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Perimenopause and night sweats

Question

I am 49 years old, very healthy, and starting to feel better as I’m skipping periods in perimenopause. But I’m just dying with night sweats twice or three times a night—I wake up soaked and barely get back to sleep before the next one hits. What’s odd is that they tend to be very bad for a while and then get better. I’ve never had any during the day. I’m having a bad patch right now. I went to my doctor about it a couple of weeks ago and she told me to take a low dose birth control pill. I don’t even need contraception. But so far I’ve seen no benefit for my night sweats. Do I need to take it longer? The flushes just keep waking me. But now I got a period in the middle of the pack, my breasts are sore and swollen and I’ve had a wicked headache for three days. Help! What can I do?

Answer

Thanks for your question. I’ll do my best to answer it.

First, let me assure you that your doctor is following current recommendations in prescribing the Pill for your night sweats. However, as you will see if you look up the articles on Perimenopause on the Centre for Menstrual Cycle and Ovulation Research website, it doesn’t make sense to add estrogen to your own levels that are swinging still and sometimes too high.

The problem is that no available therapy has been proven to be effective for hot flushes in perimenopause. Yes, a few studies that were performed in mixtures of menopausal and perimenopausal women do show estrogen has some benefit. Only one study has properly tested birth control pills in symptomatic perimenopausal women with hot flushes, heavy flow and generally feeling badly. That Canadian study used Minestrin® as therapy compared with placebo (dummy pills) to see if it would help with hot flushes, flow and quality of life (1). Although hot flushes decreased on average by about 50%, this wasn’t different from placebo. In addition, for three cycles, unexpected bleeding made flow worse before it got better. Finally, although there were also some trends to improved quality of life, again the results weren’t different than changes on placebo (1).

Recently a study from Europe tested an extract of rhubarb (with the “name” ERr731) compared with a placebo for hot flushes and symptoms in perimenopausal women. Although ERr731 was significantly more effective than placebo for hot flushes in perimenopause, it is not clear how it acts (2). It may act through a second (and less powerful) estrogen receptor (called ER beta). Most of the things we think of estrogen as doing, it does through estrogen receptor alpha. And we still have some questions about the safety of ERr731. It has been approved and used in Europe as an over-the-counter medicine since 1993—its official name there is Phytoestrol®.

However, although ERr731 is important, it will not help you. And you need help right now or will soon.

Although there are no randomized, controlled trials showing that oral natural progesterone treatment improves hot flushes and night sweats in perimenopausal women, in menopausal women 20 mg twice a day of compounded progesterone cream was significantly more effective than placebo (3). Based on my extensive experience with perimenopausal patients and my own experience, oral micronized progesterone is the best treatment for you, right now. Oral micronized progesterone requires a prescription from your physician. There are two kinds of oral micronized progesterone, first, the pharmaceutically manufactured medicine called Prometrium® that is dissolved in peanut oil, and second, compounded oral micronized progesterone in olive oil that is made by a compounding pharmacist. In either situation, you need to take it at bedtime because it has the lovely side effect of improving deep sleep (based on a randomized controlled trial in men (4)). You need a dose of 300 mg taken at bedtime, to help sleep, to provide normal luteal phase (after ovulation) 24-hour blood levels of progesterone, and to be effective for night sweats. You should take it every night because you are already skipping periods. If you were still having regular flow I would recommend you take it cyclically days 14-27 of your menstrual cycle.

The only downside to oral micronized progesterone is that it is costly at about $3.00 a day for Prometrium® and about $2.00 a day for the compounded one. However, the benefits in control of night sweats and sleep are worth it. Also, you should know that you will need two rather than just one year without flow to declare that you are menopausal. The reason is that progesterone thins the endometrium, prevents flow you might otherwise have, and therefore can make periods stop slightly sooner than they otherwise might. With the help of progesterone you will feel well enough to begin or increase your regular exercise and learn and practice relaxation training that will make you a healthier person for the good years to come!

Hope this is helpful for you.

Reference List

1. Casper RF, Dodin S, Reid RL, Study Investigators. The effect of 20 ug ethinyl estradiol/1 mg norethindrone acetate (MinestrinTM), a low-dose oral contraceptive, on vaginal bleeding patterns, hot flashes, and quality of life in symptomatic perimenopausal women. Menopause 1997;4:139-47.

2. Heger M, Ventskovskiy BM, Borzenko I, Kneis KC, Rettenberger R, Kaszkin-Bettag M et al. Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial. Menopause. 2006;13(5):744-59.

3. Leonetti HB, Longo S, Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstetrics and Gynecology 1999;94:225-8.

4. Friess E, Tagaya H, Trachsel L, Holsboer F, Rupprecht R. Progesterone-induced changes in sleep in male subjects. Am.J.Physiol. 1997;272:E885-E891.

Life Phase: 
Perimenopause
Updated Date: 
Tuesday, November 19, 2013 - 13:45

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