Q: I'm just entering menopause and I'm starting to have more hot flashes. I'd rather not take hormones. What do you suggest?
A: A hot flash is a sensation of being hot and flushed. It may last a few seconds to a few minutes. The drop in female hormone levels and body changes seen at menopause last for the rest of a woman's life. However, hot flashes disappear over time.
We don't know how to delay menopause; it's a natural change. And we don't know how to prevent hot flashes from starting. We can treat hot flashes quite effectively with estrogen, often combined with progesterone. Because of the risks, many women, like you, are reluctant to use hormones unless absolutely necessary.
"Alternative" treatments have been suggested to treat hot flashes, including black cohosh, vitamin D and primrose oil. But there's been very little good scientific evidence to support the use of most of these. A study reported in the Annals of Internal Medicine in 2006 found that the black cohosh was no better than a placebo.
Soy products also have been suggested as a treatment for hot flashes. But this is controversial because the plant estrogens in soy may also increase the risk of breast cancer.
Little evidence has been found to support the use of acupuncture or homeopathy, but few studies have been done.
Small studies in the past suggested that antidepressants help women with hot flashes. Recently, a new study reported in The Journal of the American Medical Association compared the effectiveness of the antidepressant escitalopram (Lexapro) to a placebo as a treatment for hot flashes. Fifty-five percent of the women reported fewer and less intense hot flashes. But the placebo also worked in 36 percent of the women.
Escitalopram is a selective serotonin reuptake inhibitor (SSRI). There are several other drugs in this class that might be just as effective at reducing hot flashes.
Not all women who go through menopause have hot flashes. It's not usually clear why some women get them and others don't. But we do know the following:
Smoking increases your risk of getting hot flashes.
Being obese or overweight is associated with more hot flashes.
Regular exercise may help.
(Diana Post, M.D., is an assistant professor of medicine at Harvard Medical School and a member of the department of medicine at Brigham and Women's Hospital, Boston, Mass.)
(For additional consumer health information, please visit http://www.health.harvard.edu.)
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