November 2015 Health Bulletin

When do hot flushes ever stop?

Well, for some women hot flushes and night sweats last for decades. A national Australian study conducted by our team, recently published in the medical journal Fertility and Sterility, confirms this1. This research was undertaken by Dr berihun Zeleke as part of his PhD research in the Women's Health Research Program at Monash University.

For our study 1,548 women, aged 65 to 79 years, completed a detailed menopausal symptoms questionnaire. Of the 1,548 women, 6.2% were using menopausal hormone therapy (or MHT) and 6.9% reported using vaginal estrogen therapy. One in three of the 1,426 women not using MHT were experiencing hot flushes and/ or night sweats – of these, about 10% rated their symptoms as moderate-to-severely bothersome (3.4% of all the women not using any MHT). So although severe symptoms are not common, a small subset of women do experience severe persistent menopausal symptoms. In Factors found to be independently significantly associated with hot flushes and night sweats were younger age, obesity, being a carer for another person and having had both ovaries removed.

Another important finding was that over half of the partnered women (54.4%) reported sexual symptoms. One third of partnered women reported vaginal dryness during intercourse in the preceding month. This tells us that at least one third of these women are sexually active and vaginal dryness with intercourse is a common and untreated problem!

Vaginal dryness is an important symptom of vaginal atrophy. This occurs because of thinning, drying and inflammation of the tissue that lines the vagina, as a result of loss of oestrogen production by the ovaries at menopause. Other symptoms of vaginal atrophy include irritation, itching and infection. This study provides clear evidence that vaginal health is a neglected aspect of older women's health, despite this being a condition that can be simply, effectively and safely treated with low dose vaginal estrogen. Low dose vaginal estrogen therapy also reduces urinary tract infections and urge urinary incontinence (the urge to rush to the toilet) in older women. We encourage all women experiencing these symptoms to speak to their doctor about treatment options.

Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline was published by the US Endocrine Society in October 20152.

This Guideline was developed by an international task force after an exhaustive review of the medical literature. The basic conclusions were simple:

  • Menopausal hormone therapy (MHT) is the most effective treatment for hot flushes and night sweats and other symptoms, due to menopause.
  • For most symptomatic postmenopausal women aged less that 60 years, or less than 10 years since the onset of menopause, the benefits exceed risks.
  • Treatment should be individualised based on each persons profile and preferences
  • Prior to commencing MHT women should be assessed for cardiovascular and breast cancer risk and the most appropriate therapy selected guided by risk/benefit considerations.
  • MHT should not be prescribed to prevent coronary heart disease, breast cancer, or dementia.
  • Nonhormonal therapies should be used to alleviate symptoms when MHT is contra-indicated.
  • Low-dose vaginal estrogen (and in countries where available, a tablet called ospemifene) provide effective therapy for vaginal atrophy.
  • Vaginal moisturizers and lubricants are alternatives to vaginal estrogen therapy.
  • All postmenopausal women should be encourage to adopt health lifestyle measures.
  1. Zeleke BM, Bell RJ, Billah B, Davis SR. Vasomotor and Sexual Symptoms in Older Australian Women: a Cross-Sectional Study. Fertil Steril. EPub October 9, 2015.
  2. Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ. 2015. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab:jc20152236.

Information provided might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.