Thyrotropin-releasing hormone and the menopausal hot flash

The possibility that the sudden discharge of thyrotropin-releasing hormone (TRH) in the brain triggers the climacteric hot flash was tested (double-blind) by an intra-venous, bolus injection of 500 μg of TRH into 7 post-menopausal women and 1 menstruating control. Temperatures and sweating were recorded continuously on the recumbent subject during the 2-h test. None of the women reacted either subjectively or objectively to the placebo. TRH induced gastric pain in 1 post-menopausal subject. In another subject TRH elicited no response during the first test, but a week later in a second test it evoked transient nausea and a series of hot flashes with bursts of sweating. Published results of animal studies suggest that a higher dose of TRH would probably stimulate hot flash-like responses in more women.     

Acupuncture for postmenopausal hot flashes

OBJECTIVE: To determine whether individually tailored acupuncture is an effective treatment option for reducing postmenopausal hot flashes and improving quality of life. METHODS: In a randomized, placebo-controlled pilot study, 29 postmenopausal participants averaging at least seven moderate to severe hot flashes per 24h, with a baseline estradiol concentration of less than 50 pg/mL and a normal TSH level, were randomized to receive 7 weeks (nine treatment sessions) of either active acupuncture or placebo acupuncture (placebo needles that did not penetrate the skin at sham acupuncture points). Participants recorded hot flashes in logs that were reported daily. Global indices of the severity and frequency of hot flashes were derived from the participants' daily logs. RESULTS: Participants receiving the active treatment had a greater reduction in hot flash severity (24.5+/-30.7%) compared to those receiving placebo (4.4+/-17.1%, P=0.042). Within group repeated measures analyses of variance revealed a significant reduction in hot flash severity in the active (P=0.042), but not in the placebo treatment group (P=0.15). Although there was no significant group difference in the reduction of hot flash frequency between the active (42.4+/-32.2%) and placebo groups (32.0+/-26.5%; P>or=0.352), within group repeated measures analyses of variance revealed that the reduction was statistically significant in both groups (P相似文献   

Beliefs regarding menopausal hot flushes among climacteric women as assessed with the Hot Flush Beliefs Scale

Background

Hot flushes (HFs) and night sweats are frequent complaints among both peri- and postmenopausal women. Beliefs regarding these complaints may vary from one population to another.

Objective

To assess HF beliefs and factors related to negative beliefs in a climacteric Hispanic population using the Hot Flush Beliefs Scale (HFBS).

Methods

A total of 1154 healthy women (40–59 years) were assessed with the Menopause Rating Scale (MRS), those presenting HFs were requested to fill out the HFBS and a questionnaire containing socio-demographic data (female and partner).

Results

A total of 646 presented HFs (56%) graded according to the first item of the MRS as mild (28.6%), moderate (33.2%), severe (29.1%) and very severe (9.1%). Mean age of these women was 49.5 ± 5.2 years, with 51.9% having 12 or less years of education, 61.5% being postmenopausal and 47.2% living in high altitude. At the moment of the survey 13.9% were on HT, 12.8% on phytoestrogens and 7.1% on psychotropic drugs. Women strongly disagreed in more negatively oriented items of those contained in subscale one (beliefs about self in social context). Contrary to this, women strongly agreed in more negative oriented items contained in subscale two which assesses beliefs about coping with HFs. Women presenting with severe–very severe HFs displayed higher HFBS total and subscale scores indicating a more negative belief regarding HFs. Logistic regression analysis determined that HF severity was related to higher HFBS scores for the total and subscales one and two. Current smoking, higher parity, lower female education, female psychiatric consultation, time since menopause and partner unhealthiness and alcohol consumption were also related to higher HFBS scorings. Postmenopausal status and church attendance were related to lower scores.

Conclusion

In this mid-aged Ecuadorian female series negative beliefs regarding HFs were related to the severity of HFs and individual female or partner characteristics. Data provided from clinical research using this tool, alone or in combination with other tests, is warranted.     

Stellate ganglion block for treating hot flashes: A viable treatment option or sham procedure?

Stellate ganglion block (SGB) has been used for over 70 years to treat various cervical pain syndromes. Over the past 8 years, 4 different groups have reported on SGB's effects on hot flashes from unblinded, open-label trials. Review of these studies has shown markedly disparate results in terms of the magnitude of hot flash reduction from Baseline with one trial showing a 90% reduction in hot flashes and 3 other trials showing 28–44% reductions in hot flashes. The inconsistencies in these results in addition to the known potentially large (>50%) placebo effects that can occur in randomized controlled hot flash clinical trials make it difficult to render any conclusions regarding the efficacy of SGB for hot flashes at this time. A randomized controlled trial, including a sham saline treatment arm, needs to be performed to properly assess SGB's effects on hot flashes, Methodological challenges with such a study design are addressed and several suggestions are proposed to manage these challenges.     

Treatment of menopausal hot flashes with 5-hydroxytryptophan

Objective

Much recent research has focused on nonhormonal treatments for menopausal hot flashes. The purpose of the present study was to determine the effects of 5-hydroxytroptophan (5-HTP), the immediate precursor of serotonin, upon menopausal hot flashes. Selective, serotonergic, reuptake inhibitors (SSRIs), which increase the amount of serotonin in the synaptic gap, have shown some promise in the amelioration of hot flashes.

Methods

We administered 5-HTP or placebo, in double-blind fashion, to 24 postmenopausal women reporting frequent hot flashes. Treatment outcome was measured using a miniature, electronic, hot flash recorder.

Results

No significant effects of 150 mg/day 5-HTP upon hot flash frequency were found. The 5-HTP group had 23.8 ± 5.7 (SD) hot flashes/24 h prior to treatment and 18.5 ± 9.6 at the end of treatment. The placebo group had 18.5 ± 9.6 before treatment and 22.6 ± 12.4 at treatment completion.

Conclusions

At the dose given, 5-HTP does not significantly ameliorate frequency of menopausal hot flashes, as measured objectively with an electronic recorder. Given the small size, this study must be considered preliminary in nature.     

Hot flash severity in hormone therapy users/nonusers across the menopausal transition

OBJECTIVES: The purpose of this study was to examine the pattern of and factors that influence hot flash severity across the menopausal transition (MT) and early postmenopause (PM). METHODS: Women from the Seattle Midlife Women's Health Study (N=302) provided data for these analyses: at least one annual health questionnaire and a menstrual calendar. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide and FSH. Linear mixed effects modeling was used to identify change in hot flash severity scores over time, including the relationship to age, MT-related, psychosocial and lifestyle factors. RESULTS: Increases in hot flash severity were associated with late transition stage, early postmenopause, use of HRT, duration of early transition stage, age of entry into early PM and level of FSH. Age of entry into early transition and estrone levels were associated with decreased hot flash severity. Not associated with hot flash severity were being in early transition stage, age of entry into or duration of late transition stage and all of the psychosocial (anxiety, stress, depressed mood) and lifestyle variables (BMI, activity level, sleep, alcohol use). CONCLUSIONS: Variables associated with reproductive aging independently predicted changes in hot flash severity; psychosocial and lifestyle variables did not. The effect of age dropped out when factors associated with reproductive aging were considered. Use of HRT ameliorated but did not eliminate severe hot flashes suggesting that there is room for alternative approaches less likely to cause harm.     

Cardiovascular autonomic responsiveness in postmenopausal women with and without hot flushes

Objectives

During menopausal transition autonomic balance is known to shift towards sympathetic dominance, but the role of vasomotor hot flushes in this phenomenon is not understood. We compared cardiovascular autonomic responsiveness between women with and without hot flushes.

Study design and main outcome measures

One hundred fifty recently postmenopausal healthy women with varying degree of hot flushes (none, mild, moderate, severe) underwent comprehensive cardiovascular autonomic nervous testing (controlled and deep breathing, active orthostatic test, Valsalva manoeuvre and handgrip test) assessing both sympathetic and parasympathetic activity. The responses of heart rate, heart rate variability and blood pressure in these tests were evaluated.

Results

Responses in heart rate showed differences between the study groups only in the Valsalva manoeuvre where the tachycardia ratio in all symptomatic women was lower (p = 0.041) than in women without hot flushes. Neither change in the heart rate variability analyses nor the blood pressure responses were affected by hot flush status. However, there was a non-significantly higher maximum systolic (140 (112–182) mmHg vs. 135 (102–208) mmHg) and diastolic blood pressure (94 (72–112) mmHg vs. 90 (66–122) mmHg) following the handgrip test in women without hot flushes vs. all the symptomatic women.

Conclusions

Menopausal hot flushes seem to be associated with a possibly increased sympathetic preponderance without an effect on parasympathetic activity in cardiovascular autonomic responses. This may imply a potentially negative impact on cardiovascular health in women experiencing hot flushes.     

Differential factors associated with hot flashes in Chinese perimenopausal and postmenopausal women

Objective

This study investigated factors associated with hot flashes in Chinese perimenopausal and postmenopausal women.

Methods

This cross-sectional study recruited Chinese women aged 40–60 years who were perimenopausal or postmenopausal and examined factors associated with hot flashes. Participants completed a questionnaire detailing demographic information, characteristics of menstruation, reproductive history, use of hormone replacement therapy or oral contraceptives, personal lifestyle factors (exercise, multivitamin use, soy products use, diet), and symptoms of hot flashes. Height, weight, blood pressure, and waist and hip circumference were also measured.

Results

A total of 1399 participants (817 perimenopausal women and 582 postmenopausal women) completed the study. In perimenopausal women, college or higher education decreased the prevalence of hot flashes (odds ratio (OR) 0.63; 95% confidence interval (CI) 0.46–0.86). In postmenopausal women, an omnivorous diet decreased the prevalence of hot flashes (OR 0.38; 95% CI 0.17–0.85). Strenuous exercise (≥3 times a week) increased the prevalence of hot flashes (OR 1.41; 95% CI 1.08–1.83) in perimenopausal women.

Conclusions

It is possible that modifiable risk factors for hot flashes exist in Chinese perimenopausal and postmenopausal women. Future studies with larger populations are needed to confirm these findings.     

Alternative and complementary therapies for the menopause: A homeopathic approach

The menopause is seen as a highly variable adjustment phase where for some women difficult symptoms can significantly impact on quality of life and in breast cancer that adjustment phase can be intensified and prolonged by anti-oestrogen medication. Homeopathy, defined as one of the many complementary and alternative medicines which women use to manage this transition, has been delivered within the National Health Service since its inception and has been used to alleviate menopausal symptoms both in the climacteric and more recently in breast cancer survivors. Individualized treatment by a homeopath, regarded as the gold standard of homeopathic care, is a complex intervention where the homeopathic medicine is matched to a woman presenting with a range of symptoms such as hot flushes, sleep and mood disturbance, joint pains and fatigue. These symptoms are thought to represent a whole system disturbance and the homeopathic medicine chosen reflects this disturbance. This article describes the delivery of homeopathic care within the UK, as part of an integrated approach to difficult symptoms, basic science that might offer a potential model of action, and reviews available data from observational studies and randomised trials in this clinical setting.     

Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial

OBJECTIVE: To determine the feasibility and acceptability of a restorative yoga intervention for the treatment of hot flushes in postmenopausal women. METHODS: A pilot trial in 14 postmenopausal women experiencing > or =4 moderate to severe hot flushes per day or > or =30 moderate to severe hot flushes per week. The intervention consisted of eight restorative yoga poses taught in a 3-h introductory session and 8 weekly 90-min sessions. Feasibility was measured by recruitment rates, subject retention and adherence. Acceptability was assessed by subject interview and questionnaires. Efficacy measures included change in frequency and severity of hot flushes as recorded on a 7-day diary. RESULTS: Recruitment was accomplished as planned. The majority of study subjects (93%) completed the trial. Of those who completed the trial, 92% attended seven or more of the eight yoga sessions. The majority of the subjects were satisfied with the study and 75% continued to practice yoga 3 months after the study. Mean number of hot flushes per week decreased by 30.8% (95% CI 15.6-45.9%) and mean hot flush score decreased 34.2% (95% CI 16.0-52.5%) from baseline to week 8. No adverse events were observed. CONCLUSIONS: This pilot trial demonstrates that it is feasible to teach restorative yoga to middle-aged women without prior yoga experience. The high rates of subject retention and satisfaction suggest that yoga is an acceptable intervention in this population. Our results indicate that a larger, randomized controlled trial to explore the efficacy of restorative yoga for treatment of menopausal symptoms would be safe and feasible.     

A comparative study of menopausal hot flashes and their psychosocial correlates in Taiwan and the United States

Objective

To compare the frequency, severity, and interference of menopause-related hot flashes and their psychosocial correlates in Taiwanese and U.S. women.

Study design

Cross-sectional study, using a convenience sample of 101 Taiwanese and 121 U.S. midlife women.

Main outcome measures

Hot-flash measures, including frequency, severity (Women's Health Initiative Symptom Scale), hot flash related daily interference; and psychosocial measures: Attitudes toward Menopause and Aging Scale, Coping Strategies Questionnaire, Sense of Coherence Questionnaire, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventory, and State-Trait Anger Scale.

Results

Using ANCOVA with demographic variables as covariates, U.S. women reported greater frequency and daily interference from hot flashes compared with Taiwanese women. Greater depression, greater catastrophizing about hot flashes, lower sense of coherence, lower state/trait anger, and more positive attitudes toward aging were reported in the U.S. cohort. The groups were similar in their frequency of specific coping strategies, and they did not differ significantly in menopause symptom severity, attitudes towards menopause, state/trait anxiety, or overall negative psychosocial characteristics. Hierarchical multiple regression analyses indicated that hot-flash related daily interference was predicted by marital status, frequency of hot flashes, and negative psychosocial characteristics among the U.S. women; and by frequency of hot flashes and negative psychosocial characteristics among the Taiwanese women.

Conclusions

Despite differences in the frequency and daily interference from hot flashes in the two samples, the predictors of interference were similar. Results highlight the importance of considering both psychosocial factors and cultural differences in providing guidance and treatment for women experiencing menopause-related hot flashes.     

Stellate ganglion blockade and verbal memory in midlife women: Evidence from a randomized trial

ObjectivesIn a pilot randomized clinical trial of active stellate ganglion blockade (SGB) versus sham control, SGB significantly reduced the frequency of reported moderate to severe vasomotor symptoms (VMS) and the frequency of physiologic VMS measured using ambulatory skin conductance monitors. Here we examine secondary effects of SGB on verbal learning and memory.Study designIn a randomized, sham-controlled study, 36 women met eligibility criteria for cognitive assessments, of whom 17 were randomized to receive fluoroscopy-guided SGB and 19 to sham control.Main outcome measuresAt baseline and three months post-treatment, women completed tests of verbal learning and memory (primary outcome) and other cognitive measures and also wore an ambulatory monitor for 24 h to measure physiologic VMS and VMS reported in real time.ResultsVerbal learning improved following active SGB (p < 0.05) but not sham treatment; however, the interaction between group and time was not significant (p values 0.13-0.20). Two secondary cognitive measures improved only in the sham group. Improvements in physiologic VMS correlated significantly with improvements in verbal learning (r = 0.51, p < 0.05).ConclusionsSGB might confer benefits to memory in relation to the magnitude of improvement in physiologic VMS. Broadly these findings suggest a possible link between physiologic VMS and memory problems in midlife women.     

Obesity and fat distribution in relation to hot flashes in Dutch women from the DOM-project

The authors studied obesity and fat distribution in relation to the occurrence of hot flashes in a population-based study comprising 2904 women aged 40–44 and 569 women aged 54–69 presenting for mammographic screening (the DOM-project). Women aged 40–44 in the upper tertiles of Quetelet's index and waist/hip ratio reported hot flashes significantly more often than women in the respective lower tertiles. These associations were independent of each other and independent of age. After adjustment for age, waist/hip ratio and menopausal status, the odds ratio comparing the upper tertile of Quetelet's index to the lower tertile was 1.70 (95% confidence interval, 1.30 – 2.21). After adjustment for age, Quetelet's index and menopausal status, the odds ratio comparing the upper tertile of waist/hip ratio to the lower tertile was 1.37 (95% CI, 1.05 – 1.78). In women aged 54–69 no significant associations between Quetelet's index and complaints of hot flashes were observed. Women in the upper tertile of waist/hip ratio reported hot flashes more often than women in the lower tertile, but this result was not significant (OR 1.38; 95% CI, 0.87 – 2.22).     

Dietary flour supplementation decreases post-menopausal hot flushes: Effect of soy and wheat

Plants contain compounds with oestrogen — like action called phytoestrogens. Soy contains daidzin, a potent phytoestrogen, and wheat flour contains less potent enterolactones. We aimed to show in 58 postmenopausal women (age 54, range 30–70 years) with at least 14 hot flushes per week, that their daily diet supplemented with soy flour (n = 28) could reduce flushes compared with wheat flour (n = 30) over 12 weeks when randomised and double blind. Hot flushes significantly decreased in the soy and wheat flour groups (40% and 25% reduction, respectively <0.001 for both) with a significant rapid response in the soy flour group in 6 weeks (P < 0.001) that continued. Menopausal symptom score decreased significantly in both groups (P < 0.05). Urinary daidzein excretion confirmed compliance. Vaginal cell maturation, plasma lipids and urinary calcium remained unchanged. Serum FSH decreased and urinary hydroxyproline increased in the wheat flour group.     

A critical view of the effects of phytoestrogens on hot flashes and breast cancer risk

The increased risk of breast cancer recently observed with some specific estro-progestin associations has raised concerns about the harmful effects of menopausal hormone replacement therapy (HRT). It has been proposed that phytoestrogens (PEs), which have a similar chemical structure to estrogens, could be used as HRT. The main selling points of these preparations concern the management of hot flashes and their potential beneficial effects on breast tissue. In this review, we will address the effects of PE on hot flashes and breast cancer risk as well as the questions raised on a chemical point of view. We conclude that the efficacy of a PE rich diet or nutritional supplements is not clearly established. The use of PE as an alternative for HRT cannot be advocated for now, due to insufficient and conflicting data on efficacy and safety. Moreover, due to the hormone dependence of breast cancer, PE use must be contraindicated in breast cancer survivors.     

Risk factors related to the presence and severity of hot flushes in mid-aged Ecuadorian women

Background

Several studies drawn from the Ecuadorian population have previously reported that more than half of mid-aged women present hot flushes, which can impair their quality of life. However up-to-date risk factors for their presence and severity have not been assessed.

Objective

To assess hot flush frequency and intensity and related risk factors among middle-aged Ecuadorian women.

Methods

In this cross-sectional study, 1154 healthy women aged 40–59 years, visiting healthcare centers of eight main cities of Ecuador with more than 100,000 inhabitants, were assessed with the first item of the Menopause Rating Scale (MRS) and a questionnaire containing female and partner socio-demographic data.

Results

Mean age of the entire sample was 48.8 ± 5.6 years (median 48), a 48.7% had 12 or less years of schooling, 52.8% were postmenopausal, 43.6% lived at high altitude, 56.8% were married and 10% were on hormonal therapy (HT). Hot flushes accounted for 56% (n = 646) of the whole sample, of which 29.1% and 9.1% were respectively graded as severe and very severe. Logistic regression determined that female sedentarism (OR: 2.42, CI 95% [1.63–3.59]), accessing a free healthcare system (OR: 1.96, CI 95% [1.30–2.96]), living at high altitude (OR: 1.82, CI 95% [1.14–2.90]) and having a partner abusing alcohol (OR: 1.92, CI 95% [1.09–3.35]) were significant risk factors related to the presence of hot flushes. The regression model also determined that among women with hot flushes (n = 646), sedentarism (OR: 1.73, CI 95% [1.14–2.62]) and having a partner with erectile dysfunction (OR: 2.57, CI 95% [1.44–4.59]) were significant risk factors related to severe/very severe hot flushes whereas married status (OR: 0.53, CI 95% [0.32–0.86]), living at high altitude (OR: 0.46, CI 95% [0.26–0.78]) and partner healthiness (OR: 0.59, CI 95% [0.36–0.95]) were not.

Conclusion

To the best of our knowledge this is the first and largest study assessing hot flushes in a mid-aged Ecuadorian population. We found that the presence and severity were not significantly related to age and hormonal status yet to other individual female/male characteristics and the demography of the studied population.