By Giancarlo La Giorgia - Article source: The Medical Post

"First your bones feel icy cold. Then, all of a sudden you get these unbelieveable hot flushes, and before you know it you're cold again. It can easily happen 10 times an hour." After two years of insufferable symptoms, Sara C finally went to see her doctor for help dealing with menopause. But in the end, they decided estrogen thereapy just wasn't worth the risk: she has a stong family history of breast cancer, is a little overweight and has high cholesterol. Everything would just settle down eventually, her doctor told her. All she could do was stick it out.

But now women like Sara could be given another choice, thanks to research conducted at Vancouver General Hospital's Centre for Menstrual Cycle and Ovulation Research (CeMCOR). In the first head-to-head trial, progesterone has been shown to be as effective as estrogen in treating hot flushes and sweats - collectively known as vasomotor symptoms (VMS). "For women with severe hot flushes, we now have something as good as estrogen," without the associated risks, said Dr. Jerilynn Prior, the lead researcher and head of CeMCOR.

Chill Factors

The double blind, randomized study, published in the journal Clinical Science, followed 41 women in their late 30s to early 50s undergoing surgical menopause due to a recent, pre-menopausal hysterectomy or ovariectomy. The women were treated with a daily dose of either 0.6mg conjugated equine estrogen or 10mg medoxyprogesterone, for one year. Both medications kept the incidence of hot flushes or sweating to one occurence every three or four days. By comparison, patients with severe VMS experience symptoms seven or more times per day.

Dr. Prior noted that all three of the women who dropped out of the study were in the estrogen arm. "Their reasons for discontinuing treatment were trouble sleeping, feeling depressed, feeling tired and headaches." Interestingly, these aren't listed as common side effects of estrogen therapy, she added.

Meanwhile, she found no evidence of harmful effects with medroxyprogesterone - according to the literature, it does not cause blood clots, breast cancer or increase the likelihood of migraine headaches. In fact, Dr. Prior has been prescribing the drug to her patients for over a decade.

Based on the evidence and her experience as a clinician, Dr. Prior is confident medoxyprogesterone is the safer choice. Although hers is the first study to directly compare it to estrogen, she says several studies from the 1980s demonstrated the effectiveness of medroxyprogesterone as a treatment for VMS. "There were at least five or six placebo-controlled trials by gynecologists from around the world that showed (medroxyprogesterone's) effectiveness in treating hot flushes. This knowledge should have been in the actual doctor's armamentarium, but it seems to have been forgotten," she said.

It's hard to imagine how that can happen - even a pre-eminent expert in this field like Dr. Prior is at a loss for a suitable explanation. But she hopes this head-to-head trial will help remind doctors estrogen isn't the only option.

About 20% of menopausal women experience severe VMS symptoms, which are caused by changes in estrogen levels in the brain. Those who, like Sara, are poor candidates for estrogen therapy or for whom conventional treatment is ineffective generally suffer through constant discomfort, with serious implications for their quality of life.

Thankfully, these women are the minority - most don't need any medication at all. For those with light to moderate symptoms, Dr. Prior tends to recommend lifestyle changes over medication. "Weight loss, regular exercise and perhaps some form of meditative exercise, like yoga," she suggested. "In addition, patients can use any number of over-the-counter products, such as soy beverages, black cohosh or ginseng. These may or may not be effective individually, but combined", she said, "they will probably be suffcient to manage VMS symptoms."

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