hot flash

Flashes and body composition and age, oh my! What’s the relationship?

Posted by Liz on Jul 22, 2011 in aging, hot flash | 0 comments

For some time now, experts have made the connection between body mass index (BM() and hot flashes during menopause, theorizing that body fat offer protection against hot flashes since androgen hormones are actually converted into estrogens in body fat. On  the flip side? Women with lower BMI should have more frequent hot flashes. However, this hypothesis — formally known as the “thin hypothesis” – has recently been questioned, especially among researchers whose studies have shown the opposite: that a higher BMI leads to more hot flashes because the fat acts to insulate the body and prevent heat dissipation. In the middle of this argument are women, overweight, underweight, normal weight, who may have an opportunity to prevent hot flashes before they worsen or at least ameliorate them.

To more thoroughly tease out the underlying causes of hot flashes as they relate to body composition, researchers evaluated a subset of 52 women participating in the larger Study of Women’s Health Across the Nation (SWAN, an ongoing trial at seven sites across US that are examining women’s health in middle age). These women were African-American or non-Hispanic Caucasians between the ages of 54 and 63, mostly overweight, in menopause and reported experiencing hot flashes or night sweats. None were taking hormones or antidepressants, and still had their uterus.

In the study, published online in the Journal of Clinical Endocrinology and Metabolism, broad measures of central abdominal fat/total percentage of body fat, BMI and waist circumference and blood hormones were taken. Over two, 48-hour periods, participants also wore a monitor to evaluate the frequency and severity of hot flashes and were asked to both complete electronic diaries and press buttons on their monitors that would notate when they were experiencing symptoms.

The result? A higher percentage of body fat, BMI and waist circumference were associated with a reduction in the frequency of hot flashes only in women who were 59 or older. Moreover, this association was restricted to Caucasian women in the study compared to their Black peers.  However, in so far as the interaction between estrogen levels (and sex hormone-binding globulin) and body composition, researchers found that higher levels reduced but did not fully eliminate the distinctions in hot flashes and age.

So, why the differences compared to other studies? Others have looked as self-reported hot flashes via questionnaires while this one actually took physiological measures of hot flashes via the monitors that the women were wearing. The researchers also looked specifically at the link between size, weight and proportions of the women and hot flashes rather than risk factors of any or no hot flashes.

Importantly, data are starting to emerge that show how BMI/adipose fat and the relationship to reproductive hormones varies by age and menopause status, with higher estrogen levels related to older, menopausal women and lower to younger women. What’s more, while body fat may act to produce estrogen in older women to play a role in regulating body heat and dissipation, it seems to play a different role in younger, overweight women, predisposing them to hot flashes. Finally, wellbeing also appears to play a role in symptoms: in this case, women who were anxious reported more hot flashes and hot flashes tended to increase anxiety.

Should you care?

Although the sample size is small, the is first time that researchers have considered how age and race affect the way that obesity may affect hot flash frequency. It’s worthwhile filing it under “useful information,” especially when it comes to perimenopause and preparing to deal with full blown symptoms as you enter menopause.

A special thanks to my pal Ivan Oransky, executive editor of Reuters Health and author of Retraction Watch  for giving me a heads up on this study. Thanks Ivan!

Hot flashes and night sweats. Mind over matter?

Posted by Liz on Jun 20, 2011 in hot flash, nightsweats | 2 comments

[youtube=http://www.youtube.com/watch?v=LH8xbDGv7oY]

Hot flashes and night sweats, oh my! They hit like a ton of bricks when you’re least expecting them and then exit as quickly as they arrived. They affect up to 70% of women and tend to worsen in late perimenopause and in menopause. And while hormone replacement therapy may decrease how bothersome they are and good health diminish frequency and severity, it appears that how well women believe they are controlling their symptoms outplays all of these other factors, so much so that perceived control may actually beneficially affect emotional distress, prevalence and severity of symptoms and how often women engage in behaviors that benefit their health.

Findings of a  new study that’s just been published online in Maturitas run counter to many that came before it, studies that have shown that smoking and body mass index and alcohol consumption, as well as marital status, age, professional status, parity, educational status and income may significantly influence hot flash prevalence, frequency and severity. However, this time, researchers found that among 243 women between the ages of 42 and 60 years, the most important factor was control.

Participants were first asked to assess the intensity and intensity of hot flashes and night sweats on a five point scale (i.e. never to daily to almost every day and not intense to extremely intense). They were also asked to estimate perceived control over their symptoms using a validated rating scale. Finally, menopausal status, i.e. pre-, peri- and post- were assessed. Additionally, common sociodemographic and lifestyle factors shown to influence hot flashes and sweats were accounted for.

Importantly, women who used no medications or used soy and herbal products had higher perceived control over their symptoms than women who used hormone therapy. Moreover, this distinction had nothing to do with how severe their symptoms were as the researchers say that severity was similar among all three.  Additionally, women who drank greater amounts of coffee appeared to perceive their symptoms as less severe than those who drank less. While previous research has found the opposite, i.e. caffeine intake predicts the occurrence of hot flashes, it is possible that the stimulation associated with caffeine might have boosted coping mechanisms and strategies, thereby leading to fewer or less severe symptoms. Still, perceived control ruled the day, leading to a significant beneficial impact on severity of flashes and night sweats. The reason? It’s possible that feeling in control leads to other behavioral changes, such as dressing in many layers to allow for adjustments as the inner temperatures increase, avoiding spicy foods or effectively controlling stress. However, the results also imply that how much control we feel we have strongly influences how we ultimately feel.

Clearly, more research is needed. But when it comes to hot flashes and night sweats, mind over matter may play a strong role.

Wednesday Bubble: 10 is the loneliest number…

Posted by Liz on May 11, 2011 in hot flash | 0 comments

[youtube=http://www.youtube.com/watch?v=nTO4hvLEH4Q]

I’m using this Bubble to burst a few illusions, such as hot flashes during menopause don’t actually last very long.

How about 10 years?!

Right now, one year for hot flashes to come and then go sounds pretty tempting, doesn’t it?

A few years ago, I wrote about a study in the journal Menopause that alluded to the fact that hot flashes were likely to last for five years or more. Just this week, I ran across another study in Obstetrics & Gynecology that adds another 5 years to the evidence. Yikes!

How long is long enough?

Clinical Guidelines suggest that hot flashes peak one year into menopause and for most women, last anywhere from six months to two years. So, why is popular opinion, if you will, being challenged in research circles?

Using data from the Penn Ovarian Aging Study, which followed and monitored women over a 13-year period, researchers evaluated moderate-to-severe hot flashes on average, every 9 months. The women did not report having hot flashes at the study’s start, but developed them between the first year and near the study’s end. During each assessment, interviews were conducted on overall health, height, weight, hip and waist measures were taken and blood samples collected (to evaluate hormone levels).  Menopausal status was also delineated by  five stages:

• premenopausal (regular menstrual periods)
• late premenopausal (cycle change of 7 days or more in either direction observed one time)
• early transition (change of 7 days or more observed at least twice in a row)
•  late transition (three to 11 months without a menstrual cycle)
• postmenopausal

More than 90% of women in the study were pre or late premenopausal at the study’s start.

Unfortunately, the results of the study are not very promising. On average, the median duration of moderate to severe hot flashes was 10.2 years, with only 37% of women reporting that their hot flashes stopped during the study. However, researchers found a relationship between length of time and when hot flashes began. For example. hot flashes tended to last longer (i.e. more than 11 years) in women who reported their hot flashes started in the premenopausal or late premenopausal stage compared to women whose hot flashes began in the early transition (average 7 years) and late transition (average 4 years).

Age was also a factor as the median duration of hot flashes tended to be longest in women who started flashing before the age of 40. Most commonly, however, more than a third of women tended to have the worst flashes when they were between the ages of 45 and 49.  Other factors such as African American race and a body mass index less than 30 were also associated with having hot flashes for longer periods of time.

If you are wondering about the silver lining in this story, there actually is one. The researchers say that it may be a good idea to start addressing vasomotor symptoms like hot flashes in younger women who are starting to have irregular menstrual periods.  Because “traditional hormonal therapy may not be the ideal choice for this population, given, for example, the problems with breakthrough bleeding and the need for contraception,” other treatments need to be evaluated.

I’ve long espoused the value of taking steps to shut symptoms down sooner rather than later, which is why alternative strategies may be so useful. If duration of hot flashes last longer when they start a younger age, and it is recommended that hormonal therapy be used for the shortest period of time possible, it’s not a bad idea to speak to a health practitioner about incorporating things like black cohosh into a daily routine. As always, there’s no time like the present to start taking charge of your health and get ahead of the change.

Menopause: outlook and outcomes. Is it you? Or them?

Posted by Liz on May 6, 2011 in appearance, hot flash, menopause | 2 comments

When you start flashing and sweating, the whole world, especially the world under the age of 45, is watching and judging, right?

Not so fast. In fact, what I think you think, may not be what you think at all. In other words,  personal attitudes about menopause and its symptoms could be shaping how well or poorly it’s experienced. And this experience may be based in beliefs, moods and perceptions, not reality.

According to research, many women say that menopause makes them feel “stupid, embarrassed, incompetant, unattractive, etc.”

However, more importantly, these women believe that others have the same thoughts about them, which researchers say are likely to influence the types of strategies women use to manage their symptoms, strategies that range from “keeping up appearances” to avoiding social situations altogether.

When I read this, I started to wonder if menopausal women are actually stacking the deck against themselves and contributing to societal attitudes about aging and menopause. What’s more, do women misperceive how younger adults feel when they start flashing around them?

To answer these questions, researchers polled 290 young men and women between the ages of 25 and 45. Almost two thirds were female. The questionnaire was geared towards answer the following:

• How are hot flash symptoms, namely redness and sweating, perceived when they occur?
• What types of beliefs exist around menopause?
• Is there any relationship between age, gender and perception about menopause?

Importantly, over half of those polled attributed a red face to emotions, e.g., embarrassment, anger or stress. However, while younger women tended to attribute redness to an increase in body temperature, younger men tended to believe that redness was related to physical exertion. Similar responses were provided for sweating, with women attributing sweating to a health problem and men, to environmental temperature. Hormonal factors and menopause were reported by less than half (41%) of men and women polled.

Also important was the fact that overwhelmingly, both men and women indicated that they felt empathy or neutral about symptoms and not at all uncomfortable, and almost all (97%) would inquire if a woman was feeling well or ill.

These responses truly suggest that menopausal women tend to overestimate the extent to which others are able to judge their menopausal status. Moreover, young men and women tend to empathize and show concern and compassion, emotions that are inconsistent with expectations that others will react negatively to a public hot flash or associated redness. Even more important, age did not appear to influence general beliefs about menopause, which researchers suggest implies that “the experience of menopause, or seeking information about menopause in mid life, might lead to more neutral or positive beliefs.”

So, what does this all mean? Granted, the sample in this study was primarily female and self selecting, meaning that they chose to participate or not. Therefore, it is possible that these findings do not accurately reflect the views of a broader population, especially men. However, the researchers do point out that they attempted to find participants from a variety of occupations that were more specific to setting where women might report a higher degree of social embarassment.

Nevertheless, what these findings do suggest is that real life might actually contradict how women feel others feel about their menopause, and that reactions might actually be tempered or non-existant in social settings. This should encourage a broader population of menopausal women to overcome their fear of embarrassment or to no longer resign themselves to “coping” but rather, empower them to take charge.  On a larger level, they also show that there’s a need to step up and negate stimatizing or negative views of menopause, even amongst ourselves. This can be achieved through sharing of experiences, not only with similarly aged women but also, with younger women and men who can gain a lot of life experience at a considerably younger age.

The next time you start flashing in public and looking around to see who’s staring, just remember that it may be you, not them. And your ‘tude will truly rule the day (and those flashes), if you let it.

More on soy? Oh joy!!

Posted by Liz on Apr 15, 2011 in hot flash, nightsweats | 2 comments

A close friend of mine wrote me the other day to tell me about an article she had seen. In it, the author claims that using soy sauce will help to alleviate hot flashes. However, the author neither backs this claim with any evidence or provides information on how much soy sauce you’d need to obtain the minimal level typically associated with some sort of reduction in menopausal symptoms.

Because there’s a ton of bad information floating around the interwebz, I wanted to break it down for you, right here and now. I also encourage you to peruse the archives because I’ve written a ton of posts on soy isoflavones.

Here’s what we know thus far about soy and soy isoflavones:

• Soy isoflavones are plant-based compounds that are believed to mimic the action of natural estrogen in the body. Therefore, researchers have been dissecting and studying the properties of soy for years in order to determine if this alternative to hormone replacement can help alleviate hot flashes and night sweats, and possibly even promote bone health in menopausal women.
• The deeper researchers delve into the properties of soy, the more they are learning. For example, the ratio of the most plentiful soy isoflavones, i.e. daidzein and gensistein, are important, and a metabolite of daidzein called S-equol appears to be the most potent in terms of preventing flashes and sweats.  S-equol  is produced in the gastrointestinal tract however the ability to actually manufacture it depends on the presence of certain microflora. Consequently, only 30% to 60% of individuals are actually able to produce S-equol on their own (although this figure is believed to be higher among Asians and vegetarians).
• Studies that have examined the role of a soy-based diet, mostly among Asian populations, typically focus on four main foods that are rich sources of soy isoflavones: tofu, miso (fermented soybean paste), natto (sticky, fermented soy food rich in vegetable protein) and fried tofu. Soy sauce and soy oil do not contain isoflavones! Therefore, using either in cooking will not prevent hot flashes or night sweats.
• In a more recent review of soy products published in the American Journal of Epidemiology, researchers evaluated the dietary habits of 1,106 Japanese women between the ages of 35 and 64 over six years to determine a possible association with hot flashes or lack thereof. All participants were asked to record what they were eating as well as the serving size; included were nine specific soy products (miso soup, tofu, deep-fried tofu, fried bean curd, dried bean curd, natto, houba miso, soy milk and boiled soybeans).

The findings? There was an inverse association between eating soy and hot flashes – those women eating the greatest amount of soy, i.e. 115.9 grams/day, that contained the greatest amount of isoflavones, i.e. 50.8 grams/day, had the highest amount of protection against developing hot flashes and a 6% lower risk than women who consumed the least amount for developing hot flashes over the course of the study. Moreover, the results were upheld even after researchers accounted for factors such as age, menopausal status and total daily caloric intake. Notably, if soy sauce or oil actually contained isoflavones, an individual would have to consume at least 4 ounces of soy sauce daily to obtain any benefit.

Most importantly, when it comes to soy, even supplements aren’t created equal. If you are going to go that route, speak to a licensed practitioner who specializes in herbal medicine and look for a supplement that notes standardized manufacturing on its label. Simply walking into a drugstore to make a purchase is a sure way to guarantee that skimping on price often means skimping on quality.

There’s a lot more we need to learn about soy before making blanket recommendations. Soy is more complex than researchers originally thought. And a few drops a day? No way!

Wednesday Bubble: hot flashes and antidepressants

Posted by Liz on Jan 19, 2011 in hot flash | 4 comments

Researchers have been studying antidepressant therapy (namely selective serotonin reuptake inhibitors – SSRIs, and serotonin/norepinephrine reuptake inhibitors –SNRIs) for some time now in hopes of discovering an effective treatment for hot flashes and an alternative to hormone replacement therapy (HRT). However, antidepressants’ ability to ameliorate hot flashes have yielded mixed results in the study arena. One potential advantage of using an antidepressant in this regard is the ability to also effectively address mood swings and depression that occur as hormone levels wane and decline throughout menopause. Hence, I was intrigued by a new study, published this week in the Journal of the American Medical Association, that not only evaluated the benefit of using the SSRI Lexapro for hot flashes but also, whether or not factors such as race and coexisting depressed mood and/or anxiety would affect the results. Notably, African-American women are reportedly more likely than report having particularly bothersome hot flashes.

In this particular trial, 205 menopausal or postmenopausal women reporting at least 28 hot flashes or night sweats per week over a three week period that were bothersome or severe the majority of time were asked to take 10 mg escitalopram (Lexapro) or placebo tablet daily for 8 weeks. This dosage was increased midway through the trial if hot flash frequency didn’t decrease by at least 50% and if severity did not change.

The findings:

• More than half of women reported that the frequency of their hot flashes declined by at least 50% from the study starts (compared to slightly more than a third of women taking placebo)
• Women taking Lexapro reported that the severity of their hot flashes decreased by 24% compared to the study’s start (and a 14% decline in severity among the placebo group)
• The response to Lexapro was rapid and improvements started to be seen within one week
• Reported side effects between the two groups were fairly equal, and mostly related to feeling tired, stomach issues and dry mouth
• Race did not appear to play a role in either group
• Hot flashes returned after Lexapro was stopped

Although the researchers caution that the group of women in the study were highly motivated and not necessarily reflective of women in the general population, I would argue that a woman with severe and frequent hot flashes is motivated, period. I’m not a huge fan of using pharmaceutical medications to address menopausal symptoms for two reasons: 1) menopause is not a disease and, 2) as evidenced by the archives, there is an evolving body of literature that supports the use of alternative strategies for managing menopause. Nevertheless, as someone who has had lifelong bouts of depression that are exacerbated by hormones, I welcome an effective alternative to HRT that might be more broadly embraced by the medical community. Until a greater proportion of healthcare practitioners begins to accept the distinctions between between eastern and western medical philosophies and the potential advantages of complementary strategies, the learning (and begging) curve will continue to be steep.

Perhaps antidepressants are an initial stop-gap while the body of evidence supporting alternatives like acupuncture or isoflavones for hot flashes and depression grows. I’m optimistic we’ll get there. And I will always be happy to see women provided with an alternative to HRT.