Night sweats help please. Black cohosh or HRT?

[mrsjackrussell]

I think I'm definitely going through the menopause now. I'm 50.
For the last 3 years iv had irregular periods and night sweats so I then take black cohosh and it all goes back to normal then I stop taking it and within a few months it all starts up again. Apart from 4 months last year when I wasn't taking it and I had non stop bleeding for 4 months. Had a scan all OK. I don't know whether the cohosh actually worked or if it was just coincidence.
Forward to now and no period since October.
I'm having night sweats and it's affecting my sleep badly and in turn my life.
I'm disabled too and get horrendous cramps and what with my husband snoring.
I'm thinking about taking the black cohosh again but I'm worried about the side effects re. Liver damage. Iv been put off HRT by others saying its not good to mess with your body which I agree with to some extent. Also with the HRT would I then have to stop it again in the future or is it for life?
Would all of the menopausal symptoms come back?
Coul d I have some advice please from you lovely people

@margolovebutter

I did say i didn't have time to link to all the information.

There are more trials other than that one.

This is from Climacteric- the specialist journal for menopause specialists.
If you go to pages 120-121) you will see the heading Cardiovascular Disease.

With cardiovascular disease being the leading
cause of death in women, for women starting MHT
before 60 years of age and/or within 10 years of
menopause, the most recent Cochrane analysis,
other meta-analyses, and the WHI 13-year results all
show a consistent reduction in all-cause mortality. [A]

If this is something which concerns you, maybe look into it yourself?

The advice is pretty conclusive, and those links were starters.

www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf

Right- I'm off now! This is taking up more time than my own work!

Any queries- google is your friend. :)

JinglingHellsBells indeed you did, which is why I took the time to post another study that the NHS links to.

I have looked into it myself, hence contributing on this page. I would say that the research isn't fully conclusive and there are multiple other factors for consideration - hence my questioning your statement that not taking HRT may put a menopausal woman at higher risk of cardiovascular disease.

....... and just because I think there are better ways of improving cardio vascular health risks, with a certain degree of humour, I would just point out that a study has proven that tea and coffee consumption significantly reduce CHD mortality. www.ncbi.nlm.nih.gov/pubmed/20562351

An improvement of 45% no less!!!!!!!

(Observational studies cannot prove causality.)

@margolovebutter
The NHS link to the US study showed that for women who used HRT the arterial walls were almost 50% 'better' (ie not narrowed) as the women in the control group.

It said this was significant but what they can't tell from the study is if this reduction in narrowing would continue when the women were older.

I'm not quite sure what your point is- on balance- see the Cochrane review- the consensus is that HRT provides a decrease in risk of heart disease .

This is another by a well respected dr.

www.pharmaceutical-journal.com/research/review-article/establishing-the-risk-related-to-hormone-replacement-therapy-and-cardiovascular-disease-in-women/20202066.article?firstPass=false

We can keep on trading links, but even looking at the basic facts- women's risk of heart disease rises post menopause to equal men's- it would seem that estrogen is protective. This has been known for decades.

Obviously if you use HRT or want to, it's a discussion you need to have with your own doctor.

The link seems not to work for access but this is the conclusion:

The WHI had a major impact on the management of postmenopausal women. Following initial publication, prescribers and regulatory bodies disparaged the use of HRT. Subsequent data analysis has cast doubt on the initial interpretation of the results.

Numerous epidemiological observational studies indicate a beneficial effect when the treatment is started in the early postmenopause, including that of the WHI. In most countries, this is exactly the target age group for HRT use. It may be possible to develop HRT regimens around the time of menopause to reduce the risk of CHD in such women. Appropriate starting doses should ensure that any risks of stroke or VTE are minimised. The observational findings are supported by some, but not all, RCTs that have also highlighted the importance of dose at initiation in older women.

As yet, there is no firm support for the use of HRT solely for the prevention of CHD, but the evidence for HRT use in the primary prevention of CHD in postmenopausal women continues to accumulate. When given appropriately in terms of dose at initiation and types of hormones, HRT is not harmful to the cardiovascular system and may well prove to be beneficial.

Further clinical trials of different HRT types, doses and routes of administration are urgently needed. For example, the Royal Brompton and Harefield NHS Foundation Trust in the UK is currently sponsoring a study entitled OPTIMISE (Oral vs. Patch Trial in Menopause – Individualization of oeStrogEn therapy) to compare the effect of ultra-low-dose oral oestradiol/dydrogesterone combination versus a low dose transdermal therapy on the risks of VTE and CHD. Different metabolic effects of oral versus transdermal HRT administration routes may have different effects on CHD and VTE. Few studies have performed direct comparisons, and none have compared a transdermal regimen with a new ultra-low-dose oral oestradiol/dydrogesterone combination. Studies of the effects of newer HRT regimens (e.g. combinations of oestrogens classed as tissue selective receptor modulators [TSECs]) will also be needed. In the meantime, we refer clinicians to the evidence-based NICE menopause guidance documents and evidence tables[51].

Age in itself is a risk for heart disease! So obviously, as women hit the menopause their risk will increase simply because they are getting older.

Yes, the link I posted did show an improvement but the experts at the NHS concluded the following: Hence, we have a mixed bag of results. They clearly show a link between the timing of HRT after menopause, but the link between HRT and reducing risks of heart attack and stroke is a little more fragile.

I'm not trying to trade links, I'm just trying to say that I think your bold claim that menopausal women who do not take HRT may increase their risk of cardio vascular disease is tenuous at best.

Thankyou for all of the links Margo and Hells bells. This has now reinforced my decision to go and get HRT.

From WebMD
"The U.S. Preventive Services Task Force
considered results from 18 clinical trials including more than 40,000 women.
All of the evidence suggests that combined estrogen and progesterone increase older women's risk of breast cancer and heart disease, while estrogen alone increases risk of stroke, blood clots and gallbladder disease, the task force said.
Those risks outweigh hormone therapy's benefits in preventing brittle bones and diabetes, the task force concluded."

LOL, thank you JaneJeffer! This is why I remain sceptical.

Every medicine we take comes with side effects - every single one. Doesn't matter if it is paracetamol, black cohosh or HRT. We are often a long way from being able to clearly understand the way data is presented to us, hence my post up above about the incredible and proven benefits of tea and coffee! That wasn't a fake study - it was real.

There is huge money to be made by pharmaceutical companies from HRT, statins and other interventions into the natural ageing process. That doesn't mean their products don't have benefit, but it may be that the biggest beneficiaries are shareholders.

The links are too detailed and I'm too lazy to read them. I wouldn't be taking HRT to protect against various diseases, as such. I'd be taking it in the hopes of feeling less crap. So we'll see what GP says.

I began taking sage tablets when my night sweats began as they were really making me dread going to bed and disturbing my sleep so much.
I'm evangelical about them now to everyone I know. I'm very very sceptical about herbal medicine usually but couldn't believe the difference after my SIL recommended them.
Night sweats have now stopped completely taking two tablets a day but I must stress it took about 40 days for them to take effect. The first few weeks I was annoyed they weren't working but persevered taking them daily and then as I neared the end of the pack I realised they were working. I can't recommend them enough.

Margo I'm not sure what the point of this debate is, especially if you do not use or need HRT. Do you?

No, age is not in itself a risk of heart disease. I am not sure where you have found this. Heart function may decline in later years if people do not adopt lifestyle measures like exercise and diet, or if a valve fails due to wear and tear, but heart disease per se is not directly linked to old age. Heart disease - ie blocked arteries- is a result of lack of exercise, high cholesterol and other factors.

The evidence is clear.
The last post I left includes the words this

As yet, there is no firm support for the use of HRT solely for the prevention of CHD, but the evidence for HRT use in the primary prevention of CHD in postmenopausal women continues to accumulate.

In other words the evidence is there that HRT started early is beneficial to the heart BUT there is not enough evidence that all women who are menopausal BUT HAVE NO SYMPTOMS TO WARRANT HRT [my words] should be given HRT as prevention.

It's not my claim - it's the research which is shown in the Cochrane report.

No doctor is yet going to give HRT to prevent heart disease. Let's ne clear on that.

But if you read the previous quote I left, it says clearly that HRT does not CAUSE heart disease and may EVEN be beneficial as more and more evidence accumulates.

I'm over with this now. banging head on brick wall with some posters.

Hope any lurkers have enjoyed the view! :)

Of course age is a risk in heart disease!!!!!!!! In the UK, a risk factor calculator has been developed, it is called Qrisk3. It uses twenty different factors to calculate risk qrisk.org/three/

What is at the top of that calculator? Oh - AGE!!!!!!!!!!!!!!!

My point was that you made a sweeping statement that those menopausal women who DO NOT take HRT may be at higher risk of CVD and I am disputing that.

Not sure where you get your facts from either, if you don't know that increasing age is a key risk.

In fact they only calculate up to the age of 84, because after that most people have a risk score of more than 20%, so there is no point trying to work out what is the highest risk anymore, because age outweighs every other factor.

My point was that you made a sweeping statement that those menopausal women who DO NOT take HRT may be at higher risk of CVD and I am disputing that

I will simply post again part of a former statement.

Numerous epidemiological observational studies indicate a beneficial effect when the treatment is started in the early postmenopause, including that of the WHI. In most countries, this is exactly the target age group for HRT use.

The logic- is that if using something is beneficial, not using it may be detrimental.

If you think you know better than all those people, that's fine.No point wasting my time.

One poster said that she took HRT because she wanted to feel less crap and I can't think of a better reason than that for taking it.

JinglingHellsBells I haven't said anything that I haven't supported, so it is not me thinking that I know better than other people. I think that is a very unfair accusation to throw at me.

I've come late to this discussion - about heart disease etc and don;t know a lot about it but age at menopause has a bearing on risk of CVD (cardio-vascular disease) - has this already been said? thebms.org.uk/2016/11/age-menopause-cardiovascular-risk/

"A review of 32 studies has examined the association with age of menopause and risk of cardiovascular disease. Studies involved 310,329 women in total. Outcomes were compared between women who became menopausal before the age of 45, and women who became menopausal after the age of 45.

The risk of overall Coronary Heart Disease, Fatal Coronary heart Disease, Cardiovascular mortality and overall mortality was shown to be increased in women who became menopausal under the age of 45.

Comment: Previous reports have emphasised the increased risk of cardiovascular disease in women who experience a premature menopause (under the age of 40) but this recently published report also emphasises need for consideration of cardiovascular health in women who experience an early menopause under the age of 45."

OK I know correlation does not = causation but you can't really do the trial ( and look at deaths?) as would be unethical - although what are known as surrogate markers can be used ( like the artery thickness etc referred to by JinglingHellsBells).

Here is another prospective study (not a trial) looking at early menopause and life expectancy:
www.clinicaladvisor.com/home/topics/ob-gyn-information-center/early-menopause-associated-with-shorter-life-expectancy-early-diagnosis-of-type-2-diabetes/

The Webmd data (US task force analysis) quoted above was on the archived page and was taken out of context. It was a meta-analysis and didn't look at women of different ages. You can read it all here: www.webmd.com/menopause/news/20171212/postmenopausal-women-should-avoid-hrt#3 . Also it used the flawed WHI data as far as I can see too. The task force anaylasis was criticised for various reasons....

Not an expert in all of this though!! Just had a quick look....

"To date, no good-quality randomized trials have prospectively
evaluated the effect of timing of hormone therapy initiation relative
to the onset of menopause on associated benefits and harms." USPSTF report

If you know of any such trials I would be interested to read the results. Because of selection bias (among other reasons), observational data is not reliable.

@mrsjackrussell
I'm pleased that the discussion has given you more information to make a decision.I know I said I wasn't coming back to this but it's important that women reading- far more than will be posting- are given the right information so they can decide what they want to do.

Sadly there have been a few posters here who appeared to want to turn back the clock in regard to the stats/risks/benefits around HRT (mainly quoting discredited stats from the US- the quote itself was taken out of context and has been criticised by the Mayo Clinic in the same article, but the poster chose not to include those words.)

The qrisk.org/three/ heart assessment tool quoted re age and heart disease is a very crude assessment tool.
I did that assessment some time ago and it ^increased* my BMI from within a low-normal- to 'average' because my own BMI 'was not valid for the assessment'. (In other words they made me fatter to get a result.) Thanks!
It does not take into account any lifestyle factors such as how much exercise someone takes. It's the most basic of basic assessments.

That's a bit by the way.

It's a bit depressing that in order to criticise the benefits of HRT, credible research is ignored and moreover, the advice of all of the UK's best menopause consultants who have read all these stats-which is on balance, HRT does no harm to hearts and there is evidence to show it does a lot of good (although if you are overweight, inactive and smoke, it's not going to change those risks.)

The idea that drug companies are simply out to make a profit..

well, if you take that to its logical conclusion you would

• never take any drug yourself
• eschew vaccinations

-be against drug development for all illnesses and diseases

Unless of course you believe women don't deserve treatment for menopause and should simply put up and shut up.

What about the companies who make supplements and herbal treatments? Vitabiotics is one of the main ones and their only aim is to deliver to their share holders- they aren't a charity!

Unless of course you believe women don't deserve treatment for menopause and should simply put up and shut up

I think the comments about trying to treat 'the natural ageing process' rather gave that one away.

Fazackerley is that directed at me?

I have never once said that I think HRT is a bad idea or that women shouldn't take it - not once anywhere. Nor have I said that anyone should put up and shut up.

The menopause is a natural process, same as puberty - what could possibly be contentious about that? I don't think it is unreasonable to be slightly wary of companies seeking to make huge profits from pharmaceutical products. I have not said they are all bad or filled with evil intent, but large sums of money for anything make me cautious.

I haven't criticised HRT, I questioned a bold statement that menopausal women not taking HRT may be putting themselves at higher risk of cardio vascular disease. I don't think that is unreasonable.

has been criticised by the Mayo Clinic in the same article, but the poster chose not to include those words
I didn't post the whole article but I gave a reference where it came from so posters could read for themselves which a couple at least have done.
The Mayo Clinic also said the following in that article:
"There are no clear guidelines for how long a menopausal woman can remain on hormone replacement therapy, or what dose is best for treating menopause symptoms, Fenske said. In large part, doctors are urged to be cautious because of the long-term health risks.
"It should be the smallest dose possible for the shortest period of time necessary," Fenske said."
I haven't said anyone shouldn't take HRT. I'm pointing out that there are risks and side effects as with any drug. It is a discussion forum after all.

Way back in this thread now, I made a comment for the benefit of a poster who said her GP would not allow her to have HRT because of a family history of heart disease. I said that, ironically, not having HRT could be detrimental.

This was picked up by @margolovebutter and @JaneJeffer both disputing by comment. They have continued to post out of date and erroneous studies to 'support' their case, mainly US stats.

This is in the report from the Australasion Society. It is fully referenced at the end.

It is almost word for word what I posted, yet other posters felt they knew better than all these international menopause doctors.

Cardiovascular disease is the leading cause of morbidity and mortality in postmenopausal women [1]. Hormone replacement therapy (HRT) has been shown to reduce future risk of cardiovascular disease when taken within 10 years of the menopause. Avoiding HRT in menopausal women can actually be detrimental to their health. Some experts are now recommending that HRT should be considered as part of a general prevention strategy for women at the onset of the menopause

@JaneJeffer- the UK and Europe have different guidelines around the use of HRT compared to the US.
In the UK, doctors follow NICE and the BMS. The BMS states quite categorically that there are no time limits on use of HRT (compared to your quote from the Mayo Clinic.)

As they say here in their consensus statement.

thebms.org.uk/publications/consensus-statements/hormone-replacement-therapy/

Summary points
1 All women should have access to advice so that they can make informed decisions about diet and lifestyle and treatment options to optimise their menopause transition and postmenopausal health.

2 HRT dosage, regimen and duration should be individualised, with annual evaluation of advantages and disadvantages.

3 Transdermal estradiol is unlikely to increase the risk of venous thrombosis or stroke above that of non-users and is associated with lower risk compared with oral estradiol.

4 Limited evidence suggests that micronised progesterone and dydrogesterone may be associated with lower risk of breast cancer and venous thrombosis compared to other progestogens.

5 Arbitrary limits should not be placed on the duration of use of HRT; if symptoms persist, the benefits usually outweigh the risks.

6 HRT prescribed before the age of 60 or within 10 years of the menopause has a favourable benefit /risk profile and is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.

7 If HRT is used in women over 60 years of age, low doses should be started, preferably with a transdermal estradiol preparation.

8 Women with POI should be encouraged to use hormonal therapy at least until the average age of the menopause.
HRT or the combined contraceptive pill would be suitable.

9 However, HRT may confer a more favourable improvement in bone density and cardiovascular markers compared with the combined contraceptive pill.