Hot Flashes

15th October ‘ 2021


Hot flushes or hot flashes are classical symptoms of menopause that occur in 75-80 % of women. It is the most common indication for hormonal therapy. In some women can be disabling. Excessive sweating and redness can become very embarrassing. It may appear few months before and continue 3-4 years after menopause. Periodic attacks of hot flashes occur on the face and neck and sometimes all over the body. They have been described as burning, overheating sensation with reddening of the skin and different degrees of sweating. There can be associated nausea, dizziness, and feeling of being unwell. The episode may last from 30 seconds to 5 minutes, maybe followed by chills. Some women experience palpitations (fast heartbeat) up to 200 beats per minute during an attack. During the night hot flashes are termed as night sweats. It affects the quality of sleep resulting in less refreshing sleep and low energy during the day. Attack usually occurs 3-5 times a day but may be frequent (up to 20). Episode of hot flashes occur unpredictably but there are certain stimuli which can trigger it such as hot water bath or shower, stress and anxiety etc. The prevalence of flashes is highest in the first year after the last menstrual period. Although they usually are present for less than five years, some women continue to flush in their 70s. The causes of hot flashes are complex and not completely understood. The range of core body temperature decreases as a result, a very small increase in core body temperature can trigger heat release as a hot flash. 

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It seems loss of modulating effect of estrogen on serotinergic receptors within the temperature regulating center in brain resulting in exaggerated peripheral vasodilatory responses to minor atmospheric changes in temperature.

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Treatment

Hormonal therapy (HT) is the most effective treatment for menopausal symptoms. Usually Estrogen is prescribed. Improvement is noted in about 4 weeks with maximum effect in 3 months. It improves the quality of life for symptomatic patients but, hormonal therapy is not for everyone. There is a potential health risk with treatment. Potential benefits and harms are periodically reevaluated every year.

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Menopause can be induced when ovaries are removed during pelvic surgery for different problems. Induced menopause can cause intense menopausal symptoms. Most breast carcinomas are sensitive to estrogen. In these cases and in patients in whom hormonal therapy is contraindicated, symptoms can be controlled by lifestyle modification and Alternative Complementary Therapy.

Lifestyle Modification

For hot flashes the following may help:

  • Avoiding triggers: Triggers include alcohol, caffeine, smoking, spicy food, Bright light, hot room or shower, hot food and drinks, dehydration, heightened emotions, stress, and anxiety.
  • Taking a balanced healthy diet and staying hydrated by drinking at least 1.5-liter water.
  • Abstaining smoking and alcohol consumption.
  • Cooling the environment. Cooling gel pads are available and can be used.
  • Dressing in layers with natural fibers.
  • Exercise and weight loss: Women with high body mass index tend to get worse vasomotor symptoms. Reducing weight also has a beneficial effect on bone loss and reduction in the chance of getting cardiovascular diseases.
  • Drinking cold water
  • Dealing with stress. Deep breathing, 5 seconds inhale and 5 seconds exhale is a good way of dealing with hot flashes anxiety.
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Non-Hormonal Treatment

Most of the symptoms improve by reassurance, sedative, or tranquilizers. Use of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) Fluoxetine, Paroxetine, Citalopram, and serotonin-norepinephrine reuptake inhibitors (SNRIs) Venlafaxine, and others such as alpha-agonist Clonidine, propranolol (beta-blockers), Gabapentin, Vitamin E has been shown to be moderately effective.

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Alternative and Complementary Therapy

Phytoestrogens have estrogen-like activity. Consumption of soy-based products or other phytoestrogens may also alleviate vasomotor symptoms. Soy proteins have been studied with mixed results. One soy product S-equol reported relieving hot flashes. Soy proteins also have a favorable effect on plasma lipids and may reduce the risk of cardiovascular disease. Phytoestrogens supplements are not clinically evaluated for their effects on breast carcinoma or beneficial effect on osteoporosis so their use is not recommended.

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Some other Herbal solutions are Black cohosh, sage extract, Evening promise oil, Gingko, Gingseng, kava kava, St John’s wort, red clover, and Dong Quai are often used for hot flashes. They are available as supplements at pharmacies, health food shops and used by many women. They have weak estrogenic activity. Natural estrogen are quickly degraded by liver so have not much effect. Synthetic hormones are designed in such a way that they are not degraded so fast. A high dose can have the same effect as hormonal therapy. They are not regulated as prescription drugs so should be used with caution.

Mind-body therapies are claimed to have some benefits. Use of regular exercise, relaxation techniques, yoga, Hypnotism, magnetism, Reiki, Acupuncture, reflexology, paced breathing exercises can be tried.

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