Hot Flash Symptoms Research Articles

Do Soy Isoflavones Cause Endometrial Hyperplasia?

For many years, hormone replacement therapy (HRT) was considered the gold standard for the symptomatic treatment of menopause. Clinical trials have found that HRT reduces the symptoms of hot flashes and sweating, while also decreasing vaginal dryness and urinary tract infections. HRT has also been shown to be protective against colon cancer (37%) and hip fractures (34%). However, recent findings from the Women's Health Initiative (WHI) have revealed that long-term HRT may actually lead to an increase in heart disease (29%), breast cancer (26%) and other adverse events, such as stroke (41%). Consequently, many women in the United States and abroad are actively looking for alternative treatments for menopause, including botanical dietary supplements.

National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms

National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms

Clonidine vs. venlafaxine as treatment for hot flashes in breast cancer patients: A double-blind randomised study

8038 Background: Breast cancer patients are more susceptible to severe hot flashes due to the cytotoxic and endocrine treatment. This is one of the unsolved problems in cancer treatment because classical hormone replacement therapy is contraindicated in breast cancer especially in endocrine responsive disease. Patients and Methods: In a double blind, randomised phase III study 80 consecutive breast cancer patients (pts) who had hot flashes at least twice a day, and were not taking any medication against hypertension and depressions received either clonidine 0.075mg b.d. or venlafaxine 37.5mg b.d for four weeks. The primary endpoint is defined as frequency of hot flashes at week 5. The sample size in each group is 35 with alpha 0.1, one-sided significance level and 80% power. The null-hypothesis is defined as no difference between the groups, and the alternative hypothesis assumes a difference of 20%. A self reported one week hot flash and other symptom questionnaire was kept prior to the start of treatmen...

Medroxyprogesterone acetate (MPA) versus venlafaxine for hot flashes: A North Central Cancer Treatment Group trial

8014 Background: Hot flashes are a prominent symptom in breast cancer survivors. Available data demonstrate that both venlafaxine and progestational agents substantially decrease hot flashes. This trial was developed to compare these two agents. Methods: 227 women, reporting at least 14 hot flashes/wk were randomized to venlafaxine (37.5 mg/day for a wk, then 75 mg/d, 109 pts) versus MPA (400 mg IM, 109 pts) versus MPA (500 mg IM q 2 w for 3 doses, 9 pts, arm closed early due to slow initial study accrual), after being stratified for age, tamoxifen use, raloxifene use, and the duration and frequency of hot flash symptoms. Assuming 109 pts per each of the 2 main study arms, this study had 90% power to detect a difference between the two treatments of 1 hot flash per day, or a drop of 16% from baseline, with a 5% Type I error. Results: At this time, data are reported for 185 evaluable pts (81%). All examined pretreatment factors were equally balanced between the two major treatment groups. 90% of participants reported ≥ 4 hot flashes/d while 35% reported ≥ 10 hot flashes/d. At wk 7 (compared to the baseline wk) pts on 400 mg/d MPA, vs those on venlafaxine, had greater reductions in median hot flash frequencies (85% vs 52% reduction, p<0.0001) and reductions in median hot flash scores (88% vs 57% reduction, p<0.0001). 24% of MPA (400 mg/d) pts reported no hot flashes at wk 7, compared to 1% of venlafaxine pts (p<0.0001). Pts on 400 mg/d MPA had less trouble sleeping (p=0.04), less sleepiness (p=0.01), less constipation (p<0.0001), less abnormal sweating (p=0.0001), and less hot flash distress (p<0.0001). Pts on venlafaxine had trends for less trouble with “controlling their feelings” (p=0.06), less “feeling tense” (p=0.07), and less “stress” (p=0.08). Conclusion: A single dose of MPA is well tolerated and relieves hot flashes better than does venlafaxine. No significant financial relationships to disclose.

Vasomotor symptom prevalence and language of menopause in Japan.

Objective: To characterize the prevalence of vasomotor symptoms affecting menopausal women in Japan, the relationship between vasomotor symptoms and menopause status as defined by menstrual patterns versus self-assigned konenki (climacteric) status, and the salience and specificity of hot flash terminology. Design: Participants were healthy Japanese women, aged 45 to 55 years, living in Kyoto and Fukushima prefectures, divided into menopause groups based on menstrual patterns and self-assigned konenki groups. Women recalled 82 general health symptoms during the previous 2 weeks, and provided detailed descriptions of hot flash symptom terms. Results: Hot flash prevalence ranged from 3.0% (hotto furasshu) to 17.1% (hoteri) depending on the individual term used, and was 22.1% when all hot flash terms were combined. Prevalence of vasomotor symptoms was 25.7%, but peaked at 52.6% among late perimenopausal women. Hot flash prevalence was 13.2% among premenopausal women, but zero among self-assigned pre-konenki women. The three major hot flash terms (kaa, nobose, and hoteri) vary in their physical location, characteristics, and cultural salience. Conclusions: Vasomotor symptom prevalence rates in Japan have increased over the past 20 years but are still lower than in most Western populations, and vary according to hot flash term, and between menopause and self-assigned konenki status. Konenki status appears to be a better predictor of hot flashes than menopause status. Japanese women's language, including self-assessed konenki stage and hot flash terminology, seems to be more fine-grained than Western biomedical terms of menopause status and hot flash, and may offer insight into subtle differences in experiences and underlying physiology of menopause.

Vasomotor symptom prevalence and language of menopause in Japan*

To characterize the prevalence of vasomotor symptoms affecting menopausal women in Japan, the relationship between vasomotor symptoms and menopause status as defined by menstrual patterns versus self-assigned kōnenki (climacteric) status, and the salience and specificity of hot flash terminology. Participants were healthy Japanese women, aged 45 to 55 years, living in Kyoto and Fukushima prefectures, divided into menopause groups based on menstrual patterns and self-assigned kōnenki groups. Women recalled 82 general health symptoms during the previous 2 weeks, and provided detailed descriptions of hot flash symptom terms. Hot flash prevalence ranged from 3.0% (hotto furasshu) to 17.1% (hoteri) depending on the individual term used, and was 22.1% when all hot flash terms were combined. Prevalence of vasomotor symptoms was 25.7%, but peaked at 52.6% among late perimenopausal women. Hot flash prevalence was 13.2% among premenopausal women, but zero among self-assigned pre-kōnenki women. The three major hot flash terms (kaa, nobose, and hoteri) vary in their physical location, characteristics, and cultural salience. Vasomotor symptom prevalence rates in Japan have increased over the past 20 years but are still lower than in most Western populations, and vary according to hot flash term, and between menopause and self-assigned kōnenki status. Kōnenki status appears to be a better predictor of hot flashes than menopause status. Japanese women's language, including self-assessed kōnenki stage and hot flash terminology, seems to be more fine-grained than Western biomedical terms of menopause status and hot flash, and may offer insight into subtle differences in experiences and underlying physiology of menopause.

Integrative Therapies for Menopause

Menopause is a transitional time for women. This gives practitioners an opportunity to focus on recommending healthy life-style changes. Hormone replacement therapy (HRT) has been the mainstay of therapy for menopausal symptoms. With recent research findings, women and their physicians are seeking alternatives that do not carry the risks associated with HRT. Exercise has been shown to help some women with symptoms of hot flashes, as have relaxation techniques and deep breathing. Dietary changes to incorporate whole foods and soy are thought by some to help with menopausal symptoms, and are recommended because of a positive impact on heart disease and obesity; soy isoflavones may also help with menopausal symptoms. Botanicals such as black cohosh and red clover have been shown in some studies to decrease severity and frequency of hot flashes. We recommend that HRT be prescribed when other measures have failed to adequately control symptoms. Bioidentical hormones are preferred in our practice.

The effects of drugs on thermoregulation.

Body temperature is a balance of the hypothalamic set point, neurotransmitter action, generation of body heat, and dissipation of heat. Drugs affect body temperature by different mechanisms. Antipyretics lower body temperature when the body's thermoregulatory set point has been raised by endogenous or exogenous pyrogens. The use of antipyretics may be unnecessary or may interfere with the body's resistance to infection, mask an important sign of illness, or cause adverse drug effects. Drugs may cause increased body temperature in five ways: altered thermoregulatory mechanisms, drug administration-related fever, fever from the pharmacologic action of the drug, idiosyncratic reactions, and hypersensitivity reactions. Certain drugs cause hypothermia by depression of the thermoregulatory set point or prevention of heat conservation. By affecting the balance of thermoregulatory neurotransmitters, drugs may prevent the signs and symptoms of hot flashes.

Paroxetine controlled release was effective and tolerable for treating menopausal hot flash symptoms in women

Paroxetine controlled release was effective and tolerable for treating menopausal hot flash symptoms in women

Treating hot flashes in breast cancer survivors: a review of alternative treatments to hormone replacement therapy.

As the number of breast cancer survivors continues to grow, factors associated with quality of life are receiving increased clinical and research attention. This attention is imperative given the aftermath of psychological and physiologic side effects that commonly result from a cancer diagnosis and cancer-related treatments, including menopausal symptoms. Hot flashes, the most prevalent of these symptoms, have been shown to significantly decrease quality of life in women. Although manageable with hormone replacement therapy (HRT), hot flashes often are especially problematic in breast cancer survivors, a population that typically is not treated with HRT because of controversial evidence of a relationship among estrogen and/or progesterone and breast cancer recurrence and mortality. Furthermore, hot flashes commonly are more severe in premenopausal women who experience acute menopause as a result of chemotherapy treatment. In recent years, several treatment alternatives to HRT have been investigated. Given the significant number of women affected by breast cancer and the negative impact that hot flashes can have on their quality of life, this article reviews alternatives to HRT for reducing hot flash symptoms in breast cancer survivors.

Menopausal hormone therapy informed consent

A little over a year ago now, the large hormone therapy clinical trial of the Women’s Health Initiative came to an abrupt halt. The publication of the results rocked the medical community and our patients because a class of drugs once thought to be associated overwhelmingly with benefit was found to cause more harm than good. Now doctors have the dilemma of how to inform patients of the results of the Women’s Health Initiative in a way that will help them make the best decision for themselves of whether they should use of these agents for hot flashes, night sweats, vaginal dryness, or prevention of osteoporosis. In the thousands of daily conversations on this topic, the scenario used to look like this: The patient came to the office asking questions about menopause. When the practitioner determined the patient was going through the menopausal transition, the doctor wrote a prescription for hormone pills or patches, saying they would address her concerns by replacing the hormones her body used to make. They would abolish her hot flashes, slow her bone loss, and reduce her risk of a heart attack. The patient asked if the pills caused breast cancer. Probably in some women, the doctor would acknowledge, but argued that the benefits to the heart and bones were worth taking the chance. Now the patient comes to the office and asks about the confusing information she has been reading on the increased risk of heart attack, strokes, blood clots, and dementia with hormone use. The doctor acknowledges the information has changed and is very important, but the decision to use or not to use hormones is up to her. She has menopausal symptoms and wants a solution. However, she is looking for something safe that does not cause more problems than it solves.

Hot flashes in breast cancer survivors.

Hot flashes can be a major problem for patients with a history of breast cancer. The precipitation of menopause in premenopausal women who undergo chemotherapy for breast cancer can lead to the rapid onset of hot flash symptoms that are more frequent and more severe than those associated with natural menopause. In addition, tamoxifen, historically the most commonly prescribed pharmacologic agent for the treatment of breast cancer, is associated with hot flashes in more than 50% of its users. Although estrogen relieves hot flashes in 80-90% of women who initiate treatment, its use in women with a history of breast cancer is controversial, and most physicians in the community will not use this treatment modality. In addition, the results of the long-awaited Women's Health Initiative study and other recent studies suggest that long-term estrogen therapy should not be recommended for most women for a variety of reasons. However, hot flashes in breast cancer survivors should no longer be considered untreatable, as there are many pharmacologic and nonpharmacologic treatments that can help alleviate this problem. This article reviews the current strategies for the management of hot flashes in breast cancer survivors and the evidence supporting their use.

The use of estrogen in older women

The menopause is associated with a relatively abrupt decline in the ovarian production of estrogen that results in a state of estrogen deficiency. This estrogen deficiency state is associated with an accelerated expression of cardiovascular disease, osteoporosis, urogenital atrophy, dermal aging, an increased expression of colorectal cancer, an alteration in the expression of breast cancer that results in more malignant forms of the disease, and the loss of neurons from the brain that is associated with a more rapid decline in cognitive function, balance, and an earlier expression of Alzheimer's disease. Macular degeneration and cataract formation may be additional consequences of the estrogen deficiency state. Thus the estrogen deficiency state may be characterized as a state of accelerated aging. The abrupt transition from the reproductive state of multiple estrogen-dependent neural systems within the brain may affect their function as manifested by the typical menopausal symptoms of hot flashes, mood changes, sleep disturbance, and cognitive impairment. This transition may trigger a cascade of events that contributes to the acceleration of brain aging and the expression of neurodegenerative processes as Alzheimer's disease. This article discusses the use of estrogen to prevent these age-related changes.

Mind control of menopause

The primary objective of this study was to observe the effect of hypnosis on hot flashes (HF) and overall quality of life in symptomatic patients. A secondary objective was to observe the effect of hypnosis on fatigue. Ten healthy volunteers and four breast cancer patients (total 14 patients) with symptoms of HF were treated with four, 1 h/wk sessions of hypnosis. The same physician, with the help of a nurse, conducted every session. All subjects recorded frequency, duration, and severity of HF in a HF diary. The QLQ-C30 and Brief Fatigue Inventory forms were used to assess the impact on quality of life and fatigue, respectively. The statistical evaluations were performed, including analysis of variance and nonparametric procedures. The frequency ( p < 0.0001), duration ( p < 0.0001), and severity ( p < 0.0001) of HF were significantly reduced. The overall quality of life was also improved ( p = 0.05). The subjects enjoyed better sleep and had less insomnia ( p = 0.012). There was a significant improvement on current fatigue level ( p = 0.017), but we did not find a statistically significant reduction in the total fatigue level. We conclude that hypnosis appears to be a feasible and promising intervention for HF, with a potential to improve quality of life and insomnia. Although improvement in current level of fatigue was observed in this pilot study, total fatigue improvement did not reach statistical significance.

Is this woman perimenopausal?

Perimenopause is a time of transition for women at midlife. Women want to know whether they are starting this change and physicians need to know the accuracy of a clinical examination in identifying perimenopausal women. These women should be counseled about alleviating climacteric symptoms, using contraception, and preventing diseases such as osteoporosis. To systematically review the accuracy of self-assessment, symptoms, signs, and laboratory tests in diagnosing women in perimenopause. English-language articles that presented data relevant to diagnosis of perimenopause were identified in a MEDLINE search from 1966 to 2001. References of these articles and other publications also were reviewed. Cross-sectional or longitudinal studies of women aged 40 years or older that used the definition of perimenopause as 3 to 11 months of amenorrhea or irregular periods, included a premenopausal control group, and reported a clinical examination finding. Of 1246 articles identified, 16 studies were included in the analysis. Two authors independently reviewed articles for quality (L.A.B. and C.M.S.). Discrepancies were resolved by a third author (K.N.). The prior probability of perimenopause is directly related to a woman's age. After considering age, the following yielded the greatest positive likelihood ratios (LRs+): self assessment of going through the transition (LR+ range, 1.53-2.13), symptoms of hot flashes (LR+ range, 2.15-4.06), night sweats (LR+ 1.90; 95% confidence interval [CI], 1.63-2.21), vaginal dryness (LR+ range, 1.48-3.79), high follicle-stimulating hormone levels (LR+ 3.06; 95% CI, 2.06-4.54), and low inhibin B levels (LR+ 2.05; 95% CI, 0.96-4.39). Self-assessment of perimenopausal status had the smallest negative LR (range, 0.18-0.36). No one symptom or test is accurate enough by itself to rule in or rule out perimenopause. Clinicians should diagnose perimenopause based on menstrual history and age without relying on laboratory test results.

Antidepressants Reduce Hot Flashes, May Be Estrogen Alternative

Antidepressants Reduce Hot Flashes, May Be Estrogen Alternative

Menopausal experiences and bone density of Mayan women in Yucatan, Mexico.

This cross-sectional study reports on the menopausal transition of Mayan women from Yucatan, Mexico. A total of 228 women completed the study, and 118 women were classified by history as postmenopausal; the others were premenopausal. Demographic information, reproductive history, physical examination, hormone concentrations, radial bone density, food samples, and history of physical activity were obtained. The average age at which menopause occurred by history was 44.3 +/- 4.4 years; this is reflected in the distribution of FSH levels by age. None of the women reported symptoms of hot flashes, and none recalled any history of significant symptoms associated with their menopausal transition. Hormone levels were similar to U.S. reference values with elevated FSH (66.6 +/- 29.1 mIU/ml), low estradiol (9.4 +/- 8.3 pg/ml) and estrone (13.3 +/- 7.8 pg/ml), E1 > E2, and normal levels of testosterone and androstenedione. BMD declined with age, and values were lower than reference values for United States women. Clinical evidence of fracture was not detected by history or physical examination even for those who were 20 years postmenopausal. The endocrine characteristics of menopause among Mayan women in Yucatan are similar to hormonal changes reported for women in the United States, but signs, symptoms, and apparent consequences are different in the two populations.

Menopausal age of Ghanaian women

OBJECTIVE: The purpose of the study was to determine the age of menopause among Ghanaian women. METHOD: A prospective survey involving 152 women in Akosombo District in Ghana was conducted. A questionnaire was developed including: age at menopause, symptoms of hot flushes or flashes, palpitations, anxiety, sleeplessness, headaches, frequency of urine, depression, irritability, tiredness, weight gain, poor memory and attitudes to coitus. RESULT: of 152 women interviewed, 29 were excluded because they were not sure of their birth dates and 123 women were analyzed. The mean and median ages at menopause were 48.05 years ± 3.62 S.D. and 48 years respectively. The major symptoms at menopause were tiredness 79.9%, sleeplessness 71.0%, palpitations 63.7%, weight gain 61.8%, hot flushes 56.5%, and irritability 56.5%. However, 85.6% of the women who experienced hot flushes reported this to be the most unpleasant. CONCLUSION: 1. The age at menopause in Ghanaian population was 48.05 ± 3.62. 2. Tiredness, sleeplessness, palpitations, weight gain, hot flushes, irritability, anxiety and headache were the major symptoms at menopause. 3. Hot flushes or flashes was the most disturbing symptom at menopause.

Use of Clonidine to Treat Hot Flashes Secondary to Leuprolide or Goserelin

To determine the effects of clonidine, a centrally acting adrenergic agonist, in abating symptoms of hot flashes in men receiving either leuprolide or goserelin for prostate cancer. Patients were administered transdermal or oral clonidine 0.1-0.2 mg/d. Dosages were increased in increments of 0.1-0.3 mg/d every two to four weeks if symptoms persisted or until adverse effects developed. Medical oncology clinic at the University of Illinois and the hypertension clinic at the Veterans Affairs West Side Medical Center. Consenting male patients were eligible for the study if they were receiving leuprolide or goserelin for prostate cancer and were experiencing hot flashes. Exclusion criteria included diastolic blood pressure of 75 mm Hg or below or a history of adverse reactions to clonidine. Effectiveness of clonidine was determined by questioning patients about frequency, severity, and duration of hot flashes at baseline and at two- to four-week intervals. All four patients receiving clonidine experienced a partial response within two weeks of starting treatment. No dose-dependent response was observed. Adverse effects were noted in one patient but did not result in discontinuation. Our results document the first report of the use of clonidine to treat hot flashes secondary to leuprolide or goserelin therapy. Symptomatic improvement was noted in all four patients. Further evaluation of clonidine as well as other centrally acting adrenergic agonists is needed.

Sleep patterns and stability in perimenopausal women.

Women between the ages of 40 and 59 years were classified as pre-, peri-, and postmenopausal, with and without hot flash symptoms, for comparison of somnographic sleep variables. Few differences in sleep variables were noted between the groups. However, peri- and postmenopausal women experiencing hot flashes (symptomatic) tended to have lower sleep efficiencies than those not experiencing hot flashes. As well, rapid-eye-movement (REM) latency was longer (p less than 0.05) in the symptomatic women (means = 94.2 min) than in the nonsymptomatic women (means = 71.4 min). Although an age difference existed between the menopausal status groups, it was less than a decade and a main group effect for sleep efficiency and REM latency was seen while controlling for age and/or depression.