hot flash; menopausal vasomotor symptom
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Etiology
- menopause
- treatment of breast cancer
- treatment of prostate cancer
Epidemiology
- longer duration of symptoms in black women
- shorter duration of symptoms in obese women
Pathology
- vasomotor symptoms
- hypothalamic neurokinin B & its receptor, NK3R, may play a role in the etiology of hot flashes[18]
Clinical manifestations
- symptoms exacerbated by depression[8]
- duration of moderate-to-severe hot flashes:
- effects on objective vs subjective sleep disturbance differ[11]
Complications
- women with untreated vasomotor symptoms use more outpatient healthcare services & lose more work days than symptom-free women[15]
Management
- estrogen is 1st line agent for menopausal hot flashes
- estrogen + progestin unless hysterectomy
- see hormone replacement therapy
- Megace 20 mg PO BID
- venlafaxine (Effexor): start 12.5 mg PO BID
- serotonin re-uptake) inhibitors (SSRI)[4][5]
- orally active neurokinin B antagonist (MLE4901) reduces frequency & severity of hot flashes[18]
- fezolinetant a neurokinin-3 receptor antagonist (FDA-approved 2023)
- 30mg & 45mg fezolinetant improved menopausal quality of life at 12 weeks[24]
- gabapentin (Neurontin): start 100 mg PO QHS
- clonidine, Catapres TTS, 0.1-0.3 mg/day[2][3]
- fennel may be of benefit for menopausal symptoms[19]
- exercise may benefit women with depression[8]
- soy protein of no benefit[5]
- acupuncture of no value[16]
- cognitive behavioral therapy for insomnia[20]
- mindfulness training, cognitive behavioral therapy, & behavior-based therapy helpful in relieving hot-flashes[21]
More general terms
Additional terms
- hormone replacement therapy (HRT); estrogen replacement therapy; postmenopausal hormone replacement therapy
- menopause
References
- ↑ Prescriber's Letter 7(8):44 2000
- ↑ 2.0 2.1 Greendale G, UCLA Women's Health Center, personal communication
- ↑ 3.0 3.1 Prescriber's Letter 10(6):34 2003
- ↑ 4.0 4.1 4.2 4.3 NEJM Knowledge+
Journal Watch 23(14):112, 2003 Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA. 2003 Jun 4;289(21):2827-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12783913 - ↑ 5.0 5.1 5.2 5.3 Journal Watch 25(5):40-41, 2005 Suvanto-Luukkonen E, Koivunen R, Sundstrom H, Bloigu R, Karjalainen E, Haiva-Mallinen L, Tapanainen JS. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo- controlled, double-blind study. Menopause. 2005 Jan-Feb;12(1):18-26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15668596
Kok L, Kreijkamp-Kaspers S, Grobbee DE, Lampe JW, van der Schouw YT. A randomized, placebo-controlled trial on the effects of soy protein containing isoflavones on quality of life in postmenopausal women. Menopause. 2005 Jan-Feb;12(1):56-62. PMID - ↑ Nelson HD et al, Nonhormonal therpies for postmenopausal hot flashes: Systematic review and meta-analysis. JAMA 2006; 295:2057 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16670414
Tice JA and Grady D Alternatice to estrogne for treatment of hot flashes: Are they effective and safe? JAMA 2006; 295:2076 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16670417 - ↑ Reddy SY et al, Gabapentin, estrogen and placebo for treating hot flushes: A randomized controlled trial. Obstet Gynecol 2006; 108:41 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16816054
- ↑ 8.0 8.1 8.2 Thurston RC et al, Physical activity and risk of vasomotor symptoms in women with and without a history of depression: Results from the Harvard Study of Moods and Cycles. Menopause 2006, 13:553 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16837876
- ↑ 9.0 9.1 Col NF et al. Duration of vasomotor symptoms in middle-aged women: A longitudinal study. Menopause 2009 May/Jun; 16:453.
- ↑ 10.0 10.1 Freeman EW et al. Duration of menopausal hot flushes and associated risk factors. Obstet Gynecol 2011 May; 117:1095. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21508748
- ↑ 11.0 11.1 Thurston RC et al. Are vasomotor symptoms associated with sleep characteristics among symptomatic midlife women? Comparisons of self-report and objective measures. Menopause 2012 Jul; 19:742 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22415568
Regestein QR. Do hot flashes disturb sleep? Menopause 2012 Jul; 19:715 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22735095 - ↑ 12.0 12.1 Joffe H et al Low-Dose Estradiol and the Serotonin-Norepinephrine Reuptake Inhibitor Venlafaxine for Vasomotor SymptomsA Randomized Clinical Trial. JAMA Intern Med. Published online May 26, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24861828 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1876676
- ↑ 13.0 13.1 Reed SD et al. Sexual function in women on estradiol or venlafaxine for hot flushes: A randomized controlled trial. Obstet Gynecol 2014 Aug; 124:233 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25004335
- ↑ 14.0 14.1 Avis NE et al Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. JAMA Intern Med. 2015;175:531-539 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25686030 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=2110996
Richard-Davis G, Manson JE Vasomotor Symptom Duration in Midlife Women-Research Overturns Dogma. JAMA Intern Med. Published online February 16, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25686269 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=2110993 - ↑ 15.0 15.1 Judge DE The High Cost of Hot Flashes. NEJM Journal Watch. March 10 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Sarrel P et al. Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause 2015 Mar; 22:260. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25714236
Pinkerton JV. Money talks: Untreated hot flashes cost women, the workplace, and society. Menopause 2015 Mar; 22:254. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25692878 - ↑ 16.0 16.1 Ee C, Xue S, Chondros P et al Acupuncture for Menopausal Hot Flashes: A Randomized Trial. Ann Intern Med. Published online 19 January 2016 http://annals.org/article.aspx?articleid=2481811
- ↑ Imai A, Matsunami K, Takagi H, Ichigo S. New generation nonhormonal management for hot flashes. Gynecol Endocrinol. 2013 Jan;29(1):63-6. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22809093
- ↑ 18.0 18.1 18.2 Prague JK, Roberts RE, Comninos AN et al. Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: A phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2017 Apr 3; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28385352 Free Article <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30823-1/fulltext
Sassarini J, Anderson RA. New pathways in the treatment for menopausal hot flushes. Lancet 2017 Apr 3 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28385351 Free full text <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30886-3/fulltext - ↑ 19.0 19.1 Rahimikian F, Rahimi R, Golzareh P, Bekhradi R, Mehran A. Effect of Foeniculum vulgare Mill. (fennel) on menopausal symptoms in postmenopausal women: a randomized, triple-blind, placebo-controlled trial. Menopause. May 15, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28509813 <Internet> http://journals.lww.com/menopausejournal/Abstract/publishahead/Effect_of_Foeniculum_vulgare_Mill___fennel__on.97782.aspx
- ↑ 20.0 20.1 Guthrie KA, Larson JC, Ensrud KE et al. Effects of pharmacologic and nonpharmacologic interventions on insomnia symptoms and subjective sleep quality in women with hot flashes: A pooled analysis of individual participant data from 4 MsFLASH trials. Sleep 2017 Nov 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29165623 https://academic.oup.com/sleep/advance-article-abstract/doi/10.1093/sleep/zsx190/4642822?redirectedFrom=fulltext
- ↑ 21.0 21.1 van Driel C, Stuursma AS, Schroevers MJ, Mourits M, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: A systematic review and meta-analysis. BJOG 2018 Mar 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29542222
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
- ↑ Fraser GL, Lederman S, Waldbaum A et al. A phase 2b, randomized, placebo-controlled, double-blind, dose-ranging study of the neurokinin 3 receptor antagonist fezolinetant for vasomotor symptoms associated with menopause. Menopause 2020 Apr; 27:382 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32102086 Free PMC Article https://journals.lww.com/menopausejournal/FullText/2020/04000/A_phase_2b,_randomized,_placebo_controlled,.4.aspx
- ↑ 24.0 24.1 Cano A, Nappi RE, Santoro N, et al. Fezolinetant impact on health-related quality of life for vasomotor symptoms due to the menopause: Pooled data from SKYLIGHT 1 and SKYLIGHT 2 randomised controlled trials. BJOG. 2024 Feb 6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38320967 Free article
- ↑ Pinkerton JV, Simon JA, Joffe H et al Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause. OASIS 1 and 2 Randomized Clinical Trials. JAMA. Published online August 22, 2024. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39172446 https://jamanetwork.com/journals/jama/fullarticle/2822766