Posts Tagged "hot flashes"

Newsflash! SSRIs & Hot Flash Rebound

Posted by Liz on Dec 17, 2012 in hot flash | 0 comments

You may recall the researchers have been studying the ability of the antidepressant Lexapro to reduce the frequency and severity 0f hot flashes.

The results have been impressive, with onset of action within a month of initiating therapy. Missing, however, has been information about how long a woman needs to say on Lexapro to gain benefit. And what happens when she stops taking the drug.  In one trial, women who stopped using Lexapro after 8 weeks experienced a resurgence of flashes. This is not much different than the reaction seen when HRT is stopped; both types of drug regimens only appear to work so long as a woman continues to use them.

Researchers are now reporting that when they examined the diaries of the same group of women referenced above (whose frequency, severity and bothersome factor of vasomotor symptoms improved after 8 weeks of Lexapro treatment) they found that a significant relapse occurred three weeks after stopping treatment. In fact, by the end of three week period, roughly a third (34%) of the women who had experienced a reduced frequency of their hot flashes, and roughly 39% who had experienced less severe flashes relapsed. In both of these groups of women, respectively, relapse was defined as a 15% increase in more frequent hot flashes and a roughy 11% increase in hot flash severity over the symptoms that they had when they first started the study. Overall, the women lost at least 50% of the original benefit they had gained.

The most important factor appears to be higher degree of insomnia symptoms before taking Lexapro and a weaker overall response to it while on it. In fact, every one point difference in the insomnia severity scale was associated with an 11% greater odds of a relapse; women who responded less well to Lexapro by week 8 had a threefold greater chance of relapse after stopping the agent for three weeks.

The choice is clear. It is much easier to start both hormonal and non-hormonal treatments than it is to stop them. And when you stop, you increase the odds that you will be experiencing worsened symptoms. When you do the math, it doesn’t look so good. Big gain, bigger loss.

Wednesday Bubble: It’s getting hot in here…

Posted by Liz on Dec 12, 2012 in hot flash | 0 comments

Hot flashes.

Does anyone really know what occurs in the body to cause the sudden surge of temperature, the licking of the of the internal flame and the momentary feeling that those droplets of sweat dripping down your face are doing NOTHING to alleviate the heat that is emanating from every pore of your body?

Evidently, researchers are coming closer to discovering the ‘why’ behind the flash. And the reason that this is so important is that when medical experts discover the why, they are then one step closer to figuring out how to fix it.

So, let me tell you what’s what.

As I wrote just last week, experts believe that hot flashes are related to a dysfunction in a process called ‘thermoregulation;’ this is the ability to keep our body temperature in a steady state, even when the environment changes. A decrease in estrogen levels, coupled with increased activation of the sympathetic nervous system (which assists in controlling the body’s functions and the fight or flight mechanism) narrows the natural comfort zone and tolerance for temperature fluctuations. Voila! A flash is born.

Hold on. In a new paper published in the open access Proceedings of the National Academy of Sciences, Dr. Naomi Rance from the University of Arizona College of Medicine explains that while the surface of the skin may feel hot during a hot flash, if one was to measure the internal core temperature, it is not even elevated. Rather, she and her team have identified a role that a group brain cells know as KNDy (kisspepti/neurokinin B/dynorphin) may play. These cells are located in an area of the brain — the hypothalamus — that controls metabolic processes related to the autonomic nervous system, including body temperature.

Dr. Nance and her team have only studied the KNDy neurons in rats so far, but what they’ve found is interesting: when they created a model to mimic menopause by withdrawing estrogen, they found that the KNDy cells response is extreme – they grow extremely large and manufacture greater amounts of neurotransmitters that communicate to the part of the brain that regulates body temperature. More communication equals more signalling that the body too hot and needs to release heat. The result? A hot flash and lots of vasodilation and sweating. But here’s the rub: when they measured the temperature of the tail skin in rats with normal KNDy neurons versus those who neurons were shut off, they found that their skin temperature was lower, even with the depletion of estrogen.

While these findings are not yet specific to women, they do show that the KNDy neurons appear to play an important role in regulating skin temperature and its reaction to signals that ‘it’s getting hot in here.’ Perhaps the silver lining is that if they can take it one step further and figure out how to positively control the KNDy cells in humans, they may be able to influence thermoregulation and literally stop those flashes before they start without affecting our real core body temperature.

Stay tuned!

Just breathe

Posted by Liz on Dec 3, 2012 in hot flash, mind-body therapy | 0 comments

Want to reduce the frequency of your flashes?

Just breathe.

I’m serious. Just as serious as Mayo Clinic researchers who recently published a study about paced breathing in the online version of Menopause. If you are unfamiliar with the term, paced breathing refers to slow, deep breathing from the diaphragm.

Although experts are still unclear as to the underlying cause of hot flashes, they believe that they are related to a dysfunction in a process called ‘thermoregulation;’ this is the ability to keep our body temperature in a steady state, even when the environment changes. A decrease in estrogen levels, coupled with increased activation of the sympathetic nervous system (which assists in controlling the body’s functions and the fight or flight mechanism) narrows the natural comfort zone and tolerance for temperature fluctuations. Voila! A flash is believed to be born.

So where does paced breathing fit in? Here’s the interesting part: paced breathing decreases the activity of the sympathetic nervous system. So, when the nervous system goes into overdrive, paced breathing can theoretically calm the waters. However, as we go through our busy lives, is regular paced breathing even feasible?

To find out, 105 women were provided with either audio recordings of chimes that paced their breathing or were asked to simply breathe normally. All of the women reported having at least 14 or more hot flashes a week, and they also a history of breast cancer. Women assigned to paced breathing were asked to use their audio recordings either once or twice a day and practice taking 6 breaths per minute for 15 minutes. The other women practiced regular breathing (14 breaths per minute) for 10 minutes a day. All of the women kept a daily hot flash diary.

Over nine weeks, women who practiced paced breathing twice a day reported reductions in daily hot flashes by 52%. Paced breathing practiced once a day reduced hot flashes by 42%. What’s more, women who didn’t slow their breathing deliberately but simply focused on it 10 minutes a day reduced the frequency of their hot flashes by 46%; this suggest that focusing can help alleviate symptoms and that some sort of placebo effect is at play. Still, other studies have similarly reported reductions in hot flash frequency by as much as 50% using progressive muscle relaxation which also has a positive effect on the nervous system. In fact, I just wrote about relaxation and flashes last week.

Most of the women found it challenging to fit 30 minutes of paced breathing into their day, which suggests that perhaps intensifying the effort once a day can provide the same beneficial results. For the most part, there was some initial dizziness but it was mostly mild and likely the result of significantly slowing breathing; more practice would probably help to ameliorate this effect.

It seems to me that it is possible to move away from drugs and towards the body and mind to balance our internal thermostats. The bottom line appears to be that a bit of effort can potentially a long way towards solving a problem that has long eluded the medical community.

Just breathe.

Wednesday Bubble: Relax, just do it.

Posted by Liz on Nov 28, 2012 in hot flash, Meditation/mindfulness therapy | 1 comment

You think that hormones are the only solution to hot flashes?

Think again!

This is not the first time that I have reported that the mind-body connection is an important key to menopausal symptoms. Moreover, it probably won’t be the last. In fact, in a second study published within the past 18 months in Menopause journal, researchers are again moving away from hormones and moving towards applied relaxation. (A related study topic-wise can be found here.)

This time, Swedish researchers assigned 60 women in menopause to either ten sessions of group therapy combined with relaxation or to no intervention for three months. All of the women had been experiencing moderate to severe hot flashes at least 50 times a week. During the 10 group therapy relaxation sessions, the women were taught to methodically move through the body’s muscle groups and use breathing techniques to systematically relax each group. They were then provided with exercises to practice daily at home, with the the goal being to learn the relaxation method and self-manage their symptoms. During this period, all participants kept a regular hot flash diary and filled out a quality of life survey on three different occasions. They also provided the researchers with a sample of their saliva.

The findings? Women practicing daily relaxation and engaging in regular coaching sessions actually reduced their daily hot flash count from an average of 9.1 to 4.4 a day; that’s about a 50% reduction. In the group of women who had no interventions, a reduction in daily hot flashes was also observed but on average, these women experienced less than two fewer flashes a day; this is likely the result of what researchers consider a ‘placebo effect.’

More importantly,  benefits of relaxation remained for at least three months after the study ended and the final therapy sessions. The women who practiced relaxation also reported improvements in overall wellbeing and quality of life, including sleep and memory. What’s more, saliva testing showed reductions in cortisol; as I’ve written previously, stress leads to cortisol release and ups the hot flashes ratio. Once that cycle starts, who knows how long the endless loop plays out?!

Time to stop the loop? Forget the drugs. Breathe deeply, exhale and repeat. Just do it.

I put a spell on you: hot flashes and hypnosis

Posted by Liz on Nov 5, 2012 in hot flash, mind-body therapy | 0 comments

I have written about the potential of hypnosis for ameliorating troublesome vasomotor symptoms previously, although earlier studies have focused on hot flashes in relation to breast cancer therapy. You can find those posts, and links to earlier reports, here.

Personally? I like hypnosis.

I was hypnotized several decades back by a source for another story that I was writing and recall how relaxing it felt. This particular clinician focused on teaching patients the art of self hypnosis for use in speeding recovery from surgery and the like. But I digress..

Hypnosis for menopausal symptoms? Why not?!

In a study that appears online in the Menopause journal, Dr. Gary Elkins from Baylor’s Mind-Body Medicine Research Laboratory explores the potential of clinical hypnosis — described as a “mind-body therapy to facilitate a hypnotic state, coolness and control of symptoms” — in a field where the effectiveness of alternative strategies continues to be challenged by mainstream medicine.

He write that while menopausal symptoms like hot flashes generally start to decline 5 to 7 years after menopause, they may persist in some women for up to a whopping 20 years!!!! Moreover, non-hormonal pharmacological options, e.g. antidepressants and anticonvulsants may seem promising but between side effects and the need to comply strictly to dosing regimens, they may not be a viable or reasonable option for many. Additionally, in the early studies conducted in breast cancer survivors, clinical hypnosis led to as much as a 69% reduction in hot flashes over the course of these trials,findings that are comparable if not better than those seen in women taking Effexor or Paxil.

This time, 187 women who reported having at least 50 hot flashes a week (or seven a day) participated in clinical hypnosis or a training called ‘structured attention control’ five times a week for three months. Women who were hypnotized  were given specific suggestions for mental imagery for coolness, safe places and relaxation with the goals of reducing hot flashes and improving sleep. Each session lasted 45 minutes and were recorded, so that the women could practice self-hypnosis at home. In the structured attention session, also 45 minutes long, each woman and a clinician discussed symptoms, exchanged personal information, received guidance on how to avoid negative suggestions and were encouraged. While these sessions not recorded, the women brought home a CD that provided information about hot flashes and were required to listen to it daily.

The findings are pretty impressive. Elkin reports that over the first 6 weeks, women receiving hypnosis had a mean decrease in their hot flashes of almost 64% compared to only 9% in women who had structured attention training. These reductions continued towards the end of the study, leading to a 74% decline in hot flashes compared to the beginning of the study (during the same timeframe, women in the second group only experienced overall reductions of 17%). The severity of hot flashes also significantly  declined over the course of the study by as much as 80% among hypnotized women (and only 15% among the structured attention group). What’s more, when hot flashes were actually monitored by a scientific instrument (rather than self-reports) findings were still impressive, with almost a 57% reduction in hot flashes in the hypnosis group and only a 10% reduction in the structured attention group. These women also reported better sleep quality and that their hot flashes interfered less in their daily activities than previously.

Research into pharmacological therapies and alternative therapies confirm that there is always a placebo effect at play. With regard to hot flashes in particular, this placebo effect is evidently substantial. And, with regards to mind-body therapies in particular, some women are negatively predisposed to achieving results, and either are not willing to make the commitment that is necessary for them to work. However, this is not much different than any regimen; if you are not committed to the process, you probably won’t see the best results.

Elkin writes that they still don’t know why hypnosis might work for hot flashes, although it might have something to do with improvements in heart rate and blood pressure (via a process known as ‘parasympathetic tone’). However, if it works, do we really need to know how?

Got severe hot flashes? You might want to delve into that spell before you try drug therapy. If anything, you’ll come out feeling a heck of a lot more relaxed!