Hot flash explained

Hot flash
Synonyms:Hot flushes
Field:Gynecology

Hot flashes (also known as hot flushes) are a form of flushing, often caused by the changing hormone levels that are characteristic of menopause. They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to 30 minutes for each occurrence.

Signs and symptoms

Hot flashes, a common symptom of menopause and perimenopause, are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes for each occurrence, ending just as rapidly as they began. The sensation of heat usually begins in the face or chest, although it may appear elsewhere such as the back of the neck, and it can spread throughout the whole body.[1] Some people feel as if they are going to faint. In addition to being an internal sensation, the surface of the skin, especially on the face, becomes hot to the touch. This is the origin of the alternative term "hot flush", since the sensation of heat is often accompanied by visible reddening of the face.

The hot-flash event may be repeated a few times each week or every few minutes throughout the day. Hot flashes may begin to appear several years before menopause starts and last for years afterwards. Some people undergoing menopause never have hot flashes. Others have mild or infrequent flashes. Those most affected experience dozens of hot flashes each day. In addition, hot flashes are often more frequent and more intense during hot weather or in an overheated room, the surrounding heat apparently making the hot flashes themselves both more likely to occur, and more severe.

Severe hot flashes can make it difficult to get a full night's sleep (often characterized as insomnia), which in turn can affect mood, impair concentration, and cause other physical problems. When hot flashes occur at night, they are called "night sweats". As estrogen is typically lowest at night, some people get night sweats without having any hot flashes during the daytime.[2]

Young females

If hot flashes occur at other times in a young female's menstrual cycle, then it might be a symptom of a problem with the pituitary gland; seeing a doctor is highly recommended. In younger females who are surgically menopausal, hot flashes are generally more intense than in older females, and they may last until natural age at menopause.[3]

Males

Hot flashes in males could have various causes. It can be a sign of low testosterone.[4] [5] [6] Males with prostate cancer or testicular cancer can also have hot flashes, especially those who are undergoing hormone therapy with antiandrogens, also known as androgen antagonists, which reduce testosterone to castrate levels.[7] Males who are castrated can also get hot flashes.[8] [9] [10]

Types

Some menopausal females may experience both standard hot flashes and a second type sometimes referred to as "slow hot flashes" or "ember flashes". The standard hot flash comes on rapidly, sometimes reaching maximum intensity in as little as a minute. It lasts at full intensity for only a few minutes before gradually fading.

Slow "ember" flashes appear almost as quickly but are less intense and last for around half an hour. Females who experience them may undergo them year round, rather than primarily in the summer, and ember flashes may linger for years after the more intense hot flashes have passed.

Mechanism

Research on hot flashes is mostly focused on treatment options. The exact cause and pathogenesis, or causes, of vasomotor symptoms (VMS)—the clinical name for hot flashes—has not yet been fully studied.[11] [12]

Hot flashes are associated with declining levels of estrogen (estrogen withdrawal) and other hormonal changes.[13] It does not appear that low levels of estrogen are the sole cause of hot flashes, as women who experience hot flashes have around the same plasma estrogen levels as women who do not have them, and prepubertal girls do not have hot flashes despite low estrogen levels.

There are indications that hot flashes may be due to a change in the hypothalamus's control of temperature regulation.[14]

Transgender men also commonly report experiences of hot flashes.[15] This is linked to hormonal changes possible from many aspects of masculinizing gender-affirming care, including the use of gonadotropin-releasing hormone agonists as puberty blockers,[16] reduction of estrogen levels after having undergone oopherectomy,[17] and long term testosterone use reducing production of estradiols.[18]

Treatment

Hormone replacement therapy

Hormone replacement therapy may relieve many of the symptoms of menopause. However, oral HRT may increase the risk of breast cancer, stroke, and dementia and has other potentially serious short-term and long-term risks.[19] [20] Since the incidence of cardiovascular disease in women has shown a rise that matches the increase in the number of post menopausal women, recent studies have examined the benefits and side effects of oral versus transdermal application of different estrogens and found that transdermal applications of estradiol may give the vascular benefits lowering the incidences of cardiovascular events with fewer adverse side effects than oral preparations.[21] [22]

Women who experience troublesome hot flashes are advised by some to try alternatives to hormonal therapies as the first line of treatment. If a woman chooses hormones, they suggest she take the lowest dose that alleviates her symptoms for as short a time as possible.[23] The US Endocrine Society concluded that women taking hormone replacement therapy for 5 years or more experienced overall benefits in their symptoms including relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes.[24]

When estrogen as estradiol is used transdermally as a patch, gel, or pessary with micronized progesterone this may avoid the serious side effects associated with oral estradiol HRT since this avoids first pass metabolism (Phase I drug metabolism).[25] Women taking bioidentical estrogen, orally or transdermally, who have a uterus must still take a progestin or micronized progesterone to lower the risk of endometrial cancer. A French study of 80,391 postmenopausal women followed for several years concluded that estrogen in combination with micronized progesterone is not associated with an increased risk of breast cancer.[26] The natural, plant-derived progesterone creams sold over the counter contain too little progesterone to be effective. Wild yam (Dioscorea villosa) extract creams are not effective since the natural progesterone present in the extract is not bioavailable.[27]

Selective serotonin reuptake inhibitors

SSRIs are a class of pharmaceuticals that are most commonly used in the treatment of depression. They have been found efficient in alleviating hot flashes.[28] On 28 June 2013 FDA approved Brisdelle (low-dose paroxetine mesylate) for the treatment of moderate-to-severe vasomotor symptoms (e.g. hot flashes and night sweats) associated with menopause. Paroxetine became the first and only non-hormonal therapy for menopausal hot flashes approved by FDA.[29]

Clonidine

Clonidine is a blood pressure-lowering medication that can be used to relieve menopausal hot flashes when hormone replacement therapy is not needed or not desired. For hot flashes, clonidine works by helping reduce the response of the blood vessels to stimuli that cause them to narrow and widen.[30] While not all women respond to clonidine as a hot flash medication, it can reduce hot flashes by 40% in some peri-menopausal women.[31]

Isoflavones

Isoflavones are commonly found in legumes such as soy and red clover. The two soy isoflavones implicated in relieving menopausal symptoms are genistein and daidzein, and are also known as phytoestrogens. The half life of these molecules is about eight hours, which might explain why some studies have not consistently shown effectiveness of soy products for menopausal symptoms. Although red clover (Trifolium pratense) contains isoflavones similar to soy, the effectiveness of this herb for menopausal symptoms at relatively low concentrations points to a different mechanism of action.[32]

Other phytoestrogens

It is believed that dietary changes that include a higher consumption of phytoestrogens from sources such as soy, red clover, ginseng, and yam may relieve hot flashes.

Acupuncture

Acupuncture has been suggested to reduce incidence of hot flashes in women with breast cancer and men with prostate cancer, but the quality of evidence is low.[38] [39]

Epidemiology

It has been speculated that hot flashes are less common among Asian women.[40] [41]

Menopausal women who have more hot flashes have a higher risk of hypertension and cardiovascular disease.[42]

See also

External links

Notes and References

  1. Web site: Hot Flashes - Symptoms and causes - Mayo Clinic. 2021-03-31. www.mayoclinic.org.
  2. Web site: University of Glasgow . University of Glasgow . Doctors seek the key to understanding hot flushes . University News (Archive of news) . University of Glasgow . 24 October 2007 . 19 April 2013.
  3. Web site: Menopause . About.com . n.d. . https://web.archive.org/web/20110309173415/http://adam.about.net/reports/Menopause.htm . dead . 2011-03-09 . 19 April 2013 .
  4. Web site: Bunyavanich . Supinda . vanc . Low Testosterone Could Kill You . ABC News . ABC News Internet Ventures . 6 June 2007 . 20 April 2013.
  5. Web site: Hot Flashes in Men: An Update . Harvard Medical School . March 2014 . 5 May 2020.
  6. Petering. Ryan C.. Brooks. Nathan A.. 2017-10-01. Testosterone Therapy: Review of Clinical Applications. American Family Physician. 96. 7. 441–449. 29094914. 0002-838X.
  7. Web site: What to Expect During Therapy . Lupron Depot . Abbott Laboratories . 20 April 2013.
  8. Web site: Hot Flashes in Men -- Mayo Clinic Researchers Describe A Treatment . ScienceDaily . Science Daily LLC . 19 October 2004 . 20 April 2013.
  9. Engstrom CA, Kasper CE . Physiology and endocrinology of hot flashes in prostate cancer . American Journal of Men's Health . 1 . 1 . 8–17 . March 2007 . 19482779 . 10.1177/1557988306294162 . 20123822 . free .
  10. Web site: Anitei . Stefan . vanc . Men Can Experience Hot Flashes, Just Like Women in Menopause . Softpedia . 16 April 2007 . 20 April 2013.
  11. Utian . Wulf H. . vanc . Recent Developments in Pharmacotherapy for Vasomotor Symptoms . Current Obstetrics and Gynecology Reports . 1 . 2 . 43–49 . 2012-06-01 . 2161-3303 . 10.1007/s13669-012-0009-4 . free .
  12. Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL . Pathophysiology and treatment of hot flashes . Mayo Clinic Proceedings . 77 . 11 . 1207–18 . November 2002 . 12440557 . 10.4065/77.11.1207 .
  13. Freedman RR . Menopausal hot flashes: mechanisms, endocrinology, treatment . The Journal of Steroid Biochemistry and Molecular Biology . 142 . 115–20 . July 2014 . 24012626 . 4612529 . 10.1016/j.jsbmb.2013.08.010 . Current Views of Hormone Therapy for Management and Treatment of Postmenopausal Women .
  14. Spetz AC, Zetterlund EL, Varenhorst E, Hammar M . Incidence and management of hot flashes in prostate cancer . The Journal of Supportive Oncology . 1 . 4 . 263–6, 269-70, 272-3; discussion 267-8, 271-2 . November–December 2003 . 15334868 .
  15. Moustakli E, Tsonis O. Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals . Medicina. 59 . 12 . 2094 . 29 November 2023 . 10.3390/medicina59122094 . free . 38138197 . 10744413 .
  16. Magon . Navneet . vanc . Gonadotropin releasing hormone agonists: Expanding vistas. Indian Journal of Endocrinology and Metabolism. 15 . 2 . 261–267. Oct–Dec 2011 . 10.4103/2230-8210.85575. free . 22028996 . 3193774 .
  17. Casimiro . Isabel . vanc . Severe Vasomotor Symptoms Post-Oophorectomy Despite Testosterone Therapy in a Transgender Man: A Unique Case Study. Journal of the Endocrine Society . 3 . 4. 743–736. 13 February 2019. 10.1210/js.2018-00367. 30931422 . 6436763 .
  18. Mueller A, Haeberle L, Zollver H, Claassen T, Kronawitter D, Oppelt PG, Cupisti S, Beckmann MW, Dittrich R . Effects of Intramuscular Testosterone Undecanoate on Body Composition and Bone Mineral Density in Female-to-Male Transsexuals . The Journal of Sexual Medicine . 7 . 9. 3190–3198. 1 September 2010. 10.1111/j.1743-6109.2010.01912.x. 20584125 .
  19. Web site: U.S. Food and Drug Administration . Food and Drug Administration . FDA Updates Hormone Therapy Information for Post Menopausal Women . FDA News Release (Archived content) . U.S. Food and Drug Administration . 10 February 2004 . 19 April 2013.
  20. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J . 6 . Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial . JAMA . 288 . 3 . 321–33 . July 2002 . 12117397 . 10.1001/jama.288.3.321 . free .
  21. Serock MR, Wells AK, Khalil RA . Modulators of vascular sex hormone receptors and their effects in estrogen-deficiency states associated with menopause . Recent Patents on Cardiovascular Drug Discovery . 3 . 3 . 165–86 . November 2008 . 18991792 . 10.2174/157489008786263970 .
  22. Løkkegaard E, Andreasen AH, Jacobsen RK, Nielsen LH, Agger C, Lidegaard Ø . Hormone therapy and risk of myocardial infarction: a national register study . European Heart Journal . 29 . 21 . 2660–8 . November 2008 . 18826989 . 10.1093/eurheartj/ehn408 . free .
  23. Web site: For Women - Menopause and Hormones: Common Questions. Food and Drug Administration.
  24. Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, Burger HG, Colditz GA, Davis SR, Gambacciani M, Gower BA, Henderson VW, Jarjour WN, Karas RH, Kleerekoper M, Lobo RA, Manson JE, Marsden J, Martin KA, Martin L, Pinkerton JV, Rubinow DR, Teede H, Thiboutot DM, Utian WH . 6 . Postmenopausal hormone therapy: an Endocrine Society scientific statement . The Journal of Clinical Endocrinology and Metabolism . 95 . 7 Suppl 1 . s1–s66 . July 2010 . 20566620 . 6287288 . 10.1210/jc.2009-2509 .
  25. L'Hermite M . HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT . Climacteric . 16 . 44–53 . August 2013 . Suppl 1 . 23848491 . 10.3109/13697137.2013.808563 . 20401584 .
  26. Fournier A, Fabre A, Mesrine S, Boutron-Ruault MC, Berrino F, Clavel-Chapelon F . Use of different postmenopausal hormone therapies and risk of histology- and hormone receptor-defined invasive breast cancer . Journal of Clinical Oncology . 26 . 8 . 1260–8 . March 2008 . 18323549 . 2346534 . 10.1200/jco.2007.13.4338 .
  27. Web site: Harvard Women's Health Watch . Harvard Women's Health Watch . What are bioidentical hormones? . Harvard Women's Health Watch . August 2006 . 20 September 2014.
  28. Sicat BL, Brokaw DK . Nonhormonal alternatives for the treatment of hot flashes . Pharmacotherapy . 24 . 1 . 79–93 . January 2004 . 14740790 . 10.1592/phco.24.1.79.34812 . 22844064 .
  29. News: FDA NEWS RELEASE: FDA approves the first non-hormonal treatment for hot flashes associated with menopause. Food and Drug Administration. 28 June 2013. FDA.
  30. Web site: Apo-Clonidine - Uses, Side Effects, Interactions - Drug Factsheets - C-Health. https://web.archive.org/web/20151222164827/http://chealth.canoe.com/drug_info_details.asp?brand_name_id=701. dead. 22 December 2015. chealth.canoe.com. 2015-12-21.
  31. Web site: What Patients Need to Know About Hot Flashes. Medscape.
  32. Nissan HP, Lu J, Booth NL, Yamamura HI, Farnsworth NR, Wang ZJ . A red clover (Trifolium pratense) phase II clinical extract possesses opiate activity . Journal of Ethnopharmacology . 112 . 1 . 207–10 . May 2007 . 17350196 . 10.1016/j.jep.2007.02.006 .
  33. Wiklund IK, Mattsson LA, Lindgren R, Limoni C . Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group . International Journal of Clinical Pharmacology Research . 19 . 3 . 89–99 . 1999 . 10761538 .
  34. Basch E, Bent S, Collins J, Dacey C, Hammerness P, Harrison M, Smith M, Szapary P, Ulbricht C, Vora M, Weissner W . 6 . Flax and flaxseed oil (Linum usitatissimum): a review by the Natural Standard Research Collaboration . Journal of the Society for Integrative Oncology . 5 . 3 . 92–105 . 2007 . 17761128 . . 37254359 .
  35. Bergman Jungeström M, Thompson LU, Dabrosin C . Flaxseed and its lignans inhibit estradiol-induced growth, angiogenesis, and secretion of vascular endothelial growth factor in human breast cancer xenografts in vivo . Clinical Cancer Research . 13 . 3 . 1061–7 . February 2007 . 17289903 . 10.1158/1078-0432.CCR-06-1651 . free .
  36. Touillaud MS, Thiébaut AC, Fournier A, Niravong M, Boutron-Ruault MC, Clavel-Chapelon F . Dietary lignan intake and postmenopausal breast cancer risk by estrogen and progesterone receptor status . Journal of the National Cancer Institute . 99 . 6 . 475–86 . March 2007 . 17374837 . 2292813 . 10.1093/jnci/djk096 .
  37. Web site: Flaxseed in Treating Postmenopausal Women With Hot Flashes Who Have a History of Breast Cancer or Other Cancer or Who Do Not Wish to Take Estrogen Therapy . ClinicalTrials.gov . U.S. National Institute of Health . November 2010 . 20 April 2013.
  38. Frisk JW, Hammar ML, Ingvar M, Spetz Holm AC . How long do the effects of acupuncture on hot flashes persist in cancer patients? . Supportive Care in Cancer . 22 . 5 . 1409–15 . May 2014 . 24477325 . 10.1007/s00520-014-2126-2 . 9607095 .
  39. Lee MS, Kim KH, Shin BC, Choi SM, Ernst E . Acupuncture for treating hot flushes in men with prostate cancer: a systematic review . Supportive Care in Cancer . 17 . 7 . 763–70 . July 2009 . 19224253 . 10.1007/s00520-009-0589-3 . 21847920 .
  40. Messina M, Hughes C . Efficacy of soyfoods and soybean isoflavone supplements for alleviating menopausal symptoms is positively related to initial hot flush frequency . Journal of Medicinal Food . 6 . 1 . 1–11 . 2003 . 12804015 . 10.1089/109662003765184697 .
  41. Lock M . Menopause in cultural context . Experimental Gerontology . 29 . 3–4 . 307–17 . May–August 1994 . 7925751 . 10.1016/0531-5565(94)90011-6 . 25719669 .
  42. Lee . Emma . Anselmo . Miguel . Tahsin . Chowdhury Tasnova . Vanden Noven . Marnie . Stokes . William . Carter . Jason R. . Keller-Ross . Manda L. . 2022-12-01 . Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease . American Journal of Physiology. Heart and Circulatory Physiology . 323 . 6 . H1270–H1280 . 10.1152/ajpheart.00477.2022 . 1522-1539 . 9744645 . 36367692 .

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