I just started having hot flashes within the last 30 days. I
sweat profusely at night and during the day. I have more flashes than I
thought possible. If I decide not to use HRT, when can I expect these
hot flashes to stop?
It is very common for hot flashes to come and go, particularly when they
first begin. The severity and frequency can vary as well. The normal
duration of hot flashes is they begin two years before the final
period and continue for two years afterward. However, many women
experience the continuation of hot flashes for many years after they
stop menstruating. There is, unfortunately, no way to predict for any
one individual what her pattern may be.
For high-risk breast cancer women—is there enough estrogen in
black cohosh to be as harmful as HRT?
There is no estrogen in black cohosh, so it shouldn’t be a problem for
women at risk for breast cancer or who have had breast cancer. Use of
soy products on the other hand is discouraged for women with a personal
history of breast cancer because of soy's estrogen-like properties.
What actually occurs in the body that triggers a hot flash?
I wish we knew! We do know that women who have flashes have the same
estrogen levels as women who do not. We also know from very
sophisticated studies measuring internal (core) body temperature, that
the hypothalamic control is different in women with flashes. They get
hot more easily and have higher levels of norepinethrine and lower
levels of serotonin in their systems. These are chemicals that work on
the hypothalamus to regulate body temperature.
It is also true that certain activities will set off a hot flash. Things
such as eating hot or spicy foods, drinking caffeine or alcohol,
stressful situations or being in a warm place can be triggers. Whether
they play into the hypothalamic system or have a separate effect to
cause flashes is unclear.
Concerning vaginal dryness, could taking fish oil or vitamin E
help? Does it lubricate from the inside out?
Neither fish oil or vitamin E will diminish vaginal dryness. In the
premenopausal woman, the lubrication is from the inside out. Prior to
menopause the vaginal lubrication comes from the leaking of fluid from
the blood vessels that line the vaginal walls. This fluid comes through
the walls and promotes vaginal moisture. This is particularly true with
arousal during physical intimacy. The cervix also produces mucous that
contributes to moisture whether or not there is intimacy involved. After
menopause the decrease in estrogen causes thinning of the vaginal wall
and the blood supply falls as well. There is less mucous from the
cervical glands. All of these factors cause vaginal dryness. Some
over-the-counter vaginal lubricants contain vitamin E as one of the
ingredients. But using vitamin E alone either topically or by mouth
won’t make a marked difference.
How effective is a product like Replens for vaginal atrophy?
Many women have had success with Replens™ and other over-the-counter
I’m 42, with no ovaries. I have a uterus. Does HRT cause weight
Hormone replacement therapy does not cause weight gain.
Adenoma and changes in hormone: How does the tumor affect
menopause? Adenoma and hypothalamus: Does the tumor affect the
temperature gauge? What causes the hypothalamus to go out of
I could not find anything in the literature that specifically addressed
the relationship between a pituitary adenoma and menopause. The adenoma
should have no effect on temperature regulation by the hypothalamus. It
is not clear what mechanism is at work that causes women to have hot
flashes, only that these women have a higher level of the hormone
norepinephrine. It is through the action of this hormone on the
hypothalamus that the core body temperature rises and hot flashes occur.
Are sagging, wrinkling skin, wiry hair, and rosacea symptoms of
Changes in the skin and hair are certainly common with aging. The
decrease in estrogen thins out the skin making it drier. There is also a
loss of collagen, the supportive layer for the skin. Both of these
things can cause looser, drier skin and dry hair. Roseacea, on the other
hand, has no relation to menopause and can occur at any age.
Do diet and exercise ward off menopausal symptoms?
There are dietary triggers that can provoke a hot flash. Items such as
alcohol, caffeine, spicy and/or hot food can cause a hot flash.
Cigarettes can cause the same effect. Eating certain foods or exercising
will not, per se, ward off menopause symptoms. However, women who are
overweight tend to have more hot flashes. So for many health benefits,
it is important to eat a healthy diet and exercise regularly.
Can uterine ablation affect your hormones?
Endometrial ablation is a surgical technique that thins the uterine
lining so that the menstrual flow is lighter. It will not affect
hormones. Uterine artery embolization, which is an interventional
radiology technique to decrease menstrual flow especially in women with
fibroids, can cause an earlier menopause because it sometimes decreases
blood flow to the ovaries.
If you go through menopause in your late 50s, which is seven or
eight years beyond the average age for American women, does that
indicate anything positive or negative for overall health?
It certainly has a positive effect on your bone health, and there is a
smaller chance of developing osteoporosis. You can also have a lesser
chance of heart disease during this time frame. This, of course, depends
on whether or not you have other risk factors for these problems. Women
who enter menopause later do have a slightly higher incidence of
endometrial (uterine) cancer and breast cancer.
What is your opinion on early (surgical) menopause and lack of
estrogen leading to dementia and Alzheimer’s? Is there anything you can
do to counteract this?
I am unaware of any data on the relationship of surgical menopause on
the development of Alzheimer’s disease. There is observational data that
seems to show women who have used estrogen at the start of menopause may
have less Alzheimer’s. However what isn’t clear is it the use of
hormones alone or is it that these are women that are healthy with few
risks for getting Alzheimer’s. In the WHI study, there was an increase
in Alzheimer’s disease. Remember though, that these were women who were
older when started on hormone therapy. The number of cases of
Alzheimer’s was actually small, so the value of that data is unclear.
Do you recommend HRT/BRHRT for women of premenopausal age due to
surgical menopause or menopause due to breast cancer treatment?
For women who have had a surgical menopause but do not have a personal
history of breast cancer, hormone therapy can be beneficial. Women who
have gone through an early menopause have accelerated rates of heart
disease and osteoporosis, and use of estrogen can buffer this. It is
generally contraindicated to use hormone therapy in women who have had
If a 35-year-old woman exercises, eats well and controls her
weight, are her ovaries that of a 35-year-old or less?
Her overall health is good but the age of the ovaries remains the same
as the age of the individual.
Is individualized hormone therapy determined by symptoms or do
tests determine dosage?
Therapy is based on symptoms. Dosing can be adjusted so that the symptom
relief is maximized. There is no specific hormonal level that correlates
exactly with a particular symptom.
What about long-term (15 years) use of Premarin™ 0.3 mg and
Prometrium™ 100mg? Without them, I have many hot flashes both day and
Every woman is different. As long as there are no risk factors for
hormone use, it is reasonable to continue. Therapy should be evaluated
and discussed on an annual basis with your health care provider.
Is there any scientific evidence of brain tumor development and
hormonal changes manifested during pregnancy? During menopause?
Some tumors of the pituitary gland can increase in pregnancy. I do not
know the data on tumors originating in other parts of the brain and any
influence that pregnancy or menopause may have.
Could you the relationship between circulatory diseases and
death in women? What can you do to prevent circulatory disease?
In this country the primary cause of death in women is heart disease.
Women have a 31 percent lifetime risk of dying from cardiovascular
disease. This is much higher than the risk of death from breast cancer,
which is three percent. The bulk of the deaths comes from heart attacks
(coronary artery disease). The next largest cause is stroke (cerebral
vascular disease). The development of plaque and the narrowing of
vessels is the root of the problem. Eating a low-fat diet and exercising
are the most important weapons to use against these two problems. If you
have diabetes, elevated cholesterol, or hypertension, it is crucial to
make sure these are well controlled because the risk of vascular
complications is especially high.
What new studies are going on now for safe hormone replacement?
First, hormone therapy in the appropriate patient is safe. There are at
least two studies evaluating hormone therapy in young women. They
are the KEEPS ( Kronos Early Estrogen Prevention Study) trial and the
ELITE (Early vs. Late Intervention) trial. Both of these studies are
looking at estradiol and its effect on the progression of heart disease.
What about bioidentical hormones?
There were several questions on this topic. Rather than address them
individually. I will address them all here.
First, it is important to have a common language by which “bioidentical
hormones” are defined. This term came into play as a way of
differentiating between some of the frequently used synthetic
preparations and preparations that were produced by compounding
pharmacies. The theory, proposed by some, was that the compounded
hormones were more synchronized with a woman’s body because they were
“natural.” Since they were “natural” the thought was they would be
safer, work better and have fewer risks of breast cancer and heart
disease. The problem is that there is no proof that this is true. The
other concern is that compounding pharmacies or companies are under no
legal obligation to standardize their formulations, and their
manufacturing process is not regulated by the FDA. This brings up basic
safety concerns and questions whether there is a difference in
ingredients from batch to batch.
Using that as background, let’s look at what products women have
available to them.
There are conjugated estrogen preparations and esterifed estrogen
preparations. They are now called "synthetic." These medications have
both estradiol (which is the primary estrogen that women make) and other
estrogens that are not found in a woman’s body. If patients choose not
to use one of these medications, there are multiple options, made by
pharmaceutical companies, that use only estradiol as their estrogen
component, estradiol being the primary estrogen in the bioidentical
formulas. The pharmaceutical options come in pill form, creams, vaginal
rings, mists and patches. In other countries, estrogen pellets are used.
The pellets are not commonly used in the U.S. It should be noted that
the estradiol in the “bioidentical” preparations is purchased from
pharmaceutical houses. It is not the main ingredient that is at issue,
it is the lack of standardized preparation.There are two
pharmaceutically manufactured progesterone products that are identical
to the body’s progesterone. One is in tablet form, the other is a
Overall it is a matter of safety and efficacy that concerns health care
This article is part of the Menopause and Youlibrary,
a web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own health care practitioner with your
specific concerns and questions.
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