Going Off Menopausal Hormone Therapy
As women who have been diagnosed with breast cancer know firsthand, it is possibleand from a medical perspective, perfectly okayto stop hormones cold turkey. In fact, about half of all women who stop taking hormones cold turkey will do just fine. The other half will find that the menopausal symptoms that led them to take hormones in the first place come back with a vengeance. This is because stopping hormones turns on the menopausal switch, and that is likely to result in the side effects that women typically go on menopausal hormones to avoidhot flashes, vaginal dryness, and sleep problems.
Since there is no way to predict which women will experience symptoms and which women wont when they go off menopausal hormones, every woman must determine which method of going off menopausal hormones is right for her. One option is to taper off menopausal hormones gradually, which allows the body to adjust to decreasing doses of hormones and helps to reduce side effects. The second option is to quit cold turkey and then see if you are one of the lucky ones who dont have symptoms. If you are in the lucky 50%, you can throw your menopausal hormones away. If youre not, you can go back on and then begin tapering off gradually.
Money tip: menopausal hormones costs the same regardless of the dosage you are prescribed. To help reduce your costs you may want to keep your prescription dosage the same, but cut your pills in half.
Alternatives to HRT: Prescription Options
Perimenopause Symptoms And Signs
Perimenopause describes the time period when a woman is approaching menopause. During this time is when symptoms and signs begin. Examples include, weight gain, vaginal dryness, mood changes, painful sex, and hot flashes.
The complex hormonal changes that accompany the aging process, in particular the declining levels of estrogen as a woman approaches menopause, are thought to be the underlying cause of hot flashes. A disorder in thermoregulation is responsible for the heat sensation, but the exact way in which the changing hormone levels affect thermoregulation is not fully understood.
Hot flashes are considered to be a characteristic symptom of the menopausal transition. They also occur in men and in circumstances other than the perimenopause in women as a result of certain uncommon medical conditions that affect the process of thermoregulation. For example, the carcinoid syndrome, which results from a type of endocrine tumor that secretes large amounts of the hormone serotonin can cause hot flashes. Hot flashes can also develop as a side effect of some medications and sometimes occur with severe infections or cancers that may be associated with fevers and/or night sweats.
Utilize Supplements And Herbs
Many people use black cohosh, a large plant from the buttercup family, to reduce hot flashes, although little evidence exists as to how effective it actually is. Still, some swear that black cohosh root provides effective relief from these and other symptoms of menopause, including headaches, heart palpitations, and anxiety.
According to the North American Menopause Society, despite the lack of definitive evidence, “it would seem that black cohosh is a safe, herbal medicine.” Some other herbs with anecdotal evidence of helping hot flashes include red clover, dong quai, and evening primrose oil.
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Other Menopause Symptoms And Treatments
For most women, hot flashes and trouble sleeping are the biggest problems associated with menopause. But, some women have other symptoms, such as irritability and mood swings, anxiety and depression, headaches, and even heart palpitations. Many of these problems, like mood swings and depression, are often improved by getting a better night’s sleep. Discussing mood issues with your doctor can help you identify the cause, screen for severe depression, and choose the most appropriate intervention. For depression, your doctor may prescribe an antidepressant medication.
If you want to change your lifestyle to see if you can reduce your symptoms, or if you decide any of your symptoms are severe enough to need treatment, talk with your doctor.
Bioidentical Hormones: Are They Better
After concerns began to be raised about the dangers of menopausal hormone therapy, some women and their doctors began to tout the benefits of bioidentical hormones. Practitioners who use these drugs and the compounding pharmacies that make them claim that bioidentical hormones are better because they are made with natural, rather than synthetic, hormones that are better absorbed by the body. They also claim that because these hormones are similar to those a woman produces, side effects are less likely to occur. Is this true?
Bioidentical hormones are plant-derived they are made from concentrated soy and yam. So, yes, they are natural in that they are produced by nature. But that doesnt necessarily mean they are better than the drugs made by pharmaceutical companies. In fact, Premarin and Prempro contain estrogen that comes from pregnant mares urine. That is certainly natural.
But just because something is natural does not mean its safe. Currently, only a handful of small studies have been conducted on compounded bioidentical hormones. They indicate that these drugs are effective. But that does not mean they are safe, or safer than other types of HRT. Not one large randomized trialthe gold standard of medical researchhas been conducted with bioidentical hormones. And there have been no randomized trials comparing bioidentical hormones to a drug like Prempro.
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Why Effexor Should Be Considered A Last
There is robust evidence to support the usage of Effexor for hot flashes, but that doesnt mean its necessarily a safe intervention or targeting the root of the problem. Just because a pharmaceutical drug effectively treats a condition, does not mean that it should automatically be utilized. Just like you could use an atomic bomb to clear a weed growing in your garden doesnt mean you should.
Perhaps the atomic bomb analogy is a bit extreme. However, the point to be made is that just because something works or effectively treats a condition doesnt mean you should automatically pursue it. Although the literature suggests Effexor reduces the occurrence of hot flashes as a non-hormonal intervention, the risks associated with using an SNRI antidepressant for the management of hot flashes are significant and undermined by mainstream media.
Many people start taking Effexor for hot flashes based on a recommendation from their doctor without giving any thought to what the drug is actually doing. Most users dont fully comprehend the potentially deleterious neurophysiological consequences associated with using a potent antidepressant such as Effexor for hot flashes. Using Effexor is altering your neurophysiology to a significant extent on a daily basis.
Benefits Of Using Effexor For Hot Flashes
If contemplating whether to pursue Effexor as a treatment for hot flashes, it may be helpful to consider the hypothetical benefits that it may provide. In addition to effectively reducing severity and frequency of hot flashes, Effexor may also reduce your anxiety/stress and improve your mood. Furthermore, you wont need to worry about the increased risk of breast cancer associated with hormone therapy .
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Coping With Prostate Cancer
Comparison of physical interventions, behavioural interventions, natural health products, and pharmacologics to manage hot flashes in patients with breast or prostate cancer : Protocol for systematic review incorporating network meta analysis B Hutton and othersSystematic reviews, 2015. Volume 4, Pages 1-7
Course and Moderators of Hot Flash Interference during androgen deprivation therapy for prostate cancer: A Matched ComparisonB Gonzalez and othersThe Journal of Urology, 2015. Volume 194, Pages 690-695
How long do the effects of acupuncture on hot flashes persist in cancer patients?J Frisk and othersSupportive care in cancer, 2014. Volume 22, Pages 1409-1415
Randomized trial to assess the impact of venlafaxine and soy protein on hot flashes and quality of life in men with prostate cancerM Vitolins and others
What Happens When I Stop Taking Hrt
Many women worry that if they stop taking HRT, the hot flashes will come roaring back. Will they?
They probably will come back, says Dr. Rebecca, but theyll likely be less intense and probably wont last as long. We used to think HRT just postponed the inevitable, but now we think it probably allows women to skip some of the process. Also, we may be able to push back the symptoms to a time in life when youre better able to handle them: maybe youre working less or retired maybe your kids are grown, so the occasional night of poor sleep wont have as much impact on your family.
If youre experiencing impactful hot flashes, talk with your ob/gyn or primary care doc or one of Gennev’s menopause specialists about all your options, including HRT.
If you need an expert’s advice for HRT, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.
If you’re on HRT or have been, or opted out, we’d love to hear all about how you decided and what you experienced. Please feel free to share your experience with us on our community forums!
Lifestyle Changes To Improve Hot Flashes
Before considering medication, first try making changes to your lifestyle. Doctors recommend women make changes like these for at least 3 months before starting any medication.
If hot flashes are keeping you up at night, keep your bedroom cooler and try drinking small amounts of cold water before bed. Layer your bedding so it can be adjusted as needed. Some women find a device called a bed fan helpful. Here are some other lifestyle changes you can make:
- Dress in layers, which can be removed at the start of a hot flash.
- Carry a portable fan to use when a hot flash strikes.
- Avoid alcohol, spicy foods, and caffeine. These can make menopausal symptoms worse.
- If you smoke, try to quit, not only for menopausal symptoms, but for your overall health.
- Try to maintain a healthy weight. Women who are overweight or obese may experience more frequent and severe hot flashes.
- Try mind-body practices like yoga or other self-calming techniques. Early-stage research has shown that mindfulness meditation, yoga, and tai chi may help improve menopausal symptoms.
Treatments For Hot Flushes
Many women learn to live with menopause-related hot flushes, but if they’re really bothering you and interfering with your day-to-day life, talk to a GP about treatments that may help.
The most effective treatment for hot flushes is hormone replacement therapy , which usually completely gets rid of them. Your doctor will talk to you about the benefits and risks of using HRT.
If you have had a type of cancer that’s sensitive to hormones, such as breast cancer, your doctor will not recommend HRT and will talk to you about alternatives.
Other medicines have been shown to help, including some antidepressants and a medicine called clonidine.
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Soy And Other Plant Sources For Menopause Symptoms
Isoflavones are chemical compounds found in soy and other plants that are phytoestrogens, or plant-derived estrogens. They have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been determined to be much lower than true estrogens.
Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined.
There is also a perception among many women that plant estrogens are “natural” and therefore safer than hormone therapy, but this has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.
Can Supplements Ease Menopause Symptoms
There have been countless studies on menopause supplements conducted over the past 50 years. According to one systematic review of the effectiveness of BDS in the treatment of menopausal symptoms, the most extensively studied ingredients for menopause symptom relief are black cohosh and soy.
The efficiency of these ingredients is believed to be due to their estrogenic effect, but recent studies show that this is not the case with black cohosh.
Instead, black cohosh seems to alleviate menopause symptoms by affecting serotonin receptors and thus improving vasomotor functioning and mood.
Soy, on the other hand, contains high amounts of phytoestrogens which are believed to counteract estrogen deficiency seen in menopause.
However, the mechanism of action of these phytoestrogens is unknown, and studies on their effectiveness are inconclusive. Other ingredients that may offer relief to some women are red clover, dong Quai, evening primrose, hops, Ginkgo Biloba, Ginseng, valerian, lemon balm, licorice root, and many others.
These ingredients were less studied than black cohosh and soy so their efficiency remains unknown.
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Causes Of Hot Flushes
Hot flushes usually affect women who are approaching the menopause and are thought to be caused by changes in your hormone levels affecting your body’s temperature control.
They can happen without warning throughout the day and night, but can also be triggered by:
- eating spicy foods
- some health conditions, such as an overactive thyroid, diabetes and tuberculosis
Transitioning From Contraception To Hormone Therapy
Transitioning from contraception to hormone therapy may be challenging because oral contraceptives have higher dosages than typical hormone therapy regimens. Also, measuring follicle-stimulating hormone levels after stopping oral contraceptives can be inaccurate during perimenopause.26 One small study found that a rise in follicle-stimulating hormone level without a change in estradiol levels two weeks after stopping oral contraceptives is evidence that it is safe to transition to hormone therapy.26 Others suggest discontinuation of contraception when women are in their mid-50s because spontaneous conception is rare at this age.27
Effexor For Hot Flashes: A Non
Effexor is a medication that was originally approved by the FDA in 1993 for the treatment of major depression. Upon ingestion, Effexor functions as an SNRI by inhibiting the reuptake of serotonin, and to a lesser extent, norepinephrine. As a result of serotonergic and noradrenergic reuptake inhibition, concentrations of serotonin and norepinephrine increase within the synaptic cleft, allowing for improvements in neuronal communication.
Although clinically approved for the treatment of depression, Effexor is also commonly prescribed as a non-hormonal treatment for hot flashes. A hot flash is referred to as a brief or sudden onset of heat, often accompanied by facial redness, flushing, and sweating. The exact physiological underpinnings of hot flashes arent well-understood, but a cooling of blood vessels near the surface of the skin and/or changes in circulation are known to occur during a hot flash.
Fasting And Estrogen Dominance
Women are more sensitive to intermittent fasting than men because they have more kisspeptin, which is associated with reproductive functions and creates a greater sensitivity to fasting. Women who suffer from estrogen imbalance may notice the following symptoms:
- Low energy
- Reduced hair and skin health
The hormones regulating reproductive functions are extremely sensitive to hunger hormones. An experiment done on female rats found that it took only 15 days of eating every second day to disrupt their reproductive hormones. The experiment went on for 2 weeks, which is the equivalent of 10 years for humans.
It is possible that fasting could have a similar effect on women. A females hormones and her metabolism are very closely intertwined.
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Review Of Management Options
In 2004, a nurse-run hot flash clinic was started at the London Regional Cancer Program. The purpose of the clinic was to evaluate evidence-based treatment of hot flashes and to advance symptom management research. A stepwise approach based on efficacy data, tolerability, and local clinical experience is suggested for management .
Treatment algorithm for hot flashes, based on the experience of the London Regional Cancer Program.
Why Does Hrt Help With Hot Flashes
Medical science isnt entirely clear on what causes hot flashes, so the exact mechanism by which HRT turns hot flashes down or off is also not completely known, Dr. Rebecca says.
Heres what we do know: hot flashes are caused, in part, by the lack of estrogen, though that isnt the whole picture. Women in perimenopause have estrogen yet still have hot flashes, so it isnt just the lack of the hormone thats the cause.
We think it also has to do with pulsality, Dr. Rebecca says. Your brain triggers the release of hormones by sending bursts of chemicals in pulses. These pulses help regulate the ovaries and keep everything working as it should. HRT provides an even, constant dose of estrogen that also helps to regulate the body.
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What Is A Hot Flash
It’s a sudden feeling of heat and sometimes a red, flushed face and sweating. We don’t know exactly what causes them, but they may be related to changes in circulation.
A hot flush is a hot flash plus redness in your face and neck.
Ask Yourself The Following Questions:
- What is the treatment?
- What are the side effects?
- Is it effective?
- How much does it cost?
Once you answer these questions, discuss the therapy with your doctor. Make sure your doctor knows what therapy you are considering in order to discuss possible interactions or side effects with your current treatment.
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