Caffeine may heighten Hot Flashes
Posted by on March 11, 2015 - 3:49pm

coffeeVasomotor symptoms, mainly in the form of hot flashes, are the most commonly reported menopausal symptom.  While many people assumed a connection, data was inconsistant, it was only recently that cross sectional survey using the Menopause Health Questionnaire from Mayo Clinic  was conducted that compared users and non-users of caffeine beverages.  A total of 2,507 surveys were completed and after adjusting for menopause status and smoking (caffeine users smoked more than non-users), the researchers found that caffeine users reportied higher vasomotor symptom scores. 

There was some evidence of a decrease in neurocognitive symptom bother in premenopausal (not post menopausal women) with caffeine use but more study is need to determine if this is true.  Interestingly, other menopausal symptoms (sleep, blowel/bladder function, sexual function, and general/other symptoms) did not show an association with caffeine use.

To read more on menopause, visit menopauseNU.org or read the full report HERE

Heavy Bleeding during Menopause
Posted by on April 18, 2014 - 10:00pm

Most women think menopause means low estrogen, hot flashes, and the end to regular and monthly periods. This may not be the case, however. Researchers have found that women may experience an increase in the amount and duration of bleeding, which may occur sporadically throughout the transition of menopause.

Researchers from the University of Michigan utilized data from the Study of Women's Health Across the Nation, in which participants kept track of their episodes from 1996 to 2006. Women were of various ethnicities, including caucasian, Chinese, Japanese, and African-American. This was particularly unique in that previous studies have been limited to caucasians and were of shorter duration.

The results showed that during the menopause transition, women can have prolonged bleeding of 10 or more days, spotting for a week, and heavy bleeding for 3 or more days. 91 percent of the approximately  1,300 women ages 42 to 52 years old in the study, recorded up to 3 episodes of bleeding that lasted at least 10 days. Up to 88 percent of women in the age group reported at least 6 days of spotting, and up to 78 percent recorded at least 3 days of heavy bleeding. No significant differences regarding bleeding episodes were noted amongst race and ethnicities.

More research will need to be done to determine how to evaluate alterations in menstruation during menopause. However, this research reveals some of the qualitative differences in bleeding that women may expect through the menopausal transition. Instead of consistently being alarmed with what their bodies are going through, women can now perhaps be more aware of the changes in bleeding patterns, and what may or may not require medical attention. To discover other physical symptoms that occur and may change with menopause, visit Northwestern's menopause website here.

 

Source: University of Michigan. "Prolonged, heavy bleeding during menopause is common." ScienceDaily. ScienceDaily, 15 April 2014. <www.sciencedaily.com/releases/2014/04/140415203629.htm>.

 

Hot Flashes Years After Menopause
Posted by on February 5, 2014 - 5:53pm

New long-term research shows that hot flashes continue, on average, for five years after menopause. More than a third of women can experience hot flashes for up to ten or more years after menopause.

A recent study evaluated 255 women in the Penn Ovarian Aging Study who reached natural menopause over a 16-year period. The results indicate that 80 percent reported moderate to severe hot flashes, 17 percent had only mild hot flashes, and three percent reported no hot flashes.

Hot flashes are momentary episodes of heat that can occur with other symptoms including sweating and flushing. Changing hormone levels after cessation of menses are believed to cause hot flashes as well as other menopausal symptoms including insomnia, anxiety, joint and muscle pain, and memory problems.  Hormone therapy repletes the hormones estrogen and progesterone the body stops making during menopause, and it has been proven an effective treatment for hot flashes.

Although hormone therapy is highly effective, it is not recommended for all women. In addition, concerns about health hazards linked to hormone therapy have made some physicians hesitant to prescribe it, or to adhere strictly to recommended duration guidelines; current guidelines suggest that exogenous hormones should not be taken for more than five years. This new research on the long-term persistence of hot flashes suggests that women should collaborate with their physicians to determine the risks and benefits of different hormonal and nonhormone therapies available for menopausal symptoms. Women should be able to individualize their treatment to appropriately minimize the the symptoms they may have, no matter how severe or how persistent. To learn more about the variety of treatments available for menopausal symptoms, visit Northwestern's Menopause website here

Source: Ellen W. Freeman, Mary D. Sammel, Richard J. Sanders. Risk of long-term hot flashes after natural menopause. Menopause, 2014; 1 DOI:10.1097/GME.0000000000000196

Hypertension during Pregnancy May Mean Hot Flashes later
Posted by on December 30, 2013 - 1:11am

New research shows that women with high blood pressure during pregnancy may be at higher risk of having troublesome menopausal symptoms in the future. A research study from the Netherlands examined the relationship between hypertensive diseases and hot flashes and night sweats.

Investigators looked at 853 women who regularly visited a cardiology clinic. Among these women, 274 had a history of high blood pressure during their pregnancy, such as preeclampsia. Participants were classified as having hypertension (high blood pressure) if her systolic blood pressure was 140 mmHg or higher, if her diastolic was 90 mmHg or higher, or if she took antihypertensive medication.

The study revealed that women with a history of hypertensive pregnancy disease were more likely to have vasomotor symptoms of hot flashes and night sweats during menopause. Hot flashes and night sweats are considered vasomotor because of sudden opening and closing of blood vessels near the skin. 82% women with history of hypertension during pregnancy had hot flashes and night sweats, compared to 75% women without. Moreover, women with hypertension during pregnancy reported experiencing hot flashes and night sweats for a longer time period.

Researchers concluded that the findings were modest but more research needs to be done to establish a definite association. One must also consider that every woman experiences menopause differently; you  might have symptoms that are barely noticeable, while your friends could experience almost all of them. To learn more about the different types of symptoms during menopause, visit the Women's Health Research Institute's menopause website here.

 

 

 

Hormones affecting Quality of Life during Menopause
Posted by on December 20, 2013 - 8:36pm

Women undergoing menopause experience symptoms including hot flashes, sleeplessness, depression, joint pain, and poor concentration, to name a few. Hormone therapy has proven to improve some of these symptoms in menopausal women, but new research shows that treatment may only improve quality of life in those who undergo a significant number of hot flashes.

A recently published study done in Finland, looked at use of hormone therapy in women who had recently gone through menopause. 150 women were divided into two groups, those with seven or more moderate to severe hot flashes per day, and those with three or fewer mild hot flashes per day. In each group, half the women used hormone therapy and half received only a placebo.

All women were asked to track their hot flashes as well as their additional menopausal symptoms. After six months, hormone therapy improved the overall health of women with moderate to severe hot flashes in symptoms including sleep, anxiety, memory and concentration, joint and muscle pain, and hot flashes. Hormone therapy made no difference in those with mild or no hot flashes.

Though the Finland study may not apply to women of other ethnicities, the research demonstrates how treatment must be personalized for women undergoing menopause. Physicians should take into account the different symptoms that a woman is experiencing when recommending treatment. Women should also always consider all the options in improving symptoms, from lifestyle to herbs to hormones. To read more about the different treatments available to minimize menopausal symptoms, visit http://menopause.northwestern.edu/

Relaxation for Hot Flashes
Posted by on November 1, 2013 - 12:49pm

Hot flashes: most menopausal women have them, and all menopausal women hate them. For one in ten women, hot flashes occur for five years or longer, signicantly affecting multiple aspects of their lives including relationships and sleep. While hormone replacement therapy has largely addressed the issue of hot flashes in many women, other women have sough alternatives. Alternatives including yoga, acupuncture, exercise, and applied relaxation have all been helpful in women undergoing menopause.

Applied relaxation, in particular, has recently been studied in a small Swedish pilot study and proven to be beneficial. 60 women were divided into two groups: one was given relaxation exercises  to practice daily at home, and the other received no treatment whatsoever. After three months the treatment group lowered their number of hot flushes per day from an average of 9.1 to 4.4. The control group also noticed a decrease in hot flashes per day, but only from an average of 9.7 to 7.8.

Relaxation techniques include breathing exercises, guided imagery exercises, and calming music. Consider applying relaxation in replacement of or in addition to your hormone replacement therapy. For more information on how to incorporate relaxation into your therapy for hot flushes, visit our Northwestern menopause website here.

FDA Gives Hot Flashes a Chill Pill
Posted by on August 26, 2013 - 11:00am

The United States Food and Drug Administration recently approved the first non-hormonal solution to hot flashes associated with menopause; it is the drug Brisdelle.  Nearly 75% of menopausal women experience hot flashes, which are extreme feelings of warmth accompanied with redness and sweating.  While hot flashes can spread over the entire body, they are mostly concentrated in the face and neck. Hot flashes are the most common side effect of menopause, and while the exact cause of hot flashes is unknown, a great deal of research is conducted on alleviating this discomfort for women. This new drug Brisdelle offers a non-hormonal alternative to the hormone therapy options currently available.

Brisdelle contains paroxetine mesylate, a serotonin reuptake inhibitor, which differs from other FDA-approved hot flash treatments that contain the hormones estrogen and progestin. Brisdelle underwent two randomized, double-blind, placebo-controlled studies with 1,175 postmenopausal participants and was found to produce positive results compared to the placebo control. The drug is taken once a day and some side effects include nausea, vomiting, fatigue, and headache.  The director of the Division of Bone, Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research, Hylton V. Joffe, M.D., M.M.Sc., expressed that Brisdelle is a breakthrough product for women “who cannot or do not want to use hormonal treatments” for hot flashes associated with menopause. Brisdelle can now be added to the many treatment options available to women who experience symptoms related to menopause.

To read more about Brisdelle, click here.

 

Hot Flashes: Not Just During Menopause
Posted by on August 18, 2013 - 11:09am

We all know of hot flashes and night sweats as the most common and bothersome symptoms of menopause. Hot flashes can range from tolerable to debilitating, seconds to minutes, and infrequent to consistent. What most women don't know, however, is that hot flashes can happen during and before menopause, too.

A survey conducted by researchers at Group Health, a healthcare system located in the Pacific Northwest, asked a diverse group of women whether they have experienced hot flashes and/or night sweats. The women ranged from 45 to 65 years old, regularly menstruated (no skipped cycles), were not on exogenous hormones, and came from a variety of ethnic backgrounds.

In this survey, 55% of all women reported having hot flashes or night sweats. Native Americans and African Americans had the highest proportions reporting these symptoms, at 67% and 61%, respectively. 58% of Caucasian women reported symptoms, although this was not statistically significant in comparison to Native Americans and African Americans. Asian and Hispanic women were least likely to report symptoms (31% and 26%, respectively).

So don't be dismayed if you suspect you are having a hot flash before your menopause hits. This study helps women by showing that a large percentage of women experience menopause symptoms actually before menopause, and this is normal. If you want to know what other symptoms you may have during menopause, visit http://menopausenu.org/

Menopause film now available on the big screen
Posted by on March 27, 2012 - 3:42pm

A year ago our Institute hosted a private showing of Hot Flash Havoc, an award winning documentary on menopause.  The long awaited release of this film in U.S. theaters begins later this month.  To learn more about the sites and dates, visit the film website at:  http://www.hotflashhavoc.net/

Menopause Society Supports Extended Hormone Therapy
Posted by on March 5, 2012 - 10:27am

Menopausal hormone therapy doesn't have to follow "the lowest dose for the shortest time" strategy for all women anymore, the North American Menopause Society said today.   The group endorsed a flexible approach to duration that takes into account the type and timing of therapy and individual patient characteristics in a statement in its journal, Menopause.

For women in their 50s, the absolute risks are low; younger women without a history of breast cancer can use replacement hormones at least until the normal menopause age around 51, and longer if needed for symptom management, according to the guidelines.

"No 'one size fits all' approach is acceptable anymore," JoAnn E. Manson, MD, DrPH, NCMP, of Harvard, and president of the society, said in answer to a query from ABC News and MedPage Today.

Manson's position is somewhat surprising since she was a principal investigator for the Women's Health Initiative, the landmark randomized trial that derailed the hormone therapy movement when it reported a link between Premarin (estrogen/progestin) and increased risk of breast cancer and thromboembolic conditions.

The new guidelines loosen up on timing, agreed Michelle P. Warren, MD, NCMP, of Columbia Presbyterian Medical Center in New York City, who was also involved with the guidelines.   Women who need hormone therapy can use it for as long as needed, she said in an interview.    That shift should be reassuring for many women, Manson suggested.

When the Women's Health Initiative studies indicated elevated breast cancer and heart disease risk with hormone therapy in its postmenopausal population a decade ago, prescriptions dropped precipitously across the country.   Recommendations followed suit, urging cautious, sparing use of the drugs.

Fear of prescribing to women with any suggestion of heart disease, even the common symptom of palpitations, led to "a whole generation of women who were really suffering," Warren noted.

Now with longer-term follow-up available from that and other studies, perspectives are changing, explained Manson, who serves as an investigator with the ongoing Nurses' Health Study, an observational study that was once used to bolster use of hormone therapy.  Last summer, the Endocrine Society also called for rethinking the established line on menopausal hormone therapy, stating that risks and benefits vary by age and time since menopause.

The menopause society's consensus group concluded that the estrogen-only (ET) formulations (typically used for women without a uterus) can be used for seven years without increasing risk of breast cancer, while combination estrogen-progestin therapy (EPT) increases that risk after three to five years of use.

The recommendation for duration of therapy differs for EPT and ET. For EPT, duration is limited by the increased risk of breast cancer and breast cancer mortality associated with three to five years of use; for ET, a more favorable benefit/risk profile was observed during a mean of seven years of use and four years of follow-up, a finding that allows more flexibility in duration of use.

The Women's Health Initiative and Nurses' Health Study both pointed to a possible reduced risk if use didn't start immediately after menopause.   However, the evidence for this "gap theory" (also called the critical window hypothesis)  isn't very solid and menopausal symptoms are usually worse in the first two to five years, Warren said in an email to ABC News/MedPage Today.

The bigger clinical impact from the guidelines is likely to come from its conclusions on cardio- and cerebrovascular risks, she suggested.   With estrogen alone, women in their 50s in the Women's Health Initiative actually had a reduced risk of combined endpoints including coronary heart disease and total myocardial infarction.

With combined estrogen and progestin, that trial showed an absolute increase in heart disease by an estimated eight cases per 10,000 women per year, whereas observational studies had found a longer duration of use associated with a reduced risk.

The potentially reduced coronary heart disease risk among women who used hormone therapy for five or more years was "not conclusive and should be considered in light of other factors altered by duration of therapy, such as breast cancer," the statement warned.

There was a clear differentiation in risk by timing of hormone therapy after menopause, though, in the opposite direction than for breast cancer risk.  Both unopposed estrogen and estrogen with progestin were associated with elevated coronary heart disease risk when therapy started more than 10 years after menopause.

For stroke, hormone therapy had appeared to raise risk overall, with eight additional strokes per 10,000 women per year of combined hormone therapy and 11 extra with estrogen only.  But recent analyses of the two together found no significant stroke risk for women ages 50 to 59 at initiation, the statement noted.

"They have essentially rescinded the position concerning the heart data as long as you start within 10 years of menopause commencing," Warren summarized.

However, Marcia Stefanick, MD, of Stanford University, who had been involved with the Women's Health Initiative steering committee, took issue with that conclusion, calling it misleading.The analysis actually showed no interaction with age for stroke risk, which means all age groups are at elevated risk, she told ABC News/MedPage Today.Another problem was that the women on unopposed estrogen in the Women's Health Initiative only used the drug for an average of 3.5 years because so many discontinued.

"I don't think we have data suggesting that you can go beyond three to five years," she said. "It is misleading to say [estrogen is safe for] seven or more years."

The NAMS statement urged clinicians to consider a number of additional factors when considering hormone therapy for patients:

  • A woman's individual risk and history of venous thrombosis, heart disease, stroke, and breast cancer
  • Route of administration and dosing, as transdermal and low-dose oral estrogen are associated with lower venous thromboembolism and stroke risks than standard oral estrogen doses
  • Type of symptoms, with low-dose, local administration of estrogen when only vaginal symptoms are present

Further research is still needed, especially in interpreting individual risk and assessing long-term implications, the statement noted.

By Crystal Phend, Senior Staff Writer, MedPage Today

Primary source: Menopause: The Journal of The North American Menopause Society
Source reference:
"The 2012 hormone therapy position statement of the North American Menopause Society" Menopause 2012; 19: 257-271.

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