Articles by Dr. Lotte Valentin
Menopause Part 2
Hot flashes affect about 75% of women in North America, but less than 10% of women are affected in other countries, such as Japan, Mexico, Hong Kong and Pakistan. Hot flashes are episodes of feeling hot and sweaty, and are sometimes accompanied by an increase in heart rate, palpitations and dizziness. About 60% of women will experience hot flashes before they experience a change in their menstrual pattern and the hot flashes typically lasts 1-5 years.
The causes of hot flashes are due to an imbalance in the hypothalamus, which is in charge of regulating the temperature of the body. Each hot flash correlates with a spike of LH, which is released from the pituitary gland every 30-60 minutes. When your estrogen levels drop, it also stimulates your brain to release more norepinephrine, which then causes a dilation of your blood vessels resulting in a hot flash.
Neurotransmitters such as GABA, serotonin and endorphins also affect the hormones released from the hypothalamus, which sends signals to the pituitary and can therefore cause your LH to rise, causing more hot flashes. This imbalance in hormone signaling is increased by stress.
Prostaglandins (fatty acid molecules that affect your hormones) also contribute to hot flashes and stimulate hypothalamus signaling. Prostaglandins increase from eating a diet of red meat, dairy, sugar and shellfish, and is reduced by bromelain, fish oil, curcumin and antioxidants.
Risk factors that contribute to hot flashes are:
• Stress, fatigue and inability to relax
• Hot or cold weather
• Menarche before age 12 or early menopause before age 52
• Spicy foods, hot drinks, chocolate, caffeine, alcohol, cheese, red wine
• Red meat, dairy fat, shellfish, peanuts
• Maternal history of hot flashes
Some treatments for hot flashes:
• Black cohosh - decreases hot flashes
• Vit. C - may decrease prostaglandins
• Hesperidin (found in citrus fruit) - relieves hot flashes
• Vit. E - reduces hot flashes, fatigue, palpitations, dizziness, and decreases vaginal dryness
• Calcium/Magnesium/Vit D - improves relaxation and sleep, increases bone density.
• Vit B complex - increases serotonin production, supports adrenals and relieves depression
• Curcumin - decreased inflammation
• Bromelain - decreased inflammation
• Gemmo brand Sequoia - decrease hot flashes
• Exercise 40 min / day - helps balance neurotransmitters
• Sleep in a dark room to increase melatonin levels and help you sleep more soundly.
Many women choose to balance their hormones by using hormone replacement therapy. There are different hormones available on the market; some are synthetic and some are bio-identical hormones (BHRT--Bio Identical Hormone Replacement Therapy). Bio-identical hormones have the same chemical structure as the hormones found naturally in the body (endogenous hormones). Synthetic hormones do not have the same chemical structure as the hormones in the body.
In order to understand the difference between the hormone therapies available, one needs to look to the different research that has been done on this topic. Some of the research articles available fail to differentiate between synthetic and bio-identical hormones in the study, resulting in confusion both for the physicians and the general public reading them. Many patients have asked me for research articles on this topic so that they can educate themselves, so I've included below a short list of publications with the title and link to the full article, as well as some excerpts. Before starting hormone replacement therapy it's important that you understand the difference between the different therapies available.
1. What's new in hormone replacement therapy: focus on transdermal estradiol and micronized progesterone.
• "Based on these data, which are now included in the guidelines, the use of transdermal estradiol and micronized progesterone could reduce or possibly even negate the excess risk of VTE, stroke, cholecystitis, and possibly even breast cancer associated with oral HRT use."
• (VTE: Venous Thromboembolism)
2. Micronized progesterone and its impact on the endometrium and breast vs. progestogen
• "Micronized progesterone does not increase cell proliferation in breast tissue in postmenopausal women compared with synthetic medroxyprogesterone acetate (MPA). Experimental evidence suggests that the opposing effects of MPA and micronized progesterone on breast tissue are related to the non-specific effects of MPA, including glucocorticoid activity and differences in the regulation of gene expression. Therefore, for women with an intact uterus, micronized progesterone may be the optimal choice as part of combined HRT.""
3. Postmenopausal hormone replacement therapy and cardiovascular disease: the value of transdermalestradiol and micronizedprogesterone. Click here for the link
• "There is a wealth of evidence to suggest that, unlike oral estrogens, transdermal estradiol does not increase the risk of venous thromboembolism, probably due to its lack of effect on the coagulation cascade, including thrombin generation and resistance to activated protein C, and does not increase the risk of stroke. It is cardioprotective, significantly reducing the incidence of myocardial infarction compared with non-users; it significantly reduces the incidence of new-onset diabetes, a risk factor for myocardial infarction. Micronized progesterone has also been shown not to increase the risk of venous thromboembolism and further reduced the incidence of new-onset diabetes when combined with transdermal estrogen. Micronized progesterone has a neutral effect on the vasculature, including a neutral or beneficial effect on blood pressure."
4. The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.
• "RESULTS: Over a 10-year span, starting in 2002, a minimum of 18,601 and as many as 91,610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET)."
5. Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women. Click here for the link
• "CONCLUSIONS: The synthesis of data using Bayesian meta-analysis indicates a reduction in mortality in younger postmenopausal women taking hormone therapy compared with no treatment. This finding should be interpreted taking into account the potential benefits and harms of hormone therapy"
6. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort.
• Synthetic progestin and estrogen increased risk of breast cancer. Bio-identical Progesterone and Estrogen showed reduction in breast cancer risk.
If you are experiencing the symptoms of menopause or would like to learn more about whether hormone replacement therapy or other products can help you, please call us at 928-445-2900 and we'll be happy to schedule an appointment for you.
The information contained on this site is for educational purposes only. These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Please discuss all your medical issues with your doctor.