Options alleviate hot flash miseries

WASHINGTON — About a quarter of women who stop taking hormone replacement therapy because of its risks wind up resuming the pills because of menopause misery, says the first research to explore how easy it is to quit.

Desperate for alternatives to alleviate hot flashes, more women are turning to certain antidepressants, such as Prozac and Effexor, that can offer some relief even if the users aren’t depressed.

"They’re very hot right now," says Dr. Nanette Santoro of the Albert Einstein College of Medicine. "Certainly in my clinical experience, they’re the best second alternative" to estrogen.

Very few other options are backed by scientific evidence that they relieve what’s considered menopause’s worst symptom, hot flashes. Indeed, very few of the women who returned to hormone therapy had even tried an alternative, notes Dr. Deborah Grady of the University of California, San Francisco, who led the study about ease of quitting.

"One question that’s important in my mind right now is how can we help these women?" Grady says.

It’s a dilemma not just for women who suffer serious hot flashes for a few months surrounding menopause — but especially for the 15 percent of women who keep having them for years.

Hormone therapy was long thought to protect postmenopausal women from such age-related conditions as heart disease and Alzheimer’s. But sales have plummeted since July 2002, when a major study found hormone therapy in fact slightly raised users’ risks of heart attack, stroke and breast cancer. That study examined combinations of estrogen and progestin.

Women who really need estrogen, especially if they’re otherwise at low risk of heart disease or cancer, shouldn’t be scared away from it, Grady stresses.

Nobody knows antidepressants they work. But small studies suggest they reduce hot flashes by about 60 percent, not as good as estrogen although better than other options so far have proved.

Other options: