Therapeutic Advances
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Obstet Gynecol. Nov 10, 2013; 2(4): 87-93
Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.87
Folic acid supplementation: The new dawn for postmenopausal women with hot flushes
Ayman AA Ewies
Ayman AA Ewies, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham City Hospital, Birmingham B18 7QH, West Midlands, United Kingdom
Author contributions: Ewies AAA solely contributed to this paper.
Correspondence to: Ayman A A Ewies, MBChB, MSc, FRCOG, MD, Consultant Gynaecologist, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham City Hospital, Dudley Road, Birmingham B18 7QH, West Midlands, United Kingdom. aymanewies@hotmail.com
Telephone: +44-121-5074042 Fax: +44-121-5075680
Received: March 29, 2013
Revised: June 12, 2013
Accepted: June 18, 2013
Published online: November 10, 2013
Abstract

Hot flushes, experienced by 75% of menopausal women, are associated with estrogen deprivation. Estrogen was shown to ameliorate hot flushes by interacting with monoamine neurotransmitters in the brain; reducing noradrenaline and increasing serotonin. Hormone replacement therapy (HRT), the first treatment option, causes concerns over possible increased risks particularly breast cancer. Folic acid is involved in the biosynthesis of serotonin and nordrenaline, which is responsible for its effects on mood and cognition, and degrees of folate inadequacy, not severe enough to produce megaloblastic anaemia, were found to be associated with depression and cognitive malfunctioning. Also, increased age was observed to relate to reduced serum and cerebrospinal fluid folic acid levels. There is emerging evidence that folic acid supplementation ameliorates hot flushes by the same mechanism as estrogen. To explore this hypothesis, a multi-centre, double-blind, placebo-controlled randomized is being set up to compare the effect of 5 mg folic acid vs placebo in reducing the frequency and severity of hot flushes in postmenopausal women, and on the blood level of serotonin and noradrenaline. If folic acid supplementation is demonstrated to be effective, this will be a turning point in the clinical practice since it represents a cheap, safe and well-tolerated alternative to HRT.

Keywords: Folic acid, Hot flushes, Menopause, Noradrenaline, Serotonin

Core tip: Hormone replacement therapy usage by postmenopausal women with hot flushes causes concerns over possible increased risks particularly breast cancer. The improved longevity of women in general and breast cancer survivors in particular, and the limited success shown by the non-hormonal alternatives made it imperative to find a therapy that is effective and safe. It is hypothesized that folic acid supplementation may ameliorate hot flushes by the same mechanism as estrogen supplementation, i.e., by reducing noradrenaline and increasing serotonin neurotransmitters. This article discusses the rationale, potential role, mechanisms of action and safety issues related to its use in these women.