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Gwalior 2012 march cooling down hot flushes treatment options
1. Cooling down the Hot
flushes /flashes
Cooling down the Hot
flushes /flashes
Dr. Kawita Bapat
2.
3. 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.
4. Hot flushes
Sensation of intense
heat, sweating, flushin
g,
Lasts for five to 10 min
Main reason to seek
medical help for the
menopause
Ahead of night sweats
and mood and sleep
disturbances.
5. thermostat — the
Levels of hypothalamus. at the
Estrogen fall base of brain regulates brain gets the
body temperature and ‘wrong message’
other basic processes. thinks that the
body is too
hot, creating
measures such as
extremely uncomfortable sweating and heat
horrible
embarrassing lasting loss (through the
from 3 to 5 min experience of
waking up at skin) to try to cool
many times a day down the inside of
night drenched
can last for years the body.
in sweat
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.
6.
7. Hot Flash Rates
Menstrual Status % Reporting Hot Flashes
Premenopausal* ~10%
Perimenopausal† ~30% to 85%
Recently postmenopausal ~20% to 90%
4 years postmenopause ~20% to 60%
* Menstruationwithin 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
8.
9.
10.
11. 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.
12. Hormone Replacement Therapy
Some women love it others hate it
Some women won’t others won’t consider
touch it stopping it.
But no matter how you it remains the only
fell about estrogen, government approved
drug therapy in the
United States
13. 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
14. Four types of estrogens
Human Estrogens Synthetic Estrogens.
Estradiol, strongest one manufactured in chemical plants
Estrone less active resemble human and non-human
Estriol 10 percent as active as estrogens.
estradiol
Non-Human Estrogen Plant-Based Estrogens.
phytoestrogens.
conjugated estrogens or CE.
mixture of at least 10 estrogens Some act like an estrogen
obtained from natural sources, others act like an anti-estrogen,
typically, the urine of pregnant commonly found in foods such as
mares. soy, flaxseed, red clover
15. Women's HOPE Study
Change in Number of Hot Flushes Over 12 Weeks
(n = 241)
12
12 Placebo Placebo
0.625 0.625/2.5
Adjusted Mean Daily Number*
Adjusted Mean Daily Number*
10 0.45/2.5
10 0.45
0.3 0.45/1.5
8 8 0.3/1.5
6 6
4 4
2 2
0 0
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Week Week
*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.
16. HRT
Personal decision
needs to be individualized
detailed discussion
personal needs
wants and desires
Symptoms hoping to alleviate
risks explained
alternatives exist
17.
18. 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!
19.
20. 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
21.
22. 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
23. 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
24. 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
26. 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
27. 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
28. 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
29. 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
33. 1. Dress for success
Dress in layers
Easy care fabrics
Loose fitting clothes
Comfy style
Wardrobe planning
34. 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.
35. 3.COOL THE ROOM
Open the windows
Air-conditioner/fan
Constant cool
temperature
36. 4.AVOID THE HOT SPOT
Stay away from
outdoor places
No sun bathing
Avoid hot tubs
Sauna and steam bath
cautiously
37. 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’
38. 6.EAT TO BEAT THE HEAT
Turn down the spices
Hot & spicy food-flash
maker.
Avoid hot drinks &
alcohol.
Pay attention to own
food----
43. 10. Herbal hot flashes remedies
Vitamin-E
Yam phyto-
estrogen
Black cohosh
Red clover
Chinese herbs
44.
45. 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.
46. MEDITATION
Learn to Relax
stress, 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.
47. 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
48. Some suggestions as conclusion
Non-HRT prescription meds such as:
SSRI antidepressants
SNRI antidepressants.
anti-seizure medication
Clonidine
49.
50. Some suggestions as conclusion
HRT with low Estrogens.
Tailor made and designer HRT
With persistence and patience
Notas del editor
The physical and financial burden imposed by menopause associated hot flushes is immense," she says. "Optimum management includes lifestyle changes in all women and HRT in women with moderate-to severe symptoms. Less effective herbal remedies or non-hormonal therapies may be appropriate in certain women, such as those with mild symptoms or those who cannot or will not take HRT."