This is the third in a series of articles on menopause titled: Menopause: Not for the Faint of Heart. My last article was about natural remedies for symptoms of menopause.
Many women, despite having tried all the natural remedies available, are still bothered by the 3 most common menopausal symptoms. These symptoms are: hot flashes/night sweats, anxiety and insomnia. Insomnia is usually an effect of the night sweats (that goes away when night sweats cease), but in some women insomnia can go on for years.
If you’ve tried the natural route and are still bothered by hot flashes and night sweats there are prescription medications that your doctor can prescribe. Many doctors will recommend hormone replacement therapy (HRT) as a first step. HRT is either estrogen given alone or a combination of estrogen and progesterone, which can be taken in pill form or as a trans-dermal patch. HRT is proven effective in reducing hot flashes and night sweats and can decrease the frequency and/or eliminate them by 80 – 90%. That’s the good news. The bad news is that HRT, when taken for a long period of time can increase a woman’s risk for stroke, heart attack, breast cancer and endometrial cancer. The experts are now saying that a woman’s medical history and the risks and benefits should be weighed before starting HRT. If hormone replacement therapy is prescribed, it should be at the smallest dose for the shortest period of time.
If you are afraid to take HRT, alternative prescription medications are available to combat hot flashes and night sweats. SSRI’s (selective serotonin reuptake inhibitors) are a class of medications that are used to treat depression and anxiety. They have also been found to be 70% effective in reducing and/or eliminating hot flashes and night sweats. The brand name that has been tested most extensively is Effexor (generic: venlafaxine) and evidence suggests that Paxil (generic: paroxetine) and Prozac (generic: fluoxetine) also work well. If you are having multiple menopausal symptoms, including: insomnia, anxiety and/or depression along with hot flashes and night sweats, one pill will help reduce or eliminate all of them. Most women tolerate SSRI’s well, but they can cause a variety of side effects. If you are considering SSRI’s as an option it’s best to visit: www.medline.gov and find the list of possible side effects before you start. Remember: knowledge is power.
Other drugs that can be tried to help alleviate hot flashes (which work for some women but are generally less effective) include: Clonidine and Gabapentine. Clonidine is usually prescribed to decrease blood pressure and commonly has the side effects of dry mouth, constipation, drowsiness and difficulty sleeping. Gabapentine is usually used to treat seizures and is well tolerated by most women. The only side effect reported is drowsiness.
If the only menopausal symptom you are having is insomnia, your doctor may write you prescription for Ambien or Sonata. These drugs are in a class of medications that are short-acting nonbenzodiazepines, that have fewer risks of dependence than benzodiazepines (examples: Xanax, Lorazapam, Halcion, Restoril) . Ambien and Sonata should be prescribed for the shortest amount of time because a person builds up a tolerance to the medication and it slowly stops working, even when higher doses are taken. Some of the side effects for these medicines include nausea, dizziness, nightmares, agitation and headache.
My thoughts on prescription medicines is that you need to weigh the benefits versus the side effects. Talk to your doctor, but more important, educate yourself and become your own Advocate for treatment.