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Estrogen alternatives available for hot flashes: remedies such as progestins often are proposed, but few have been evaluated in controlled studies.(Gynecology)
SAN FRANCISCO -- In the wake of the Women's Health Initiative, "It's easier to get OxyContin out of a doctor's office than Prempro," Melissa A. McNeil, M.D., joked at the annual meeting of the American College of Physicians.
The question then is how is a physician to manage the vasomotor symptoms of menopause? asked Dr. McNeil, who is women's health program director at the University of Pittsburgh. Although many remedies have advocates, few have been evaluated in controlled studies. She offered several evidence-based suggestions:
* Time. Tincture of time works for many women. Although 75% of menopausal women do experience hot flashes, for 30%-50% of them, the symptoms improve within months, and hot flashes resolve completely for most women within 4-5 years.
"That can be a very long 4 or 5 years," Dr. McNeil acknowledged. In addition, "A substantial minority will continue to have hot flashes for years beyond menopause."
The fact that women's hot flashes frequently resolve spontaneously leads to a large placebo effect--in the neighborhood of 25%--in various studies of drugs and supplements.
* Progestins. There's good evidence from randomized, controlled trials for the efficacy of a number of progestins. Medroxyprogesterone and megestrol (Megace) both were reported to result in a 74% reduction in hot flashes. Depo-Provera was reported in one study to result in a 90% reduction in hot flashes. Uterine bleeding is a frequent side effect of progestin therapy, limiting its use in women who have uterine cysts. Furthermore, there are no long-term safety data available.
The most significant bar to progestin therapy, however, comes from Women's Health Initiative results, which suggest that progesterone supplementation may confer an increased risk of certain cancers or adverse cardiovascular events, compared with estrogen alone.
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