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Guest column

Monthly MPA shot treats postmenopausal hot flashes

By V. UPENDER RAO
Published October 17, 2005

There are about 50-million postmenopausal women in the United States. Seventy percent of menopausal women suffer from hot flashes. The frequency varies from one or two a day to almost one every hour.

Hot flashes are often accompanied by profuse sweating and nighttime arousal, causing social embarrassment and sleep disturbance. The onset of hot flashes occurs at a mean age of 51, but ranges from 44 to 51. This usually coincides with the fall in estrogen levels.

Replacement of estrogen alleviates hot flashes successfully. However, the results of the Women's Health Initiative study revealed a significant risk of breast cancer and cardiovascular events among women who took estrogen-progesterone combinations. Another study of women who took unopposed estrogen alone did not report these problems.

At any rate, there is enough concern and controversy regarding hormone replacement of any form in postmenopausal women that they should not be experimenting with this form of therapy for relief from hot flashes.

Nonhormonal treatments for hot flashes include the selective serotonin reuptake inhibitors, a class of antidepressants. Venlafaxine (Effexor), which inhibits the reuptake of serotonin and/or epinephrine, is frequently used for the treatment of hot flashes quite successfully. However, it has to be taken daily and side effects include dryness of mouth, anorexia, nausea and constipation, especially with higher doses.

Dr. Charles J. Loprenzi of the Mayo Clinic compared daily Venlafaxine to monthly injection of Medroxyprogesteron in a randomized clinical trial. Six weeks after the initiation of treatment, 80 percent of women in the MPA group reported relief of hot flashes compared to only 60 percent in the Effexor group.

Another way of stating this result is that at the end of six weeks of treatment, 24 percent of the MPA-treated group had no hot flashes as compared to only 1 percent of women in the Effexor group.

There were no major side effects to these two treatments. The MPA-treated women had less trouble falling asleep, fewer hot flashes, and less dryness of mouth and constipation, whereas the Effexor-treated women had less anxiety and depression.

The important question: Is it advisable to use MPA, which is a hormone, for fear of risk of breast cancer, although there is no compelling data to negate its use?

Dr. William J. Gardishar, associate professor of medicine at Fienberg School of Medicine at Northwestern University Memorial Hospital, said, "While it is generally good to avoid hormones, we must keep in mind that progesterones (MPA) are actually used to treat advanced breast cancer."

The other important issue is whether patients will prefer the greater ease of taking oral medication or the more efficient monthly injection. Because the intensity and frequency of hot flashes diminish over a few years, one approach may be to treat savior symptoms with MPA monthly injections and introduce oral medications when symptoms have become less intense. As always, the risks and benefits should be discussed with the patients.

--V. Upender Rao, MD, FACP practices at the Cancer and Blood Disease Center in Lecanto.

[Last modified October 17, 2005, 01:18:14]