Question

After all the recent news, I've tried stopping HRT, but it's difficult. My hot flashes have come back with a vengeance, and my life is absolutely miserable. What can I do? My friends say flavonoids work, but I'm not sure if they are any safer than HRT. Can you advise me?

Answer

Most experts agree that HRT can be used for a short period to eliminate really severe hot flashes - "short" means a matter of months, not years. If you and your doctor want to avoid HRT, consider non-hormone medication.

Several drugs from the SSRI (selective serotoninergic reuptake inhibitor) class, usually used as antidepressants, have been shown to be effective in reducing the number and severity of hot flashes in menopausal women. They include: paroxetine, fluoxetine, and sertraline. Side effects can include headache, nausea, loss of appetite, and insomnia or sedation.

Clonidine is an older drug that's about twice as effective as placebo in treating hot flashes. Side effects include a dry mouth, constipation, and low blood pressure on standing, which may lead to dizziness or fainting.

Phytestrogens, which are contained in isoflavonoid tablets, do not really control menopause symptoms very well. A recent study (see the reference below) found that symptoms were improved by about 15% in both those taking the isoflavonoid and those taking a placebo (dummy tablet). And other herbal preparations - red clover, black cohosh, soy, etc. - are not any better. You can try one or other of them; it may be that you respond well, partially, or not at all.

Links

• New Updates on Hormone Replacement Therapy
• Hot Flashes - What Can be Done?