Untreated Hot Flashes Costly for Society

Should treat post menopausal symptoms with hormone replacements or antidepressants?

By Kathryn Doyle
Reuters Health

The extra healthcare expenses and lost productivity of menopausal women with untreated hot flashes may cost the U.S. billions of dollars each year, a new study suggests.

Three-quarters of postmenopausal women experience hot flashes, which can include night sweats and anxiety attacks and often accompany other menopause symptoms like disturbed sleep, irritability, trouble concentrating and short-term memory problems.

“Not everybody who has hot flashes sees an impact on their ability to function in the workplace or to function at home,” but some do, said lead author Dr. Philip Sarrel of Yale University in New Haven, Connecticut.

Around nine million women in the U.S. currently suffer from severe hot flashes, by the best estimate, said Sarrel, an emeritus professor in the departments of Obstetrics, Gynecology and Reproductive Sciences, and Psychiatry.

“In the past it wouldn’t have been anywhere near that number because of the use of hormone replacement,” he told Reuters Health.

In 2002, the Women’s Health Initiative found that using hormones to treat menopausal symptoms could increase the risk of breast cancer, heart disease and stroke, and use of hormone therapy dropped off dramatically, he said.

The new research was supported by Noven Pharmaceuticals Inc., makers of hormonal and non-hormonal treatments for menopausal hot flashes, including Combipatch, Minivelle and Brisdelle.

Sarrel and his team used data from 1999 to 2011 to match 250,000 women with untreated hot flashes to the same number of women of similar age, region and other characteristics who never had hot flashes.

All the women had commercial health insurance.

Women with hot flashes used more healthcare services, particularly outpatient services, than women without symptoms, the researchers found. The extra services added up to $1,336 more per person per year compared to women without symptoms, and the indirect economic loss due to missed work was an extra $770 per woman per year.

Some of the extra healthcare costs come from trying to diagnose and treat problems, like chest pains, without addressing the root cause of menopausal symptoms. A coronary angiogram, for example, costs $10,000, Sarrel said.

Employers, paying premiums to insurance companies, shoulder those costs, he added.

Sarrel blamed the inadequate treatment of hot flashes on poor communication between women and doctors.

The women “all have an annual visit but no one asks them about hot flashes, it’s just not asked,” he said.

“Women don’t mention it because their fear is if I say I’m having 10 to 14 hot flashes each day, the doctor is going to say ‘go on hormones,’ and they’re terrified of using hormones,” Sarrel said.

Writing in the journal Menopause, the authors attribute a loss of more than $300 million per year to untreated hot flashes just for the women in their study.

For the full population of U.S. women with untreated hot flashes, the loss could run into billions of dollars.

For many women, the symptoms could be controlled with hormonal therapies costing around $40 per month, Sarrel said.

“It is not coincidental that the most rapid decline in the rate of women’s work ability occurs at 51 years, the peak of menopausal symptoms,” said Dr. Henk Oosterhof, an OB/GYN at Hospital Nij Smellinghe inDrachten, The Netherlands.

Estimates in Holland also attribute the loss of more than 100 million euro per year to untreated menopausal symptoms, Oosterhof told Reuters Health by email.

Less than one in five women with hot flashes seeks treatment, with hormone replacement by far the most efficient option, and those who do face a great deal of prejudice, he said.

The basic drug options are oral, transdermal or vaginal estrogen therapies, progesterones, combination estrogen and progesterones, selective estrogen receptor modulators and antidepressants, said Marco DiBonaventura, vice president of health outcomes at the market research firm Kantar Health in New York.

Non-drug alternatives, such as relaxation therapies or exercise, have not been proven to control hot flashes, but experts say they’re unlikely to hurt and might help with other menopause symptoms like disturbed sleep (see Reuters Health article of August 2, 2013, here: http://reut.rs/1uCs4ay).

Recent studies have found that hormone therapy prescribed before age 60 confers more benefit than risk, Oosterhof said, but all women should speak to their doctors about the pros and cons of treatment. For women who have had a hysterectomy, hormone therapy is especially safe, Sarrel noted.

“We need to raise awareness of what kinds of hormone treatments are harmful, and what kinds are not harmful and are effective and life saving,” Sarrel said.

SOURCE: http://bit.ly/1rHyDeK Menopause, online August 25, 2014.

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