Natural Remedies for Hot Flushes
Agerelated Changes in Hormones and Their Receptors in Animal Models of Female Reproductive Senescence
Traditionally, the onset and progression of menopause in humans has been attributed to ovarian follicular decline. Because the follicles are the primary source of circulating estrogens, these age-related changes lead to a number of symptoms such as hot flashes, mood swings, irritability, and depression, as well as increased risk of osteoporosis, cardiovascular disease, and age-associated diseases. Recent research indicates that along with the ovarian changes at menopause, the hypothalamic and pituitary levels of the reproductive axis also undergo significant changes during reproductive aging. Indeed, current research suggests a neural, as well as hormonal, mechanism involved in the menopausal process. A number of animal models are available to study these processes, most commonly the nonhuman primates and rodents, and to a lesser extent, avian systems. Here, we will discuss Old and New World monkey models, rats, mice (wild type, transgenic, and genetically modified), and birds as...
This study was an open-label, historically controlled, single center phase IIa study in which men diagnosed with HG PIN were treated with 60 mg day oftoremifene for 120 days. The study primary objectives were to determine whether toremifene was able to reduce HG PIN in men with HG PIN, to evaluate its effect on other intermediate endpoints including serum total PSA and free PSA, as well as its safety and impact on male hormonal status. The effects of toremifene on quality of life issues, i.e., changes in libido, erectile function, and hot flashes were also assessed. Once informed consent was obtained, subjects were referred to the study if any prostate biopsy within the last 6 mo had HG PIN (at least 6 prostate cores were needed to be included in the study). The prostate pathology was re-evaluated to confirm HG PIN. Subjects who had HG PIN and fulfilled all of the eligibility requirements were enrolled in the study. At study day 120, subjects underwent transrectal...
The natural oestrogen-receptor activity of soy is popularly considered an alternative to controversial HRT for postmenopausal women (Sliva 2005). A recent analysis of 17 trials, however, found mixed results for the effects of soy isoflavone extracts on menopausal symptoms (Nelson et al 2006). Although some data seem to support the efficacy of isoflavones in reducing the incidence and severity of hot flushes, many studies have not found any difference between the isoflavone recipients and the controls. Inadequate data exist to evaluate the effect of isoflavones on bone mass and vaginal dryness (Greenwood et al 2000).
This chapter deals with menopause-associated symptoms including hot flashes, night sweats, sleep disturbances, and vaginal symptoms. Other symptoms that accompany the perimenopause transition but are related to other life events or aging, including sexual dysfunction and mood disturbances, are discussed. The options for managing these changes include menopause hormone therapy, both systemic and local, as well as complementary therapies and nonhormonal therapies for each of the symptoms.
Brenda (age 55) and Alexander (age 57) had been married for 30 years when they were referred to a sex and couple therapy clinic for dyspareunia by her gynecologist. A comprehensive pain assessment revealed that Brenda experienced a rubbing, cutting, and sometimes burning pain upon penetration and a deeper dull, pulling pain during intercourse. She reported that the pain started 4 years ago, at a time when she began to experience hot flashes and irregular periods, with an increase in intensity of the superficial pain over the last
Jon and Linda were referred to the author by Jon's current psychopharmacolo-gist. Jon is a 62 years old financier who has been married to Linda (53 years old) for over 20 years. She began HRT 4 years ago, which successfully stopped her hot flashes. This is his second marriage and her first marriage. They had three teenage children together. Their marriage was marked by periods of disharmony secondary to multiple etiologies. Jon and Linda had a symbiotic relationship where she dominated much of their daily life. She tended to be explicitly critical of him, which he resented but managed passive-aggressively. This, of course, merely exacerbated their marital tension. Linda was particularly sensitive to rejection, and was considerably upset when Jon withdrew from her in response to her criticism. This infuriated her and she provoked confrontations. He eventually responded, becoming loud and aggressive, which initially dissipated his tension. He then felt guilty as she expressed hurt and...
Hormonal therapy for prostate cancer eventually produces decreases in libido and potency in virtually all patients regardless of the modality used.34,124 Additional side effects include lethargy, depression, anorexia, breast swelling with or without tenderness, hot flashes, anemia, and osteoporosis with potential for pathological fracture.14,125-130 Most side effects, including impotence and infertility, are slowly reversible with cessation of therapy. However, reduced bone mineral density often does not reverse after prolonged hormonal suppression. There is a consensus that irreversible changes occur more often after suppression of longer than 18-24 months. etate produces less gynecomastia, diarrhea, nausea, and liver function abnormality than flu-tamide but cyproterone is associated with a higher incidence of thrombotic problems.131 Hot flashes are more common with castration than flutamide or biclutamide alone.45
Acute toxicity was low for participants in the pilot study, and compliance remained correspondingly high 77 of women on tamoxifen and 82 of women on placebo remained on medication at 5 years.163 There was a significant increase in hot flashes (34 vs. 20 , p 0.005), mostly in premenopausal women vaginal discharge (16 vs. 4 , p 0.005) and menstrual irregularities (14 vs. 9 , p 0.005). At the most recent follow-up, 320 women had discontinued tamoxifen and 176 had discontinued placebo prior to the study's completion.160
Estrogenic symptoms, including hot flushes, vaginal dryness, and sleep disturbances. In the majority of studies with protracted GnRH analogue treatment, loss of bone mineral density (BMD) has been evident. As oophorectomy at a young age is associated with an increased risk of cardiovascular disease, long-term use of GnRH analogues is of concern. While the side effects and risks associated with hypoestrogenemia are acceptable in the setting of metastatic breast cancer and in the adjuvant treatment of early breast cancer, such effects may not be acceptable to women only at risk for the development of the disease. While a GnRH analogue should achieve major reduction in a woman's lifetime breast cancer risk, the benefit will occur only if the agent were to be continued for prolonged periods of time. To permit such protracted use, methods for reducing the side effects and morbidity must be considered.
Chemotherapy, particularly alkylating agents like cyclophosphamide, can induce infertility and, in women, premature menopause, with its attendant problems of hot flashes, mood swings, vaginal dryness, and urinary incontinence. Cyclophosphamide is commonly used in breast cancer, but management of the menopausal symptoms is complicated by the fact that hormone replacement therapy is considered contraindi-cated in patients with a history of breast cancer. Consequently, other treatments must be used for hot flashes, such as antidepressants.52 This example illustrates the importance of both recognizing the symptoms related to ovarian failure in a cancer patient in which it would be otherwise unexpected, and having knowledge of the oncologic considerations of the therapies being chosen.
Menopausal hot flushes According to one randomised, double-blind placebo-controlled study EPO supplementation significantly reduces the maximum number of night-time flushes, although other symptoms failed to respond. The study used a dose of four capsules daily (each containing 500 mg EPO and 10 mg vitamin E) over 6 months (Chenoy et al 1994).
Quality of life in menopause encompasses more than just absence of symptoms. It includes enjoyment of life, participation in meaningful relationships, work, and play (Matthews and Bromberger, 2005). Although most women in Western societies report hot flashes and night sweats, for most of these women such symptoms do not affect quality of life. In fact, data from the Melbourne Women's Mid-life Project show that well-being increases across the menopause transition (Dennerstein et al., 2003). Lifestyle changes are recommended first for vasomotor symptoms. These include weight reduction for women who are significantly overweight it has long been considered that women who were obese had fewer vasomotor symptoms because of elevated estrone levels from aromatization of adipose tissue to androgens than to estrone. However, new evidence shows that the occurrence of VMS in obese perimenopausal women may be due to the increased heat insulation afforded by greater adiposity, leading to more hot...
Assessment of quality of life showed similar depression scores between groups. Hot flashes were noted in 81 of the women on tamoxifen compared to 69 of the placebo group, and the tamoxifen-associated hot flashes appeared to be of comparable severity. In the tamoxifen group, 29 of the women and 13 in the placebo group reported moderate or severe vaginal discharge. No differences in the occurrence of irregular menses, nausea, fluid retention, skin changes, or weight gain or loss were reported.
A potential role for analogues of gonadotropin hormone-releasing hormone (GnRH) to prevent cancers of the breast, ovary, and endometrium was first suggested by Pike et al.1 The rationale for considering GnRH analogues is their ability to suppress ovulation and sex-steroid production. The suppression of ovulation should prevent ovarian cancer, and the suppression of sex steroids should prevent cancers of the breast and endometrium. However, the GnRH analogue-induced hypo-estrogenic state will have associated symptoms (hot flashes) and morbidity (urogenital atrophy and osteoporotic fractures). To minimize the deleterious effects of hypoestrogenemia, addition of other agents, including bisphosphonates, selective estrogen receptor modulators (SERMS), and low-dose add-back sex steroids, is under consideration for study. In this chapter, the epidemiological basis for considering GnRH analogues to prevent breast cancer and available preclinical and clinical data will be reviewed.
Lepirudin administration during prospective studies in patients with HIT was associated with a low incidence of allergic events, as well as during the much larger clinical trials in patients with ACS. Among the adverse events reported were eczema, rash, pruritus, hot flushes, fever, chills, urticaria, bronchospasm, cough, stridor, dyspnea, angioedema (face, tongue, larynx), and injection-site reactions. Any causal relationship of lepirudin to these adverse events is unclear.
Another unpleasant experience associated with menopause are sensations of extreme heat, particularly in the upper part of the body. These so-called hot flashes, which are often accompanied by a drenching sweat, diminish gradually and usually disappear altogether within a year or two following their onset.
It Is suggested that the effects of A. racemosa may be due to dopaminergic activity, because black cohosh extract BNO 1055 displayed dopaminergic activity with a D(2)-receptor assay (Jarry et al 2003). Considering that dopaminergic drugs reduce some symptoms (e.g. hot flushes) associated with menopause, this theory is feasible however, further studies are required to explain why black cohosh is devoid of the typical side-effects associated with dopaminergic drugs (Borelli & Ernst 2002).