Elsevier

The Lancet

Volume 360, Issue 9348, 7 December 2002, Pages 1851-1861
The Lancet

Review
Hot flushes

https://doi.org/10.1016/S0140-6736(02)11774-0Get rights and content

Summary

Almost every woman and some men will encounter hot flushes during their lifetime. Despite the prevalence of the symptoms, the pathophysiology of hot flushes remains unknown. A decline in hormone concentrations might lead to alterations in brain neurotransmitters and to instability in the hypothalamic thermoregulatory setpoint. The most effective treatments for hot flushes include oestrogens and progestagens. However, many women and their physicians are reluctant to accept hormonal treatments. Women want non-pharmacological treatments but unfortunately such treatments are not very effective, and non-hormonal drugs are often associated with adverse effects. Results from recent studies showed that selective serotonin reuptake inhibitors and other similar compounds can safely reduce hot flushes. Moreover, the efficacy of these drugs provides new insight into the pathophysiology of hot flushes. In this critical review, we assess knowledge of the epidemiology, pathophysiology, and treatment of hot 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

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.

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