Businesswoman in Menopause fanning herself, HRT, hormone replacement therapy

Q. I am at my wit’s end. I’ve been taking Prempro for hot flashes. Now my doctor wants me to stop because of cancer concerns. Whenever I quit, though, the hot flashes return worse than ever.

My friends swear by bio-identical hormones but my doctor says that they have not been proven any safer than Prempro. She wants me to try Effexor XR but I am not ready to take an antidepressant for hot flashes. Help!

A. Your doctor may be reacting to a study reported at the American Association for Cancer Research this spring. The Nurses Health Study acquired data from 60,000 women over several decades. Those who took postmenopausal estrogen were at greater risk of breast cancer. Progesterone increased the risk even more.

Bio-identical hormones have not been tested so thoroughly, so your doctor is erring on the side of caution. For more information on dealing with hot flashes and vaginal dryness plus the pros and cons of hormones, we are sending you our Guide to Menopause. In it we discuss non-drug approaches such as Pycnogenol and black cohosh.

Although antidepressants like fluoxetine (Sarafem), venlafaxine (Effexor) or paroxetine (Paxil) may ease hot flashes, stopping such drugs suddenly can cause unpleasant withdrawal symptoms including dizziness, headache and hot flashes. Sexual side effects are not uncommon with such medications. Lower libido and inability to achieve orgasm are other possible complications.

Should you wish a more in-depth overview of dealing with menopausal symptoms, we think you will find our chapter in Best Choices from The People’s Pharmacy quite robust. It goes from page 353 to page 371 and includes a detailed discussion of the pros and cons of estrogen and progesterone, black cohosh, soy, antidepressants, gabapentin, Estring and various personal lubricants.

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    need help with hotflashes!

  2. DB

    When I first started getting hot flashes I used Progensa cream. This is supposedly a bio-identical hormone. It started working in only 3 days and was perfect. Hot flashes completely gone! I only used it for 3 weeks. Went off for a week (as it states in the instructions) and when the hot flashes didn’t return, I just stayed off. No hot flashes for 6 months!
    During that time I had an abnormal mammogram, a biopsy and an excision on one of my breasts. No cancer thankfully but “atypical hyperplasia” which is a potential warning sign that increases my odds of breast cancer.
    When the hot flashes returned, I didn’t want to go back on the hormone so tried to ride them out but when an entire week went by with almost no sleep, I tried the herbal route. I make one cup of tea per day with 2 tsp of red clover and 1/2 tsp of black cohosh. I got the herbs from a store that sells them loose (i.e. not in tea bags or pre-packaged). I put the leaves in a tea ball and steep for 3-5 minutes. I also started taking Borage oil (one capsule per day).
    Much to my amazement, the hot flashes have almost completely disappeared! I’ve tried researching these and unfortunately there isn’t much information as to whether their use could lead to cancer. According to a good friend who is a doctor (and was the person who recommended the tea), the jury is out on the herbs. They just don’t know. I am happier not taking drugs but I also realize that there are risks no matter what path I choose.

  3. KiwiRob

    I can absolutely vouch for the effectiveness of Black Cohosh, just one tablet a day & no side effects :)

  4. emma k.

    I’m a big believer in making my own informed decisions. I remember the ‘hoo-rah’ several years ago (Women’s Health Initiative?) when I was still taking Prempro. Instead of going cold turkey, I did some research. I suggest you do the same. Go to your local library and ask them to help you. They will steer you to solid information.
    For instance I read Medical Journals (tough going but I figured it out) and found that the actual risks for me were not those in the headlines. Then I made a conscious decision about what I risk was able to take.
    Later (a year or two) I spoke with my GYN and we decided to gradually step down my Prempro dosage so that after several months I was no longer taking it–and no hot flashes.
    Because I had hot flashes so severely that they made my life – including my ability to support myself – hell, I can empathize with your dilemma. But adding an antidepressant is such a BAD answer in my opinion.

  5. VG

    Do NOT take Effexor for hot flashes. It may work for some, but did not work for me. It interfered with my sleep, killed my libido, prevented orgasm, and exacerbated my restless leg. Once it was determined that I indeed had RLS, I was immediately weaned off Effexor. To add to that, did you know that RLS can contribute to heart problems? I also developed A-fib and have since had to have a heart ablation done. I just had to ride out the hot flashes. I have a friend who is encouraging me to use bio-identical hormones. Not sure what my Dr. will say to this.

  6. Karen

    My doctor believes the opposite; that the benefits of hormones far outweigh the risk of cancer. The practice composed a letter to its perimenopausal patients outlining the medical questions about those studies and why the doctors don’t believe the conclusions can be applied across the board. Bio-identical hormones have no patent protection and no-one has the financial wherewithal to pay for the kind of testing that Pempro paid for.
    The best lay-person’s article I found is in the NY Times; google NYTimes on Estrogen replacement and draw your own conclusions. You might also want to schedule a consultation with your friends’ doctor. Even if you pay out of pocket, the different perspective is probably worth the cost.
    What they don’t say in the “risk of cancer” stories is that women who take supplemental estrogen have better cancer survival rates than them that don’t. Furthermore, antidepressants do nothing to protect your bones, and as many of us will die of the consequences of broken bones as we will from cancer. It’s just that cancer is scarier, and “broken bones” sounds like an easily preventable accident that happens to someone else.
    For me, at least, the very real chance of becoming a bag lady, with no home and no insurance, because I was so disabled by my menopausal symptoms outweighed any other risk. YMMV.

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