Drug improves sleep of women with hot flashes

 A medication that is used for a variety of conditions, mostly seizures, may help women whose sleep is disrupted by menopausal hot flashes.

Menopausal hot flashes are common, and about 40% of women with hot flashes experience sleep disruption. Hormone replacement therapy is a proven remedy for the condition. However, studies on the risks associated with long-term use of hormone replacement therapy has left many women looking for alternatives.

The study, published today in the Journal of Women's Health, found that the drug gabapentin improved sleep quality in women experiencing hot flashes. Researchers gave 59 postmenopausal women either 300 milligrams of gabapentin three times a day or a placebo. After 12 weeks of treatment, the study showed significant improvement in overall sleep quality for the women receiving gabapentin compared with those receiving the placebo.

"Gabapentin improves sleep quality but does not have the potential dependency problems of some other sleep medications and does not involve the use of hormone replacement therapy," the lead author of the study, Dr. Michael E. Yurcheshen of the University of Rochester Medical Center, said in a news release.

"It has minimal side effects and it is a generic drug. That makes it a very attractive treatment for these problems in this patient population."

Researchers aren't sure why the drug improves sleep in women with hot flashes. It could be that it reduces the hot flashes, stabilizes sleep or decreases the amount of time to transition from wakefulness to sleep. Gabapentin may also help with other sleep problems such as restless leg syndrome.

-- Shari Roan

Hot flashes: Hormones outperform botanicals, but take a toll on memory

The botanical remedies black cohosh and red clover, widely taken by middle-aged women to tame night sweats and hot flashes, took third place behind hormone replacement therapy and -- surprisingly -- a placebo pill in their ability to provide relief from menopausal symptoms, a government-sponsored study has found.

But a second study by the same researchers found that women taking Prempro, the hormone-replacement medication used in the clinical comparison, fared worse on a key cognitive complaint about menopause: memory.

The studies are published in the August issue of the journal Menopause.

University of Illinois at Chicago psychiatry professor Pauline Maki called the additional memory decline that came with Prempro use "slight." But, she added, the effect leaves researchers on the hunt for medication that can ease hot flashes and night sweats without worsening memory problems for women making the menopausal transition. 

Among the 89 women with moderate to severe hot flashes related to menopause, those who were given the second-place finisher -- a dummy pill -- had a powerful response, the study found. Over the 12-month study period, during which the women recorded the frequency and intensity of their surges, those on the dummy pill observed a 63% reduction in hot flashes. That made placebo more effective than red clover, which reduced women's hot flashes by 57%, and black cohosh, which decreased the bothersome symptoms 34%.

Hormone therapy drove down hot flashes 94% in subjects given Prempro.

A smaller group -- 66 women -- participated in the second study, which found that of the four treatments tested, only Prempro use had a measurable decline in a memory as a side effect. Black cohosh and red clover, though no more effective in reducing hot flashes than placebo, had no negative impact on memory, nor on liver enzymes, lipid profiles or measures of breast and endometrial safety.

"Botanicals were safe," said Stacie Geller, a professor of gynecology and obstetrics at the University of Illinois at Chicago. "Which is good, because many women will continue to use them," Geller added.

-- Melissa Healy

Whale of a hot flash

It's a question that stumps evolutionary biologists and women of a certain age:

What's the deal with menopause?

OK, so maybe the evolutionary biologist puts the question a little differently: If the goal of any organism is to pass on his or her genes, why do females go on living beyond their reproductive years?

Researchers in Washington and British Columbia sought an answer in killer whales, the black-and-white beauties that cruise their inland and near-shore waterways. Among little-known killer-whale factoids: They are extremely long-lived. And not only do female killer whales go through menopause, they have the longest post-menopause lifespan of any mammal, including humans.

Male killer whales rarely live to be 50, although they can father calves up to their last spout. Females enter their reproductive years around age 10 and lose fertility rapidly after age 40, but live to be 55 and older. One of the female killer whales in the study was known to be more than 90 years old.

One possible explanation for menopause is the grandmother hypothesis: Females who are past their own reproductive stage can help their daughters or other kin raise their offspring, allowing the daughters to produce even more babies because grandma is around to babysit.

But in the study published in the journal Frontiers in Zoology, the scientists saw no effect of grandma whales on either the fecundity of their daughters or the survival of their grand-calves.

They did find some support for another explanation: the attentive-mother hypothesis. Like humans, killer-whale calves remain dependent on their mothers well beyond weaning. Living, on average, 10 years beyond menopause allows a mother to see her final offspring through to maturity (assuming that the "mature" young adult whale doesn't try to move back into the pod basement).

The researchers also found that the calves of the oldest mothers had a 10% greater chance of survival than the offspring of younger mothers -- a comforting thought for any older mammal undertaking motherhood and menopause back-to-back.

-- Mary Engel

Photo credit: AP

Don't blame everything on menopause

Women tend to find their health going downhill after menopause. A lot of the problems are blamed on the loss of hormones that occurs during menopause. But sometimes the things that happen around that time of life aren't really linked to hormones.

High blood pressure may be one of those things. A study published in the October issue of Journal of Hypertension found that increases in blood pressure and heart disease that occur in women after menopause probably have to do with weight gain rather than changes in hormone function. The study, by researchers in the Czech Republic, looked at blood pressure measurements in about 900 women ages 45 to 54. The women were classified according to whether they were pre-menopausal, menopausal or post-menopausal. After adjusting for the effects of age, there was no relationship between blood pressure and menopausal status. But blood pressure was strongly related to a woman's body mass index.

In another study in the same journal, this one by Italian researchers, age seemed to be the strongest factor for why blood pressure rises in women in mid- to later life, not menopause or BMI.

There's something positive in this, I suppose. You can't do much about aging or menopause but maintaining a healthy weight is achievable. For more information on menopause, see this Web page from the North American Menopause Society.

-- Shari Roan

Photo credit: Mel Melcon / Los Angeles Times