"First your bones feel icy cold.
Then, all of a sudden you get these unbelievable hot
flushes, and before you know it you're cold again. It
can easily happen 10 times an hour." After two years
of insufferable symptoms, Sara C finally went to see
her doctor for help dealing with menopause. But in the
end, they decided estrogen therapy just wasn't worth
the risk: she has a strong family history of breast
cancer, is a little overweight and has high cholesterol.
Everything would just settle down eventually, her doctor
told her. All she could do was stick it out.
But now women like Sara could be
given another choice, thanks to research conducted at
Vancouver General Hospital's Centre for Menstrual Cycle
and Ovulation Research (CeMCOR). In the first head-to-head
trial, progesterone has been shown to be as effective
as estrogen in treating hot flushes and sweats —
collectively known as vasomotor symptoms (VMS). "For
women with severe hot flushes, we now have something
as good as estrogen," without the associated risks,
said Dr Jerilynn Prior, the lead researcher and head
of CeMCOR.
CHILL
FACTORS
The double blind, randomized study, published in the
journal Clinical Science, followed 41 women in their
late 30s to early 50s undergoing surgical menopause
due to a recent, pre-menopausal hysterectomy or ovariectomy.
The women were treated with a daily dose of either 0.6mg
conjugated equine estrogen or 10mg medroxyprogesterone,
a synthetic progesterone, for one year. Both medications
kept the incidence of hot flushes or sweating to one
occurrence every three or four days. By comparison,
patients with severe VMS experience symptoms seven or
more times per day.
Dr Prior noted that all three of
the women who dropped out of the study were in the estrogen
arm. "Their reasons for discontinuing treatment were
trouble sleeping, feeling depressed, feeling tired and
headaches." Interestingly, these aren't listed as common
side effects of estrogen therapy, she added.
Meanwhile, she found no evidence
of harmful effects with medroxyprogesterone — according
to the literature, it does not cause blood clots, breast
cancer or increase the likelihood of migraine headaches.
In fact, Dr Prior has been prescribing the drug to her
patients for over a decade.
Based on the evidence and her experience
as a clinician, Dr Prior is confident medroxyprogesterone
is the safer choice. Although hers is the first study
to directly compare it to estrogen, she says several
studies from the 1980s demonstrated the effectiveness
of medroxyprogesterone as a treatment for VMS. "There
were at least five or six placebo-controlled trials
by gynecologists from around the world that showed [medroxyprogesterone's]
effectiveness in treating hot flushes. This knowledge
should have been in the usual doctor's armamentarium,
but it seems to have been forgotten," she said.
It's hard to imagine how that can
happen — even a pre-eminent expert in this field
like Dr Prior is at a loss for a suitable explanation.
But she hopes this head-to-head trial will help remind
doctors estrogen isn't the only option.
About 20% of menopausal women experience
severe VMS symptoms, which are caused by changes in
estrogen levels in the brain. Those who, like Sara,
are poor candidates for estrogen therapy or for whom
conventional treatment is ineffective generally suffer
through constant discomfort, with serious implications
for their quality of life.
Thankfully, these women are the
minority — most don't need any medication at all.
For those with light to moderate symptoms, Dr Prior
tends to recommend lifestyle changes over medication.
"Weight loss, regular exercise and perhaps some form
of meditative exercise, like yoga," she suggested. "In
addition, patients can use any number of over-the-counter
products, such as soy beverages, black cohosh or ginseng.
These may or may not be effective individually, but
combined," she said, "they will probably be sufficient
to manage VMS symptoms."
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