Healthpharmablog. About Health & Medicine

- What causes night sweats, and how are they linked with hot flushes?

Night sweats are probably hot flushes with the bedclothes on. Flushing and sweating attacks tend to go hand in hand and peak in the years after menopause. The sweating sensation usually takes longer to subside than flushes do.

- Will my hot flushes return with a vengeance if I stop HRT too soon?

HRT does not seem to affect the duration of hot flushes. If you stop HRT, and you are still in the flushing phase after menopause, your flushes will return. Every woman on HRT for control of hot flushes reaches a point where she wonders if it’s time to take a break and see how her body responds. Going off HRT may indicate that the phase of flushes is over or, if not, it will remind you of why you started on HRT in the first place. After a while, of course, the flushes will subside normally — just as they would if you had no HRT.

- I’m told many women give up HRT after a year or two. Why would they do that?

For a variety of reasons, such as bleeding, a dislike of being on medication for an extended time, and concerns about the long-term possibility of increased risks of breast and endometrial cancers.

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BLADDER DISEASE Hormone replacement therapy undertaken by such women may change the composition of bile and increase the incidence of gallstones. If you have gallstones and want HRT, be cautious about it and give preference to the patch format. Hormone therapy is suitable for women who have had their gall bladders removed, provided there are no other reasons against it.

WOMEN WITH DIABETES Hormone replacement therapy may be prescribed for women with diabetes. However, if you have diabetes you should realise that your blood sugar levels are likely to be disrupted during the first few months of hormone use. This may necessitate changes in the dosage and timing of your medications, particularly if you use insulin. Patches or implants are the preferred form of HRT for women with diabetes. Although some research has been conducted on the impact of oestrogen on blood glucose levels, there is relatively little information on the effects produced by hormone combinations such as oestrogen and progestogen.

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The HRT dosage prescribed depends on a number of factors such as its purpose (for example, mainly for symptom control or mainly for reducing the risk of later heart or fracture problems) and a woman’s individual response to it. The oestrogen dosages needed to relieve symptoms may be higher or lower than those required to provide long-term protection against heart disease and osteoporosis, depending on the severity of symptoms. Women on HRT before menopause is confirmed cannot rely on it for contraception as hormone dosages are insufficient to prevent pregnancy. As explained previously, a low-dose combined Pill is one way of obtaining both the benefits of HRT and contraceptive protection.

Whether it is taken every day or for ten to fourteen days per cycle, the total monthly dose of progestogen in HRT is similar to that given to a woman on the Pill. The dosage used by Tessa, who is taking progestogen daily, was arrived at by lowering the daily dose until she had breakthrough bleeding, then adjusting upwards.

Individual variability in the body’s capacity to deal with the hormones of HRT is another reason why a dose that relieves symptoms in one woman has little effect on another. In the case of hormone patches and implants, the position on or in the body affects the amount of hormone the body absorbs and therefore the dosage required.

When a doctor is deciding on the most suitable dosage or hormone format for you, your individual response will be crucial. The hormones used initially may not relieve your symptoms adequately, or they may have unwanted effects. It may then be necessary to change the kind of oestrogen or progestogen used, or to alter the dose.

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An artificial menopause can also be caused by chemotherapy, the drug treatment used against many types of cancer. Chemotherapy directed at any part of the body prior to menopause may result in a chemical menopause, but regrettably many women are not warned about this possibility. Marcia was upset to learn while having chemotherapy for leukaemia that her ovaries would no longer function after the treatment. ‘It was the last thing on my mind at the time I started chemotherapy, and the hot flushes I experienced some weeks later came as a most unpleasant surprise,’ she recalled. ‘Fortunately I have three children and wasn’t intending to have any more. However, I would have appreciated being told earlier about this effect of chemotherapy.’ Menopause may also be caused by radiotherapy to the ovaries, when x-ray treatment is given for a cancer in the pelvis.

Early natural menopause in the absence of any medical intervention is more likely in women who smoke (smokers experience menopause one to two years earlier, on average, than non-smokers and ex-smokers, the reason being that smoking reduces the availability of oestrogen to body tissues). Later menopause is more likely in woman with many children, and women who are heavier than average. Genetic and nutritional factors also seem to play a part: the menopause for Asian women apparently occurs earlier than for those with northern European backgrounds.

Sometimes none of these reasons accounts for spontaneous premature menopause, which on rare occasions can be found in women in their thirties or, even more rarely, in their teens or twenties. Studies suggest that the egg supply of most of these women has run out, but it is not clear whether this is due to a shortage of eggs at birth or, as is more likely, some unknown factor.

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