Natural Remedies for Hot Flushes
Botanicals such as soy and black cohosh are promoted to reduce treatment-related hot flashes in cancer patients. However, evidence suggests that they are not effective. Randomized, placebo-controlled trials show no benefit for black cohosh118 or soy119,120 in reducing the frequency of hot flashes in breast cancer patients. Vitamin E decreases hot flashes only minimally,121 but its low cost and lack of toxicity have led at least some authorities to recommend its use.122
Menopause may cause uncomfortable symptoms in many women and can be controlled to a great extent by HRT. Some of these symptoms, hot flashes, fatigue, and bone thinning (leading to osteoporosis) can intensify symptoms and problems related to MS. Osteoporosis has been linked to the treatment of MS with steroids, and this condition may worsen during the peri-menopausal or menopausal state of life.
Ovarian suppression with GnRH agonists induces menopause. PMS symptoms will be relieved, but patients experience menopausal side effects, including irritability, insomnia, hot flashes, and vaginal dryness. To prevent osteoporosis, add-back therapy with estrogen and progesterone is required.
Changes in neurologic function such as increased irritability, mood disorders, mild depression, hot flushes, and sleep disturbances may arise during the perimenopausal transition. Estrogen replacement therapy is the most effective treatment for hot flushes. Hormone replacement with estrogen may help to reverse cognitive changes and improve function.
Reproductive hormones, especially estrogen, have a significant impact on pelvic floor function. Hormonal changes that occur during a woman's lifespan impact many aspects of female physiology. With the onset of menopause, it becomes evident that estrogen sensitivity is greatest in the central nervous system and the genital tissues. The most frequently occurring initial symptoms of estrogen deprivation include hot flushes, mood changes, and emotional irritability. These central nervous system symptoms are promptly reversible with systemic estrogen replacement. More prolonged duration of estrogen deprivation will lead to other known consequences such as osteoporosis and urogenital atrophy. It is estimated that 80 of postmenopausal women have hot flushes, and that not all women will develop osteoporosis. However, urogenital atrophy occurs universally. Interestingly, many women with urogenital atrophy are asymptomatic.1 Many treatments are currently available for prevention of and therapy...
Nausea, vomiting, and hot flashes may accompany tamoxifen administration. Tamoxifen may cause a transient flare of tumor growth and increased pain due to bone metastases. These reactions are thought to be due to an initial estrogenic action of this drug. Mild or tran Raloxifene and clomiphene use is associated with an increased frequency of vasomotor disturbances (hot flashes) and thromboembolism formation.
Tamoxifen, clomiphene, and raloxifene are orally active. The primary route of excretion of all three drugs is in the feces. The undesirable effects common to all three of these SERMs are increased frequency of hot flashes and increased risk of thromboembolism. Both effects are attributable to their estrogenic activity.
Leuprolide is a potent LH-RH agonist for the first several days to a few weeks after initiation of therapy, and therefore, it initially stimulates testicular and ovarian steroidogenesis. Because of this initial stimulation of testosterone production, it is recommended that patients with prostatic cancer be treated concurrently with leuprolide and the antiandrogen flutamide (discussed earlier). Leuprolide is generally well tolerated, with hot flashes being the most common side effect.
The four most common symptoms associated with menopause are vasomotor disorders, or hot flashes urogenital atrophy osteoporosis and psychological disturbances. A varying proportion of women may have one or more of these symptoms. Vasomotor disorders (hot flashes) are common, affecting 70 to 80 of postmenopausal women. The cause of the vasomotor changes appears to be associated with the release of LH after normal female estrogen levels have fallen. These symptoms occur with variable frequency but generally disappear without treatment within 2 to 3
Most patients with panic disorder experience at least one sleep-related panic attack, and one-third or more of patients have recurrent nocturnal panic attacks. (2D Data from the few sleep panic attacks that have been recorded suggests that they occur more commonly during NREM sleep, at the transition to SWS. (22,23,) Symptoms of sleep panic attacks are essentially the same as those which occur during daytime attacks. Typically, patients report waking in a state of intense fear or anxiety, commonly with palpitations, shortness of breath, choking sensation, chest discomfort, and chills or hot flushes. They do not usually report dreaming just before the attacks. Unlike night terrors, which are characterized by incomplete arousal from sleep, patients having a sleep panic attack are awake and alert immediately after the attack begins. Patients with frequent sleep panic attacks may become fearful of going to sleep, which can contribute further to their insomnia.
Menopause is a natural life transition for women and usually occurs between the ages of 45 and 55. Hormonal changes result in a decline of estrogen and some women experience symptoms such as hot flashes, mood swings, and vaginal dryness. These changes may begin 4 to 6 years before the cessation of menstruation. Low-dose estrogen creams are effective for vaginal dryness. Antihistamines, diuretics, caffeine, and alcohol have a tendency to dry mucous membranes including those in the vagina. Regular exercise reduces hot flashes and other meno-pausal symptoms.
Those found in soy products, as a potential alternative to the synthetic estrogens in HRT (24,36,42,43). Together with lig-nans, coumestans, flavones, and flavanones, isoflavones belong to the larger group of nonsteroidal phytoestrogens. Interest in phytoestrogens has been fueled by observational studies showing a lower incidence of menopausal symptoms, osteoporosis, cardiovascular disease, and breast and endometrial cancers in Asian women who have a diet rich in soy products. Consistent with epidemiological studies are the findings that soy phy-toestrogens prevent mammary tumors and bone loss in rodents and atherosclerosis of coronary arteries in monkeys. Soy protein relieves hot flashes in postmenopausal women and attenuates bone loss in the lumbar spine of perimenopausal women. Furthermore, a high intake of dietary phytoestrogens is associated with a lower incidence of cancers of the colon, breast, and prostate. Isoflavones and other phytoestrogens have been considered to exert...
Flutamide (Eulexin) is a nonsteroidal antiandrogen (see Chapter 63) compound that competes with testosterone for binding to androgen receptors. The drug is well absorbed on oral administration. It is an active agent in the hormonal therapy of cancer of the prostate and has been shown to complement the pharmacological castration produced by the gonadotropin-releasing hormone (GnRH) agonist leuprolide. Flutamide prevents the stimulation of tumor growth that may occur as a result of the transient increase in testosterone secretion after the initiation of leuprolide therapy. The most common side effects of flutamide are those expected with androgen blockade hot flashes, loss of libido, and impotence. Mild nausea and diarrhea occur in about 10 of patients.