Hot Flashes: the Value of Individualized Hormone Replacement Therapy

“Menopause-related hot flashes are usually treated with a standardized dose of estrogen. This general approach to the most prevalent menopausal symptom is predicated on the belief that all menopausal women will respond to a uniform dose of estrogen, irrespective of the type or route of administration.”

Morris Notelovitz, MD, Ph.D., MB BCh, FRCOG

 
However, 20% of naturally menopausal and 10% of surgically menopausal women (all of whom are estrogen deficient) never experience hot flashes and many perimenopausal menstruating women (with adequate endogenous estrogen levels) have estrogen responsive hot flashes during their luteal and menstrual phases. Also, women’s perception of the sensation of heat and the severity of accompanying symptoms such as sweating, palpitations, anxiety and irritability is extremely variable. In most symptomatic women, hot flashes cease within 5 years of onset. Yet, hot flashes can be debilitating and persist for up to 15 years after menopause in about 20% of women. Hot flashes often correlate more closely with fluctuating estrogen concentrations than with absolute hormone values. Persistent hot flashes in women receiving “adequate” estrogen therapy are often indicative of reduced blood levels of active free estrogen due to excess binding of estrogen with sex hormone binding globulin (SHBG).

Androgens are hormones that are naturally present in women, and include testosterone and DHEA. A recent study showed that high androgen levels indicate a shorter duration of hot flashes. Androgen therapy can be used to relieve vasomotor symptoms in women whose hot flashes do not respond to adequate estrogen replacement, because both estrogen and androgen receptors are present in the areas of the central nervous system relevant to hot flashes.

Mayo Clinic Proceedings 2004 Apr;79(4 Suppl):S8-13

 
It is essential that all forms of hormone replacement therapy are administered using the most appropriate route, dose, and dosage form to optimize benefits and minimize the risk of side effects. We welcome your questions.

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