Symptoms
A hot flash is a spontaneous feeling of warmth that may be accompanied by sweating, palpitations, flushing of the skin, feelings of anxiety, and subsequent chills, and lasts for a few minutes. The flushes affect mainly the head and upper body, but sometimes the whole body. The flushes often also occur at night, are accompanied by sweating, and cause sleep disturbances (night sweats). The intensity and frequency vary greatly from woman to woman, ranging from mild and infrequent to severe and very frequent. Hot flashes are one of the most common symptoms of menopause. They occur in women from about 40 years of age and may precede menstrual cycle changes. They can persist for many years, but usually disappear on their own. Complications include reduced quality of life and interference with normal daily routines. Flushes can lead to feelings of shame, helplessness, frustration, and anger.
Causes
Hot flashes are caused by peripheral vasodilatation. A possible acute trigger has been identified as a slight increase in body temperature, for example, during physical activity, stress, or inappropriate clothing. In one study, it was shown that the so-called thermoneutral temperature range, in which people neither shiver nor sweat, is reduced in women with hot flashes. This seems to be a disorder of thermoregulation at the level of the hypothalamus. Falling estrogen levels at menopause are blamed as a deeper cause, but other mechanisms also seem to be involved. Both increased body weight and smoking may increase risk.
Diagnosis
Except for the itching and the appearance of wheals, the symptomatology of flushing closely resembles cholinergic urticaria, but it occurs mainly in younger people. Medications also trigger flushes, for example SERMs such as tamoxifen and raloxifene (common). They cancel the effects of estrogens and are used against breast cancer. A number of others, for example endocrine and metabolic disorders, may be considered as differential diagnoses. Men may be very commonly affected by hot flashes as part of therapy for prostate cancer (see under bicalutamide).
Nonpharmacologic treatment
Avoiding stress, relaxation techniques, exercise, and sports can have a positive effect. Potential risk factors such as smoking, alcohol (dilates blood vessels), caffeine, and increased body weight should be eliminated whenever possible. Avoid heat and cool as needed:
- Light clothing appropriate to the environment
- Remove clothing that is too warm
- Shortly in the fresh air to cool down
- Drink a cool drink or suck on an ice cube
- Regulate room climate
Drug treatment
Estrogens:
- Estrogens are very effective according to clinical trials, reducing frequency and intensity by about 70% to 90%. Because estrogens may increase the risk of breast cancer and cardiovascular disease, among other things, they should be used cautiously at the lowest possible dose and for short durations. Since the effect is dose-dependent, the dose can be adjusted accordingly. In addition to estrogens, other hormones such as tibolone are available and some progestins are also effective.
Antidepressants:
- Especially venlafaxine and einge SSRIs such as paroxetine are effective against flushes, but somewhat weaker than estrogens. They additionally help with co-existing mental illness. Low-dose paroxetine was approved in the United States in 2013 for the treatment of menopausal-related flushes (Brisdelle).
Cimicifuga (black cohosh):
- Is widely used in phytotherapy and approved in many countries for this indication. Preparations are available that need to be taken only once a day. Possible adverse effects include digestive problems and very rarely liver damage. If yellowing of the skin or other symptoms suggestive of liver damage occur, the remedies should be discontinued. According to rational phytotherapy, standardized extracts should be used.
Sage:
Phytoestrogens:
- Such as the lignans, isoflavones, and coumestans are secondary plant compounds without a steroidal structure with weak estrogenic effects. Isoflavones are found, for example, in red clover or soy. Their efficacy is controversial. Red clover is not marketed as a drug, but as a food supplement. From our point of view, they should not be applied (see under red clover).
Alternative medicine:
- In alternative medicine, many other agents such as ginseng, evening primrose oil, vitamin E, anthroposophics, spagyric and homeopathics are used. An attempt at therapy is possible, provided there are no contraindications or interactions. The clinical data is insufficient; the effectiveness is not scientifically confirmed. Of advantage is the better tolerability compared with the synthetics.
Placebo:
- Finally, many treatments have been shown to have a high placebo effect; therefore, many treatments are subjectively perceived as effective.