Abstract
The mechanisms behind hot flashes in menopausal women are not fully understood. The flashes in women are probably preceded by and actually initiated by a sudden downward shift in the set point for the core body temperature in the thermoregulatory center that is affected by sex steroids, β-endorphins, and other central neurotransmitters. Treatments that influence these factors may be expected to reduce hot flashes. Since therapy with sex steroids for hot flashes has appeared to cause a number of side effects and risks and women with hot flashes and breast cancer as well as men with prostate cancer and hot flashes are prevented from sex steroid therapy there is a great need for alternative therapies. Acupuncture affecting the opioid system has been suggested as an alternative treatment option for hot flashes in menopausal women and castrated men. The heat loss during hot flashes may be mediated by the potent vasodilator and sweat gland activator calcitonin gene-related peptide (CGRP) the concentration of which increases in plasma during flashes in menopausal women and, according to one study, in castrated men with flushes. There is also evidence for connections between the opioid system and the release of CGRP. In this paper we discuss acupuncture as a treatment alternative for hot flashes and the role of CGRP in this context.
Highlights
Hot flashes are classic menopausal symptoms in women [1, 2]
Since therapy with sex steroids for hot flashes has appeared to cause a number of side effects and risks and women with hot flashes and breast cancer as well as men with prostate cancer and hot flashes are prevented from sex steroid therapy there is a great need for alternative therapies
The heat loss during hot flashes may be mediated by the potent vasodilator and sweat gland activator calcitonin gene-related peptide (CGRP) the concentration of which increases in plasma during flashes in menopausal women and, according to one study, in castrated men with flushes
Summary
Hot flashes are classic menopausal symptoms in women [1, 2]. flashes are reported by 43–77% of men after castration therapy [3,4,5], and they usually persist for many years and may impair quality of life [4]. The reduced βendorphin and serotonin concentrations increase the release of noradrenaline, and this may in turn cause sudden drops in the set point in the thermoregulatory centre in the hypothalamus and elicit inappropriate heat loss [18,19,20,21]. According to this hypothesis, any intervention that increases estrogen, β-endorphin, or serotonin concentrations or decreases noradrenalin levels may be expected to reduce hot flashes. Urinary excretion of CGRP over 24 h is higher in flashing postmenopausal women than in postmenopausal women without hot flashes, and in a group of postmenopausal women with hot flashes CGRP in 24 h urine decreased significantly after 12 weeks of successful treatment with acupuncture [30]
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