Posted on: Saturday, December 25, 2004

PRESCRIPTIONS
Foods ineffective in reducing hot flashes

By Landis Lum

Q. What can I do about hot flashes? Do soy or red clover products work?

A. A hot flash usually begins in the head and neck and spreads to the face, chest and arms. It lasts 1 to 5 minutes and may occur with sweating, anxiety and palpitations. They're worse at night, causing insomnia and fatigue.

Up to 75 percent of women get hot flashes, which are worse the first two to three years after menopause. However, up to25 percent of women continue to have them five years later.

Try wearing layers of clothing so that you can take some off during hot flashes. Avoid triggers such as caffeine, stress, spicy foods or alcohol. Get regular exercise. Try meditation, slow rhythmic breathing and relaxation measures.

What about soy, red clover and other phytoestrogen products? Dr. Erin Krebs and others from the University of Minnesota did the most comprehensive study to date of their effectiveness in the Oct. 2004 issue of the journal Obstetrics & Gynecology. They studied soy or isoflavone-containing foods, beverages and extracts, and red clover extracts. Using only the most accurate type of studies — randomized trials, where half the people get a placebo or fake product and half the real thing — they found that none of these foods reduced hot flushes. And their estrogen effect may increase the risk of uterine cancers, blood clots, etc.

And black cohosh? Three of four randomized studies showed no benefit. There are reports of liver failure, but direct cause-and-effect was not established. And as with phytoestrogen supplements, purity and potency may be questionable.

But serotonin drugs such as Venlafaxine, Fluoxetine and Paxil reduce hot flashes for many women. Gabapentin, a seizure drug, may work. Hormones work the best, but slightly increase the risk of breast cancer, stroke, heart attacks, Alzheimer's disease (dementia) and blood clots in the legs and lungs. These risks are relatively low — if you take Premarin (an estrogen) and Provera (a progesterone) for five years, there's about a one in a hundred chance of getting either a stroke, heart attack or breast cancer. It's unknown whether other forms or lower doses of estrogen or progesterone would be safer. Breast cancers increase after four to five years of use — it's unclear whether stopping hormones earlier reduces this risk.

Nonetheless, I tell my patients that if they have hot flashes and nothing else works, use the lowest dose of hormones that is effective, but try to stop them every year and try to stop them completely by four to five years. And consider adding a baby aspirin every morning to possibly reduce heart attacks and strokes.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send questions to: Prescriptions, Island Life, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.