Wednesday Bubble: 10 is the loneliest number…
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I’m using this Bubble to burst a few illusions, such as hot flashes during menopause don’t actually last very long.
How about 10 years?!
Right now, one year for hot flashes to come and then go sounds pretty tempting, doesn’t it?
A few years ago, I wrote about a study in the journal Menopause that alluded to the fact that hot flashes were likely to last for five years or more. Just this week, I ran across another study in Obstetrics & Gynecology that adds another 5 years to the evidence. Yikes!
How long is long enough?
Clinical Guidelines suggest that hot flashes peak one year into menopause and for most women, last anywhere from six months to two years. So, why is popular opinion, if you will, being challenged in research circles?
Using data from the Penn Ovarian Aging Study, which followed and monitored women over a 13-year period, researchers evaluated moderate-to-severe hot flashes on average, every 9 months. The women did not report having hot flashes at the study’s start, but developed them between the first year and near the study’s end. During each assessment, interviews were conducted on overall health, height, weight, hip and waist measures were taken and blood samples collected (to evaluate hormone levels). Menopausal status was also delineated by five stages:
- premenopausal (regular menstrual periods)
- late premenopausal (cycle change of 7 days or more in either direction observed one time)
- early transition (change of 7 days or more observed at least twice in a row)
- late transition (three to 11 months without a menstrual cycle)
- postmenopausal
More than 90% of women in the study were pre or late premenopausal at the study’s start.
Unfortunately, the results of the study are not very promising. On average, the median duration of moderate to severe hot flashes was 10.2 years, with only 37% of women reporting that their hot flashes stopped during the study. However, researchers found a relationship between length of time and when hot flashes began. For example. hot flashes tended to last longer (i.e. more than 11 years) in women who reported their hot flashes started in the premenopausal or late premenopausal stage compared to women whose hot flashes began in the early transition (average 7 years) and late transition (average 4 years).
Age was also a factor as the median duration of hot flashes tended to be longest in women who started flashing before the age of 40. Most commonly, however, more than a third of women tended to have the worst flashes when they were between the ages of 45 and 49. Other factors such as African American race and a body mass index less than 30 were also associated with having hot flashes for longer periods of time.
If you are wondering about the silver lining in this story, there actually is one. The researchers say that it may be a good idea to start addressing vasomotor symptoms like hot flashes in younger women who are starting to have irregular menstrual periods. Because “traditional hormonal therapy may not be the ideal choice for this population, given, for example, the problems with breakthrough bleeding and the need for contraception,” other treatments need to be evaluated.
I’ve long espoused the value of taking steps to shut symptoms down sooner rather than later, which is why alternative strategies may be so useful. If duration of hot flashes last longer when they start a younger age, and it is recommended that hormonal therapy be used for the shortest period of time possible, it’s not a bad idea to speak to a health practitioner about incorporating things like black cohosh into a daily routine. As always, there’s no time like the present to start taking charge of your health and get ahead of the change.
Read MoreMenopause: outlook and outcomes. Is it you? Or them?
When you start flashing and sweating, the whole world, especially the world under the age of 45, is watching and judging, right?
Not so fast. In fact, what I think you think, may not be what you think at all. In other words, personal attitudes about menopause and its symptoms could be shaping how well or poorly it’s experienced. And this experience may be based in beliefs, moods and perceptions, not reality.
According to research, many women say that menopause makes them feel “stupid, embarrassed, incompetant, unattractive, etc.”
However, more importantly, these women believe that others have the same thoughts about them, which researchers say are likely to influence the types of strategies women use to manage their symptoms, strategies that range from “keeping up appearances” to avoiding social situations altogether.
When I read this, I started to wonder if menopausal women are actually stacking the deck against themselves and contributing to societal attitudes about aging and menopause. What’s more, do women misperceive how younger adults feel when they start flashing around them?
To answer these questions, researchers polled 290 young men and women between the ages of 25 and 45. Almost two thirds were female. The questionnaire was geared towards answer the following:
- How are hot flash symptoms, namely redness and sweating, perceived when they occur?
- What types of beliefs exist around menopause?
- Is there any relationship between age, gender and perception about menopause?
Importantly, over half of those polled attributed a red face to emotions, e.g., embarrassment, anger or stress. However, while younger women tended to attribute redness to an increase in body temperature, younger men tended to believe that redness was related to physical exertion. Similar responses were provided for sweating, with women attributing sweating to a health problem and men, to environmental temperature. Hormonal factors and menopause were reported by less than half (41%) of men and women polled.
Also important was the fact that overwhelmingly, both men and women indicated that they felt empathy or neutral about symptoms and not at all uncomfortable, and almost all (97%) would inquire if a woman was feeling well or ill.
These responses truly suggest that menopausal women tend to overestimate the extent to which others are able to judge their menopausal status. Moreover, young men and women tend to empathize and show concern and compassion, emotions that are inconsistent with expectations that others will react negatively to a public hot flash or associated redness. Even more important, age did not appear to influence general beliefs about menopause, which researchers suggest implies that “the experience of menopause, or seeking information about menopause in mid life, might lead to more neutral or positive beliefs.”
So, what does this all mean? Granted, the sample in this study was primarily female and self selecting, meaning that they chose to participate or not. Therefore, it is possible that these findings do not accurately reflect the views of a broader population, especially men. However, the researchers do point out that they attempted to find participants from a variety of occupations that were more specific to setting where women might report a higher degree of social embarassment.
Nevertheless, what these findings do suggest is that real life might actually contradict how women feel others feel about their menopause, and that reactions might actually be tempered or non-existant in social settings. This should encourage a broader population of menopausal women to overcome their fear of embarrassment or to no longer resign themselves to “coping” but rather, empower them to take charge. On a larger level, they also show that there’s a need to step up and negate stimatizing or negative views of menopause, even amongst ourselves. This can be achieved through sharing of experiences, not only with similarly aged women but also, with younger women and men who can gain a lot of life experience at a considerably younger age.
The next time you start flashing in public and looking around to see who’s staring, just remember that it may be you, not them. And your ‘tude will truly rule the day (and those flashes), if you let it.
Read MoreFriday Folly…gone fishing
This just places an entirely new spin on the term “on ice.”
And the double entendre – gone fishing. Some of my readers will understand.
Happy Friday and may your day be Flash Free.
Wednesday Bubble: News Flash – there’s a new kid in town
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Hey Ladies:
There’s a new kid in town: Menerba®. Although it’s not yet available, the Food & Drug Administration has cleared the way for its manufacturing and production.
Menerba is characterized as an oral botanical drug because its activities are derived from botanical sources, implying that although it is is a pharmaceutical agent, it acts like a plant-based formulation. Nevertheless, Menerba, which is a selective estrogen receptor modulator (or SERM) is apparently a safe alternative to both selective and non-selective SERMS, as well as HRT, for the treatment of hot flashes/vasomotor symptoms associated with menopause. The reason it is considered an alternative is that unlike traditional SERMS, which activate estrogen pathways that have been implicated in breast and uterine cancers, Menerba specifically targets the estrogen pathway in the body that is directly associated with hot flashes. So, theoretically it should be equally if not more effective for addressing hot flashes and also, safer than agents that have come before it.
Thus far, Menerba has been shown in clinical studies to reduce hot flash frequency by as much as 50% and also significantly improve sleep disruptions due to night sweats, with higher doses yielding the best results. Generally, it is well tolerated and has not had any noted impact on uterine or breast tissue. A larger trial of 600 postmenopausal women is slated to begin this year and is currently recruiting.
The bottom line?
Menerba looks pretty promising. I’m not quite sold on the characterization of Menerba as a botanical and would like to see more information on this, especially because its characterization as such could certainly be confusing once clinical trials are completed and the drug reaches the market. Nevertheless, you may want to keep an eye out for this new kid in town.
Read MoreSoy! Everything you wanted to know. Or should.
Confusion about soy abounds. Does it help hot flashes, improve bone health or prevent heart disease by lowering cholesterol? Or it is no more effective than placebo? Does its effectiveness rely upon the ratio of certain isoflavones — the plant-based estrogen-like components, which in soy include genistein (50-55% of total isoflavone content of soy), daidzein (40% to 45% of total isoflavone content) and glyceitein (5% to 10% of total isoflavone content) — or is the metabolite S-equol the only component that will yield estrogen-like benefits without negative health risks?
Are you perplexed? I sure am, which is why this particular post may be a bit to scientific for a few and too long for others. however, it’s important to understand some of the reasons why soy continues to intrigue, baffle and well, show differing results in terms of benefits for menopausal symptoms. So I encourage you to bear with me.
I’ve written previously that there are several key reasons why researchers have yet to make any any definitive conclusions about soy during menopause, such as poorly designed studies, small number of study participants, wide range of ages and years from menopause, and the fact that the pros and cons of an agent or strategy are not being studied for a long enough period of time. In other cases, there is an inconsistency in the soy preparation being studied and the ratio of isoflavones may differ; alternatively, researchers have not accounted for the presence of other isoflavones in the diet, which may influence results.
Does a new study that appears in the advanced online edition of Maturitas journal, comparing low-dose hormone therapy to soy powder in women with hot flashes, offer any anything more definitive or different than what’s gone before?
Briefly:
The 16-week study enrolled 60 women between the ages of 40 and 60, all of whom had had their last period at least 12 months, had the same frequency of hot flashes (more than 8 per 24 hours), had not used any hormonal treatment in the 6 months leading up to the study period, and were not currently using any drugs that lower blood fats, treat diabetes, taking other soy-based products or using herbal supplements.
Women participating in the study were randomly assigned:
- low-dose hormone therapy (a Activelle ®tablet daily, better known as Activella® in the US) plus a placebo powder or
- 2 portions daily of dietary soy supplementation powder (comprising 45 mg isoflavone per dose) plus a placebo tablet, or
- 1 placebo tablet/2 portions placebo powder.
All women were first screened for current hormone levels, reproductive history, age at menopause, time since menopause, medication use and cigarette/alcohol consumption. During the study, they were asked to use a standardized scale to evaluate menopausal symptoms (hot flashes, heart discomfort, sleep, and muscle and joint problems) mood (depression, irritability, anxiety, physical/mental exhaustion) and sexual problems, bladder problems and vaginal dryness.
The results?
Both hormone therapy and soy supplementation were associated with significant improvements in hot flashes and joint/muscle pain (which declined by about 45.6% in the hormone group and 49.8% in the soy group) and in vaginal dryness (which decline d by 38.6% in the hormone group and 31.2% in the soy group) compared to women who took placebo. Improvements in mood scores were consistent between the three groups, indicating that other factors, such as caring and attention by medical practitioners throughout the study, may have played some role in wellbeing. Moreover, both treatments were considered safe with few side effects.
These results are quite promising, as they indicate that soy may indeed, offer an alternative to hormone therapy in menopausal women seeking relief. However, it’s important to consider the following:
- Like many of its predecessors, the study is a small one.
- The study length was short, lasting only 16 weeks, which some critics might say is too short a time period to elicit a satisfactory clinical response.
- The researchers did not analyze whether or not the women actually took the drugs or soy consistently, and relied on their self-reports.
On the other hand:
- The study followed strict Western scientific guidelines and the women and the researchers did not know who was taking what.
- Symptoms were measured using a common quality of life scale whose goal it is to diminish errors by healthcare practitioners when analyzing results of questionnaires. This particular scale, better known as the MRS, is widely used and allows researchers to evaluate symptoms and treatment over time.
There has been a lot of criticism geared towards alternative treatments, such as acupuncture, herbs and Chinese medicine, as being shams, especially because there is no evidence supporting their use for addressing troublesome menopausal symptoms. Others will claim that the placebo effect is at play, i.e. a situation in which symptoms are relieved by an otherwise ineffective treatment due to expectations or beliefs. However, the researchers of this particular study point to the placebo effect in studies comparing estrogen to placebo, demonstrating for example, a 75% reduction in hot flashes among hormone users compared to a 57% reduction in hot flashes among women taking placebo.
The most important conclusion to be drawn is that there is early evidence that soy supplementation may be as effective as low-dose hormonal therapy in relieving certain vasomotor symptoms and possibly, vaginal dryness. We need more studies like this one, enrolling larger numbers of women, in order to definitively demonstrate benefit. Dollar for dollar, the monthly difference between the two treatments may only be about $30. Yet, this is one of the first studies I’ve seen that followed enough rules to quiet the rioters. And that alone, is worth the price of admission.
Stay tuned. The fat lady hasn’t sung her soy aria as of yet.
[Special thanks to Reuters Health Executive Editor Ivan Oransky, for your continued support of my mission to provide timely, evidence-based information on menopause and midlife to my readers.]
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