Gwalior 2012 march cooling  down hot flushes treatment options
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  • 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."
  • SELECTIVE SEROTONIN Reuptake inhibitorSerotonin nonepinephrin
  • FLASH followed by FLUSH
  • TAKE HOME MESSAGE

Transcript

  • 1. Cooling down the Hot flushes /flashesCooling down the Hot flushes /flashes Dr. Kawita Bapat
  • 2. 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.
  • 3. 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.
  • 4. 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 asextremely uncomfortable sweating and heat horribleembarrassing lasting loss (through thefrom 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 sweatthrough the menopausaltransition. menopause is inevitable the mind also has a major influence over the body and can be hypnotically trained to cool down hot flashes.
  • 5. 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
  • 6. What works, what might, and what doesnt 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.
  • 7. 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
  • 8. 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
  • 9. 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. estradiolNon-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
  • 10. Womens 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-severeflushes/week or at least 50 flushes per week at baseline.Utian WH, et al. Fertil Steril. 2001;75:1065-79. Used with permission.
  • 11. HRT Personal decision needs to be individualized detailed discussion personal needs wants and desires Symptoms hoping to alleviate risks explained alternatives exist
  • 12. Sign of the Times - Menopausal Sayings ★ I was going to send in a suggestion...but I cant remember what it was : ★ Everyone around you is freezing cold, you have your personal fan turned on to turbo cool. ★You dont know whether to laugh or cry, sometimes you do both!
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. 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
  • 17. 7. GABAPENTIN Drug for migrain
  • 18. 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
  • 19. Traditional Chinese herbs  weak estrogen-like activity  Jiawei Qinge Fang  EXPERT OPINION current findings suggest that Jiawei Qinge Fang has benefits beyond the placebo  Rating 5/10
  • 20. 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
  • 21. 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
  • 22. 10 COOL ways to stop hot flushes in tracts
  • 23. 1. Dress for success Dress in layers Easy care fabrics Loose fitting clothes Comfy style Wardrobe planning
  • 24. 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.
  • 25. 3.COOL THE ROOM Open the windows Air-conditioner/fan Constant cool temperature
  • 26. 4.AVOID THE HOT SPOT Stay away from outdoor places No sun bathing Avoid hot tubs Sauna and steam bath cautiously
  • 27. 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’
  • 28. 6.EAT TO BEAT THE HEAT Turn down the spices Hot & spicy food-flash maker. Avoid hot drinks & alcohol. Pay attention to own food----
  • 29. 6. EXERCISE 30 minutes / day Walk/ run/ride/any- other
  • 30. 7.HORMONE HELP Short course Estrogen is still most effective.
  • 31. 8. Other medications possibilities Anti - depressents. Anti - hypertensives Anti –seizures Drug of migraine Gabapentin
  • 32. 9. Flaxseed 40 grms of ground flax seed/ Decreased joint & muscle pain.
  • 33. 10. Herbal hot flashes remedies Vitamin-E Yam phyto- estrogen Black cohosh Red clover Chinese herbs
  • 34. 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.
  • 35. MEDITATIONLearn to Relaxstress, emotional or physical byreleasing adrenaline into.blood flow to increase, bodytemperature to rise. Hot flashes are a response to anincrease in body temperature, andthus stress can cause to feel flush.That’s why stress-reductiontechniques are among therecommended home remedies forhot flashes. Think yoga, deepbreathing, and meditation.
  • 36. 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
  • 37. Some suggestions as conclusionNon-HRT prescription meds such as: SSRI antidepressants SNRI antidepressants. anti-seizure medication Clonidine
  • 38. Some suggestions as conclusion HRT with low Estrogens. Tailor made and designer HRT With persistence and patience