Hot-Flash Relief

By Ian K. Smith, M.D.

My mother is going to kill me for including her in a column about menopause, but when I read about a doctor treating hot flashes with a drug for seizures, it reminded me of a conversation my mother and I had a few months ago. For some reason we were talking about hormone-replacement therapy for menopausal women when out of the blue, she asked, "What do you think about those herbal supplements?" This was my mother's way of telling me that she was one of the 30 million American women going through the change of life, at least 60% of whom experience those inconvenient and unpredictable hormonal disruptions that can make a woman's body feel as if it's undergoing meltdown.

Hormone-replacement therapy, as every woman of a certain age knows, is designed to make up for the body's lowered estrogen output during menopause. But many of these women also know that HRT has been linked--controversially--to an increased risk of breast cancer. Thus the interest in alternative therapies, both old and new.

The older alternatives include a long list of natural remedies--vitamins, minerals, herbs and various supplements containing phytoestrogens (plant estrogens that seem to have estrogen-like effects in humans). Lately, phytoestrogens have become popular alternatives to standard HRT. Sales of supplements that contain soy isoflavones, a form of phytoestrogen, tripled from 1998 to 1999. Some women also take vitamin E for hot flashes, while others are turning to remedies based on such exotics as black cohosh, flaxseed, red clover, dong quai and wild yam.

Unfortunately, there is little hard, scientific evidence to support the use of most hot-flash remedies sold in health-food stores. The exceptions are the soy supplements. Soy isoflavones have been subjected to quite a bit of scientific testing, with mixed results. While some studies show as much as a 45% reduction in hot flashes, others have found that a placebo can be nearly as effective. Also, whereas the moderate amounts of soy isoflavones contained in food are safe, there are hints that the high concentrations found in supplements may promote breast tumors.

The newest alternative to HRT has won FDA approval, but for a different condition. It's a drug called gabapentin, okayed in 1993 to treat seizures but commonly used for relief from migraines and chronic pain. In a study of five women taking gabapentin, neurologist Thomas Guttuso Jr. of the University of Rochester reported an 87% reduction in hot-flash frequency. But Guttuso admits his study is too small to be more than just an interesting first step. Besides, gabapentin can have unpleasant side effects; patients taking it have complained of feeling sedated.

After going over the various supplements my mother had seen advertised in women's magazines, I repeated the conclusion of Dr. Steven Goldstein, professor of obstetrics and gynecology at New York University Medical Center: "Eighty percent of women who experience hot flashes are over the hump within 18 to 24 months. They could get away with taking hormones for that period without an increased breast-cancer risk." My mother and I finally reached an agreement. If she was still determined to try alternatives, she would take them in moderation until they were better studied and better understood.

Dr. Ian appears on WNBC-TV in New York City. E-mail him at [email protected] For more on hot flashes, try menopause.org