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Women typically seek medicinal cures for hot flashes when they realize dressing in layers and carrying a portable fan just do not help them enough. Doctors would then traditionally treat the hot flashes by starting a hormone therapy regime. Given concerns about the impact of hormones, however, that approach has somewhat fallen out of favor. So, many doctors new deal with patients’ hot flashes by prescribing antidepressants. A new study conducted by Brigham and Women’s Hospital in Boston looked at the effectiveness of estrogen, antidepressants and placebos in treating hot flashes.
People who have not experienced hot flashes or been with a women having one, it is hard to understand the severity. Hot flashes, which occur in 75 to 80 percent of menopausal women, usually begin with a sudden rush of heat on the face and upper chest that then becomes generalized. An intense, severe hot flash can last from two to four minutes during which there is profuse sweating, then shivering and the chills. Physiologically, a hot flash is the body’s attempt to cool down just like sweating in a sauna. The difference is that there is a need to cool down from a sauna, whereas during menopause the body thinks it needs to cool down, but does not really. Most women have hot flashes for two to four years, but some will experience them for 10 years or more.
Most women do tough out menopause successfully. But, some suffer through severe hot flashes day and night that are totally debilitating and lack of sleep makes it worse. Hormone therapy with estrogen will reduce or eliminate the flashes, but given the side effects many women steer clear. In fact, only about 7 percent of women nowadays who have hot flashes wind up with an estrogen prescription.
One alternative used today was discovered by accident. An estimated 10 percent of women suffer from depression, although that number drops off post menopause. Doctors found that women on antidepressants do not have as severe hot flashes, and scientific studies corroborated the anecdotal evidence. So, some doctors began prescribing low dose antidepressants, like Brisdelle, a type of paroxetine, which is a selective serotonin reuptake inhibitor (SSRI) antidepressant.
The Brigham and Women’s Hospital study, published in the latest issue of JAMA (May 27), looked at 339 peri- and post-menopausal women who took venlafaxine (an antidepressant), estrogen, or a placebo for dealing with their hot flashes over an eight-week period. The results showed that the women who took venlafaxine had nearly similar reductions in symptoms as women who took estrogen. After two months, the frequency of hot flashes and night sweats for women taking estrogen therapy declined by 53 percent and for women taking venlafaxine by 48 percent. Symptoms did drop 29 percent for the women taking placebo.
In addition, this study looked at the patients’ satisfaction with the treatment and the effect of symptoms on their daily life. They did find highest satisfaction for those on estrogen and lowest for those on the placebo.
The study was extremely limited. Two months is a short period of time, particularly since it often takes a month for antidepressants to really kick in. They also did not evaluate libido or weight gain effects. IN addition, they did not look at diet, which has been shown to affect hot flashes. Clearly further research is needed. However, they did show that venlafaxine, like other SSRIs, does reduce hot flashes about as well as estrogen in the short term. Hopefully, this study is just the latest, not the last, to look at ways of dealing with hot flashes.
By Dyanne Weiss