screen-shot-2017-02-13-at-23-01-41Hot flushes

Hot flushes, otherwise known as vasomotor symptoms or Hot Flashes in the USA, are a sudden unpleasant sensation of burning heat spreading across the face, neck and chest followed shortly after by sweating then a feeling of being cold and clammy, sometimes associated with and even shivering. In extreme cases hot flushes cause a drop in blood pressure and dizziness. Night sweats are described as a sudden sweating which tend to happen at night and usually disrupt sleep patterns.

This page highlight some of the possible medical interventions but provides some useful lifestyle and nutritional tips which may help you cope with this tedious symptom.

Causes of Hot Flushes (HF):

Most commonly, women entering the menopause experience troublesome hot flushes, due to a drop in oestrogen production from the ovaries, and these can persist for years afterwards. Women, with cancer may have premature menopause induced by chemotherapy or surgery yet those with breast cancer are denied oestrogen replacement therapy because of concerns about potential recurrence. In addition, drugs such as tamoxifen or aromatase inhibitors, exacerbate vasomotor symptoms as well as other menopausal issues such as weight gain, joint pain and vaginal dryness [Thomas, Love]. Men with prostate cancer treated with drugs or surgery which, lower their testosterone also suffer with hot flushes and night sweats. Occasionally bone hardening drugs (bisphosphonates) can exacerbate the intensity and frequency of hot flushes. Whatever the cause, hot flushes cause considerable distress and impact on quality of life [Thomas 2004].

Standard medical management

For women without breast cancer the most successful medical treatments are oestrogen hormone replacement therapies (HRT). When lifestyle measures have failed, these are certainly worth considering but they do increase the risk of breast cancer if taken for more than 10 years. For women with breast cancer progesterones such as megestrol acetate and cyperoterone acetate help but they can cause fluid retention, weight gain and an increased risk thromboembolism [Loprinzi]. In women, the anti-depressant venlaflexane helps to reduce intensity [Loprinzi] but this does not help men [Quella, Vitolins]. The anti-hypertensive, methyl dopa had some popularity in the 80’s [Nesheim and Saetre] but this was largely replaced by clonidine which helps a minority of women but can have its own side effect profile [Goldberg].Published Research has shown that trying different hormone drugs many help i.e. switching from tamoxifen to an aromatase inhibitors or even switching between different brands [Thomas].

Lifestyle and self help strategies?

The situations, which trigger or exacerbate HF can vary between people; you may find it useful to keep a diary to note when you have one so that you can identify any pattern. If you know when to expect hot flushes you can be better prepared. Otherwise here are some practical tips, which may help [Whiteman, Richardson]:

Clothes & environment:

  • Smokers suffer significant worse hot flushes – giving up will help you
  • Before entering a warm room, take off your coat or warm clothing
  • Wear cotton clothing rather than polyester or other man made fibres, as cotton absorbs moisture and still provides warmth after a flush is over
  • Try wearing layers of clothing that can be taken off or put on as your body temperature changes
  • Use layers of bedclothes (natural fabrics are better) which you can remove as required
  • Carry a water vapor sprays or moist wipes to help lower your skin temperature (you could add pleasant smelling oils to the spray, such as peppermint for its cooling properties or lavender for its relaxing effect.
  • Carry a hand held fan to use as soon as a flush started
  • Placed a small electric fan on a desk to help lower your skin temperature
  • Try to avoid warm, stuffy rooms as they can make flushes worse
  • Take plenty of cool baths and showers
  • Regular saunas help some people (making sure you cool down afterwards)

Exercise: Regular gentle exercise may help reduce hot flushes. Choose an activity that you enjoy and feel comfortable with. It’s important to try to exercise at least three times a weak to an intensity which gets you hot and sweaty then make sure you cool down properly afterwards.

Relaxation techniques: Stress can increase the number and intensity of hot flushes. Being anxious about hot flushes could make your symptoms worse. Knowing what to expect and being prepared will help you feel more in control and ease your anxiety. Relaxation therapy can reduce stress and flushes. Hot flushes usually come and go over short periods, so try to relax and wait for the sensation to pass. You may find it helps to imagine yourself in a cool place, for example by the sea, when you feel a hot flush coming on. It may also help to know that although hot flushes are uncomfortable for you, other people are unlikely to notice them happening. (For information on training courses and resources, contact the Stress Management Training Institute. There is also a wide range of relaxation tapes available from health food shops and bookshops).

Acupuncture and electroacupuncture has been extensively investigated and a number of RCT’s have reported it helped the severity and frequency of hot flushes at a level equal to venlaflexane. Its benefits appear to last up to 2 years [[Frisk , Bao, Bokmand, Deng G, Liljegren[Nedstrand E]] Frisk, Hervik J].

 Chiropody has been investigated for symptom management but its efficacy has yet to be established [Kronenberg].

 Diet and Nutritional interventions:

Some foods, can exacerbate the frequency of hot flushes and others, try and identify foods which apply to you identify so you can adjust you diet accordingly.

  • Some people report spicy foods trigger a HF other say they help
  • Avoid overeating large meals or eating too fast as this stimulates sweating
  • Sugary foods and drinks can cause swings in blood glucose
  • Hot drinks can be a trigger – open a window, take your coat & scarf off first
  • Being over weight can be more difficult to regulate body temperature
  • Some Avoid stimulants such as caffeine
  • Drink plenty of healthy fluids, particularly if you are sweating a lot
  • Avoid too much alcohol
  • Avoid alcoholic drinks with a high sulphite content (some wines and ciders).
  • Avoids with a high additive content

Black cohosh (Actaea racemosa) has been used for the treatment of hot flushes and other menopausal symptoms for many years (Zierau 2002). In Germany, it is approved as a non-prescription drug for premenstrual and menopausal ailments thought to help via a phyoestrogenic effect [Bodinet, Blumenthal 1998], although recent studies dispute this [Zierau 2002). Systematic reviews summarising the clinical efficacy of black cohosh have concluded that while there appears to be a minor benefit for menopausal patients, there is a paucity of research focusing on its use in cancer patients particularly as the 2 biggest RCTs to date reporting on the effects of black cohosh in cancer patients suffered from methodological limitations including a lack of reporting and a high attrition rate [Borrelli, Smith].

Minerals and Vitamins E did not help vasomotor symptoms in the women investigated within one trial [Barton].

Evening primrose.  Many people have found that taking evening primrose oil helps with hot flushes, although it may take several months before any improvement is noticed. Evidence from clinical trials is lacking apart from an underpowered, small trial which reported a small benefit [Farzaneh]. Apart from the calories it is regarded as generally safe.

Vitamin and mineral supplements Vitamin E, selenium and vitamin B6 have provided relief for some people. Again evidence is lacking but provided you check with your GP or cancer specialist before you start taking any vitamins or minerals and never take more than the recommended dose they are probably not harmful.

Soya and other phyto-oestrogen rich foods: Phytoestrogens are natural polyphenol chemicals, which are found in some plants such as soya beans, chick-peas, lentils, whole grains, peanuts and flax seed. They are similar in structure to the female sex hormone oestrogen. Studies show that women whose diets are high in phyto-oestrogens have a lower incidence of hot flushes and other menopausal symptoms [Greendale]. Diets high in phytoestrogens are safe and two large studies from the USA and China both showed they are associated with a lower risk of breast cancer relapse [Boyapati]. This is due to the phenomenon that at low concentrations they suppress the oestrogen receptors on hormone sensitive cells reducing the risk of abnormal growth and potential change into cancer. What’s more, a study of female volunteers, who eat a diet high in soya and linseed over several weeks, found that their lower own oestrogen levels dropped although no benefit for HF was seen [Pruthi]. Slightly Lower oestrogen levels, over long periods of time would be potentially useful as this would reduce excess proliferation of cells in the breast and uterus without risking osteoporosis (in fact bone density usually increases with these foods).

Despite the benefits of these whole foods, concentrated them in to capsules did not demonstrated prospecctive benefits in the five RCT’s conducted so far [quella, van patten, MacGregor, Faure] or men [Vitolins]. Furthermore some safety concerns have been raised with phytoestrogenic extracts following a study from New York which reported that blood taken from women receiving a high dose soy extract supplement (geneisten) increased markers of proliferation (growth) when added to to breast cancer cells grown in a laboratory. Another study found that a high dose phytoestrogenic isoflavones supplement altered uterine wall thickness in primates [Foth]. It is thought that, although low to moderate rises in blood phytoestrogens is helpful, too high a concentration over rides the beneficial effect. Although no study has shown these supplements could increase the cancer risk, until further studies are performed, they are best avoided – especially as they as they don’t even help sufferers of hot flushes.

Non-phytoestrogenic polyphenols. The benefits of polyphenol rich foods (teas, spices, green vegetables etc) have been highlighted throughout this blog as they help a wide range of conditions due to their anti-inflammatory and antioxidant properties. Unlike, phytoestrogenic they are generally regarded as safe particularly those studied in large randomised studies such as those in the Pomi-T trial. This particular supplement includes concentrated broccoli, which contains indol-3-carbinol which as effects on oestrogen metabolism. Although no randomised trials have reported a positive effect on hot flushes a number of users are anecdotally reporting an improvement, [see text box] which has influenced the Primrose Scientific committee to include HF as an end point in their next study:

screen-shot-2017-02-07-at-16-28-30“After watching the TV program featuring Pomi-T some months back I thought I would give it a go, simply to help get rid of free radicals. After taking it for a short while I noticed that I no longer had ANY hot flushes. I racked my brain trying to work out why this had happened as I hadn’t taken any prescribed medication for this. The only change I had made was taking Pomi-T twice daily. I was amazed and thought I would stop them and see what happened. Within a day or two the flushes came back, oh boy! I started the Pomi-T immediately and within two days they had completely stopped again. I have taken them now for six months and have not had a single flush. I would never at the outset thought for one moment this would have happened. I cannot thank you enough, flushes are debilitating and this truly has transformed my life”.

 

References:

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Pruthi S et al 2012. A Phase III, Randomized, Placebo-Controlled, Double-Blind Trial of Flaxseed for the Treatment of Hot Flashes. Menopause 19 (1): 48-53.

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