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Recently, a headline in an Associated Press newspaper article read, "Live with hot flashes if you can". The problem with using estrogen to decrease hot flash symptoms is that it may produce paradoxical benefits, i.e. although estrogen reduces hot flashes, there is a corresponding increase in developing breast cancer, heart disease, stroke, and serious blood clots. Advances in the knowledge of the physiology of hot flashes are leading to a wider variety of treatment options.
About 75% of postmenopausal women experience hot flashes. From a physiological sense, a hot flash is the body's way of cooling down. Somewhere between declining estrogen levels and hot flashes, a series of complex biological reactions takes place. A review of the literature illustrates there are many questions about hot flashes that remain unanswered. According to Fredi Kronenberg, Columbia University, the data indicate that hot flashes may start much earlier and continue far longer than is commonly recognized by physicians or acknowledged in textbooks of gynecology. Hot flashes can be caused by either estrogen or progesterone deficiency, or both. Estrogen may involve other yet to be documented autonomic response factors. Unfortunately, measurement of the hot flash symptoms is complicated, making it difficult to study. Many doctors believe that hot flashes result from a dysfunction in the hypothalamus, the body's thermoregulatory center. This gland is responsible for maintaining core body temperature within a regulated normal range. Research shows that there are disturbances in a number of circulating hormones after a hot flash. Lower estrogen levels lead to alterations in a number of chemical messengers, including a decrease in your body's own natural painkillers (endorphins) and a decrease in a byproduct of estrogen processing (catecholestrogen). These changes may in turn cause a cascade of other changes in the levels of certain chemicals (neurotransmitters) in the brain. This includes a decrease in the blood level of serotonin, a mood regulator in the hypothalamus. These changes in norepinephrine and serotonin levels may cause your hypothalamus to narrow the normal range of your core body temperature and shift it downward. Consequently, just a tiny elevation in your core body temperature above this lower range can trigger perspiration and blood vessel dilation, culminating in the classic signs of a hot flash.
Men can experience hot flashes too as they go through their own menopausal symptoms. Night sweats can cause considerable sleep disruption, and can lead to sleep deprivation that can often be mistaken for insomnia. Night sweats can also be correlated to adrenal fatigue. Some researchers have been concerned that black cohosh might have estrogen-like effects on breast and uterine tissues, but it appears safe for women to use for up to 6 months to relieve symptoms of hot flashes. Currently, the U.S. government is funding a 12 month study on the use of black cohosh for the treatment of menopausal symptoms, following up on years of German research. Although taking vitamin E (800 IU per day) provides precursor material for female hormone production, this author's clinical observations find it results in minor, if any decrease in hot flashes. However, combined with other remedies it may be more effective. Although sage is known as a cooling and drying herb, and using this oil in aromatherapy application is somewhat effective, this herb does not alleviate vaginal dryness. An estrogen cream applied directly to the labia may be used for vaginal dryness. Tribulus terrestris, an Indian/Ayurvedic herb can stimulate vaginal secretions. Postmenopausal women can take Tribulus continuously during the month, but premenopausal women should only take it during the follicular phase (days 5 - 14). There is mixed evidence on the effectiveness of soy protein for reducing hot flashes. Soy contains isoflavones, which have many beneficial effects including reducing many menopausal symptoms, reducing the risk of breast cancer, (in those that don't have cancer) osteoporosis, and endometrial cancer. If a patient is hypothyroid, soy may inhibit thyroid hormone synthesis and mineral absorption. The safety of using soy in women with a history of breast or uterine cancer is controversial and not well researched. Some studies have reported potential estrogenic effects of soy on breast cancer cells in vitro, while other studies have not found such effects.
Besides isoflavones, other flavone-containing products such as hesperidin, rutin, etc. may also be beneficial. Hesperidin has been reported to help in regulating estrogen levels and decreasing related pain, inflammation and swelling. In a clinical study, 94 women suffering from hot flashes and other menopausal symptoms were given a formula containing 900 mg of hesperidin, 300 mg of hesperidin methylchalcone and 1200 mg of vitamin C daily. At the end of 1 month, symptoms of hot flashes were relieved in 53% of the patients and reduced in 34% of the patients. (Note: The above material is pertinent to physiologically induced hot flushes and should not be applied to tamoxifen induced hot flashes since the hesperidin blocks the same receptor sites that tamoxifen occupies in breast cancer chemotherapeutic treatment). Phytoestrogen-containing foods such as oats, barley, alfalfa, almonds and lentils can also modify symptoms. Of course family history must always be taken into consideration when determining the risks for breast cancer, heart disease osteoporosis and Alzheimer's disease. If patients are experiencing hot flashes, it is important to rule out hyperthyroidism, anxiety, carcinoid syndrome, pheochromocytoma and niacin flushes. |