate amounts of calcium and vitamin D, either from food or supplements, and follow a healthy diet and exercise program, preferably one that includes weight-bearing exercises.
"All these things also help your cardiovascular system and the discomfort of menopause. I get a lot less complaints about symptoms from my patients who are physically active and take good care of themselves with diet and stress management," Dr. Kostic concluded.
Learn more about Osteoporosis here
