Effective treatment of hot flashes at menopause: reviews of doctors

The question of what effective treatment for hot flashes during menopause should be has remained the focus of attention for doctors and patients for decades. And although all physical symptoms of menopause are caused by age-related changes in ovarian function (reduction in the synthesis of sex steroids) and are a natural manifestation of the physiology of the female body, it is possible to reduce the intensity of unpleasant vasomotor symptoms of menopause – hot flashes and night hyperhidrosis.

What is the treatment for hot flashes during menopause based on?

In the context of age-related ovarian involution, treatment of hot flashes during menopause is based on “correction of hormonal imbalance,” that is, on increasing estrogen levels, although with age, the number of membrane estrogen receptors in ovarian tissues and their sensitivity decrease.

Those who want to alleviate the condition associated with climacteric hot flashes and curb sweating during menopause should be reminded that the production of estrogens is “commanded” not by the ovaries, but by the hypothalamus and pituitary gland: the hypothalamus produces special gonadotropic neurohormones – gonadotropins. Under their influence, the pituitary gland produces FSH (follicle-stimulating hormone), LH (luteinizing hormone) and prolactin. FSH transmits an enhanced signal to the receptors of ovarian cells through the adenylate cyclase system, and they increase the production of estrogens in the follicles.

But, since during menopause the ovarian reserve of the ovaries is exhausted and their follicular apparatus involution occurs, not only the synthesis of estradiol is reduced, but also the hormone inhibin B, which is produced by the granular cells of the ovaries and suppresses the production of FSH in the pituitary gland. Therefore, during menopause, the content of FSH and LH in the blood of women is extremely high. How do they behave? After all, all hormones have not only individual, but also interrelated functions in the human body.

There are studies that show that FSH in women during menopause acts on low-density lipoprotein receptors (LRP1, A2MR, APOER) in the brain, and these receptors are involved in lipid metabolism (and women experience a significant increase in abdominal fat mass), in the regulation of vascular tone (women experience increased blood pressure during menopause) and cholesterol levels, cell growth and cell migration, as well as neurodegenerative pathologies.

However, estrogen synthesis does not stop completely, but a minimal amount of estrone begins to be produced by aromatase P450 not in the ovaries, but in adipose tissue. As a paracrine hormone, estrone acts locally: on mesenchymal cells of adipose tissue, osteoblasts and chondrocytes of bone tissue, vascular endothelium and aortic smooth muscle cells, as well as numerous areas in the brain.

But the sympathetic nervous system reacts to all hormonal changes in its own way - with neurogenic arterial hyperemia, that is, the notorious hot flashes that occur spontaneously when exposed to receptors of neurotransmitters such as acetylcholine, adrenaline, and noradrenaline.

Medicines for hot flashes during menopause

Most gynecologists believe that the treatment of hot flashes during menopause is best carried out using herbal remedies such as the multi-component homeopathic preparation Remens, which contains an extract of the roots of the plant black cohosh or black cohosh (Cimicifuga racemosa - black cohosh) - a source of phytosterols (phytoestrogens). This plant is also used as an active substance in the medicines Klimadinon, Klimakt, Qi-Klim and a sufficient number of various dietary supplements.

It should be borne in mind that substances of black cohosh can cause headaches, dizziness, nausea, vomiting, bradycardia. And British experts warn that long-term use of extracts of this plant has a toxic effect on the liver and, in addition, can lead to thickening of the uterine mucosa.

Medicines for hot flashes during menopause may contain extracts of red clover (Trifolium pratense), soy (due to the isoflavones genistin and genistein, which are similar to estrogens), as well as extract of the rhizome of wild yam or the root of angelica (Angelica sinensis).

Full information about the drugs recommended by doctors for the treatment of menopausal hot flashes, with a description of the active ingredients, methods of use, contraindications and side effects, in the article - Pills for hot flashes during menopause

Other medications can also be used to treat hot flashes during menopause. For example, the anticonvulsant Gabapentin (Gabantin, Gabagama, Gabalept, and other trade names) helps reduce neuronal activity and reduces excitation of the central and autonomic nervous systems. The recommended dosage is one capsule (300 mg) once a day. Possible side effects of this drug include increased blood pressure, increased heart rate, headache, tinnitus, increased fatigue, insomnia, etc.

Often, sedatives or antidepressants of the selective serotonin and norepinephrine reuptake inhibitor group help to reduce hot flashes: Paroxetine (Paroxetine hydrochloride, Paxil) - 12.5-25 mg per day, or Venlafaxine (Effexor, Efectin, Phenethylamine) - 37.5-75 mg per day. However, both drugs can cause serious side effects in the form of decreased blood pressure, headaches and dizziness, tachycardia, drowsiness, general weakness, dry mouth, nausea, constipation, bleeding of the mucous membranes, increased cholesterol in the blood, decreased appetite, weight gain, etc.

So, it is much safer to take regular hawthorn tincture (20 drops twice a day) - if there is no diabetes, as well as calendula tincture - provided there is no arterial hypotension and stones in the bladder or kidneys).

The information provided can be supplemented by the material - Remedies for hot flashes during menopause

Treatment of hot flashes during menopause with folk remedies

Recommended treatment for hot flashes during menopause with folk remedies includes:

• rubbing the skin with pieces of ice wrapped in cotton cloth;
• applying peppermint oil to the back of the neck;
• taking flaxseed oil orally (a dessert spoon a day).

It is also recommended to drink decoctions and water infusions of medicinal herbs: primrose (roots), sage (herb), oregano (herb), calendula (flowers), St. John's wort (herb). For the decoction, a tablespoon of dry raw materials is poured with 1.5 cups of boiling water, boiled over low heat for 15 minutes, infused for about an hour (in a closed container) and filtered.

Drink a decoction of primrose, one tablespoon 3-4 times a day, and sage (only if there is no acute kidney disease) - a quarter of a glass (during meals).

A decoction or infusion of oregano is taken one tablespoon three times a day; calendula can be taken twice a day - 100 ml (contraindications - gallstones). But St. John's wort should be taken three tablespoons 2-3 times a day, but it should be borne in mind that this plant promotes a good appetite and causes increased sensitivity of the skin to UV rays.

Treatment of hot flashes during menopause with hormone replacement

Despite the obvious popularity of treating hot flashes during menopause using drugs containing analogues of female sex hormones – esterified estrogen, ethinyl estriol and progesterone (in the form of synthetic progestin) – there is no scientific evidence that would confirm the need of the female body after menopause to replenish with exogenous sex steroids.

Moreover, hormone replacement therapy is not able to restore the level of sex hormones that existed before menopause using synthetic chemicals.

But anti-climacteric hormonal drugs can improve a woman’s condition, that is, relieve some symptoms of menopause and prevent possible complications.

Their names, mechanism of action, side effects, contraindications, dosage and drug interactions are detailed in the publication - Herbs for Menopause Relief

In recent years, several studies have shown that the risk of breast cancer and cardiovascular disease increases after hormone replacement therapy. The largest study, involving nearly 162,000 healthy postmenopausal women, was conducted in the United States by the Women's Health Initiative (WHI) under the auspices of the National Institutes of Health (NIH).

Before 2002, 6 million American women were treating menopausal hot flashes with hormones, but after the study's results were published, that number quickly dropped by about half. The number of breast cancer diagnoses soon began to decline, too.

At the same time, as The Journal of the American Medical Association writes, the frequency of breast cancer diagnosis increases with long-term use of estrogen and, to a greater extent, with treatment with drugs with a combination of estrogen and progestin (progestogen). The results of mammography have proven that in 36.2% of women of climacteric age who took sex hormones, the density of breast tissue increased, which required the use of biopsy and histological examination. This is explained by the fact that sex steroids can increase the proliferation of breast tissue, and this is already a pathology.

Many doctors suggest that women can safely take hormones for only four to five years at most to reduce menopausal symptoms.

Several years ago, the German medical journal Deutsches Arzteblatt International published an article by researchers from the Medical Center (Department of Obstretics and Gynecology) of the University of Regensburg (Germany), which noted: hormones can be used to treat climacteric symptoms only after a comprehensive examination of patients, as well as informing them about the benefits and risks of such treatment. And the widespread use of hormones by all women with climacteric symptoms, including hot flashes, cannot be recommended.

According to the latest report from Global Industry Analysts, Inc. (May 2016), demand in the global pharmaceutical market for hormone replacement therapy for menopause will grow by 8% in five years to $3.5 billion. And all thanks to the fact that the population of women of menopausal age is growing, and many doctors offer them to “prolong youth” with the help of hormones.

Treatment of hot flashes during menopause: advice from doctors

Menopause is a natural part of a woman's life cycle. You cannot prevent it, but it is very important to lead a healthy lifestyle during menopause. For example, doctors advise, first of all, to eliminate the most common triggers of hot flashes during menopause: alcohol, caffeine, spicy food, smoking; tight clothing made of synthetic fabrics, staying in stuffy rooms with high air temperature.

You also need to eat right and maintain a normal body weight, get enough sleep (daily sleep duration should be at least 7-8 hours), try not to be nervous, exercise regularly (best of all - in the fresh air), monitor your blood pressure, take multivitamins.

And only if all of the above is ineffective, a gynecologist can prescribe treatment for hot flashes during menopause and recommend medications to alleviate menopause.