Some women not candidates for HRT

Dear Dr. Roach: I am a 75-year-old woman who has been suffering from four to five bouts of hot flashes with night sweats (about every two hours from bedtime until morning) since I stopped taking HRT at age 62. I haven’t had an uninterrupted night’s sleep since then, and I rarely wake up feeling rested. My GP has had me try over-the-counter remedies, but none of them has worked. He doesn’t know how to help me. This has gone on way too long, and I am tired (literally and physically) of dealing with it. Do you have any solutions that could help me?

M.E.

Answer: The fact that the hot flashes stopped when you stopped the hormone replacement therapy is strong evidence that these are menopausal hot flashes, and attests to how effective estrogen is at treating them. Doctors used to say that hot flashes go on for only a few years, but many women know that they may continue for years or decades after menopause.

Because estrogen has risks, most doctors are more comfortable using nonhormonal treatments for persistent hot flashes. Anti-depression drugs such as citalopram (Celexa) and paroxetine (Paxil) can reduce hot flashes by as much as 50% to 60%. Antiepilepsy drugs, such as gabapentin (Neurontin), are not quite as effective.

When nonhormonal treatments are not effective, a woman should discuss the risks of hormone therapy. Some women are not candidates. This includes women with a history of breast cancer, with heart or liver disease, a history of abnormal blood clotting or those who are at high risk for developing these. Women without these conditions should carefully consider the risks of estrogen and balance against the improvement in quality of life.

Being tired all the time and not getting good sleep has risks as well.

Gynecologists have expertise in discussing the risks and benefits of estrogen (and progestins, for a woman with a uterus), and since your doctor seems not to have expertise in this area, I’m not blaming him. Nobody has expertise in everything, but it does seem a consultation is long overdue. A visit with an expert is appropriate.