Question

Joy is a 47-year-old G2 P2 who is experiencing periods of hot flashes or flushes and night sweats and has difficulty sleeping at night. She has mild hypertension but does not take any hypertensive medications since she started a daily walking regimen 6 months ago. Joy says that her menopausal symptoms are interfering with her quality of life. She made an appointment with the nurse practitioner at her gynecologist’s office to discuss natural or alternative therapies to help relieve her symptoms.

1. Why do menopausal women experience hot flashes or flushes and night sweats?

2. Why do these symptoms interfere with the women’s quality of life?

3. What are comfort measures to help with hot flashes or flushes?

4. What are examples of complementary and alternative therapies for relieving hot flashes or flushes and night sweats? 5. What are examples of plant sources for relieving hot flashes or flushes and night sweats?

Answer 1

QUESTIONS:

1. Why do menopausal women experience hot flashes or flushes and night sweats?

2. Why do these symptoms interfere with the women’s quality of life?

3. What are comfort measures to help with hot flashes or flushes?

4. What are examples of complementary and alternative therapies for relieving hot flashes or flushes and night sweats?

5. What are examples of plant sources for relieving hot flashes or flushes and night sweats?

ANSWERS:

1. Why do menopausal women experience hot flashes or flushes and night sweats?

• Hot flashes and night sweats occur before and during menopause because of changing hormone levels, including estrogen and progesterone, affecting the body’s temperature control.
• Changes in these hormone levels affect the action of other hormones that are responsible for regulating the body’s temperature.
• This causes the characteristic feelings of sudden warmth, flushing, and excessive sweating.The frequency of hot flashes and night sweats differ between people.
• Hot flashes occur when decreased estrogen levels cause your body's thermostat (hypothalamus) to become more sensitive to slight changes in body temperature.
• When the hypothalamus thinks the body is too warm, it starts a chain of events, a hot flash to cool down.

2. Why do these symptoms interfere with the women’s quality of life?

Some only experience occasional hot flashes while, for others, the symptoms can get in the way of daily life.

• Severe hot flashes can be negatively associated with sexual activity. Hot flashes can contribute to sexual problems in any number of ways:
• Simple sweatiness. The sensation of heat brought on by hot flashes can be so intense and unpleasant that the idea of intimacy or being sexual may be inconceivable around the time that flashes occur. Being red and sweaty just doesn’t feel sexy.
• Sleep disturbances and reduced energy. Although studies have not shown a clear cause-and-effect relationship between hot flashes and sleep disturbance, nighttime hot flashes and night sweats certainly do not make for restful sleep. The result can be fatigue and less energy for sex.
• Less closeness in bed. Women who used to enjoy sleeping close to their partner may find that their partner’s body heat triggers hot flashes. For some couples, differences over what’s a comfortable bedroom temperature can lead to sleeping in separate rooms.
• General negative effect on quality of life. Severe hot flashes have been found to take a toll on women’s social function, energy level, concentration, and overall quality of life. They also can intensify underlying symptoms of depression. Under these circumstances, women may not feel motivated to have sex.
• Hot flashes may impact daily activities and quality of life. Nighttime hot flashes (night sweats) can wake person from sleep and, over time, can cause long-term sleep disruptions.
• women who have hot flashes may have an increased risk of heart disease and greater bone loss than women who do not have hot flashes.

3. What are comfort measures to help with hot flashes or flushes?

• Hormone therapy

The most effective way to relieve the discomfort of hot flashes is to take estrogens, but taking this hormone carries risks.

• Antidepressants and anti-seizure
• Medications such as antidepressants and anti-seizure drugs also might help reduce hot flashes, although they're less effective than hormones.
• If hot flashes don't interfere with life, women probably don't need treatment. Hot flashes subside gradually for most women, even without treatment, but it can take several years for them to stop.
• Lifestyle and home remedies

If hot flashes are mild, try managing them with these lifestyle changes:

• Keep cool. Slight increases in body's core temperature can trigger hot flashes. Dress in layers so that she can remove clothing when she feels warm.
• Open windows or use a fan or air conditioner. Lower the room temperature, if she can. If she feels a hot flash coming on, sip a cold drink.
• Watch what she eats and drinks. Hot and spicy foods, caffeinated beverages and alcohol can trigger hot flashes. Learn to recognize triggers and avoid them.
• Relax. Some women find relief from mild hot flashes through meditation; slow, deep breathing; or other stress-reducing techniques. Even if these approaches don't quell hot flashes, they might provide other benefits, such as easing sleep disturbances that tend to occur with menopause.
• Don't smoke. Smoking is linked to increased hot flashes. By not smoking, she might reduce hot flashes, as well as her risk of many serious health conditions, such as heart disease, stroke and cancer.
• Lose weight. If she is overweight or obese, losing weight might help ease her hot flashes.

4. What are examples of complementary and alternative therapies for relieving hot flashes or flushes and night sweats?

Mind and body approaches

A growing body of evidence suggests that certain techniques can help ease hot flashes, including:

• Cognitive behavioral therapy (CBT). CBT is a widely used type of individual or group counseling and is recommended by the North American Menopause Society as an effective treatment for hot flashes and night sweats. CBT doesn't typically reduce the frequency of hot flashes, but may reduce how much they bother her.
• Hypnosis. The North American Menopause Society recommends hypnosis for the treatment of hot flashes. Research indicates that hypnosis might help reduce both the frequency and severity of hot flashes.
• Mindfulness meditation. This type of meditation has her focus on what's happening from moment to moment. Although not shown to relieve hot flashes, it might reduce how much they bother her.
• Acupuncture. Some studies indicate that acupuncture might reduce the frequency and severity of hot flashes, but results are conflicting, with many studies showing improvements in both active and control groups, but no difference between the two groups.

Dietary supplements

Dietary supplements commonly considered for menopause symptoms include:

• Plant estrogens. Asian women, who consume soy regularly, are less likely to report hot flashes and other menopausal symptoms than are women in other parts of the world. One reason might be related to the estrogen-like compounds in soy.
• However, studies have generally found little or no benefit with plant estrogens, although research is ongoing to determine whether specific components of soy, such as genistein, help hot flashes.
• Black cohosh. Black cohosh has been popular among many women with menopausal symptoms. Studies of black cohosh's effectiveness have had mixed results, and the supplement might be harmful to the liver in rare circumstances.
• Ginseng. While ginseng may help with mood symptoms and insomnia, it doesn't appear to reduce hot flashes.
• Dong quai. Study results indicate that dong quai isn't effective for hot flashes. The supplement can increase the effectiveness of blood-thinning medications, which can cause bleeding problems.
• Vitamin E. Taking a vitamin E supplement might offer some relief from mild hot flashes. In high doses, it can increase your risk of bleeding.

Hormone therapy

• Estrogen is the primary hormone used to reduce hot flashes.
• Most women who have had a hysterectomy can take estrogen alone.
• But if she still has a uterus, she should take progesterone with estrogen to protect against cancer of the lining of the uterus (endometrial cancer).

Antidepressants

• A low-dose form of paroxetine (Brisdelle) is the only nonhormone treatment for hot flashes approved by the U.S. Food and Drug Administration.
• Other antidepressants that have been used to treat hot flashes include:

· Venlafaxine (Effexor XR)

· Paroxetine (Paxil, Pexeva)

· Citalopram (Celexa)

· Escitalopram (Lexapro)

• These medications aren't as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can't use hormones. Possible side effects include nausea, difficulty sleeping or drowsiness, weight gain, dry mouth or sexual dysfunction.

Other medications

Other medications that might offer relief for some women include:

• Gabapentin (Neurontin, Gralise, others). Gabapentin is an anti-seizure medication that's moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness, water retention in the limbs (edema) and fatigue.
• Pregabalin (Lyrica). Pregabalin is another anti-seizure medication that can be effective in reducing hot flashes. Side effects can include dizziness, drowsiness, difficulty concentrating and weight gain.
• Oxybutynin (Ditropan XL, Oxytrol). Oxybutynin is a pill or patch most often used to treat urinary conditions like overactive bladder. It may also help relieve hot flashes in some women. Side effects can include dry mouth, dry eyes, constipation, nausea and dizziness.
• Clonidine (Catapres, Kapvay, others). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth and constipation.

5. What are examples of plant sources for relieving hot flashes or flushes and night sweats?

Dietary supplements commonly considered for menopause symptoms include:

• Plant estrogens. Asian women, who consume soy regularly, are less likely to report hot flashes and other menopausal symptoms than are women in other parts of the world. One reason might be related to the estrogen-like compounds in soy.
• However, studies have generally found little or no benefit with plant estrogens, although research is ongoing to determine whether specific components of soy, such as genistein, help hot flashes.
• Black cohosh. Black cohosh has been popular among many women with menopausal symptoms. Studies of black cohosh's effectiveness have had mixed results, and the supplement might be harmful to the liver in rare circumstances.
• Ginseng. While ginseng may help with mood symptoms and insomnia, it doesn't appear to reduce hot flashes.
• Dong quai. Study results indicate that dong quai isn't effective for hot flashes. The supplement can increase the effectiveness of blood-thinning medications, which can cause bleeding problems.
• Vitamin E. Taking a vitamin E supplement might offer some relief from mild hot flashes. In high doses, it can increase your risk of bleeding.