What
Are Hot Flashes?Hot Flashes
Hot flashes mark the beginning of menopause in many women. It is estimated that 85% to 90% of women experience hot flashes. Hot flashes have also been known to occur in association with certain drug therapies. They are a common adverse event among patients who have prostate cancer and are receiving hormonal therapy. Among men who had an orchiectoy, 73% reported that they had hot flashes at some time. Of those men who experienced hot flashes, 36% felt that they required some type of intervention. Among women who are currently receiving the antiestrogen tamoxifen for the treatment of breast cancer, about 50% have reported the occurrence of hot flashes.
What
Are Hot Flashes?
Hot flashes begin without the slightest warning and can occur at any time of the day. There is a sudden onset of a warm sensation that may or may not be coupled with reddening of the face or neck. This warmth quickly spreads to the entire body, at which point the patient can experience palpitations and diaphoresis. After these symptoms have resolved, patients often complain of feeling cold and having chills and shivers.
The exact mechanism of action has not yet been identified. However, there is consensus among the experts about the mechanism that is about to be described. It is believed that the disorder occurs at the level of the hypothalamus. A decrease in the release of sex hormone, in men or women, causes decreased release of opioids, which are responsible for inhibiting the secretion of norepinephrine from the hypothalamus. Hence, there is an increased amount of circulating norepinephrine. The high level of catecholamines in the blood stream causes stimulation of the hypothalamus, which responds with increased luteinizing hormone--releasing hormone (LHRH) activity. In addition to increasing LHRH release from the hypothalamus, norepinephrine acts on the thermoregulatory center of the hypothalamus. This cascade results in an increased secretion of luteinizing hormone and the occurrence of hot flashes.
Hot flashes can be very anoying and uncomfortable. As a result of this adverse event, people may discontinue therapy with drugs that may be vital either in providing treatment for their particular disease, or in prolonging the progression of that disease. Also, hot flashes decrease the quality of life of postmenopausal women, as well as certain other patient populations. Although hot flashes are bothersome, they can easily be managed by pharmacologic intervention. The mainstay of treatment for hot flashes has been hormone replacemen therapy (HRT). However, there are certain people in whom HRT can be contraindicated. It is well known that HRT is not an option in breast cancer survivors, some women with endometrial cancer, and patients with a history of acute vascular thrombosis. So, what are these individuals supposed to do?
Many drugs have been studied in the hope of finding an alternative to the use of estrogen for the treatment of hot flashes. Some of the drugs that have been studied include megestrol acetate, medroxyprogesterone, vitamin E, and clonidine. It appears that megestrol acetate and medroxyprogesterone offer some promise for reducing the number and severity of hot flashes. Clonidine and vitamin E appear to be less efficacious, but research is ongoing to assess the effectiveness of all of these drugs in the treatment of hot flashes.
Other treatments for hot flashes include herbal medicines and a combination of phenobarbital, ergotamine tartrate, and belladonna alkaloids (Bellergal, Sandoz Pharmaceuticals). Herbal medicines such as ginseng have been used by women to relieve hot flashes. It is difficult to determine the appropriate dosage of these medicines; for this reason, one should practice great caution when using them. Herbal medicines, although they may be helpful, are not free of adverse events. The very few data that are available regarding Bellergal suggest that it may be helpful in relieving hot flashes. It is noteworthy to say that Bellergal does carry an indication for the treatment of hot flashes. It is important to keep in mind that there are a considerable number of contraindications to the use of this product; there is also a possibility that drug interaction and/or dependence will result.
Some nonpharmacologic interventions to alleviate hot flashes include exercise, diet, and relaxation. Physical activity can increase the concentration of endogenous estrogen and can decrease the amount of endogenous luteinizing hormone in the body. Relaxation may increase the quantity of catecholamines in the circulation. This increase may cause a slight downregulation of the target organs, which leads to a quicker recovery because of the increased ability of the body to adapt to stressful situations. Also, the avoidance of caffeine, alcohol, and foods that are spicy and an increased uptake of vitamines may help.
There are many options for the treatment of hot flashes. Once therapy has begun, the patient should be followed to enable detection of adverse events or inadequacy of the therapy. Hot flashes can be a natural occurrence, as in postmenopausal women, or they can occur as an adverse event associated with a drug that may be essential for the treatment of a patient's disease state. Some therapies offer promise for patients seeking relief from the annoyance of hot flashes. Each patient should be evaluated individually in terms of risks versus benefits; then, appropriate therapy, as deemed by the physician, should be initiated.
Osteopathic Family Physician
and Surgeon
Family Health Center
"An Osteopathic Family Physician, In the Rocky Mountain Region,
Who Combines The Best of Traditional and Alternative Medical Services for The Whole
Family.
Also specializing in allergy, thyroid, adrenal and weight problems"
Jonathan
Singer D.O.
307-635-4362