November 27, 2013
Severity of Hot Flashes Linked to Hormone
Supplement Effectiveness

Cleveland—Here’s a quick way pharmacists can help menopausal women determine if their symptoms are likely to be helped by hormone supplementation: Just ask them how often they have moderate-to-severe hot flashes.

A study from Helsinki University in Finland found that hormones at menopause can help with sleep, memory, and other bothersome symptoms but only when a woman also has hot flashes. If moderate-to-severe hot flashes are not involved, hormone therapy likely will not improve quality of life, the researchers found. The results were published online in the journal Menopause.

“There has been a long debate over this issue. This new, well-designed study puts forth good evidence that hormone therapy does not improve quality of life in recently menopausal women who do not have numerous hot flashes,” said Margery Gass, MD, executive director of The North American Menopause Society.

Of the 150 women who recently had gone through menopause in the Helsinki study, 72 had seven or more moderate-to-severe hot flashes per day compared to 78 who only had three or fewer mild hot flashes per day—or no hot flashes at all. For 6 months, about half the women in each group used a variety of hormone therapies—transdermal estradiol (1 mg/d), oral estradiol (2 mg/d) with or without medroxyprogesterone acetate (5 mg/d)—while the other participants received only a placebo with no hormones.

At the beginning and during the study, the women tracked their hot flashes and answered questions about their general health, sexual well-being, and menopause symptoms, such as insomnia, depressed mood, nervousness, aching joints or muscles, memory and concentration, anxiety and fears, and menstrual cycle–like complaints, such as abdominal bloating and breast tenderness.

Not surprisingly, the women with moderate-to-severe hot flashes had more sleep problems, irritability, exhaustion, depressed mood, joint pains, palpitations, nausea, and swelling than the other study participants.

For the women who had moderate-to-severe hot flashes, hormone therapy had a positive effect on a variety of symptoms, according to the results. Significantly improved at 6 months into the study were scores for sleep (0.787 [0.243] versus 0.557 [0.249] with placebo; memory and concentration capacity (0.849 [0.228] versus 0.454 [0.301] for placebo, and anxiety and fears (0.942 [0.133] versus 0.826 [0.193] for placebo, according to the report.

“Hot flashes contribute differently to various variables affecting health-related quality of life shortly after menopause,” the authors noted. “Estradiol or an estradiol-medroxyprogesterone acetate combination similarly alleviates hot flashes and improves health-related quality of life in relation to elimination of hot flashes. Hormone therapy use does not confer any detectable quality-of-life benefit over placebo in women without disturbing baseline flashes.”

The study was limited, according to the researchers, because all of the women were white, healthy, and lean, meaning the results might not apply to women of other ethnicities or with pre-existing health conditions.

U.S. Pharmacist Social Connect