Severity Of Hot Flashes Research Articles

The Influence of Breast Cancer Treatment on the Occurrence of Hot Flashes

Approximately 65% of women report hot flashes (HFs) during or following breast cancer treatment. However, few studies have compared the occurrence of vasomotor symptoms according to the type of adjuvant treatment received, and little is known about other risk factors for HFs among this population. This longitudinal study aimed to: 1) compare the frequency and severity of HFs in breast cancer patients according to treatment regimen; 2) evaluate the potential contribution of hormone therapy on the frequency and severity of HFs; and 3) identify other potential risk factors for HFs in breast cancer patients. Forty-one women receiving radiation therapy and chemotherapy and 40 women receiving radiation therapy without chemotherapy completed a daily diary of HFs for seven days, and the vasomotor scale of the Menopause-Specific Quality of Life Questionnaire prior to and following each type of treatment, and at a three-month follow-up evaluation. Z-scores and percentiles computed from an age-matched control group ( n = 45) without a history of cancer revealed a higher frequency and severity of HFs among breast cancer patients compared with control participants. Chemotherapy and hormone therapy were both associated with increased HFs. Past use of hormone replacement therapy (HRT) and a lower body mass index (BMI) were significantly associated with more severe vasomotor symptoms. This study highlights the clinical significance of HFs among breast cancer patients, particularly in women receiving chemotherapy and hormone therapy, and the necessity to offer effective therapeutic strategies to relieve HFs in this population.

The association between physical activity and hot flash severity, frequency, and duration in mid‐life women

The value of physical activity to reduce vasomotor symptoms has yet to be determined conclusively. As a result, we used a cross-sectional population-based design to examine the association between self reported physical activity level and hot flash symptoms in 45-54-year-old women. Participants (n = 603) completed a detailed survey to report physical activity level at work, home, and leisure as well as a detailed history of the frequency and severity of hot flash symptoms. Results showed that higher levels of physical activity were significantly associated with increasing odds of moderate or severe hot flashes (P for trend = 0.02). These findings suggest that there is a positive relation between physical activity and moderate or severe hot flash symptoms but no relation between physical activity and the reporting of any hot flashes, daily hot flashes, or hot flashes experienced for greater than 1 year.

Is megestrol acetate a suitable option for treatment of hot flashes in women with breast cancer?

Chemotherapy for breast cancer is associated with the development of hot flashes, which can cause the patient considerable discomfort. Estrogen replacement therapy alleviates the number and severity of hot flashes but is contraindicated in such cases. Alternative methods to treat hot flashes are, therefore, urgently needed. Goodwin et al. have performed a 6-month, double-blind, randomized, placebo-controlled trial of megestrol acetate in 286 women with breast cancer. After 3 months, 65% of the patients receiving 20 mg megestrol acetate daily had achieved an appreciable reduction in the number of hot flashes (> or = 75% from baseline), compared with 48% in the 40 mg megestrol acetate group and 14% in the placebo group. The positive effects of megestrol acetate on hot flash frequency were maintained at 6 months. In this Practice Point commentary, I discuss the key findings of Goodwin et al. and place them into clinical context, highlighting the need for additional studies of hormonal therapies in women with breast cancer.

Objective hot flashes are negatively related to verbal memory performance in midlife women

To test the hypothesis that hot flashes specifically relate to verbal memory performance by examining the relationship between objective hot flashes and cognitive test performance in women with moderate to severe vasomotor symptoms. In an observational study, 29 midlife women (mean age, 53 y) with moderate to severe hot flashes provided measures of objective hot flashes with an ambulatory hot flash monitor, subjective hot flashes with a diary and questionnaire, and objective measures of verbal memory and other cognitive functions with standardized neuropsychological tests. The mean number of objective hot flashes was 19.5 per day (range, 6 to 35), including 15.3 (range, 6 to 35) during waking hours and 4.2 (range, 0 to 9) during sleep. The mean sensitivity (ie, subjective detection of objectively measured hot flashes) was 60%. Regression analyses revealed that total number of objective hot flashes, sleep duration, and verbal knowledge were significant predictors of delayed verbal memory. Verbal fluency correlated positively with objective daytime hot flashes. Hot flashes did not predict performance on any of the other secondary cognitive measures (ie, attention, working memory, visual memory), although poor sleep predicted worse performance on several outcome measures. Highly symptomatic women underreport the number of objective hot flashes that they experience by 43%. Verbal memory performance relates significantly to the objective number of hot flashes women experience but not to the number of hot flashes that they report. These findings suggest that physiological factors related to hot flashes, rather than psychological factors, predict poorer verbal memory function.

Venlafaxine versus clonidine for the treatment of hot flashes in breast cancer patients: a double-blind, randomized cross-over study

Breast cancer patients with treatment-induced menopause experience frequent and severe hot flashes (HF). We compared venlafaxine and clonidine for the treatment of HF with regard to side effects, efficacy, quality of life and sexual functioning. In a double-blind, cross-over study, 60 breast cancer patients experiencing HF were randomized to 8 weeks venlafaxine followed by 2 weeks wash-out, and 8 weeks clonidine or vice versa. HF frequency and severity, side effects, quality of life and sexuality were assessed. Thirty patients started with venlafaxine and 30 with clonidine. Premature discontinuation for toxicity occurred in 14/59 during venlafaxine and 5/53 during clonidine (P = .038). Venlafaxine induced more side effects. Median reduction in HF score was 49% for venlafaxine and 55% for clonidine (ns). Venlafaxine and clonidine are equally, but moderately effective in HF reduction. Side effects are the main reason for drug discontinuation, occurring more often with venlafaxine.

Meta-analysis examining the efficacy of serotonin and/or norepinephrine reuptake inhibitors in the treatment of women with hot flashes

20606 Background: Hot flashes can be particularly troublesome in post-menopausal women, as well as those who are on medications such as tamoxifen or aromatase inhibitors for breast cancer treatment. Patients with chemotherapy-induced amenorrhea may also develop hot flashes that can impact on their quality of life. Serotonin and/or norepinephrine reuptake inhibitors have been studied to determine if they reduce the frequency or severity of hot flashes. The objective of this study is to provide a systematic review and meta-analysis of the randomised controlled trials evaluating SSRI and SNRI use in women experiencing hot flashes. Methods: Five medical literature databases were searched to identify all potential randomised placebo-controlled trials evaluating SSRI/SNRI’s in women with hot flashes. The methodological quality of the trials were also assessed. The results of all studies that met the inclusion criteria were compiled and systematically reviewed. The primary outcome for the pooled analysis was the...

Does efficacy of non-estrogenic therapies for hot flashes among women vary by breast cancer history and tamoxifen use? A pooled analysis

9595 Background: Various non-estrogenic therapies have been found to be effective in mitigating hot flashes. However, it is unclear whether the efficacy of these therapies is different among women with breast cancer, and/or those taking tamoxifen, as compared to the counterparts. Methods: All clinical trials (pilot and randomized trials) conducted by a group of investigators at Mayo Clinic and the North Central Cancer Treatment Group (NCCTG) that evaluated the efficacy of any non-estrogenic agent for hot flashes, and had information on breast cancer history and/or tamoxifen use, were eligible for this analysis. All these trials had similar study methodology, including design and measurement tools. Hot flash scores were computed as the daily frequency of hot flashes times the average hot flash severity. The analysis was done using patient level data. Statistically significant changes from the 4th treatment week versus the baseline week were assessed using the Student’s t-test. Forest plots as well as stepwise linear regression models were created to assess the differences among subgroups. A p-value of 0.05 was considered significant. Results: A total of 1,415 women from 20 hot flash studies were eligible for analysis. Among the patients with available information, 80% had a history of breast cancer and 53% were using tamoxifen. Overall, patients without breast cancer had similar percentage of baseline hot flash score at week four, as did those with breast cancer (53% versus 50%, p=0.92). Patients without a history of tamoxifen use had a significantly lower percentage of hot flash score at week four, as compared to those who used tamoxifen (54% versus 61%, p =0.01). However, further analysis showed that this was due to a higher reduction of hot flashes in the placebo arms among patients not receiving tamoxifen. The percentage reduction in hot flash score at week 4 (from baseline) by the therapy arms over placebo arms in the randomized trials, and by the therapies in pilot trials, was similar among tamoxifen users and non- users. Conclusions: The efficacy of non-estrogenic therapies on hot flashes is similar among women with or without a history of breast cancer, as well as among patients taking tamoxifen versus non-users. No significant financial relationships to disclose.

Well-Being During the Menopausal Transition and Early Postmenopause: A Within-Stage Analysis

<h3>Purpose</h3> to identify whether menopausal transition (MT)-related factors—including MT stage, hot flash severity, levels of estrone glucuronide (E₁G) and follicle stimulating hormone (FSH); number of negative life events; or personal resources of mastery and social support—are associated with stage specific well-being. <h3>Methods</h3> Women from the Seattle Midlife Women's Health Study (N=334) provided at least one annual health questionnaire and a menstrual calendar; a subset provided first morning voided urine specimens assayed for E₁G and FSH. Descriptive statistics were calculated and Pearson's product-moment correlations were estimated. <h3>Results</h3> Mean levels of well-being were the same across MT stages (4.1, range 1.8-5.9). Physiologic variables were not significantly correlated with well-being: E₁G levels (r = −.11 to 0.16), FSH levels (r = −.17 to .20) and hot flash severity (r = −.07 to .05). Significant correlations were observed between well-being and number of negative life events (r = −.48 to −.33, p ≤ 0.01), mastery (r = .51-.64, p ≤ 0.01), and satisfaction with social support (r = .04 non-significant) to r=.41, (p ≤ 0.01). <h3>Conclusion</h3> The association of well-being with life events and personal resources, and not MT-related indicators, hormone levels or vasomotor symptoms, supports work by other researchers. Further study is needed to determine whether patterns of well-being vary across the MT, and if so, what might predict that variability.

Modeling the hot flash experience in breast cancer survivors

To evaluate relationships among different measures of hot flashes, perceived hot flash interference, and associated outcomes (positive affect, negative affect) while controlling potential covariates. Breast cancer survivors (N=236) provided demographic data, objective hot flash frequency data via sternal skin conductance monitoring, prospective diary-based hot flash frequency and severity data, and questionnaire data via the Hot Flash Related Daily Interference Scale and the Positive and Negative Affect Scale. Objective hot flash frequency and subjective hot flash severity emerged as separate factors in the structural equation model. Subjective hot flash frequency was associated with a high degree of unexplained variance (error) and seemed to be a potentially less accurate measure of either frequency or severity. Objective frequency was directly related to greater positive affect. In contrast, greater hot flash severity was (1) directly related to greater perceived hot flash interference and (2) indirectly related to more negative affect and lower positive affect through interference. Findings provide a theoretical basis for selecting among symptom measures and anticipating how interventions aimed at different hot flash measures might affect perceived hot flash interference or associated outcomes. Because objective hot flash frequency and subjective hot flash severity seemed to measure different dimensions, measuring both may provide a more comprehensive picture of women's symptom experiences.

A Randomized Controlled Trial of Relaxation Training to Reduce Hot Flashes in Women with Primary Breast Cancer

Hot flashes are experienced by about 52% of perimenopausal women. After breast cancer, this may increase to 70%. The use of hormone replacement therapy is not recommended in women who have had breast cancer; therefore, alternatives are required to help relieve hot flashes. This study was conducted to assess the efficacy of relaxation training in reducing the incidence of hot flashes in women with primary breast cancer. This was a randomized controlled trial of 150 women with primary breast cancer who experienced hot flashes. The intervention group received a single relaxation training session and was instructed to use practice tapes on a daily basis at home for one month; the control group received no intervention. Outcomes were incidence and severity of flashes using a diary and validated measures of anxiety and quality of life. The incidence and severity of hot flashes, as recorded by diaries, each significantly declined over one month ( P < 0.001 and P = 0.01, respectively), compared with the control group. Distress caused by flashes also significantly declined in the treatment group over one month ( P = 0.01), compared with the control group. There were no significant differences between the treatment group and the control group at three months and no changes in anxiety or quality-of-life measures. Relaxation may be a useful component of a program of measures to relieve hot flashes in women with primary breast cancer.

Evaluation of core and surface body temperatures, prevalence, onset, duration and severity of hot flashes in men after bilateral orchidectomy for prostate cancer

To assess the prevalence, onset, duration and severity of hot flashes in men after bilateral orchidectomy (BO) for prostate cancer, to evaluate body temperature changes during hot flashes and to determine whether an elevated temperature within a few days after BO can be caused by deprivation of androgen. Patients (n = 101) were questioned about the characteristics of their hot flashes after BO for prostate cancer. A subgroup of these men (n = 17) were instructed to record their oral and forehead temperatures during and at fixed intervals between hot flashes daily for 4 weeks. The mean age was 71.6 years, mean follow-up after BO was 33.2 months. Hot flashes were reported by 87 men (86%) with previous spontaneous remission in 9 (10%). The median time between BO and the onset of hot flashes was 21 days (range 1-730), median number of hot flashes 3 per day (range 1-20), and median duration was 120 seconds (range 5 to 1800). There was no significant difference between median oral (36.4(o) C) and forehead (36.0(o) C) temperature in the normal state, but during hot flashes the median forehead temperature (37.0(o) C) was higher than the oral temperature (36.5(o) C) (p = 0.0004). Both median oral and forehead temperatures were higher during hot flashes (36.5(o) C and 37.0(o) C) than in the normal state (36.4(o) C and 36.0(o) C, respectively) (p < 0.0001). During hot flashes, the oral temperature was 38(o) C to 40(o) C in only 3.2% of 593 readings in 17 patients. The median oral and forehead temperatures are higher during hot flashes than in normal periods. Oral temperature elevation > 38(o) C within days after a BO is unlikely to be the result of androgen deprivation alone.

Hot flashes and panic attacks: A comparison of symptomatology, neurobiology, treatment, and a role for cognition.

Despite decades of research, the causal mechanisms of hot flashes are not adequately understood, and a biopsychosocial perspective on hot flashes remains underdeveloped. This article explores overlooked parallels between hot flashes and panic attacks within 5 areas: course and symptomatology, physiological indicators, neurocircuitry and biochemical mechanisms, pharmacotherapy, and psychological treatment, noting both similarities and important differences between the 2 events. An integrative conceptual model is presented that identifies key ways in which psychological factors may influence the experience of hot flashes, with clinical implications and areas of future research. This model yields readily testable hypotheses and may provide a template for exploring the role of cognition in the frequency and severity of hot flashes and, in turn, a basis for the development of nonpharmacological treatments.

Severe Hot Flashes Are Associated With Chronic Insomnia.

Severe Hot Flashes Are Associated With Chronic Insomnia.

Mental Workload under Time Pressure can Trigger Frequent Hot Flashes in Menopausal Women

The aim of this study is to examine the relationship between mental workload and occurrence of hot flashes. Twelve women with moderate to severe menopausal hot flashes participated in the study. Subjects participated in both a mental arithmetic task (Task) and control (Non-task) experiments. We measured heart rate, heart rate variability, blood pressure, near infrared spectroscopy, skin temperature, and skin potential level. The incidence of hot flashes was greater in Task than in Non-task. No significant differences between before, during and after hot flashes emerged for the percentage of correct responses and reaction time. However, the percentage of correct responses for two subjects among the ten who experienced hot flashes in Task substantially declined during hot flashes. Chest skin temperatures increased in both Task and Non-task during hot flashes, and regional oxygen saturation was significantly higher in Non-task than in Task. The present study suggested that mental workload under time pressure might be a risk factor for menopausal hot flashes, and the performance of most people who experienced hot flashes was not affected by hot flashes, however, work-related difficulties due to cognitive disturbance during hot flashes might arise in some people.

Perimenopausal Depression

Perimenopausal Depression

Hot flash severity in hormone therapy users/nonusers across the menopausal transition

Objectives The purpose of this study was to examine the pattern of and factors that influence hot flash severity across the menopausal transition (MT) and early postmenopause (PM). Methods Women from the Seattle Midlife Women's Health Study ( N = 302) provided data for these analyses: at least one annual health questionnaire and a menstrual calendar. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide and FSH. Linear mixed effects modeling was used to identify change in hot flash severity scores over time, including the relationship to age, MT-related, psychosocial and lifestyle factors. Results Increases in hot flash severity were associated with late transition stage, early postmenopause, use of HRT, duration of early transition stage, age of entry into early PM and level of FSH. Age of entry into early transition and estrone levels were associated with decreased hot flash severity. Not associated with hot flash severity were being in early transition stage, age of entry into or duration of late transition stage and all of the psychosocial (anxiety, stress, depressed mood) and lifestyle variables (BMI, activity level, sleep, alcohol use). Conclusions Variables associated with reproductive aging independently predicted changes in hot flash severity; psychosocial and lifestyle variables did not. The effect of age dropped out when factors associated with reproductive aging were considered. Use of HRT ameliorated but did not eliminate severe hot flashes suggesting that there is room for alternative approaches less likely to cause harm.

The variable response of women with menopausal hot flashes when treated with sertraline

To evaluate the variable response of women when treated with a selective serotonin reuptake inhibitor (sertraline) to decrease hot flashes. A double-blind, placebo-controlled, crossover trial was conducted in 102 women aged 40 to 65 years who were experiencing hot flashes and not taking any hormone therapy. The original purpose of the study was to evaluate the effectiveness of sertraline for the treatment of hot flashes. After 1 week of baseline hot flash data collection, study participants were randomized to receive placebo or active drug (sertraline 50 mg) for 4 weeks. This intervention was followed by a 1-week washout and crossover to the opposite treatment for 4 weeks. The number and severity of hot flashes were measured. One hundred two women were enrolled in the study, and 87 completed the study. The average response was a statistically significant but clinically modest reduction in hot flash frequency and hot flash index (frequency x severity). These data on the average response have been previously published. Although the average response was modest, some women responded vigorously, others modestly, and some women actually worsened. This is a post hoc analysis of those data. Percentage of change was divided into three categories of clinical response: women with a clinically significant reduction (>or=30%, n=27), women with a nonsignificant reduction (<30% to none, n=28), and women with an increase (1%-100%, n=32). A vigorous response to sertraline for the treatment of hot flashes was related to activity level, education, and menopausal status. Women have markedly variable responses when treated with antidepressants for their hot flashes. We have begun to describe the characteristics of those most likely to respond to treatment with a selective serotonin reuptake inhibitor.

The Effect of Vitamin E on Hot Flashes in Menopausal Women

Background: Hot flashes affect as many as 75% of menopausal women. Estrogen reliably reduces the severity of hot flashes and remain the single most effective treatment. Today, however, more and more women are seeking alternatives. Instead of hormonal therapy, women are turning to vitamins, and other over-the-counter products for relief from hot flashes. This study was undertaken to assess the effect of vitamin E on hot flashes. Method: A placebo double blind-controlled trial was conducted. After 1 week baseline period, the enrolled patients (n = 51) received placebo (identical in appearance to vitamin E softgel) daily for 4 weeks, followed by 1 week wash out and 400 IU vitamin E (softgel cap) daily for the next 4 weeks. Diary was used to measure hot flashes before and at the end of the study. Result: There were statistical significant differences in hot flashes severity score (2.37 ± 0.74, 1.80 ± 0.87) and their daily frequency (5.00 ± 3.34, 3.19 ± 2.74) after the treatments between the placebo and vitamin E therapies (p < 0.0001). Conclusion: Based on our trial, vitamin E is recommended for the treatment of hot flashes.

A double-blind, randomized cross-over trial of venlafaxine versus clonidine to treat hot flashes in breast cancer patients

9083 Background: Breast cancer patients who become postmenopausal due to their treatment can experience more frequent and severe hot flashes than healthy postmenopausal women. Estrogens are considered to be contra-indicated. Venlafaxine and clonidine are both used to alleviate hot flashes, with different side effects. This study compared side effects, efficacy and patient preference. Methods: In a double-blind, cross-over study women &lt;60 years, with a history of breast cancer, and experiencing at least 14 hot flashes/week were randomized to receive venlafaxine 75 mg od (and placebo bid) for 8 weeks, followed by a 2 week wash-out period, and 8 weeks of clonidine 0.025 mg bid (and placebo od) or vice versa. Hot flash frequency and hot flash score (frequency × severity) were recorded in a diary and side effects were scored using a questionnaire during the 2nd and 8th week of both treatment periods, and these were compared to a baseline week. Results: Sixty patients were randomized to start with venlafaxine (n=30) and clonidine (n=30), 40 completed both treatment periods. Premature treatment discontinuation occurred in 15/59 patients during venlafaxine and in 5/53 during clonidine due to side effects (p&lt;0.05). The main side effects of venlafaxine were nausea and headache, and of clonidine dry mouth. In the 8th week of treatment women reported more loss of appetite (24% vs 4%; p=0.03) and improved sleeping (55% vs 75%; p=0.03) with venlafaxine. A =50% reduction in hot flash score was found in 21 (49%) and 26 (55%) of the patients with venlafaxine and clonidine respectively (ns). The decrease in hot flash score was most marked in the first treatment period. At study completion 20 (33%) of the patients chose to continue clonidine, and 17 (29%) preferred venlafaxine (ns), whereas 23 (38%) declined further treatment. Conclusions: Venlafaxine and clonidine are both moderately and equally effective in the reduction of hot flashes. Side effects are the main reason for discontinuation, occurring more often during treatment with venlafaxine. No significant financial relationships to disclose.

Symptoms during the Menopausal Transition and Early Postmenopause and Their Relation to Endocrine Levels over Time: Observations from the Seattle Midlife Women's Health Study

To determine whether hot flashes, depressed mood, sleep, cognitive and sexual symptoms correlate with urinary follicle-stimulating hormone (FSH), estrone (E(1)G), and testosterone (T) and with each other during the menopausal transition and early postmenopause (PM). Forty-one women who transitioned from middle or late transition stage to PM rated symptoms and provided monthly urine specimens as part of a longitudinal study of the menopausal transition. Correlations between endocrine levels and symptom severity ratings over time revealed that hot flash severity was significantly and positively related to FSH and negatively to E1 G. Vaginal dryness was positively correlated with FSH and negatively correlated with T. Decreased sexual desire was correlated negatively with E(1)G levels. Forgetfulness was positively correlated with FSH; difficulty concentrating was negatively correlated with T. Severity of sleep symptoms and depressed mood were not correlated with E(1)G, FSH, or T. Correlations among the symptoms revealed that severity of hot flashes was associated with sleep disruption and forgetfulness. Depressed mood was correlated with sleep disruption, difficulty concentrating, and decreased sexual desire but not with hot flashes or vaginal dryness. Awakening during the night was correlated with decreased sexual desire and vaginal dryness, as well as hot flashes. Forgetfulness was associated with hot flashes and difficulty concentrating, whereas difficulty concentrating was associated with depressed mood and early awakening. Symptoms many women experience during the menopausal transition and early PM are related to different endocrine levels (FSH, E(1)G, and T).