The Cold Truth About Hot Flashes

It may be winter, but menopausal women across the country are still sweating, flashing and disrobing. You would think that by now someone would have come up with something better than a portable fan to fix this problem.

For those who plan on getting along without therapies to alleviate symptoms, be aware that the average woman can expect to experience moderate to severe hot flashes for about five years -- or even longer (like forever).

So what's a woman to do, beyond layering one's clothing and stripping down to shorts and a T-shirt during board meetings?

There Are Ways to Alleviate Symptoms

Estrogen can relieve menopausal symptoms and works well in even very small doses, but many women can't -- or chose not to -- take estrogen.

It doesn't help that every time you open a newspaper, there is more alarming information about the potential dangers of estrogen replacements. The reassuring information that doctors might learn about estrogen never seems to make it to the front page.

In the 1870s, Lydia Pinkham's Vegetable Compound was a popular cure-all for virtually every gynecologic ailment, including menstrual and menopausal distress. The ads claimed the compound was a "Positive Cure for all those Painful Complaints and Weaknesses so common to our best female population and is particularly adapted to the change of life."

No doubt, the 18 percent alcohol content had something to do with the compound's efficacy -- even proper ladies could remain happily inebriated while dealing with difficult menopausal symptoms if they kept the compound handy.

Another key ingredient in Pinkham's remedy was none other than black cohosh, an extract of dried underground roots derived from a plant used by native North American Indians. Today black cohosh is one of the most widely used alternative therapies for treatment of hot flashes -- despite recent research suggesting its ineffectiveness.

New Research Throws Cloud on Black Cohosh

Researchers looked at 351 women between the ages of 45 to 55 who suffered from hot flashes and night sweats over the course of one year and found that those taking black cohosh got about the same amount of relief as those who took a placebo. And those groups experienced nothing close to the improvement that women taking hormones experienced. The study was published in a recent issue of the Annals of Internal Medicine.

This new data, though perhaps disappointing, is important. Few researchers have carried out scientific, well-designed studies on alternative treatments for hot flashes -- in part because such studies are extremely expensive and difficult to do since they require many patients and a lot of time.

Another hurdle to the study of hot-flash remedies is the high placebo effect from the products used to treat hot flashes. Whether you give women soy, Chinese herbs or broccoli, at least 30 percent will experience fewer flashes for at least a few weeks.

Keep in mind that the companies that produce alternatives to estrogen are just as profit motivated as pharmaceutical companies. A multimillion dollar industry has evolved to promote so-called natural products to a vulnerable population of women who are suffering and seeking safe, effective options.

Although women generally distrust the pharmaceutical industry -- which is legally obligated to test and report all safety risks and negative findings -- the general population seems to have little problem placing its trust in companies that have no such efficacy or safety standards.

Just because something is "natural" doesn't mean it is safe. Just because the health food store clerk seems to know a lot about it, doesn't mean it works.

Safety and Effectiveness of Supplements Often Unproved

There are only two appropriate questions to ask when deciding whether to use an alternative product: Is it safe and does it really work?

Too often, no one really knows the answer to either question. Since supplements like black cohosh or Chinese herbs are neither food nor drug, the Food and Drug Administration doesn't actually have to approve them, and manufacturers don't have to prove that a product is safe or effective. The only ones who consistently benefit from the supplements are the companies selling them.

Hormones might not be safe for everyone, and supplements may not work. So what nonhormonal options do work?

Selective serotonin reuptake inhibitors were serendipitously found to significantly reduce hot flashes in menopausal women years ago, but the FDA has approved the drugs only for their intended use as antidepressants. Drugs such as fluoxetine (Prozac), paroxitene (Paxil) and venlafaxine (Effexor) have all been found to help. Effexor is the most studied and seems to do the best job of reducing flashes.

Tibolone, a synthetic testosterone derivative widely prescribed in Europe, has received a lot of recent attention. This once-a-day pill alleviates flashes, increases bone mass and decreases vaginal dryness.

Tibolone is a hormone derivative, but clinical studies have detected no increased risk of breast or uterine cancer. In fact, Tibolone seems to significantly decrease the risk of uterine cancer -- but the drug isn't currently available in the United States.

Last year, the FDA determined that Tibolone was "not approvable," despite an almost 20-year track record in more than 80 countries. Organon, the company that manufactures Tibolone, has no plans to pursue FDA approval at this time and is focusing on the international market. The only way American women can get a prescription for Tibolone is to travel to South America or Europe.

Gabapentin (Neurontin) is ordinarily used to treat neurologic disorders but has also been shown to reduce hot flashes. For many women, a single nighttime dose provides relief. An added bonus for women with menopausal insomnia is that this medication tends to make people sleepy.

Symptom Relief Without Pills

Drugs aren't the only available option. Don't underestimate the value of exercise. Multiple studies demonstrate that women who work out regularly have fewer hot flashes due to exercise-induced endorphin production.

Those old folk remedies, alas, don't work the way we might have thought they did. And while Lydia Pinkham's Vegetable Compound is still available, it no longer contains any alcohol.

Dr. Lauren Streicher is an assistant professor of obstetrics and gynecology at Northwestern University and a practicing OB-GYN at Northwestern Memorial Hospital in Chicago.