Clarifying Today’s NY Times Article on Menopausal Symptoms

2/17/2015

In today’s NY Times a story on the front page has the headline “Up To 14 Years of Hot Flashes Found in Menopause Study”. I agree totally. In my years of practice I have had many patients, some who resist therapy, and some unable to get off Hormone Replacement Therapy (HRT) who have symptoms even longer than that! I went to the original article published yesterday in the Journal of the American Medical Association (JAMA). This is still another report from a study called SWAN (Study of Women Across the Nation) begun in 1996 with ongoing analysis, this time through 2013. It involved 3302 women. This report was only of women who reported “frequent” hot flashes or night sweats. It was 1449 women, which is 44% of the total. Obviously to them their symptoms are important, but it also underscores the importance of not over ”generalizing”. I have always stressed to all of you that advice, and treatment decisions, must be individualized. It is never “one size fits all.”

In addition, in analyzing how long these symptoms persisted, they evaluated only 27% of the total population of SWAN. 28% of the original group had no visits where they reported “frequent” hot flashes or night sweats (recorded in the two weeks prior by an annual questionnaire) and thus were not included in the article. Another 18% of women were not included because they went on HRT because of their symptoms…so we do not know how long symptoms persist in those who DO choose therapy since this paper only included those who DID NOT.

Some other random (but hopefully worthwhile comments):

-The study confirmed something we already knew: that African American women tend (operative word here is “tend”) to have symptoms longer, then non white Hispanics, then Caucasians, and finally Asians. This is well known and once again may be true of POPULATIONS but may not necessarily apply to INDIVIDUALS.

-Other studies have looked at the issue of how long symptoms last and some have reported LONGER and some SHORTER. I often tell patients that by 4-5 years “out” (after menopause, that is the “Final Menstrual Period”), that about 75% of women have little or no symptoms and feel they are quite manageable (unlike the vaginal dryness and atrophy of menopause which gets a little worse the further out one gets). This study was close to that… at 5 years about 65% of women who started at menopause no longer had frequent symptoms and if the symptoms started in perimenopause it was a little more persistent (only 60% were symptom free).

-It is important to reiterate that in those patients whose symptoms do start in PERIMENOPAUSE , 1.) pregnancy CAN still occur and 2.) traditional HRT is NOT indicated. If such patients are non-smokers and have normal blood pressure they are excellent candidates for ultra low dose birth control pills. (These are extremely safe, and will actually reduce a number of cancers, but this is another whole topic which I have discussed with many of you.)

-Finally, the NY Times article mentions depression being higher in the women with persistent symptoms. Be careful. Is this “which came first: the chicken or the egg?”

They did NOT study women with depression and compare their hot flashes with a control group. If women are not sleeping and their lives are disrupted by symptoms this may well be the CAUSE of more depression and anxiety type symptoms. Or maybe not…

I hope this is helpful to you or someone important in your life. Share the information. The most important message though is 1.) don’t believe EVERYTHING you read and 2.) medicine is best administered one patient at a time.

Individualization, not generalization is key!