Thanks to new advancements, it is becoming increasingly easy for doctors to help patients manage their menopause symptoms better.

A new research article published in the journal Menopause throws light on a new class of experimental drugs (compound MLE4901) that reduces hot flashes in menopausal women by almost three-quarters in just three days.

The drug blocks chemical messengers in the brain that controls hot flashes.

82% menopausal women who were administered this drug (compound MLE4901) reported a decrease in hot flashes and, consequently, slept better.

77% women found that with this drug(compound MLE4901), menopause-related symptoms hampered their concentration a lot less.

The research was a small, randomised, double-blinded crossover conducted among 37 women and was a repeat analysis of a study that published the effects of MLE4901 over 4 weeks of treatment. Participants who were part of the study were in the early menopause stage and reported having 7 or more hot flashes per day. They were either given 4 weeks of the new drug or a placebo. Treatment and placebo were stopped after 4 weeks for a period of 2 weeks and followed by another treatment course for 4 weeks, but this time the treatment was reversed. Women who were given the drug previously were shifted to placebo and those given the placebo were given the new treatment.

One way the study was different from the previous one, was that researchers recorded the mean daily hot flashes after the 3rd day and mean weekly totals as well.

MLE4901 reported 75% reduction in hot flushes on day 3 of treatment. Secondary outcomes were also noted such as sleep disruption and distress were also found to have decreased.

However, the researchers underlined that they still need to ascertain whether improvements in sleep and concentration were due to less disruption from hot flashes or if the compound also affected sleep and concentration pathways in the brain. The research though small, signals positive news for women struggling with menopausal symptoms, especially since d evelopment of this drug promises an alternative to Hormone Replacement Therapy (HRT), which comes with its own risks.

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Hormone Replacement Therapy

The pros and cons of HRT must be weighed against the patient’s personal and family history, with a careful evaluation of ovarian, breast, endometrial cancer and a history of thromboembolism. The patient’s age and duration since menopause should also be considered.

-Dr. Jayati Dureja,

Consultant Gynaecologist, Pulse Medical Centre, Delhi

Main risks

• Thromboembolism: To avoid this condition, HRT should be avoided in women with a history of stroke, ischemic heart disease, women who smoke and are obese, and women with a family history of venous thromboembolism.
• Endometrial cancer: This risk can be dealt with by annual screening and by adding 10 days of progesterone each month (combined HRT, and not Estrogen Replacement Therapy alone).
• Breast cancer: Women undergoing HRT should undergo mammography once a year.
• Cardiovascular risks: HRT should be avoided in case of women above the age of 60 years.

Women with a history of breast cancer, liver problems or a history of blood clotting may not be advised HRT. When HRT first began, it was given in the form of tablets. Now, it can be administered in the form of tablets, patches on the skin or vaginal preparations. Vaginal preparations are safer than tablets for women who have risk factors for developing blood clots.

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Who can undergo HRT?

Women with premature menopause can safely opt for hormone replacement therapy. This is because the replacement is designed towards just replacing the natural hormone, which should be ideally there in women of that age group.

Women who have not had hysterectomy should be given estrogen and progesterone as it protects the lining of the uterus. Women who have had their uterus removed can be given estrogen hormones only.

-Dr Gayathri Kamath,

Consultant Obstetrician and Gynaecologist, Fortis Hospital, Bangalore

She says HRT helps prevent osteoporosis, protects the heart and helps in elevating mood and eliminates hot flashes, which is common for women undergoing menopause. It also helps in maintaining libido and sexual life.

Current evidence says women who experience premature menopause can safely opt for HRT, given that the healthcare provider has checked for certain risk factors as mentioned earlier.

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Early menopause

Dr. Deepa Dureja, mentions the role of genetics in early menopause. “I have come across many women who have early onset of menopause at the age of 35 to 40 years. I have even had a case where menopause arrived at 23 years of age, but the cause was genetic in nature.”

Primary Ovarian Insufficiency (POI) refers to premature menopause that is caused because of various reasons.

“Some women land up in premature menopause due to autoimmune conditions where antibodies are generated to fight against one’s own proteins. Women with Turner syndrome, who harbour only one X chromosome instead of two, can also experience premature menopause,” says Dr. Kamath. However, not all women with POI will have typical menopause-related symptoms. Just like in pregnancy, each woman will respond to menopause in her own way- both physically and emotionally.

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Understanding perimenopause

There are three stages of menopause: Perimenopause, menopause, post-menopause. Perimenopause occurs when the menstrual cycle gets irregular.

Dr. Jayati Dureja says symptoms during this period are termed as climacteric, where the period cycle shortens and vasomotor symptoms may appear. It usually lasts from one to five years preceding the final menstrual period. Postmenopause triggers a decrease in estrogen levels and leads to vaginal dryness and hot flashes. It also elevates the risk of related diseases, such as osteoporosis.

Experts say studies are underway to understand the role of diet in minimising the symptoms associated with menopause. While the findings are not yet out, they say doctors would do well to stay abreast of such developments so that they can give the best advice to their patients.

This story is contributed by Sonali Desai, a Mumbai based freelance writer and a member of 101Reporters, a pan-India network of grassroots reporters.