Menopause
HOT FLASH NEWS FLASH
(A summary of a statement from the North American Menopause
Society)
What is a hot flash/hot flush? Recurrent episodes of flushing,
perspiration, and a sensation ranging from warmth to intense
heat in the upper body and face.
“Night sweats” are hot flashes that occur with perspiration
during sleep.
How long will they last? They can start before noticing any
changes in your cycles and can last ten years or more. Some
women have them hourly, daily, weekly, monthly…and many women
notice more hot flashes during warm summer months.
What can I do to limit hot flashes?
There are several lifestyle
changes to make:
• Core body temperature: Hot flashes may be triggered by small
changes in core body temperature in symptomatic women. Using a
fan, dressing in layers, consuming cold/cool foods or drinks may
lower the frequency of hot flashes.
• Exercise: Active women report fewer hot flashes. Note that
strenuous exercise that can cause perspiration may also trigger
a hot flash.
• Body mass index: Maintaining a healthy body weight will lower
your core body temperature and reduce the number of not flashes.
• Smoking: Women who smoke report more hot flashes.
• Relaxation techniques: Paced respiration is a slow, controlled
breathing technique that may reduce a hot flash if performed
when the hot flash begins.
What about nonprescription remedies?
• Isoflavones, Phytoestrogens:
- Soy: 30-50% of caucasion women metabolize soy into the proper
protein (equol) to have any effect at all. An example of the
amount of soy needed to profound effects would be to eat 1.5
blocks of tofu a day.
- Red Clover: three randomized, controlled, double blinded
studies (really good studies) showed no benefit for hot flash
treatment. If anything, Promensil at 80mg/day for 8 weeks showed
a slight reduction in hot flashes.
-
Black cohosh:
- *Not known to be safe in breast cancer patients!
- There is some improvement of symptoms with 4mg twice daily for
3 months (Remifemin is the most studied form of black cohash).
-
DongQuai: Inconclusive data on effectiveness.
Evening primrose oil: no benefit over placebo in only one
randomized, double blinded, controlled study.
•
Ginseng: A randomized double blinded, controlled study shows no
benefit. There are case reports of women having bleeding
episodes with ginseng. Breast pain is also reported. Ginseng
should not be taken with certain anti-depressants (MAO
inhibitors), anticoagulants, or stimulants.
• Licorice: No clinical data regarding safety or efficacy for
treatment of hot flashes. Large continuous doses of licorice can
lead to other hormone conditions that result in high blood
pressure, swelling, and low potassium.
• Vitamin E: In 1953, a well controlled, double-blind study was
performed and showed no benefit. Vitamin E can lead to increased bleeding(not just vaginal) in women with low vitamin K. We
recommend women stop their vitamin E before surgical procedures.
• Topical progesterone: Diosgenin, the precursor of progesterone
found in plants (soy beans, wild yam) CANNOT be converted to
progesterone by the body. Most ‘natural’ creams are often
adulterated with progesterone.
• Nevertheless: a 1 year double-blind controlled study found
that ProGest (progesterone, vitaminE, and aloe vera) cream did
significantly reduce hot flashes by up to 83%.
• ProFeme (progesterone with vitamin E) showed no detectable
change in hot flashes.
• BioGest (Wild yam extract, vitaminE) showed no effect.
*The North American Menopause Society does NOT recommend use
of progesterone creams for treatment of hot flashes.
What about nonhormone prescriptions?
• Antidepressants: Certain antidepressants may decrease hot
flashes in women. Serotonin injected into the thermoneutral zone
in rate/guinea pigs show that it widens this zone. The wider the
thermoneutral zone, the fewer hot flashes noted. The FDA did not
approve the use of antidepressants for hot flashes because women
enrolled in preliminary studies didn’t have a high enough
baseline number of hot flashes.
• Venloafaxine(Effexor): an antidepression investigated for
menopause related hot flashes. A randomized, controlled,
double-blind study showed 37% reduction in hot flashes at a
lower dose (37.5mg) to 60% reduction on higher doses(75mg or
more).
-Side effects were mostly GI: 5-10% of women stopped using this
due to nausea/vomiting.
• Paroxetine: (Paxil) has been found to diminish hot flash
rates. At 12.5-25mg, hot flashes diminished by 62% by 6 weeks.
• Fluoxetine (Prozac, Sarafem): Approved by the FDA for PMS has
also been studied for hot flashes. A double-blind, controlled
study showed a 20% reduction in hot flashes.
• Gabapentin: An anticonvulsant studied for treatment of hot
flashes. Women using 900mg/day showed a reduction in hot flash
frequency by 45%. Dizziness and lightheadedness were the two
most common side effects. Seizure doses are up to 3000mg/day).
• Clonidine: Two randomized, controlled trials found a reduction
in hot flash frequency by 46%. Side effects/other effects of
this medication include lower blood pressure, changes in heart rhythmn, drowsiness, dry mouth, dizziness, constipation, and
sedation.
• Methyldopa: Two randomimzed, double-blinded, controlled trials
showed that there was a modest improvement of hot flashes. Doses
ranged from500 to 1000 mg/day. Effects/side effects include
lower blood pressure, hemolytic anemia, and liver disorders.
• Bellergal Spacetabs: There is only limited data to support
using this sedative.