Some 40% of women 60 to 65 years old still have hot flashes – a new study has shown that for many, the hot flashes are occasional and mild, but for some, they remain really troublesome. Sexual symptoms also remain a problem for more than half these older women. Furthermore, women bothered by these symptoms are often not getting treatment, even though treatments are available.
This large study is one of the few to quantify how prevalent troublesome hot flashes are for women at different ages, not just whether the women have them. It included 2,000 women 40 to 65 years old who were representative of the Australian population.
More than 90% of them used no hormonal contraception, menopausal hormone therapy, or other prescription drugs to control their symptoms. Among these women, the share having hot flashes ranged from 33% of the pre-menopausal women to 74% of the post-menopausal women younger than 55. Hot flashes persisted in 42% of the women 60 to 65 years old. Hot flashes were troublesome – that is, they were rated moderately to severely bothersome on a standard questionnaire – for about 3% of the pre-menopausal women, 28% of the post-menopausal women younger than 55, 15% of the post-menopausal women 55 to 59 years old, and 6% of the post-menopausal women 60 to 65 years old.
Among all the women surveyed, nearly 10% of the 60- to 65-year-olds were using hormone therapy, presumably because they still had troublesome symptoms. And fewer than 1% of the women in the oldest age group were using non-hormonal prescription therapies for hot flashes.
Among the women who used no vaginal oestrogen, the rate of sexual symptoms (such as pain with intercourse) ranged from 44% in pre-menopause to 68% after menopause. Those sexual symptoms persisted in 62% of women 60 to 65 years old. Only 8% of the older women overall were using vaginal oestrogen, despite the high rate of sexual symptoms.
Today, most guidelines recommend against using systemic hormones for women more than 10 years after menopause or after age 60 and to use them only for a limited time – ideally three to five years. But that leaves a group of women older than age 60 who have really bothersome symptoms without a hormone therapy option.
The "disconnect" between guideline recommendations and real-world clinical practice and the low utilisation of effective non-hormonal therapies for hot flashes highlight that "menopause has gone 'off the radar' as an important health issue and remains under-treated," say the authors. "Women need to know that they do still have options to treat their hot flashes and sexual symptoms, even if they are older or cannot or do not wish to use hormone therapy," says North American Menopause Society (NAMS) executive director Dr Margery Gass. "NAMS encourages all women bothered by their menopause symptoms to seek the help they need and not to give up."
[link url="http://www.menopause.org/docs/default-source/2015/hot-flashes-at-age-64-still-bothersome.pdf"]The North American Menopause Society material[/link]
[link url="http://journals.lww.com/menopausejournal/pages/articleviewer.aspx?year=9000&issue=00000&article=98219&type=abstract"]Menopause abstract[/link]