We did a Medline search of reports published in English using the keywords hot flushes, menopause, vasomotor symptoms, therapies, and serotonin. We have also reviewed the Cochrane review about hormone replacement therapy. With regards information about treatment of hot flushes, we focused on prospective placebo-controlled randomised clinical trials.
ReviewHot flushes
Section snippets
Definitions
Hot flush is a subjective sensation of heat that is associated with objective signs of cutaneous vasodilatation and a subsequent drop in core temperature. Other terms used to describe hot flushes include vasomotor, menopausal, or climacteric symptoms. The hot flush may be accompanied by sweating, flushing, palpitations, anxiety, irritability, and even panic,3 and women may also report night sweats. Hot flushes can also be caused by systemic disease, neurological disorders, alcohol, drugs,
Associated symptoms
Symptoms such as depression, nervousness, agitation, insomnia, and inability to concentrate have been associated with menopause.16, 17 Although these symptoms could be regarded as risk factors for hot flushes, whether they make hot flushes worse, or are side-effects associated with hot flushes is unclear. Menopause is also thought to exacerbate pre-existing psychological disturbances;8 however, the link between symptoms of depression and perimenopause is not well studied.
Menopausal women often
Assessment and measurement
Because hot flushes vary in duration, frequency, intensity, and duration of an individual flush, quantitative assessment of the disorder can be difficult. Subjective measures are prone to individual perception, which might be noted differently with daily activities or while asleep. Nonetheless, women seem to reliably describe their hot flushes as mild, moderate, or severe.25 A diary of hot flush frequency and severity that was used by Mayo Clinic investigators in seven clinical trials with 968
Menopausal symptoms and cancer
Breast cancer—About two-thirds of postmenopausal women who have had breast cancer report hot flushes, and just over half report these flushes to be severe.31, 32 Because three-quarters of breast cancers occur in women older than 50 years, there is a substantial overlap between the two conditions, and the apparent causal association between oestrogen and breast cancer means that hormone replacement therapy (HRT) is usually discontinued at the time of a breast-cancer diagnosis. In addition,
Hot flushes and thermoregulation
Despite the prevalence and bothersome nature of hot flushes, few studies have addressed the pathophysiology of this occurrence. Because hot flushes are generally systemic, they are likely to arise as a result of an alteration in the CNS thermoregulatory set-point located in the anterior portion of the hypothalamus. Changes in body temperature are recognised in the thermoregulatory set-point centre, which controls physiological responses that conserve or dissipate heat (figure),3 such as skin
Treatment for hot flushes
The frequency and morbidity of hot flushes have led to various treatments throughout the years—both hormonal and non-hormonal. Because hot flushes occur most commonly in women, most studies assessed interventions in this population, and unless otherwise stated, we assume that study participants were women.
Conclusions
Menopausal symptoms are very common and can impair the daily lives of many women and sometimes men. In the absence of good models to assess hormone and brain amine concentrations in the CNS, understanding of the pathophysiology of vasomotor instability and hot flushes is poor. Nonetheless, there are many treatment options: tolerance, behaviour modifications, naturally occurring substances, and hormonal and non-hormonal drugs. Although not as efficacious as hormones, the most promising
Search strategy and selection criteria
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