Pathophysiology and Treatment of Menopausal Hot Flashes

Obstetrics and Gynecology, Wayne State University School of Medicine, C.S. Mott Center, 275 E. Hancock Avenue, Detroit, MI 48201, USA.
Seminars in Reproductive Medicine (Impact Factor: 2.35). 06/2005; 23(2):117-25. DOI: 10.1055/s-2005-869479
Source: PubMed


Hot flashes are the most common symptom of menopause. Although the appearance of hot flashes coincides with estrogen withdrawal, this does not entirely explain the phenomenon because estrogen levels do not differ between symptomatic and asymptomatic women. Luteinizing throughout? hormone pulses do not produce hot flashes nor do changes in endogenous opiates. Recent studies suggest that hot flashes are triggered by small elevations in core body temperature (T(c)) acting within a reduced thermoneutral zone in symptomatic postmenopausal women. This narrowing may be due to elevated central noradrenergic activation, a contention supported by observations that clonidine and some relaxation procedures ameliorate hot flashes. Because hot flashes are triggered by T(c) elevations, procedures to reduce T(c), such as lowering ambient temperature, are beneficial. Estrogen ameliorates hot flashes by increasing the T(c) sweating threshold, although the underlying mechanism is not known. Recent studies of hot flashes during sleep call into question their role in producing sleep disturbance.

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    • "The thermoneutral zone may narrow with increased sympathetic activity, as shown by studies in which relaxation exercises have resulted in decreased hot flushes (Freedman 1998, Freedman & Woodward 1992, Germaine & Freedman 1984, Irvin et al. 1996, Wijma et al. 1997). The mechanism underlying this relationship remains to be clarified (Freedman 2005). The observation that control of sympathetic activity can reduce hot flushes is interesting given the focus in Japan on the role of the autonomic nervous system in menopausal disorders (Lock 1993). "
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    ABSTRACT: Each menopausal body is the product of decades of physiological responses to an environment composed of cultural and biological factors. Anthropologists have documented population differences in reproductive endocrinology and developmental trajectories, and ethnic differences in hormones and symptoms at menopause demonstrate that this stage of life history is not exempt from this pattern. Antagonistic pleiotropy, in the form of constraints on the reproductive system, may explain the phenomenon of menopause in humans, optimizing the hormonal environment for reproduction earlier in the life course. Some menopausal symptoms may be side effects of modernizing lifestyle changes, representing discordance between our current lifestyles and genetic heritage. Further exploration of women's experience of menopause, as opposed to researcher-imposed definitions; macro- and microenvironmental factors, including diet and intestinal ecology; and folk etiologies involving the autonomic nervous system may lead to a deeper understanding of the complex biocultural mechanisms of menopause.
    Full-text · Article · Oct 2011 · Annual Review of Anthropology
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    • "Vasomotor flushes are among the most common complaints of women during and after the menopausal transition, affecting about 75 percent of this population.1,2,3 Episodes are characterized by a sudden sensation of intense heat, joined by skin flushing, profuse sweating, and possibly palpitations or anxiety.1,2 "
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    ABSTRACT: Vasomotor flushes are common complaints of women during and after menopause, affecting about 75 percent of this population. Estrogen therapy is the most effective treatment for hot flashes. However, there are a significant number of women who have contraindications or choose not to use estrogen due to potential risks such as breast cancer and thromboembolic disorders. These women need alternative options. The selective norepinephrine reuptake inhibitors, venlafaxine and desvenlafaxine, have shown efficacy in alleviating hot flashes. The purpose of this review is to assess the efficacy and tolerability of these two agents for treatment of hot flashes in healthy postmenopausal women. A literature search of the MEDLINE and Ovid databases from inception to June 2011 was conducted. Randomized controlled trials, published in English, with human participants were included. Studies included postmenopausal women, and trials with breast cancer only populations were excluded. Venlafaxine reduced hot flashes by 37 to 61 percent and desvenlafaxine by 55 to 69 percent. Both agents were well tolerated. The most common adverse effects were headache, dry mouth, nausea, insomnia, somnolence, and dizziness. Based on the evidence, venlafaxine and desvenlafaxine are both viable options for reducing the frequency and severity of hot flashes.
    Full-text · Article · Jul 2011
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    • "HF/NS are commonly described as sensations of intense heat, accompanied by sweating and sometimes shivering and palpitations [29] [43] [49]. The sensation of heat and consequent flushing of the skin typically occurs in the face, neck, and chest. "
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    ABSTRACT: Hot flushes and night sweats (HF/NS) are commonly experienced by mid-aged women during the menopause transition. They affect approximately 70% of women but are regarded as problematic for 15-20% largely due to physical discomfort, distress, social embarrassment, and sleep disturbance. There is a need for effective and acceptable nonmedical treatments for menopausal symptoms due to the declining use of hormone therapy (HT) following publication of the Women's Health Initiative and other prospective studies which associated HT use with increased risk of stroke and breast cancer. HF/NS are an example of a physiological process embedded within, and moderated by, psychological processes, as evidenced by discrepancies between subjective experiences and physiologically measured symptoms. We describe a cognitive model of menopausal hot flushes that can explain symptom perception, cognitive appraisal, and behavioral reactions to symptoms. Theoretically, the model draws on symptom perception theory, self-regulation theory, and cognitive behavioral theories. The model can be used to identify the variables to target in psychological interventions for HF/NS and to aid understanding of possible mediating factors. As part of Phase II intervention development, we describe a cognitive behavioral treatment which links the bio-psycho-social processes specified in the model to components of the intervention.
    Full-text · Article · Nov 2010 · Journal of psychosomatic research
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