For Many Women, Hot Flashes Continue 7 Years After Menopause

What You Need to Know: More than half of women experience menopause-relatedhot flashes and night sweats for 7 years or more.

The Evidence: Nancy Avis, PhD, a professor of social sciences and health policy at the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues collected data on 1,449 women who took part in the Study of Women’s Health Across the Nation (SWAN) from February 1996 through April 2013. All reported having frequent hot flashes and night sweats for at least 6 days in the past 2 weeks.

  • The researchers found that, on average, these symptoms lasted for 7.4 years, but in general, the earlier symptoms started, the longer they continued.
  • Those who had hot flashes and other menopausal symptoms before menopause suffered longest — 11.8 years was the midpoint for that group.
  • Women who underwent early menopause suffered symptoms for roughly 9.4 years.
  • Women whose hot flashes and night sweats started after menopause reported symptoms for 3.4 years on average.
  • Race and ethnicity seemed to have some bearing on symptom duration. Black women reported the longest duration of symptoms — 10.1 years. Japanese and Chinese women suffered the shortest length of time — 4.8 and 5.4 years, respectively. Among white women, 6.5 years was the midpoint, and among Hispanic women, it was 8.9 years.

My Take: Women today have more options for managing the symptoms of menopause. Continued research in this area holds promise for further advances that will guide future care of women experiencing hot flashes. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References:

  1. Avis NE et al. JAMA Intern Med. 2015;doi:10.1001/jamainternmed.2014.8063.
  2. Richard-Davis G, Manson J. JAMA Intern Med. 2015;doi:10.1001/jamainternmed.2014.8099.

Hot Flashes: What You Need to Know

I recently got several requests (from women suffering from hot flashes) to blog about possible remedies. Apologies for the blog length, but there is much to address.

What You Need to Know: No matter how disruptive and frustrating they may be, hot flashes are not a sign of a medical problem. They are a normal response to natural hormonal changes in your body. Hot flashes usually subside after the first or second year following menopause, when estrogen levels stabilize at a low level.

  • Tobacco use, heavy alcohol use, stress, spicy foods, and heat tend to make hot flashes worse. By avoiding these risk factors, exercising regularly, and eating well, you can prevent or reduce hot flashes.
  • The body-mind connection is a powerful element of hot flashes and emotional symptoms. Rhythmic breathing exercises (paced respiration), which help you meditate and relax, may reduce your hot flashes.
  • Background: Most women experience hot flashes at some point before or after menopause, when their estrogen levels are declining. While some women have few to no hot flashes, others have them numerous times each day. If hot flashes are disrupting your sleep or daily life, you are no doubt looking for relief. Fortunately, you have a number of self-care and medical treatment options that can help you manage your symptoms.

If you have experienced hot flashes, you’re already well aware that they are sudden sensations of intense body heat, often with heavy sweating and reddening of the head, neck, and chest or the entire body. At night, they commonly cause drenching “night sweats,” making them a cause of sleep problems for perimenopausal and postmenopausal women. During a typical hot flash, your skin temperature rises. Although you may feel very warm during a hot flash, because of the heat lost by your body’s cooling mechanism (perspiration), your body temperature may actually drop. Some women feel chilly after a hot flash, and some women feel the chill without the flash.

The biochemical cause of hot flashes is not well understood. But they are linked to declining estrogen levels, and they do seem to be made worse by stress, heavy alcohol use, and cigarette smoking. Although menopausal hot flashes can be disruptive, frustrating, and at times embarrassing, they are medically harmless. They are not a sign of a medical problem, nor do they cause medical problems.

It is normal for hot flashes to:

  • Happen in women of all ages when they are upset or embarrassed.
  • Happen during the perimenopausal years before menopause, when estrogen levels fluctuate. They are most common, most frequent, and most intense during the 2 years following menopause (postmenopause), when estrogen declines.
  • Be accompanied by mild to severe heart palpitations, anxiety, or irritability. In rare cases, panic attacks are triggered at the same time as hot flashes, usually in women who have a history of panic attacks.
  • Be especially severe in women who become menopausal from chemotherapy, antiestrogen treatment for breast cancer, or surgical removal of the ovaries.
    Subside within a couple of years after menopause. But some women do continue to have hot flashes for years after menopause. There is no reliable method for predicting whether, when, or how long you will have hot flashes.
  • Hot flashes are uncommon in various places around the world. More research is necessary before experts can identify specific factors about American women’s environment and lifestyle that make hot flashes a common problem.

Lifestyle choices for preventing or reducing hot flashes

  • Eat and drink well, and avoid smoking.
  • Limit your intake of alcohol.
  • Drink cold beverages rather than hot ones.
  • Eat smaller, more frequent meals to avoid the heat generated by digesting large amounts of food.
  • Make healthy eating a priority.
  • Do not smoke or use other forms of tobacco.
    Stay cool.
  • Keep your environment cool, or use a fan.
    Dress in layers, so you can remove clothes as needed.
    Wear natural fabrics, such as cotton and silk.
    Sleep with fewer blankets.
  • Reduce stress.
  • Get regular physical exercise.
  • Use relaxation techniques, such as breathing exercises, yoga, or biofeedback. Using a breathing-for-relaxation exercise called paced respiration may reduce hot flashes and emotional symptoms.

Medical treatment options for hot flashes

Short-term, low-dose hormone therapy (HT) can reduce or stop hot flashes and other perimenopausal symptoms by raising your body’s estrogen level. Use the lowest dose needed for the shortest possible time and have regular checkups. This is because HT may increase the risk of blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia in a small number of women. Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause. If you have a history of cardiovascular disease or breast cancer, avoid using estrogen for hot-flash relief—other options are available.

  • Estrogen-progestin birth control pills (before menopause) can reduce or stop hot flashes and other perimenopausal symptoms by evening out fluctuating hormones. Don’t use estrogen for hot-flash relief if you are older than 35 and smoke; have diabetes, cardiovascular disease, or breast cancer; or have a family history of breast cancer.
    Antidepressant medicine can reduce the number and severity of hot flashes by improving the brain’s use of serotonin, which helps regulate body temperature. Side effects are possible. This type of medicine is a good choice if hot flashes, irritability, or mood swings are your only perimenopausal symptom.
  • Clonidine may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent. This type of medicine is a good choice if hot flashes are your only perimenopausal symptom, especially if you have high blood pressure.
  • Gabapentin, an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes.
  • Black cohosh may reduce or prevent hot flashes, depression, and anxiety. As with HT, have regular checkups when taking black cohosh. The use of black cohosh during pregnancy has not been rigorously studied. Thus, it would be prudent for pregnant women not to take black cohosh unless they do so under the supervision of their health care provider. Women with breast cancer may want to avoid black cohosh until its effects on breast tissue are understood. In the United States, the U.S. Pharmacopeia (the standards-setting organization for foods and drugs) advises that black cohosh products be labeled with the following cautionary statement: “Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice.” Individuals with liver disorders should avoid black cohosh. Individuals who develop symptoms of liver trouble such as abdominal pain, dark urine, or jaundice while taking the supplement should discontinue use and contact their doctor.
  • Some women eat and drink a lot of soy to even out hot flashes and other perimenopausal symptoms. So far, studies have used many different soy sources and different measures of success, which are hard for experts to compare. Soy isoflavone (rather than soy protein) studies have shown the most promise for hot flash treatment.

I’m Dr. Michael Hunter. I hope that this post helps you.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: http://www.webmd.com/menopause/managing-hot-flashes#

Caffeine Worsens Hot Flashes

What You Need to Know: An association between caffeine intake and more bothersome hot flashes and night sweats in postmenopausal women has been made by researchers. Vasomotor symptoms (hot flashes and night sweats) are the most commonly reported menopausal symptoms, occurring in 79 percent of perimenopausal women and 65 percent of postmenopausal women. The study also shows an association between caffeine intake and fewer problems with mood, memory and concentration in perimenopausal women, possibly because caffeine is known to enhance arousal, mood and attention.

Background: Approximately 85 percent of the U.S. population consumes some form of caffeine-containing beverage daily. Vasomotor symptoms (hot flashes and night sweats) are the most commonly reported menopausal symptoms, occurring in 79 percent of perimenopausal women and 65 percent of postmenopausal women. Although it has long been believed that caffeine intake exacerbates menopausal vasomotor symptoms, research has challenged this assumption, as caffeine has been both positively and negatively linked to hot flashes.

The Study: Researchers conducted a survey using the Menopause Health Questionnaire, a comprehensive assessment of menopause-related health information that includes personal habits and ratings of menopausal symptom presence and severity. Questionnaires were completed by 2,507 consecutive women who presented with menopausal concerns at the Women’s Health Clinic at Mayo Clinic in Rochester between 2005 and 2011. Data from 1,806 women who met all inclusion criteria were analyzed. Menopausal symptom ratings were compared between caffeine users and nonusers.

“While these findings are preliminary, our study suggests that limiting caffeine intake may be useful for those postmenopausal women who have bothersome hot flashes and night sweats,” says Stephanie Faubion, M.D., director of the Women’s Health Clinic at Mayo Clinic in Rochester. “Menopause symptoms can be challenging but there are many management strategies to try.”

In addition,

  • Be aware of triggers such as spicy foods and hot beverages, heat, and stress.
  • In addition to caffeine, limit alcohol and tobacco.
  • Dress in layers, so you can remove a layer when you’re warm.
  • Consider products to stay cool at night such as wicking sheets and sleepwear, fans, and cooling pillows.
  • Try stress management strategies such as meditation, yoga, Tai Chi, acupuncture and massage.
  • Maintain a healthy weight, exercise regularly and stay active.
  • Talk with your provider about hormone therapy and non-hormonal prescription medications to alleviate symptoms.
  • Consider acupuncture

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Mayo Clinic. “Caffeine intake may worsen menopausal hot flashes, night sweats.” ScienceDaily. ScienceDaily, 23 July 2014. <www.sciencedaily.com/releases/2014/07/140723105945.htm>.

 

Curious About Menopause? Read This.

menopause woman sweats hot flashes

Summary: Vasomotor and vaginal symptoms are cardinal symptoms of menopause. Vasomotor symptoms can be particularly troubling to women and are the most commonly reported menopausal symptoms, with a reported prevalence of 50-82% among U.S. women who experience natural menopause (1, 2). The occurrence of vasomotor symptoms increases during the transition to menopause and peaks approximately 1 year after the final menstrual period (3-5).

Today’s New York Times has an interesting take on menopause. Here it is:

In the-better-late-than-never department, the American College of Obstetricians and Gynecologists has revised its guidelines for effective treatment of the symptoms of menopause. Published as a practice bulletin for doctors called “Management of Menopausal Symptoms,” the new guidelines recognize that up to three-fourths of women in the United States experience troublesome side effects when their bodies stop producing estrogen as a result of natural or medically induced menopause. The document addresses the most common distressing consequences: hot flushes and vaginal atrophy.

  • Hot flushes can last for months or even decades, but vaginal problems, if untreated, persist for the remainder of a woman’s life.
  • Hot flushes can cause drenching, sometimes embarrassing sweating, and seriously disrupt sleep night after night. Vaginal atrophy and the loss of lubrication and elasticity can make sexual encounters painful, depress libido and cause irritation and bleeding during exercise.

You might think the standard treatment would be to administer the hormones that menopausal women are losing. Indeed, supplementation with estrogen was a common practice for decades, and not just for curbing menopausal symptoms. Estrogen was widely promoted as a way to protect women’s health and to keep looking and feeling young well into old age.

But in 2002, a large clinical trial called the Women’s Health Initiative found that the most popular form of hormone replacement, a pill that combined estrogen and synthetic progesterone called Prempro, increased a woman’s risk of heart disease, breast cancer, stroke and blood clots .

The highly publicized results tainted hormone therapy with a broad brush. Although the Women’s Health Initiative was designed primarily to test the popular premise that hormone replacement after menopause protected women’s hearts, the unexpected findings prompted millions of middle-aged and older women to stop using the hormones and kept many millions more from starting them. Even though the vast majority of the 16,608 participants in the study were older women well past menopause, the findings were widely interpreted to apply to all women going through menopause, even younger women just approaching the end of their fertile years.

Somewhat frenetic experimentation ensued as physicians, drug companies and women themselves searched for effective alternatives to hormone replacement. Various nonhormonal remedies were promoted, from soy foods and black cohosh to exercise and acupuncture. Each had its advocates, but all lacked rigorous scientific evidence for effectiveness.

Those promoting soy-based foods and supplements, for example, cited the low reported rates of menopausal symptoms among Asian women, whose diets are especially rich in soy, which has estrogenic effects. An authoritative review of placebo-controlled studies of plant-based estrogens, however, found no convincing evidence that they were helpful in curbing menopausal hot flushes. (One exception was genistein, a substance in soy, which the researchers said warranted further study.)

The new bulletin, prepared by Dr. Clarisa R. Gracia, an associate professor of obstetrics and gynecology at the University of Pennsylvania, examines the various claims and scores of studies. It offers treatment recommendations based on the best available evidence for preserving the health and well-being of women experiencing menopausal symptoms.

In an interview, Dr. Gracia acknowledged that “there’s a strong placebo effect” when women try one or another suggested remedy for menopausal distress. She admitted that “it’s all for the better” if an innocuous placebo, like a food or supplement, brings relief to some women.

But most women do best when their physicians offer remedies that have been shown to be effective in well-designed studies. And as you might guess, estrogen alone, or in combination with a natural or synthetic progesterone (progestin) for women who still have a uterus, is the “most effective therapy” for curbing hot flushes, the report found.

  • Data do not support the use of progestin-only medications, testosterone or compounded bioidentical hormones,” the report also said.
  • Estrogen with or without progestin can be administered orally or through the skin with a patch, gel or spray. The transdermal route is considered safer: When absorbed through the skin, the hormones bypass the liver, which would otherwise create substances that might raise the risk of heart attack or cancer.
  • The report emphasizes that treatment with hormones must be individualized and that doctors should prescribe the lowest effective dose for the shortest time needed to relieve hot flushes. But because some women may need hormone therapy to control hot flushes even in their Medicare years, the guidelines recommend “against routine discontinuation of systemic estrogen at age 65.”
  • Hormone replacement can be risky for some women, especially those who have had breast cancer. Alternatives that have proved helpful include low doses of antidepressants known as selective serotonin reuptake inhibitors (S.S.R.I.’s), like Paxil, and serotonin-norepinephrine reuptake inhibitors (S.N.R.I.’s), like Pristiq. Clonidine, a blood pressure medication, and gabapentin, an anticonvulsant, may also be helpful, though neither is approved by the Food and Drug Administration for menopausal treatment.
  • The report found little or no data to support the use of herbal remedies, vitamins, phytoestrogens (like isoflavones, soy and red clover) or acupuncture to relieve hot flushes. It did recommend “common sense lifestyle solutions” like dressing in layers, lowering room temperatures, consuming cool drinks, and avoiding alcohol and caffeine. For overweight and obese women, weight loss can also help.
  • As with hot flushes, vaginal symptoms respond best to estrogen therapy, which can be administered through the mouth or skin or locally via a cream, tablet or ring. Even a low-dose vaginal tablet containing 10 micrograms of estradiol improves symptoms, the report noted.
  • Low-dose vaginal treatments are administered daily for a week or two at first, then once or twice a week indefinitely as maintenance therapy.

Because small amounts of estrogen used vaginally can enter general circulation, women who have had hormone-sensitive breast cancer are advised to try nonhormonal remedies first.

Many women experience relief of symptoms with lubricants and moisturizers prepared with water or silicone. Lubricants, applied just before intercourse, can reduce friction and pain caused by dryness. Moisturizers are used routinely to relieve dryness, itching, irritation and pain, and to improve elasticity.

Last year, the Food and Drug Administration approved Osphena (ospemifene) to treat vaginal atrophy related to menopause. The drug, taken orally once a day, is a selective estrogen receptor modulator that has estrogenlike effects in the vagina. But Osphena, too, can promote endometrial growth. It is not recommended for women who have had breast cancer, and it is not intended for long-term use.

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Yoga in Menopause May Help Insomnia – But Not Hot Flashes

yoga lotus meditationWhat You Need to Know: Taking a 12-week yoga class and practicing at home was linked to less insomnia, but not to fewer or less bothersome hot flashes or night sweats. This association of yoga and better sleep was the only statistically significant finding in the MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Network randomized controlled trial.

Background: Hormone therapy is the only treatment approved by the US Food and Drug Administration for the management of hot flashes and night sweats, and fewer women are opting for hormone therapy recently. In this context, the MsFLASH tried to see whether three more natural approaches – yoga, exercise, or fish oil – might help. The study assigned 249 healthy, previously sedentary women at multiple sites (including Group Health Medical Center, USA) to do yoga, a moderate aerobic exercise program, or neither – and to take an omega-3 fatty acid supplement or a placebo.

The Results: Exercise slightly improved sleep and (to a lesser degree) insomnia and depression, but these effects were not statistically significant. The omega-3 fatty acid did not help with any of the symptoms under study. Yoga was linked to better sleep.

I’m Dr. Michael Hunter, and (even though I am not menopausal), I really should think about doing yoga for health!

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Newton KM, et al. Efficacy of yoga for vasomotor symptoms: a randomized controlled trial. Menopause, September 2013.

Hot Flashes: Management Options

Full of Soy Lunch
Full of Soy Lunch (Photo credit: Bunches and Bits {Karina})

Long blog warning: I wish I could be more like the Dadaist Marcel Duchamp, who once offered: I shall be so brief that I am now done!

There are a wide variety of options for those with hot flashes. These may be conveniently divided into pharmaceuticals, neutraceuticals, surgical ones (stellate ganglion blacked). Complementary/behavioral therapies include acupuncture, exercise, yoga, and others. In today’s blog, we will look at neutraceuticals. Neutraceuticals include herbal remedies, vitamins, and phytoestrogens.

Herbals: Black cohosh is an herb made from a North American perennial plant, and has been well-studied among women with menopausal symptoms (bit not for men with prostate cancer). Black cohosh is not estrogenic, instead acting on serotonin receptors. A study of studies (meta-analysis) showed that in 6 of 9 randomized trials, black cohosh as the potential to reduce hot flashes. But, more recent trials show no effectiveness among women without cancer. Potential side effects include mild gastrointestinal upset, headaches, vomiting, and dizziness at higher doses.

St. John’s Wort is a perennial herb from Europe, and has been reported to have anti-depressant properties. Most of the studies regarding hot flashes have been limited to women experiencing natural or surgical menopause. The data is mixed on its efficacy. Because it can activate certain enzymes (called cytochrome P450 enzymes), you must check with your health care provider before taking it.

Vitamins: Vitamin E has been investigated for hot flashes: There have been 3 randomized trials, and to me it seems that vitamin E has minimal efficacy. It appears to reduce the number of hot flashes per day by only 1 to 2. A study of studies (meta-analysis) of 57 trials showed no relationship between death rates (all-cause mortality) and vitamin E. Those with heart disease, diabetes, and high blood pressure should take heed. And there is some concern about a possible increase in cancer incidence. Multivitamins with minerals may help hot flashes improve for a few months, but the advantage over placebo disappears by the 3 month mark. Folic acid is under investigation, but there are some hints that it may reduce hot flashes by reducing levels of a byproduct of norepinephrine.

Phytoestrogens: Soy products have been analyzed in a meta-analysis of 19 randomized controlled trials of soy isoflavones. Soy did appear to reduce hot flashes, when compared to a placebo. The median dose across the studies was 54 mg. The effects on men are not clear, but at least one report has not shown a benefit among men with prostate cancer. And the safety for men has not been established.

Similar to soy, red clover results have not been especially impressive. A recent randomized trial of black cohosh, red clover, placebo, and hormone therapy showed red clover didn’t work (at a dose of 398 mg per day). Among men, it has not been well-studied. Flax seed is a rich source of lignans. Three randomized trials have shown no benefit for hot flashes (women). It has not been well-investigated among men.

My take: For these interventions, differences in information about product purity, dosing, and side effects makes comparisons across studies difficult. Unfortunately, there is a lack of standardization (the US Food and Drug Administration) has minimal oversight. Multivitamins with minerals may temporarily improve symptoms, and soy seems to have some activity against hot flashes in women. For many, neutraceutical do not have the desired reduction in hot flash frequency or severity. Next, we’ll turn to surgical therapies such as a stellate ganglion block. Hint: It may work(!), but the data is limited.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. All can be found at the Apple Ibooks store. Thank you.

Reference: Fisher WI et al. CA: A Journal for Clinicians, vol 63 (3).

Hot Flashes: Physiology

hot flashes

Don’t blame the messenger! The physiological mechanisms of hot flashes are unknown. However, we have some clues that they are linked to 1) thermoregulatory disruption; and 2) neurochemical disruption.

Thermoregulatory Disruption: Hot flashes have been described to be an exaggerated response to changes in the thermoregulatory system. What does that mean? Thermoregulation maintains your body temperature. Did you know that the threshold point between sweating and shivering can occur with a 0.4 degree (C) change in internal temperature: Sweating happens at higher-than threshold temperatures, with shivering at lower temperatures. In individuals with hot flashes, this thermoregulatory system is disrupted. This disruption may be due to changes in neurochemicals such as estrogen, norepinephrine, serotonin, glucose, and others.

Neurochemical Disruption: Estrogen is a strong suspect neurochemical linked to hot flashes. Unfortunately, while estrogen is the most effective drug intervention for hot flashes, we cannot offer it is your cancer is hormone-dependent. Estrogen appears to stabilize thermoregulatory disruption. It may reduce spontaneous fluctuations in core boy temperature after ovary removal. Estrogen therapy raises the sweating threshold.

But could it be that estrogen works via other chemicals? For example, changes in estrogen levels alter levels of the brain chemicals norepinephrine and serotonin. Drugs (such as clonidine) that activate norepinephrine can alleviate hot flashes. Drugs (such as  yohimbine) that block norepinephrine can exacerbate the symptoms. Around menopause, serotonin levels are positively correlated to hot flashes. Low blood sugar levels (hypoglycemia) may trigger hot flashes. Eating may provide an average of 90 minutes free from hot flashes.

We will turn to the management of hot flashes in the next blog. Thanks for hanging in there through the biochemistry-speak! I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Coming Soon for iPad  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Thank you.

Reference: Fisher WI et al. CA: A Journal for Clinicians, vol 63 (3).