The Non-Hormone Hormone Therapy

Estrogen treats hot flashes successfully and can reduce hot flashes by 80-90%. Having an alternative to hot flash treatment that is non-hormonal is important to women. There is a growing list of alternatives to hormone therapy that are available to women who either must avoid hormones, or just want to avoid hormone therapy. Black cohosh, red clover, St Johns's Wort are all alternatives to hormone therapy that have in studies been shown to be better than placebo for the treatment of hot flashes, as are the SSRI anti-depressants.The use of antidepressants, and now the use of the medications gabapeptin and pregabalin also can help relieve hot flashes. Let's compare and contrast some of these therapies. As a rule of thumb even placebo treatments work 25% of the time, and these estrogen alternatives work about 60% of the time. The number one prescribed estrogen, one that has been around for
many decades is Premarin. Patients will tell me that they are on "the estrogen therapy Premarin". In fact there are literally dozens of compounds in the medication called Premarin formulated to treat menopausal symptoms. This mix of hormones is why this therapy, derived from pregnant mare (horse) urine, is such a benefit, and why it is both unique and potentially more expensive than other therapies. Many of the compounds in Premarin are indeed estrogens, some of which are similar to those humans have, and some only found in female horses. But interestingly, the alternative therapy women may not know, that one of the most successful non-hormone compounds used to treat menopause, is also to some extent a massive mix of actual hormones; and also found in the Premarin as one of the components!

The use of alternatives to hormone therapy has recently become more common than hormone therapy for the treatment of menopausal symptoms.  One of the most talked about alternatives to traditional hormone therapy is the use of soy, or soy by products. Soy products for the benefits of health became one of the main stories of the 1990s when it was discovered that soy protein could help one's cholesterol level, and by 1999 the FDA allowed soy products to be labeled as heart healthy. For hot flash therapy soy, more specifically it's plant estrogens (termed phytoestrogen) of the category isoflavones, is a non-estrogen way of stimulating estrogen action on cells. The way this works when we swallow soy to treat our hot flashes is really very complex. A bacterial energy metabolic byproduct of the soy isoflavone called daidzein is produced when some adults eat soy. This compound which some of us can make when we eat soy is called equol. So when we say 'soy' some of us actually are getting a mix of plant estrogens to treat our hot flashes. A woman has to be able to metabolize soy in a specific way in order to get this compound and see benefit from soy! And it may be why some women really get well treated from soy and others seem to not notice that soy is helpful at all. Equol can also be ingested in a supplement form for those of us who can't make it. Interestingly, the urine of pregnant mares has equol in it. This makes sense in that mares are often fed soy protein in their feed. So, although the fact that the horse estrogens are very potent and part of the success of this treatment, it also turns out that a very popular alternative therapy is one of the secrets as to why Premarin is a more effective hot flash treatment for many women!

As for the anti-depressants: although they aren't going to raise your risk of heart disease or breaast cancer they can cause upset stomach, sexual dysfunction, and sleep disorders including insomnia and somnolence. So treatments of hot flashes should be unique, and reason to gab with your gyno about!

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