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Are hot flashes caused only by declining estrogen levels or are there other contributing factors?
There is no doubt that estrogen is effective for alleviating hot flashes, which occur during menopause as estrogen levels decline. However, the initiation of a hot flash is quite complex, and is not completely understood.
While estrogen can be effective, other drugs and treatments work as well. For instance, the drug Effexor, which is an anti-depressant and alters levels of serotonin and dopamine, can alleviate hot flashes. Clonidine, which works on nerve impulses, is also effective. Exercise has been shown to improve hot flashes, as has soy, and progesterone.
There are a number of nutrients and drugs that work on different systems in the body, that seem to help hot flashes. So to say that hot flashes are only caused by the decreasing levels of estrogen in a women’s body, ignores the complexity of hot flashes that is demonstrated by the fact that other drugs and nutrients are effective for treatment.
What is the best approach to resolving hot flashes?
Our approach is to start with the lowest risk and lowest cost interventions first. This would include over-the-counter and non-prescription therapies, such as soy, black cohosh, adrenals (i.e. Rhodiola rosea, suntheanine and phosphatidylserine), amino acids (such as 5-hydroxytryptophan and tyrosine), magnesium, vitamin E and essential oils.
Depending on the severity and frequency of the hot flashes, we then move step wise into more complex therapies.
Using the Body Chemistry Balancing (BCB) test, we can create a plan to effectively deal with hot flashes. In the BCB test, over 100 different metabolic components are measured, including amino acids, vitamin E, micronutrients, hormone levels, neurotransmitter levels, and adrenal and thyroid function. We try to deal with hot flashes by balancing a women’s body chemistry without the use of HRT.
When hot flashes are debilitating and severe, and other therapies have not been successful, then the use of hormone replacement may be necessary. We suggest bioidentical hormone replacement therapy, using the lowest possible dose for the shortest time necessary, through the skin, to alleviate hot flashes.
What are your top non-prescription and prescription items for hot flashes?
• Soy – Standardized products such as Nutrigenistein
The use of soy to reduce the frequency and/or severity of hot flashes is well-established (1-7). Research in this field has been plagued by the use of non –standardized extracts. Therefore it is critical to use a soy formula with a standardized extract of phytoestrogens to give consistent results.
• Black cohosh
Most of the original research on black cohosh was conducted in Germany, where it has been used for more than 40 years (8). Black cohosh is also commonly prescribed in other parts of Europe (9). The North American Menopause Society has finally recognized the European research and recommends black cohosh for mild vasomotor symptoms, such as hot flashes (10).
More recent research is confirming its therapeutic value - showing that black cohosh is more efficient than placebo and as effective as a variety of medications in relieving hot flashes (11-16).
Due to its regular use in Europe, black cohosh has been demonstrated to have an excellent safety profile with a low risk of side effects (17-18). As with soy, taking a standardized preparation of black cohosh is critical to its effectiveness.
• Magnesium glycinate
Magnesium levels drop as estrogen levels diminish during menopause but a search of the scientific literature fails to find any studies using magnesium as a therapy for menopause. However, it has been suggested by several authors that magnesium may be beneficial to alleviate hot flashes, and help maintain bone and cardiovascular health (19-21). We have anecdotal evidence in our clinic of its usefulness to improve hot flashes. Furthermore, inadequate magnesium intake in postmenopausal women has been shown to impair glucose tolerance, induce heart rhythm changes, and adversely affect the metabolism of other nutrients, including calcium, phosphorus, and potassium (22-23). Magnesium is critical for a balanced body chemisty.
• Vitamin E and Essential Oils
Vitamin E - As early as the 1940’s, vitamin E was being used to effectively decrease hot flashes (24-26). More recent research suggests a statistically significant but moderate lowering of the number of hot flashes with vitamin E supplementation (27-28).
Polyunsaturated Fatty Acids - One small study has shown a reduction in hot flashes with polyunsaturated fatty acids (29).
Evening Primrose Oil - In a randomized double-blind placebo controlled study, evening primrose oil was found to significantly reduce night sweats (30). Daytime hot flashes were also decreased, but this result was not statistically significant.
• Balanced Body Chemistry
The initiation of a hot flash is a complex interaction of the body’s thermoregulatory system, neurotransmitters, and hormones. A variety of nutrients can affect these metabolic interactions, as evidenced by their efficacy in treating hot flashes.
Using the Body Chemistry Balancing (BCB) test, we analyze over 100 different metabolic components including amino acids, vitamin E, micronutrients, hormone levels, neurotransmitter levels, and adrenal and thyroid function. We investigate the metabolic issues behind each woman’s hot flashes in order to provide a comprehensive, nutritionally-balanced therapy without the use of HRT.
• Natural Human Progesterone – available by prescription
Progesterone has been shown to help with hot flashes, without the side effects associated with estrogen. Women using a transdermal progesterone cream experienced a significant decrease in the number of hot flashes compared to women using a placebo cream (31).
References
Soy
1. Albertazzi P, et al. (1998) The effect of dietary soy supplementation on hot flushes. Obstet Gynecol 91:6-11.
2. Crisafulli A, et al. (2004) Effects of genistein on hot flushes in early postmenopausal women: a randomized, double-blind EPT- and placebo controlled study. Menopause 11:400-404.
3. Faure ED, et al. (2002) Effects of a standardized soy extract on hot flushes: a multicenter, double-blind, randomized, placebo-controlled study. Menopause. 9:329-334.
4. Han KK, et al. (2002) Benefits of soy isoflavone therapeutic regimen on menopausal symptoms. Obstet Gynecol. 99: 389-394
5. Scambia G, et al. (2000) Clinical effects of a standardized soy extract in postmenopausal women: a pilot study. Menopause. 7: 105-111.
6. Upmalis DH, et al. (2000) Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study [erratum appears in Menopause. 2000;7:422]. Menopause 7: 236-242.
7. Washburn S., et al. (1999) Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women. Menopause 6:7-13
Black cohosh
8. Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.
9. McKenna DJ, et al. (2001) Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Altern Ther Health Med 7:93-100.
10. North American Menopause Society. (2004) Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause. 11(1):11-33.
11. Bai W, et al. (2007) Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas. 58(1):31-41.
12. Liske E, et al. (2002) Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 11:163-174.
13. Oktem M, et al. (2007) Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther. 24(2):448-61.
14. Osmers R, et al (2005) Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol. 105:1074–83.
15. Raus K, et al (2006) First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause. 13(4):678-91.
16. Wuttke W, et al (2003) The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas 44 (Suppl 1):S67–77.
17. Liske E, Wustenberg P. (1998) Efficacy and safety for phytomedicines for gynecologic disorders with particular reference to Cimicifuga racemosa and Hypericum perforatum. In: Limpaphayom K, ed. 1st Asian-European Congress on the Menopause. Bangkok, January 28-31, 1998. Bologna, Italy: Monduzzi Editore p. A; 1998;187-191.
18. Liske E. (1998) Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 15:45-53.
Magnesium
19. University of Maryland Medical Center www.umm.edu http://www.umm.edu/altmed/articles/magnesium-000313.htm
20. Kass-Annese B. (2000) Alternative therapies for menopause. Clin Obstet Gynecol. 43(1):162-83.
21. Seelig, M. et al. (2004) Benefits and Risks of Sex Hormone Replacement in Postmenopausal Women J Am Coll Nutr 23: 482S–496S.
22. Nielsen FH, et al. (2007) Moderate magnesium deprivation results in calcium retention and altered potassium and phosphorus excretion by postmenopausal women. Magnes Res. 20(1):19-31.
23. Nielsen FH, et al. (2007) Dietary magnesium deficiency induces heart rhythm changes, impairs glucose tolerance, and decreases serum cholesterol in post menopausal women. J Am Coll Nutr. 26(2):121-32.
Vitamin E and Essential Oils
24. Christy CJ. (1945) Vitamin E in menopause. Am J Obstet Gynecol 50:84-87.
25. McLaren HC. (1949) Vitamin E in the menopause. Br Med J ii:1378-1381.
26. Finkler RS. (1949) The effect of vitamin E in the menopause. J Clin Endocrinol Metab 9:89-94.
27. Barton DL, et al. (1998) Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol 16:495-500.
28. Ziaei, S. et al. (2007) The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet Invest. 64(4):204-7.
29. Campagnoli C, et al. (2005) Polyunsaturated fatty acids (PUFAs) might reduce hot flushes: an indication from two controlled trials on soy isoflavones alone and with a PUFA supplement. Maturitas. 51(2):127-34.
30. Chenoy R, et al. (1994) Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. BMJ 308(6927):501-3.
Progesterone
31. Leonetti HB, et al. (1999) Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol 94:225-8.
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