Hot Flashes (cont.)
How are hot flashes diagnosed?
Hot flashes are symptom, not a medical condition. Through a thorough
medical history, the healthcare practitioner will usually be able to determine
whether a woman is having hot flashes. The patient will be asked to describe the hot
flashes, including how often and when they occur, and if there are other
associated symptoms. A physical examination together with the medical history
can help determine the cause of the hot flashes and direct further testing if
necessary.
Blood tests may be performed if the diagnosis is
unclear, either to measure hormone levels or to look for signs of other
conditions (such as infection) that
could be responsible for the hot flashes.
What is the treatment for hot flashes?
There are a variety of treatments for hot flashes such as:
- hormone therapy,
- bioidentical hormone therapy,
- other drug treatments,
- complementary and alternative treatments,
- phytoestrogens,
- black cohosh, and
- other alternative therapies.
Some of these have not been proven by clinical studies, nor are they approved
by the FDA.
Hormone Therapy
Traditionally, hot flashes have been treated with either
oral or transdermal (patch) forms of estrogen. Hormone therapy (HT), also
referred to as hormone replacement therapy (HRT) or postmenopausal hormone
therapy (PHT), consists of estrogens alone or a combination of estrogens and
progesterone (progestin). All available prescription estrogen medications, whether oral or transdermal; are
effective in reducing the frequency of hot flashes and their severity. Research
indicates that these medications decrease the frequency of hot flashes by about
80% to 90%.
However, long-term studies (the NIH-sponsored Women's
Health Initiative, or WHI) of women receiving combined hormone therapy with both
estrogen and progesterone were halted when it was discovered that these women
had an increased risk for heart attack, stroke, and breast cancer when compared
with women who did not receive hormone therapy. Later studies of women taking estrogen
therapy alone showed that estrogen was associated with an increased risk for
stroke, but not for heart attack or breast cancer. Estrogen therapy alone,
however, is associated with an increased risk of developing
endometrial cancer
(cancer of the lining of the uterus) in postmenopausal women who have not had their uterus
surgically removed.
More recently, it has been noted that the negative effects associated with
hormone therapy were described in older women who were years beyond menopause, and some researchers have suggested that these negative outcomes
might be lessened or prevented if hormone therapy was given to younger women
(prior to or around the age of menopause) instead of women years beyond
menopause.
The decision in regard to starting or continuing hormone therapy, therefore,
is an individual one in which the patient and doctor must take into account the
inherent risks and benefits of the treatment along with each woman's own medical
history. It is currently recommended that if hormone therapy is used, it should
be used at the smallest effective dose for the shortest possible time.
Next: Bioidentical hormone therapy »
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