gwalior 2012 march cooling down hot flushes treatment options

Cooling down the Hot flushes /flashes

Treatment options

Dr. Kawita Bapat

Cooling down the Hot flushes

/flashes

HOT FLASES /FLUSHES

Whatever the cause, the effects can include a rise in skin temperature in the cheeks, forehead, upper arms, chest, abdomen, back, calves, thighs and fingers

with increased blood flow in the hands, calves, and forearms.

The increase in heat causes blood vessels just under the skin surface to dilate - get bigger - resulting in the classic florid cheek look associated with hot flushes.

Hot flushes

Sensation of intense heat, sweating, flushing,

Lasts for five to 10 min

Main reason to seek medical help for the menopause

Ahead of night sweats and mood and sleep disturbances.

thermostat — the hypothalamus. at the

base of brain regulates body temperature and other basic processes.

Levels of Estrogen fall brain gets the

‘wrong message’ thinks that the

body is too hot, creating measures such as sweating

and heat loss (through the skin) to try to cool down the inside of the

body.

horrible experience of waking up at

night drenched in sweat

extremely uncomfortable embarrassing lasting from 3 to 5 min many times a day can last for years through the menopausal transition.

menopause is inevitable the mind also has a major influence over the body and can be hypnotically trained to cool down hot flashes.

Hot Flash RatesMenstrual Status % Reporting Hot FlashesPremenopausal* ~10%Perimenopausal† ~30% to 85%Recently postmenopausal

~20% to 90%

4 years postmenopause

~20% to 60%

* Menstruation within the 3 prior months with no change in regularity of cycle.†3 to 11 months of amenorrhea or increased menstrual irregularity.1. McKinlay SM et al. Maturitas. 1992;14:103-115.2. Kronenberg F. Ann N Y Acad Sci. 1990:592:52-86.3. Nachtigall LE. Clin Obstet Gynecol. 1998;41:921-927

TREATMENT OPTION

What works, what might, and what doesn't

Hormone therapy Trials show it is effective According to a report from Thomas

Jefferson University, an analysis of 24 trials, which included 3,329 women, showed a 75.3 per cent drop in the frequency of hot flushes experienced each week, and an 87 per cent reduction in severity of symptoms.

Hormone Replacement Therapy

Some women love it

Some women won’t touch it

But no matter how you fell about estrogen,

others hate it

others won’t consider stopping it.

it remains the only government approved drug therapy in the United States

Estrogens and Hot Flushes

Higher doses associated with higher rates of response associated with more rapid response Response depends on bioavailability

and reaching adequate serum-tissue-receptor levels

BOTTOM LINE: More is better

Four types of estrogens

Human Estrogens Estradiol, strongest one Estrone less active Estriol 10 percent as active

as estradiol

Non-Human Estrogen conjugated estrogens or CE. mixture of at least 10 estrogens obtained from natural sources, typically, the urine of pregnant

mares.

Synthetic Estrogens. manufactured in chemical

plants resemble human and non-

human estrogens.

Plant-Based Estrogens. phytoestrogens. Some act like an estrogen others act like an anti-

estrogen, commonly found in foods such

as soy, flaxseed, red clover

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*Adjusted for baseline.Mean hot flushes at baseline = 12.3 (range 11.3–13.8). Analyses included women who recorded taking study medication and had at least 7 moderate-to-severe flushes/week or at least 50 flushes per week at baseline.Utian WH, et al. Fertil Steril. 2001;75:1065-79. Used with permission.

Change in Number of Hot Flushes Over 12 Weeks (n = 241)

Women's HOPE Study

HRT

Personal decision needs to be individualized detailed discussion personal needs wants and desires Symptoms hoping to alleviate risks explained alternatives exist

Sign of the Times - Menopausal Sayings

★ I was going to send in a suggestion...but I can't remember what it was :

★ Everyone around you is freezing cold, you have your personal fan turned on to turbo cool.

★ You don't know whether to laugh or cry, sometimes you do both!

Phyto Soya Twice a day mimic the hormones oestrogen. A study of published in the journal

Menopause in 2002 found it reduced hot flushes in 60 per cent

Expert opinion ‘There is some evidence to support the effectiveness of isoflavones, but not all the studies are conclusive and some are small.

Rating: 5/10

Black cohosh

one-a-day tablets member of the buttercup family side-effects digestive upsets and itchy skin Expert opinion : ‘Black cohosh is the most

extensively tested of all the herbal products for the menopause, but most of these studies have been small. It has been found to be effective for some women.’

Rating: 4/10

Lady Care magnet

This small magnet is attached to the front of the underwear, and is ideally worn all day

It is thought to have an effect on the part of the nervous

system that affects heart rate and perspiration.

A study of 35 women last year who wore it found that 70 per cent of them reported an improvement in hot flushes and night sweats.

Expert opinion : ‘how this would help overcome a fall in hormone levels. If it does have any benefit, then it is down to placebo effect.’

Rating: 2/10

Single bed cooling pad

This is a pad filled with a gel that delivers a cooling effect.

Around the size of a small blanket (70cm by 90cm), it absorbs the heat from the body and requires no batteries or mains electricity, and can be used again and again.

Expert opinion : ‘Anything that is cooling may help women having a hot flush. Normally they have to leap out of bed and have a cold shower or a drink, so this may help.

Rating: 4/10

7. GABAPENTIN

Drug for migrain

RED CLOVER

one tablet daily traditionally used One small study, commissioned by the

manufacturer, and involving 69 women, found that taking this reduced the number of hot flushes experienced by two-thirds.

EXPERT OPINION : ‘There is very little

evidence to suggest that THIS does actually work.’

Rating: 2/10

Traditional Chinese herbs

weak estrogen-like activity

Jiawei Qing'e Fang

EXPERT OPINION current findings suggest that Jiawei Qing'e Fang has benefits beyond the placebo

Rating 5/10

Primrose oil

one or two tablets daily help with ‘hormonal balance’. EXPERT OPINION: ‘Evening primrose oil is

taken for many hormonal complaints such as the menopause and PMT despite there being virtually no evidence that it works.

‘This does though also contain isoflavones which maybe of benefit to some – but no more than a placebo pill would be.’

Rating: 3/10

Vitex Agnus Castus

Nature’s Best flowering plant chasteberry fruit.

It was shown to stabilise hormone levels, reduce hot flushes and lessen vaginal dryness in a German study of 100 women published in Menopause in 2009.

EXPERT OPINION : ‘One trial did show that this had some benefit, but this was quite small. It needs more research.’

Rating: 3/10

10 COOL ways to stop hot flushes in tracts

1. Dress for success

Dress in layers

Easy care fabrics

Loose fitting clothes

Comfy style

Wardrobe planning

2.BREATHE

Deep breathing shortens the time of hot flushes

Abdominal breathing halve the number of attacks

Slow & deep breathe

Expand rib cage

Train ahead of time.

3.COOL THE ROOM

Open the windows

Air-conditioner/fan

Constant cool temperature

4.AVOID THE HOT SPOT

Stay away from outdoor places

No sun bathing

Avoid hot tubs

Sauna and steam bath cautiously

5.STAY HYDRATED

Plenty of water throughout day

Keep glass of water by self

15-20 Glass /day Water is important

for functioning ‘WATER GLASS

HABIT’

6.EAT TO BEAT THE HEAT

Turn down the spices

Hot & spicy food-flash maker.

Avoid hot drinks & alcohol.

Pay attention to own food----

6. EXERCISE

30 minutes / day

Walk/ run/ride/any-other

7.HORMONE HELP

Short course Estrogen is still

most effective.

8. Other medications possibilities

Anti -depressents.

Anti -hypertensives

Anti –seizures

Drug of migraine Gabapentin

9. Flaxseed

40 grms of ground flax seed/

Decreased joint & muscle pain.

10. Herbal hot flashes remedies

Vitamin-E Yam phyto-

estrogen Black cohosh Red clover Chinese herbs

Some suggestions as conclusion

Lifestyle non-HRT approaches include:

Drink plenty of water daily (8 glasses or more)

Daily exercise (walking 30 minutes is great) Yoga classes ( Kundalini Yoga best) Meditate daily – even 1 to 5 minutes at first

and work way up to longer. Keeping the mind calm and silent works

wonders.

MEDITATIONLearn to Relaxstress, emotional or physical by releasing adrenaline into.blood flow to increase, body temperature to rise. Hot flashes are a response to an increase in body temperature, and thus stress can cause to feel flush. That’s why stress-reduction techniques are among the recommended home remedies for hot flashes. Think yoga, deep breathing, and meditation.

Some suggestions as conclusion

Mindfulness-Based Stress Reduction mindfulness exercises.

Acupuncture –

Avoid caffeine, spicy foods and alcohol

Carry a cool wipe

Herbal approaches

vitamin D3 supplement

Some suggestions as conclusion

Non-HRT prescription meds such as:

SSRI antidepressants

SNRI antidepressants.

anti-seizure medication

Clonidine

Some suggestions as conclusion

HRT with low Estrogens.

Tailor made and designer HRT

With persistence and patience

THANK YOU