Published January 20, 2004 in issue 0403 of The Hook

By JOHN HONG, MD

Donna Sommers ruled the '80s. "Last Dance," "Bad Girls," and "Hot Stuff" blared from nearly every radio, the latter being an anthem for many women who go through menopause. "Hot, hot, hot, haaaaaut...." With the large number of menopausal women suffering hot flashes, don't you think there would be effective medical treatments?

I've had women tell me stories about waking up in bed in a puddle of sweat, which wouldn't be so bad if you were a frog or some pond creature. However, for a human being, it doesn't sound so fun.

Women can be fine and suddenly, like a broken dam, sweat pours out of their chests and heads like Rome's Trevi Fountain. With my luck, if that happened to me people would throw pennies at my head. Ow!

Hot flashes can make pleasant experiences like drinking alcohol or eating spicy food turn into a bad episode of Cops-- like getting pepper sprayed in the face.

Anything that can precipitate dilation of the arteries can cause a hot flash. Remember Mr. Heatmeister in The Year Without A Santa Claus? Women with hot flashes can become just as red as him.

The majority of women go through menopause between age 45 and 55. Hot flashes can last from six months to years. "Years?" my patients sometimes gasp back at me. That's like being a chicken in a rotisserie for two to three years. Boston Market anyone? So the question at this point is, "What can I use to stop my hot flashes?"

Hormonal replacement therapy (HRT) is the most effective way to stop hot flashes during menopause. However, under recent scrutiny of the federal Women's Health Initiative in 2002, HRT has been shown to increase the risk of heart attacks, strokes, breast cancer, and blood clots. Though the increased risks (with the exception of blood clots) is relatively low, it is enough to make most women think twice about HRT. In fact, HRT decreased by 38 percent in the year after the Women's Health Initiative study was published.

There is always a trade off when a person takes a medication. Statin medications lower cholesterol but might cause muscle pains or liver inflammation. Certain pain medications (like ibuprofen) stop pain but might cause a bleeding ulcer. In HRT, the tradeoff for stopping hot flashes is an increased risk of heart attacks and strokes. It is that quote from Saturday Night Live character Rosanne Rosanna Danna: "It's always something. If it's not one thing, then it's another."

I have been asked more about what I think of HRT than Kathie Lee Gifford has been asked about what she thinks of Regis. It's a difficult decision to make and has to be personalized for each patient.

Clonidine is a blood pressure medicine that can reduce hot flashes, but it also can cause dry mouth, lightheadedness, and confusion. Low dose antidepressants like Cymbalta can reduce hot flashes, but can also cause sexual dysfunction and nausea. "It's always something..."

Black Cohosh is an over-the-counter treatment Native Americans have been using for hundreds of years. It seems to work for many women with hot flashes. Vitamins don't seem to have much effect.

Maybe Dolce & Gabbana can create menopause dresses. Maternity dresses exist, why not hot flash dresses? When a woman has a hot flash-- which usually originates from the chest-- a cool pack will be activated inside the dress to cool the woman down. The specialized fibers of the dress will miraculously breathe more to allow the perspiration to evaporate, allowing the woman to preserve her looks. Simply fabulous.

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