Hot Flush Score Research Articles

자궁절제술 후 증후군 환자의 복합 한방 증례 보고

Objectives The purpose of this study was to report a case of a woman diagnosed with post hysterectomy syndrome treated with combined Korean medical treatment. Methods A combination of treatment including chuna manual therapy, pharmacopuncture at the lumbar facet joints, acupuncture, cupping, and herbal medicine was provided for 1 month. Progress was assessed using the Numeric Rating Scale, Oswestry Disability Index, EuroQol-5Dimension, and Hot Flush Score before and after treatment. Results After treatment, the symptoms were reduced and the quality of life was enhanced, although there was no improvement in the abnormal sensation in the anterior part of the thigh. No adverse events were observed. Conclusions The findings indicate that a combination of Korean medical treatment can be a safe and effective alternative treatment in reducing LBP and hot flushes after hysterectomy.

Effect of Kuntai Capsule Combined with Nilestriol Tablets in the Treatment of Perimenopausal Syndrome and on Reproductive Hormones

To investigate the efficacy of the Kuntai capsules combined with nilestriol tablets in the treatment of perimenopausal syndromes and on reproductive hormones, a total of 108 patients with perimenopausal syndromes detected by clinical diagnosis in the department of gynecology and obstetrics in Beijing Tongren Hospital were enrolled from January 2018 to June 2019. These clinical subjects were randomly divided into the observation group (n=54) and control group (n=54). The patients in the control group were treated with nilestriol 2 mg once every 2 w and the dosage was changed to 1 mg, twice a month after symptom improvement. The patients in the observation group were treated with oral Kuntai capsules in addition to nilesteriol, 4 each time, twice a day. Both groups were treated continuously for 3 mouths. The curative effect, clinical symptom score and reproductive hormone level before and after treatment were compared between the two groups. The results showed that the Kupperman menopause index and hot flush scores of both groups were significantly decreased from baseline levels. In the 3 mouths after treatment, the Kupperman menopause index in the observation group was lower than that in the control group (p=0.031), but there was no significant difference after 6 mouths (p=0.178). In the observation group, the hot flush score was significantly lower than that of the control group (p=0.05). The results showed that after treatment, the levels of reproductive hormones, follicle stimulating hormone, luteinizing hormone and testosterone and blood lipids, Triglyceride, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in the two groups changed significantly compared to those before treatment. The levels of follicle stimulating hormone, luteinizing hormone, total cholesterol and lowdensity lipoprotein cholesterol in the observation group were lower than those in the control group, while the levels of serum estradiol and high-density lipoprotein cholesterol in the observation group were higher than those in the control group. Kuntai capsule may be a good alternative therapy for patients who have contraindication or concerns of hormone therapy.

Resistance training for hot flushes in postmenopausal women: A randomised controlled trial

ObjectivesTo investigate the effect of 15 weeks of resistance training on the frequency of moderate to severe hot flushes in postmenopausal women. Study designPostmenopausal women with at least 4 moderate or severe hot flushes or night sweats per day day were randomized to a 15-week resistance training intervention or unchanged physical activity. Participants did not exercise regularly at baseline and had not used any therapy for hot flushes two months prior to study entry. The resistance training was performed three times per week and the program contained 8 exercises performed with 8–12 repetitions in 2 sets. Loads were set individually from eight-repetition maximum-strength tests and increased progressively. Main outcome measuresThe primary outcome was change in mean moderate or severe hot flushes per day from baseline to week 15, assessed with symptom diaries. Secondary outcomes included change in hot flush score and time spent on physical activity. ResultsBetween November 19, 2013, and October 26, 2016, 65 women were enrolled; 58 completed the trial and were included in the analyses. The mean age was 55 and the mean number of moderate or severe hot flushes per day at baseline was 7.1; there were no baseline differences between groups. The frequency of hot flushes decreased more in the intervention group than in the control group (mean difference −2.7, 95% CI −4.2 to −1.3). The mean percentage change was -43.6% (−56.0 to −31.3) in the intervention group and −2.0% (−16.4–12.4) in the control group. ConclusionA 15-week resistance-training program decreased the frequency of moderate and severe hot flushes among postmenopausal women and could be an effective and safe treatment option to alleviate vasomotor symptoms.

A double-blind, placebo-controlled trial of Fennel (Foeniculum vulgare) on menopausal symptoms: A high placebo response

Objective:The present study aimed to evaluate the effects of oral fennel on menopausal symptoms.Material and Methods:This double-blind, randomized, placebo-controlled trial was conducted on 50 postmenopausal women in Mashhad (Iran). Patients were randomly divided into two groups of fennel (n=25) and placebo (n=25). Measurements were performed at baseline and after three months using the Menopause-Specific Quality of Life questionnaire.Results:Both placebo and treatment groups revealed significant improvements in the hot flush score (p<0.001 for fennel and p<0.01 for placebo), night sweats (p=0.007 for fennel and p<0.01 for placebo), sweating (p=0.002 for fennel and p<0.01 for placebo), symptoms of anxiety (p=0.05 for fennel and p=0.001 for placebo), feeling depressed (p<0.01 for fennel and p=0.006 for placebo), and impatience with other people (p<0.01 for fennel and p=0.003 for placebo). There were no significant differences in any menopausal symptoms between the fennel and placebo groups, except for coughing and sneezing when urinating (p=0.03).Conclusion:The failure to indicate a significant effect may have been caused by a high placebo response. It is suggested that future trials should include a placebo run-in phase or design a sequential, parallel study with larger sample sizes to mitigate the placebo effect.

A Multi-center, Randomized, Controlled and Open Clinical Trial of Heyan Kuntai Capsule () and Hormone Therapy in Perimenopausal Women.

To evaluate the efficacy and safety of Heyan Kuntai Capsule (, HYKT) and hormone therapy (HT) on perimenopausal syndromes (PMSs). From 2005 to 2008, 390 women with PMSs were recruited from 4 clinic centers. The inclusion criteria included ages 40 to 60 years, estradiol (E2) below 30 ng/L, and follicle stimulating hormone (FSH) above 40 IU/L, etc. The patients were randomly assigned to HYKT group or HT group by random number table method, administrated HYKT or conjugated estrogen with/without medroxyprogesterone acetate tablets for 12 months. During treatment, the patients were interviewed quarterly, Kupperman Menopausal Index (KMI) scores, hot flush scores, insomnia scores, Menopause-Specific Quality of Life (MENQOL) scores and adverse effects were used for evaluating drug efficacy and safety respectively. The last interview was made at the end of 12-month treatment RESULTS: After treatment, KMI scores of HYKT group and HT group were both significantly decreased compared with baseline (P <0.01) and there was no significant difference between groups (P >0.05), except that KMI of HYKT group was higher after 3-month treatment (P <0.05). After treatment, hot flush and insomnia scores were both improved significantly in two groups (P <0.01); and HT had a better performance than HYKT in improving hot flush (P <0.05). MENQOL were significantly improved in both groups after treatment (P <0.01); but there was no significant difference between two groups (P >0.05). The incidence of adverse event in the HYKT group was much lower than that in the HT group (P <0.01). HYKT could effectively relieve PMSs and improve patients quality of life without severe adverse reactions. Although HYKT exerted curative effects more slowly than hormone, it possessed better safety profile than hormone.

Hot flushes among aging women: A 4-year follow-up study to a randomised controlled exercise trial

ObjectivesThe aim of this follow-up study was to explore the long-term effects of a 6-month trial of exercise training on hot flushes. The follow-up was 4 years after the exercise intervention ended. Study designA cohort study after a randomised controlled trial. Ninety-five of the 159 randomised women (60%) participated in anthropometric measurements and performed a 2-km walk test. Participants completed a questionnaire and kept a one-week diary on physical activity, menopause symptoms and sleep quality. The frequency of 24-h hot flushes was multiplied by severity and the total sum for one week was defined as the Hot Flush Score (HFScore). Multilevel mixed regression models were analysed to compare the exercise and control groups. Main outcome measureHot Flush Score (HFScore) as assessed with the one-week symptom diary. ResultsThe women in the exercise group had a higher probability of improved HFScore, i.e. a decrease in HFScore points, adjusted for hormone therapy (OR 0.95; 95% CI 0.90–1.00) than women in the control group at the 4-year follow-up. After additional adjustment for sleep quality, the result approached statistical significance at HFScore≥13 with women in the exercise group. Women who had the least amount of hot flushes, HFScore<13, benefited most from exercise during the 4-year follow-up when compared with women in the control group. ConclusionsWomen in the exercise group had positive effects on their HFScore 4 years after a 6-month exercise intervention.

Randomized clinical trial of a handheld cooling device (Menopod®) for relief of menopausal vasomotor symptoms

Objective Anecdotal reports suggest that application of a cool device to the back of the neck at the onset of a hot flush can afford symptomatic relief. The effects of a novel handheld mechanical cooling device in a population of perimenopausal women with moderate-to-severe vasomotor symptoms were evaluated.Methods In this randomized, double-blind, sham-controlled pilot study, 40 perimenopausal women experiencing ≥ 7 moderate-to-severe hot flushes per day were recruited at a single university site. Women were randomized to the active (n = 20) or sham (n = 20) device, which was applied to the back of the neck with each hot flush over the 4-week treatment period. Hot flush scores were calculated based on frequency and severity of symptoms. The Carpenter Hot Flash Related Daily Interference Scale and Zung Anxiety Scale were used to evaluate impact on quality of life. At study end, participants completed an open-ended questionnaire to assess the degree of unblinding and overall subjective improvement in symptoms with use of the device.Results No statistically significant differences were observed between the effects of the active and sham device. However, thematic analysis of the open-ended questionnaire revealed that 12/17 women (70.6%) in the active group, compared to 4/18 (22.2%) women in the sham group felt the device provided some symptomatic relief.Conclusions Although the majority of women using the active device acknowledged that its cooling effect afforded a degree of symptomatic relief, the symptom scores chosen for this pilot study did not reflect a beneficial effect.

약침을 이용한 수화조절법으로 호전된 갱년기 상열감 및 발한과다 환자 치험 3례

목 적: 상열감과 발한과다는 갱년기 증후군의 대표적 증상이다. 본 연구에서는 약침을 이용한 수화조절법을 사용하여 갱년기 증후군 환자의 상열감과 발한과다 증상 감소에 유의한 효과를 얻어 이를 보고하고자 한다. 방 법: 황련해독탕 약침을 양측 견정(GB21), 풍지(GB20) 혈에 각각 0.1 cc씩 총 0.4 cc를 주입하고, BUM(웅담, 우황, 사향)약침은 전중(CV17), 중완(CV12), 기해(CV16)혈에 각각 0.05cc씩 총 0.15cc를 주입한다. 시술은 매일 시행하였으며, 증상에 관하여 상열감점수(Hot flush score), 발한에 대한 Visual Analogue Scale(VAS) 및 발한 부위를 기록하여 증상변화 정도를 평가하였다. 결 과: 1번 증례는 약침 수화조절법 시행 후 상열감점수는 24에서 4로, 발한에 관한 VAS는 7에서 2로 감소하였다. 상열감 및 발한과다 증상의 감소와 더불어 손발이 화끈거리는 증상도 함께 감소되었다.2번 증례는 약침 수화조절법 시행 후 상열감점수가 28에서 2로, 발한에 관한 VAS는 10에서 3으로 감소하였다. 상열감 및 발한과다 증상의 감소와 더불어 불안, 우울, 분노 증의 정서적 증상도 70%정도 감소하였다.3번 증례는 약침 수화조절법 시행 후 상열감점수가 8에서 1로, 발한에 관한 VAS는 6에서 1로 감소하였다. 상열감 및 발한과다 증상의 감소와 더불어 두통, 가슴 답답함 등의 증상도 함께 소실되었다.모든 증례에서 발한 부위의 변화는 없었다. 결 론: 본 증례에서 약침을 이용한 수화조절법은 갱년기 상열감과 발한과다 증상을 감소시키는 효과가 있었으며 부가적으로 호소하던 증상도 감소하거나 소실되는 효과가 있었다. 그러므로 약침을 이용한 수화조절법은 상열감과 발한과다를 호소하는 갱년기 증후군 환자에게 효과적인 치료법이라 사료된다. Objectives : The purpose of this study is to evaluate the clinical effects of ascending kidney water and descending heart fire pharmacopuncture treatment for hot flush and sweating. Methods : Ascending kidney water and descending heart fire pharmacopuncture is achieved by injecting pharmacopuncture on a specific acupoint to change from the state of water-fire disharmony to harmonious state. Hwangryunhaedok-tang (黃連解毒湯) pharmacopuncture is injected on both side Gyeonjeong (GB ₂₁ ), Pungji (GB ₂₀ ). Total 0.4 cc was injected by 0.1 cc each point. BUM (Bear&#x2019;s gall bladder, ox bezoar and musk) pharmacopuncture is injected on both side Jeonjung (CV ₁₇ ), Jungwan (CV ₁₂ ), Gihae (CV ₆ ). Total 0.15 cc was injected by 0.05 cc each point. Treatment was done daily. The method of evaluation are Hot Flush Score (HFS), VAS and sweating areas. Results : In case 1, after treatment hot flush score was reduced from 24 to 4 points. VAS scale was reduced from 7 to 2. It took about two weeks for the symptoms to decrease by half. Associated symptoms almost did not stay at discharge. In case 2, after treatment hot flush score was reduced from 28 to 2 points. VAS scale was reduced from 10 to 3. And emotional symptoms were reduced about 70%. In case 3, after treatment hot flush score was reduced from 8 to 1 points. VAS scale was reduced from 6 to 1. And headache and chest discomfort symptoms have disappeared. Conclusions : Ascending kidney water and descending heart fire pharmacopuncture treatment is effective for improve ascending kidney water and descending heart fire energy. Therefore, it will be used to alleviate hot flush and sweating.

Exercise for vasomotor menopausal symptoms.

Evidence suggests that many perimenopausal and early postmenopausal women will experience menopausal symptoms; hot flushes are the most common. Symptoms caused by fluctuating levels of oestrogen may be alleviated by hormone therapy (HT), but a marked global decline in its use has resulted from concerns about the risks and benefits of HT. Consequently, many women are seeking alternatives. As large numbers of women are choosing not to take HT, it is increasingly important to identify evidence-based lifestyle modifications that have the potential to reduce vasomotor menopausal symptoms. To examine the effectiveness of any type of exercise intervention in the management of vasomotor symptoms in symptomatic perimenopausal and postmenopausal women. Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials (RCTs): Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Internet interface), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), the Science Citation Index and the Social Science Citation Index (Web of Science), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Ovid) and SPORTDiscus.Searches include findings up to 3 March 2014. RCTs in which any type of exercise intervention was compared with no treatment/control or other treatments in the management of menopausal vasomotor symptoms in symptomatic perimenopausal/postmenopausal women. Five studies were deemed eligible for inclusion. Two review authors independently selected the studies, and three review authors independently extracted the data.The primary review outcome was vasomotor symptoms, defined as hot flushes and/or night sweats. We combined data to calculate standardised mean differences (SMDs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for main comparisons using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods. We included five RCTs (733 women) comparing exercise with no active treatment, exercise with yoga and exercise with HT. The evidence was of low quality: Limitations in study design were noted, along with inconsistency and imprecision. In the comparison of exercise versus no active treatment (three studies, n = 454 women), no evidence was found of a difference between groups in frequency or intensity of vasomotor symptoms (SMD -0.10, 95% CI -0.33 to 0.13, three RCTs, 454 women, I(2) = 30%, low-quality evidence). Nor was any evidence found of a difference between groups in the frequency or intensity of vasomotor symptoms when exercise was compared with yoga (SMD -0.03, 95% CI -0.45 to 0.38, two studies, n = 279 women, I(2) = 61%, low-quality evidence). It was not possible to include one of the trials in the meta-analyses; this trial compared three groups: exercise plus soy milk, soy milk only and control; results favoured exercise relative to the comparators, but study numbers were small. One trial compared exercise with HT, and the HT group reported significantly fewer flushes in 24 hours than the exercise group (mean difference 5.8, 95% CI 3.17 to 8.43, 14 participants). None of the trials found evidence of a difference between groups with respect to adverse effects, but data were very scanty. Evidence was insufficient to show whether exercise is an effective treatment for vasomotor menopausal symptoms. One small study suggested that HT is more effective than exercise. Evidence was insufficient to show the relative effectiveness of exercise when compared with HT or yoga.

Acupuncture for menopausal vasomotor symptoms: study protocol for a randomised controlled trial.

BackgroundHot flushes and night sweats (vasomotor symptoms) are common menopausal symptoms, often causing distress, sleep deprivation and reduced quality of life. Although hormone replacement therapy is an effective treatment, there are concerns about serious adverse events. Non-hormonal pharmacological therapies are less effective and can also cause adverse effects. Complementary therapies, including acupuncture, are commonly used for menopausal vasomotor symptoms. While the evidence for the effectiveness of acupuncture in treating vasomotor symptoms is inconclusive, acupuncture has a low risk of adverse effects, and two small studies suggest it may be more effective than non-insertive sham acupuncture. Our objective is to assess the efficacy of needle acupuncture in improving hot flush severity and frequency in menopausal women. Our current study design is informed by methods tested in a pilot study.Methods/designThis is a stratified, parallel, randomised sham-controlled trial with equal allocation of participants to two trial groups. We are recruiting 360 menopausal women experiencing a minimum average of seven moderate hot flushes a day over a seven-day period and who meet diagnostic criteria for the Traditional Chinese Medicine diagnosis of Kidney Yin deficiency. Exclusion criteria include breast cancer, surgical menopause, and current hormone replacement therapy use. Eligible women are randomised to receive either true needle acupuncture or sham acupuncture with non-insertive (blunt) needles for ten treatments over eight weeks. Participants are blinded to treatment allocation. Interventions are provided by Chinese medicine acupuncturists who have received specific training on trial procedures. The primary outcome measure is hot flush score, assessed using the validated Hot Flush Diary. Secondary outcome measures include health-related quality of life, anxiety and depression symptoms, credibility of the sham treatment, expectancy and beliefs about acupuncture, and adverse events. Participants will be analysed in the groups in which they were randomised using an intention-to-treat analysis strategy.DiscussionResults from this trial will significantly add to the current body of evidence on the role of acupuncture for vasomotor symptoms. If found to be effective and safe, acupuncture will be a valuable additional treatment option for women who experience menopausal vasomotor symptoms.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000393954 11/02/2009.

Changes in bone mineral density are correlated with bone markers and reductions in hot flush severity in postmenopausal women treated with bazedoxifene/conjugated estrogens

A post hoc exploratory analysis was conducted to examine correlations between changes in bone density, bone markers, and hot flushes after the treatment of postmenopausal women with bazedoxifene (BZA)/conjugated estrogens (CE). In a 2-year phase 3 study, 3,397 postmenopausal women were randomized to BZA 10 mg/CE 0.45 mg, BZA 20 mg/CE 0.45 mg, BZA 40 mg/CE 0.45 mg, BZA 10 mg/CE 0.625 mg, BZA 20 mg/CE 0.625 mg, BZA 40 mg/CE 0.625 mg, raloxifene 60 mg, or placebo. In this analysis, bone density changes at 2 years were compared with baseline levels of the bone markers serum C-telopeptide and osteocalcin. Correlations between changes in bone density and changes in 12-week hot flush composite scores in symptomatic women were also analyzed. Treatment with BZA 20 mg/CE 0.45 mg or BZA 20 mg/CE 0.625 mg increased lumbar spine bone density more in women with higher bone resorption and formation, categorized by baseline levels of C-telopeptide and osteocalcin (P < 0.001, both BZA/CE doses). With placebo, larger decreases in lumbar spine bone density were seen in the highest tertile of serum C-telopeptide. There was no correlation between changes in total hip bone density and baseline bone markers. There were significant correlations between percent change in hot flush score at week 12 and percent changes in lumbar spine (r = -0.31, P = 0.006) and total hip (r = -0.23, P = 0.044) bone densities at month 24. With 2-year BZA/CE treatment, women with larger increases in lumbar spine and total hip densities also have higher baseline bone markers. Early reductions in hot flush score (12 wk) are predictive of long-term increases in bone density (24 mo).

단기 입원 프로그램 후 호전된 갱년기 환자의 상열감 및 발한과다에 대한 치험 1례

Objectives: Postmenopausal hot flush and sweating is troublesome symptom to most of climacteric women. It is well known that Korean medicine is safe and effective on climacteric symptoms. So this study aims to report the clinical effect of Korean medicine on postmenopausal hot flush and sweating. Methods: The patient received herbal medication, acupuncture, moxibustion, cupping therapy, Gong-jin therapy, and Korean medicine music therapy during hospitalization (about 8 days). Results: Hot flush and sweating was effectively reduced after the treatment. Visual Analogue Scale (VAS) for hot flush and sweating decreased from 9 to 2. Hot flush score decreased from 20 to 8. Area of hot flush and sweating also markedly decreased. Conclusions: This case shows that Korean medicine is effective on climacteric symptoms.

A randomized, double-blind, controlled trial of a Chinese herbal formula (Er-Xian decoction) for menopausal symptoms in Hong Kong perimenopausal women

The aim of this study is to investigate the effectiveness and safety of a Chinese herbal formula, Er-Xian decoction (EXD), in the treatment of menopausal symptoms among Hong Kong perimenopausal women. A randomized, double-blind, controlled trial was conducted for 12 weeks among 108 Hong Kong perimenopausal women who reported Menopause Rating Scale (MRS) total scores of 28 or higher. Posttreatment follow-up was performed 3 months after the intervention. The primary outcome measure was the frequency and severity of hot flushes. The secondary outcome measures included the MRS, the Menopause-Specific Quality of Life questionnaire, and serum hormone levels. Among 108 participants, 101 participants finished the study. EXD significantly reduced the mean (SD) frequency of hot flushes from 5.8 (5.0) to 2.2 (3.0) in the treatment group and from 5.0 (3.8) to 2.4 (2.5) in the placebo group (P = 0.04). The mean (SD) hot flush score was also reduced from 19.6 (6.6) to 4.9 (7.8) in the treatment group and from 16.6 (5.4) to 7.0 (6.4) in the placebo group (P = 0.02). The superiority of EXD to placebo was also observed with greater improvement in the total scores for the MRS (P = 0.03) and the Menopause-Specific Quality of Life questionnaire (P < 0.01). There were no differences in serum hormone levels between the EXD group and the placebo group. There were no serious adverse events, and the safety indices of whole blood counts, renal function, and liver function were within the normal range before and after treatment. The Chinese herbal formula EXD is superior to placebo in reducing the frequency and severity of hot flushes and in improving menopausal symptoms in Hong Kong perimenopausal women. It is well tolerated, with no serious adverse events noted during the study period.

Auricular Acupuncture Effect to Hot Flush Score Decrease and Quality of Life Increase Associate with Luteinizing Hormone-Releasing Hormon (LHRH) Agonist Treatment for Prostate Cancer Patient

Hot flush merupakan efek samping yang paling banyak dialami oleh penderita kanker prostat yang diterapi dengan agonis LHRH. Ternyata terdapat hubungan yang erat antara hot flush dengan penurunan kualitas hidup para penderita kanker. Ada banyak terapi untuk hot flush , di antaranya dengan akupunktur telinga. Akupunktur telinga meringankan gejala hot flush karena adanya ?-endorfin yang mempertahankan mekanisme negatife feedbeeck pada produksi noradrenalin hipotalamus. ?-endorfin juga menghambat efek CGRP sehingga terjadi penurunan gejala hot flush . Gejala hot flush yang menurun setelah diakupunktur akan dapat mengembalikan kembali kualitas hidup dari penderita prostat. Penelitian ini bertujuan untuk mengetahui efek akupunktur telinga terhadap penurunan skor Hot Flush Diary , skor Hot Flush Related Daily Interference Scale (HFRDIS) , dan peningkatan kualitas hidup pasien kanker prostat yang diterapi dengan agonis LHRH setelah 12 kali tindakan akupunktur. Kata kunci: biopsi, diagnosis, kanker prostat, spesialis urologi, TRUS

Stellate-ganglion block as a treatment for severe postmenopausal flushing

ABSTRACTObjective Hormone replacement therapy is the most effective treatment for postmenopausal flushing. Unfortunately, its use is often contraindicated. A limited amount of uncontrolled data suggests that stellate-ganglion block (SGB) may be useful for the treatment of hot flushes. In the present study, we examined whether previously reported results could be reproduced in women with severe postmenopausal flushing.Methods Twenty postmenopausal women with a baseline hot flush score ≥ 15 were treated with SGB in an open, uncontrolled setting. This mean daily hot flush score was calculated as the product of flush frequency and flush severity over a period of 1 week. The response to treatment was evaluated by flush scores and assessment of quality of life at baseline and 4 weeks after SGB.Results The per-protocol analysis included 19 women. One woman was excluded because of lack of Horner syndrome after SGB. Four weeks after SGB, the mean flush score had decreased by 34 ± 7.4% (95% confidence interval (CI) 18–49%; p < 0 .005). Nine women had a decrease in flush score between 40 and 90%, with a mean response of 65 ± 4.9% (95% CI 53–76%). The other ten women were non-responders with a decrease in flush score between 0 and 11%. Quality of life and sleep, both assessed by questionnaire, improved significantly.Conclusions The results of this study support the observation that SGB may be a useful therapy for a subset of women with severe postmenopausal flushing. A sham-controlled, single-blinded study is warranted to improve the evidence of efficacy.

Acupuncture for Hot Flushes in Perimenopausal and Postmenopausal Women: A Randomised, Sham-Controlled Trial

To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women. The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes. 54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was -6.4±5.2 in the real acupuncture group and -5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period. Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches.

Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes

Evaluate effects of electro-acupuncture (EA) and hormone therapy (HT) on health-related quality-of-life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms. Forty-five women, randomized to EA (n = 27) for 12weeks or HT (n = 18) for 24months, were followed for up to 2years. Distress caused by, and numbers of, hot flushes, hours slept and times woken up/night, Psychological and General Well-being Index (PGWB) and Women's Health Questionnaire (WHQ) were registered before and during treatment and at 6, 9, 12, 18 and 24months after start of treatment. After 12weeks of EA (n = 19), WHQ improved from 0.32 (IQR 0.23-0.53) at baseline to 0.24 (IQR 0.12-0.39; p < 0.001) and PGWB from 78 (IQR 53-89) to 79 (IQR 68-93; p = 0.002). All sleep parameters improved and Hot Flush Score (HFS) decreased by 80%. At 12months, WHQ, PGWB and all sleep parameters remained significantly improved (n = 14) and HFS decreased by 65%. After 12weeks of HT (n = 18), WHQ improved from 0.29 (IQR 0.15-0.44) at baseline to 0.15 (IQR 0.05-0.22; p = 0.001), PGWB from 75 (IQR 59-88) to 90 (62-97; p = 0.102) and three of five sleep parameters improved. Both EA and HT increased HRQoL and sleep, probably through decreasing numbers of and distress by hot flushes. Although flushes decreased less in the EA group than in the HT group, HRQoL improved at least to the same extent maybe due to other effects of EA, not induced by HT, e.g. on anxiety, vitality and sleep, supported by subscale analyses. EA should be further evaluated as treatment for women with breast cancer and climacteric complaints, since HT no longer can be recommended for these women.

Hot flushes in prostatic cancer patients during androgen-deprivation therapy with monthly dose of degarelix or leuprolide

The aim of the study was to compare the onset, incidence and frequency/intensity of hot flushes during androgen-deprivation therapy with a gonadotropin-releasing hormone antagonist (GnRH) blocker versus an agonist using data from a randomized Phase 3 clinical trial. In total, 610 prostate cancer patients received monthly degarelix (s.c., 240/80 mg, n=207, or 240/160 mg, n=202) or leuprolide (i.m., 7.5 mg, n=201) for 12 months. Data on hot flushes was collected as self-reported adverse events and in a subgroup of 254 patients with electronic diaries. The onset of hot flushes was faster on degarelix versus leuprolide, and was accompanied by higher median hot flush scores during the first 3 months. However, there were no significant differences in overall incidence rates and median hot flush scores over the entire 12 months. After the third month, incidence rates dropped below 6%, whereas prevalence rates remained constant in all the three treatment arms. In multivariate analysis, body weight and heart rate at baseline were independent predictors of hot flushes (P<0.05). Except for a more rapid onset with the GnRH antagonist, there were no major differences in the overall pattern of hot flushes between treatment options. Weight control may help to minimize the incidence of hot flushes.

Effect of abrupt discontinuation versus gradual dose reduction of postmenopausal hormone therapy on hot flushes

Objective To compare the effects of the abrupt discontinuation of postmenopausal hormone therapy (HT) and reduction of the daily dosage of the hormone on climacteric symptoms.Methods The study included Brazilian postmenopausal women who were using estrogen–progestogen hormone therapy in full doses previously prescribed for vasomotor symptoms. The patients were randomized to receive one of three treatments: placebo for 6 months; estradiol (E2) 1 mg/day + norethisterone acetate (NETA) 0.5 mg/day for 2 months, followed by placebo for 4 months; or E2 1 mg/day + NETA 0.5 mg/day for 4 months, followed by placebo for 2 months. The climacteric symptoms were assessed by the Blatt–Kupperman Menopausal Index at baseline and at 2, 4 and 6 months. Statistical evaluation was performed using the χ2 or Fisher's test for categorical data, the Kruskal–Wallis test for numerical data, and ANOVA for time and group relationship with the Blatt–Kupperman Menopausal Index.Results We randomized 60 women (20 in each group), and 54 completed the study. It was observed that both the full Blatt–Kupperman Menopausal Index and the hot flush score did not change significantly in the HT group during low-dose therapy compared with baseline; however, the evaluation performed at 2 months after low-dose-HT cessation showed that the full Blatt–Kupperman Menopausal Index and the hot flush score were similar to those of the group who stopped HT abruptly and significantly higher than at baseline (hot flush scores: p < 0.001 for all three groups at months 2, 4 and 6, respectively, vs. baseline).Conclusion Discontinuation of HT by reducing the daily dose of estrogen for a period of 2 or 4 months did not differ in its effect from that of abrupt cessation with regard to vasomotor symptoms.

Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial

Hot flushes are the most common complaints reported by men undergoing androgen suppression treatment for prostate cancer. We designed a randomised double-blind trial to compare the efficacy of three drugs, each of which has proven effective for preventing hot flushes in previous studies. Men with prostate cancer with an indication for androgen suppression were enrolled in the study at 106 urology centres in France between April 14, 2004, and April 20, 2007. All patients were treated for 6 months with leuprorelin (11.25 mg). At month 6, patients who spontaneously asked for treatment, or those who presented with 14 hot flushes or more during the week before the visit, were randomly assigned to either venlafaxine 75 mg daily, medroxyprogesterone acetate 20 mg daily, or cyproterone acetate 100 mg daily. All patients received two indistinguishable pills in the morning and one in the evening from week 1 to week 8, and one indistinguishable pill in the morning from week 9 to week 10, to comply with the double-blind design. Random assignment with a block size of three was done centrally, by fax, and each patient was given a randomisation number. The allocation sequence was stratified by centre. Assessment was done at inclusion, at randomisation, and then at 4 weeks, 8 weeks, and 12 weeks after randomisation. Participants completed a daily hot-flush diary for 1 week, and a quality of life questionnaire before each visit throughout the study. The primary outcome was the change in median daily hot-flush score between randomisation and 1 month. All patients who received at least one study treatment dose were included in the efficacy analysis. This trial is registered with ClinicalTrials.gov, number NCT01011751. Of the 919 men initially enrolled, 311 were randomly assigned to one of the study treatments at 6 months: 102 to venlafaxine, 101 to cyproterone, and 108 to medroxyprogesterone. 309 patients were included in the efficacy analysis, since two were excluded for protocol deviations (one in the cyproterone and one in the medroxyprogesterone group; both were excluded because they were already undergoing treatment with serotonin reuptake inhibitor antidepressants at randomisation). The change in median daily hot-flush score between randomisation and 1 month was -47.2% (IQR -74.3 to -2.5) in the venlafaxine group, -94.5% (-100.0 to -74.5) in the cyproterone group, and -83.7% (-98.9 to -64.3) in the medroxyprogesterone group. The decrease from baseline was significant for all three groups (p<0.0001). Pairwise comparison of treatment groups adjusted by the Bonferroni method confirmed that the decreases in hot-flush score were significantly larger in the cyproterone and medroxyprogesterone groups than in the venlafaxine group, regardless of the interval considered (p<0.0001 in all cases). There was no significant difference between the cyproterone and medroxyprogesterone groups (p>0.2 in all cases). Serious side-effects occurred in four, seven, and five patients in the venlafaxine, cyproterone, and medroxyprogesterone groups, respectively, of which none, one (dyspnoea), and one (urticaria) were considered related to the drug, respectively. After 6 months of treatment with leuprorelin, venlafaxine, cyproterone, and medroxyprogesterone proved to be effective in reducing hot flushes. However, the hormonal treatments cyproterone and medroxyprogesterone were significantly more effective than venlafaxine. As cyproterone is a recognised treatment in prostate cancer, and its use could interfere with hormonal therapy, medroxyprogesterone could be considered to be the standard treatment for hot flushes in men undergoing androgen suppression for prostate cancer. Takeda Laboratories, Puteaux, France.