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Cooling down the Hot flushes /flashes
Treatment options
Dr. Kawita Bapat
Cooling down the Hot flushes
/flashes
HOT FLASES /FLUSHES
Whatever the cause, the effects can include a rise in skin temperature in the cheeks, forehead, upper arms, chest, abdomen, back, calves, thighs and fingers
with increased blood flow in the hands, calves, and forearms.
The increase in heat causes blood vessels just under the skin surface to dilate - get bigger - resulting in the classic florid cheek look associated with hot flushes.
Hot flushes
Sensation of intense heat, sweating, flushing,
Lasts for five to 10 min
Main reason to seek medical help for the menopause
Ahead of night sweats and mood and sleep disturbances.
thermostat — the hypothalamus. at the
base of brain regulates body temperature and other basic processes.
Levels of Estrogen fall brain gets the
‘wrong message’ thinks that the
body is too hot, creating measures such as sweating
and heat loss (through the skin) to try to cool down the inside of the
body.
horrible experience of waking up at
night drenched in sweat
extremely uncomfortable embarrassing lasting from 3 to 5 min many times a day can last for years through the menopausal transition.
menopause is inevitable the mind also has a major influence over the body and can be hypnotically trained to cool down hot flashes.
Hot Flash RatesMenstrual Status % Reporting Hot FlashesPremenopausal* ~10%Perimenopausal† ~30% to 85%Recently postmenopausal
~20% to 90%
4 years postmenopause
~20% to 60%
* Menstruation within the 3 prior months with no change in regularity of cycle.†3 to 11 months of amenorrhea or increased menstrual irregularity.1. McKinlay SM et al. Maturitas. 1992;14:103-115.2. Kronenberg F. Ann N Y Acad Sci. 1990:592:52-86.3. Nachtigall LE. Clin Obstet Gynecol. 1998;41:921-927
TREATMENT OPTION
What works, what might, and what doesn't
Hormone therapy Trials show it is effective According to a report from Thomas
Jefferson University, an analysis of 24 trials, which included 3,329 women, showed a 75.3 per cent drop in the frequency of hot flushes experienced each week, and an 87 per cent reduction in severity of symptoms.
Hormone Replacement Therapy
Some women love it
Some women won’t touch it
But no matter how you fell about estrogen,
others hate it
others won’t consider stopping it.
it remains the only government approved drug therapy in the United States
Estrogens and Hot Flushes
Higher doses associated with higher rates of response associated with more rapid response Response depends on bioavailability
and reaching adequate serum-tissue-receptor levels
BOTTOM LINE: More is better
Four types of estrogens
Human Estrogens Estradiol, strongest one Estrone less active Estriol 10 percent as active
as estradiol
Non-Human Estrogen conjugated estrogens or CE. mixture of at least 10 estrogens obtained from natural sources, typically, the urine of pregnant
mares.
Synthetic Estrogens. manufactured in chemical
plants resemble human and non-
human estrogens.
Plant-Based Estrogens. phytoestrogens. Some act like an estrogen others act like an anti-
estrogen, commonly found in foods such
as soy, flaxseed, red clover
0
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12
1 2 3 4 5 6 7 8 9 10 11 12Week
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1 2 3 4 5 6 7 8 9 10 11 12Week
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r* 0.6250.450.3
Placebo
0.45/2.50.625/2.5
0.45/1.50.3/1.5
Placebo
*Adjusted for baseline.Mean hot flushes at baseline = 12.3 (range 11.3–13.8). Analyses included women who recorded taking study medication and had at least 7 moderate-to-severe flushes/week or at least 50 flushes per week at baseline.Utian WH, et al. Fertil Steril. 2001;75:1065-79. Used with permission.
Change in Number of Hot Flushes Over 12 Weeks (n = 241)
Women's HOPE Study
HRT
Personal decision needs to be individualized detailed discussion personal needs wants and desires Symptoms hoping to alleviate risks explained alternatives exist
Sign of the Times - Menopausal Sayings
★ I was going to send in a suggestion...but I can't remember what it was :
★ Everyone around you is freezing cold, you have your personal fan turned on to turbo cool.
★ You don't know whether to laugh or cry, sometimes you do both!
Phyto Soya Twice a day mimic the hormones oestrogen. A study of published in the journal
Menopause in 2002 found it reduced hot flushes in 60 per cent
Expert opinion ‘There is some evidence to support the effectiveness of isoflavones, but not all the studies are conclusive and some are small.
Rating: 5/10
Black cohosh
one-a-day tablets member of the buttercup family side-effects digestive upsets and itchy skin Expert opinion : ‘Black cohosh is the most
extensively tested of all the herbal products for the menopause, but most of these studies have been small. It has been found to be effective for some women.’
Rating: 4/10
Lady Care magnet
This small magnet is attached to the front of the underwear, and is ideally worn all day
It is thought to have an effect on the part of the nervous
system that affects heart rate and perspiration.
A study of 35 women last year who wore it found that 70 per cent of them reported an improvement in hot flushes and night sweats.
Expert opinion : ‘how this would help overcome a fall in hormone levels. If it does have any benefit, then it is down to placebo effect.’
Rating: 2/10
Single bed cooling pad
This is a pad filled with a gel that delivers a cooling effect.
Around the size of a small blanket (70cm by 90cm), it absorbs the heat from the body and requires no batteries or mains electricity, and can be used again and again.
Expert opinion : ‘Anything that is cooling may help women having a hot flush. Normally they have to leap out of bed and have a cold shower or a drink, so this may help.
Rating: 4/10
7. GABAPENTIN
Drug for migrain
RED CLOVER
one tablet daily traditionally used One small study, commissioned by the
manufacturer, and involving 69 women, found that taking this reduced the number of hot flushes experienced by two-thirds.
EXPERT OPINION : ‘There is very little
evidence to suggest that THIS does actually work.’
Rating: 2/10
Traditional Chinese herbs
weak estrogen-like activity
Jiawei Qing'e Fang
EXPERT OPINION current findings suggest that Jiawei Qing'e Fang has benefits beyond the placebo
Rating 5/10
Primrose oil
one or two tablets daily help with ‘hormonal balance’. EXPERT OPINION: ‘Evening primrose oil is
taken for many hormonal complaints such as the menopause and PMT despite there being virtually no evidence that it works.
‘This does though also contain isoflavones which maybe of benefit to some – but no more than a placebo pill would be.’
Rating: 3/10
Vitex Agnus Castus
Nature’s Best flowering plant chasteberry fruit.
It was shown to stabilise hormone levels, reduce hot flushes and lessen vaginal dryness in a German study of 100 women published in Menopause in 2009.
EXPERT OPINION : ‘One trial did show that this had some benefit, but this was quite small. It needs more research.’
Rating: 3/10
10 COOL ways to stop hot flushes in tracts
1. Dress for success
Dress in layers
Easy care fabrics
Loose fitting clothes
Comfy style
Wardrobe planning
2.BREATHE
Deep breathing shortens the time of hot flushes
Abdominal breathing halve the number of attacks
Slow & deep breathe
Expand rib cage
Train ahead of time.
3.COOL THE ROOM
Open the windows
Air-conditioner/fan
Constant cool temperature
4.AVOID THE HOT SPOT
Stay away from outdoor places
No sun bathing
Avoid hot tubs
Sauna and steam bath cautiously
5.STAY HYDRATED
Plenty of water throughout day
Keep glass of water by self
15-20 Glass /day Water is important
for functioning ‘WATER GLASS
HABIT’
6.EAT TO BEAT THE HEAT
Turn down the spices
Hot & spicy food-flash maker.
Avoid hot drinks & alcohol.
Pay attention to own food----
6. EXERCISE
30 minutes / day
Walk/ run/ride/any-other
7.HORMONE HELP
Short course Estrogen is still
most effective.
8. Other medications possibilities
Anti -depressents.
Anti -hypertensives
Anti –seizures
Drug of migraine Gabapentin
9. Flaxseed
40 grms of ground flax seed/
Decreased joint & muscle pain.
10. Herbal hot flashes remedies
Vitamin-E Yam phyto-
estrogen Black cohosh Red clover Chinese herbs
Some suggestions as conclusion
Lifestyle non-HRT approaches include:
Drink plenty of water daily (8 glasses or more)
Daily exercise (walking 30 minutes is great) Yoga classes ( Kundalini Yoga best) Meditate daily – even 1 to 5 minutes at first
and work way up to longer. Keeping the mind calm and silent works
wonders.
MEDITATIONLearn to Relaxstress, emotional or physical by releasing adrenaline into.blood flow to increase, body temperature to rise. Hot flashes are a response to an increase in body temperature, and thus stress can cause to feel flush. That’s why stress-reduction techniques are among the recommended home remedies for hot flashes. Think yoga, deep breathing, and meditation.
Some suggestions as conclusion
Mindfulness-Based Stress Reduction mindfulness exercises.
Acupuncture –
Avoid caffeine, spicy foods and alcohol
Carry a cool wipe
Herbal approaches
vitamin D3 supplement
Some suggestions as conclusion
Non-HRT prescription meds such as:
SSRI antidepressants
SNRI antidepressants.
anti-seizure medication
Clonidine
Some suggestions as conclusion
HRT with low Estrogens.
Tailor made and designer HRT
With persistence and patience
THANK YOU