Which Treatment Is Best For Hot flashes

Hot flashes are one of the most involving temporary but recurring flushing with a sensation of warmth or heat on the upper body and face. Some hot flashes are easily tolerated, others are annoying or embarrassing, and others can be debilitating.

Hot flashes are most commonly associated with perimenopause and menopause. In any woman presenting with hot flashes, whether she is of perimenopausal age or status-post surgical or medically induced menopause, pathology must be ruled out as the cause. Menopause can be confirmed by the cessation of menses for at least 12 months and with estradiol and FSH levels.

What’s the connection to sex?

Studies have shown that severe hot flashes can be negatively associated with sexual activity. Hot flashes can contribute to sexual problems in any number of ways:

• Simple sweatiness – The sensation of heat brought on by hot flashes can be so intense and unpleasant that the idea of intimacy or being sexual may be inconceivable around the time that flashes occur. Being red and sweaty just doesn’t feel sexy.
• Sleep disturbances and reduced energy – Although studies have not shown a clear cause-and-effect relationship between hot flashes and sleep disturbance, nighttime hot flashes and night sweats certainly do not make for restful sleep. The result can be fatigue? and less energy for sex.
• Less closeness in bed – Women who used to enjoy sleeping close to their partner may find that their partner’s body heat triggers hot flashes. For some couples, differences over what’s a comfortable bedroom temperature can lead to sleeping in separate rooms.
• General negative effect on the quality of life – Severe hot flashes have been found to take a toll on women’s social function, energy level, concentration, and overall quality of life. They also can intensify underlying symptoms of depression. Under these circumstances, women may not feel motivated to have sex.

Causes of Hot Flashes

• The exact pathogenesis of hot flashes is unknown, but studies indicate that VMS (vasomotor symptoms) results from a defect in central thermoregulatory function in the human body.[rx]
• Various hormones and neurotransmitters lead to hot flashes and modulate vasomotor symptoms, most importantly, estrogen.
• Suddenly estrogen withdrawal causes is the initial mechanism leading to hot flashes.
• Norepinephrine and serotonin also have a role in the defect in thermoregulation with VMS, which is why SSRIs and SNRIs have been used to treat VMS.[rx]
• Research documents that plasma levels of norepinephrine metabolites rise before and during a hot flash.[rx]
• Peripheral vasodilation occurs, increasing up to 10 to 15 degrees C in the fingers and toes.[rx] A rise in systolic blood pressure and heart rate also occurs.[rx]
• Drugs withdrawal symptoms
• Blood vessels related to a disease problem.
• Hormonal change

Symptoms of Hot Flashes

During a hot flash, you might have

• A sudden feeling of warmth spreading through your chest, neck, and face
• A flushed appearance with red, blotchy skin
• Rapid heartbeat
• having skin that suddenly feels warm
• experiencing redness on parts of the body, such as the face, neck, ears, or chest
• sweating, especially in the upper body
• tingling in your fingers
• experiencing a heartbeat that’s faster than usual
• Perspiration, mostly on your upper body
• A chilled feeling as the hot flash lets up
• Feelings of anxiety

Diagnosis? of Hot Flashes

History

• Test and diagnosis? for hot flashes should take place in all perimenopausal women or not.
• Take any hormonal drugs or not.
• Hot flashes should also receive treatment if they impair a woman’s quality of life, in particular, daytime activities and sleep.
• At the same time, many women have hot flashes and do not need treatment. In the most severe cases, a woman can awake several times during the night, which in the long term, can cause cognitive and anxiety disorders with hot flashes

Treatment of Hot Flashes

Several treatment options exist, with only a few being FDA approved.

• Selecting a treatment option –  the healthcare provider should encourage the safest option first, such as lifestyle changes, and then proceed to the following hormonal and/or non-hormonal treatments.
• Estrogen – The most effective treatment for hot flashes is systemic? estrogen, with a 75% reduction of VMS frequency.[rx]
• Progestin therapy  – at high doses, including DMPA and megestrol, also decreases hot flashes but is not nearly as effective as estrogen.[rx]
• Progesterone – treatment should be a consideration in women who cannot take estrogen therapy. Hormone therapy (HT) administration can be in various forms, including oral, parenteral, topical, transbuccal, vaginal, or transdermal, with each route having various formulations and doses of estrogen and/or progesterone.[rx] The consensus is that HT for the treatment of hot flashes or vasomotor symptoms should be prescribed at the lowest effective dose for the shortest amount of time needed for the management of the symptoms.[rx]
• Vitamin E with Vitamin C – Vitamin E and C help to tissue regeneration, wound healing, and skin-brightening.
• Antioxidant – You can take antioxidant and omega 3 for hot flashes, that will help for making freer and freer radicals that are essential for healthy skin.

Prescription? nonhormonal therapies include

• Gabapentin/Pregabalin – Gabapentin is an anti-seizure? medication that’s moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness, water retention in the limbs (edema?), and fatigue?.
• SSRIs (paroxetine) – An anti-depression drugs that work in hot flash
• SNRIs (venlafaxine, desvenlafaxine)
• Paroxetine – was the first nonhormonal prescription? medication that was FDA approved for use in the treatment of menopausal vasomotor symptoms, including hot flashes.[rx] The typically prescribed dose is an ultra-low 7.5mg daily. It moderately reduces hot flashes versus the placebo.[rx] Paroxetine and other SSRIs are not recommended for women with tamoxifen-induced hot flashes due to their effects as a strong inhibitor of the drug-metabolizing enzyme CYP2D6 and therefore interfering with tamoxifen’s therapeutic benefit.[rx]
• SNRIs such as venlafaxine – although not FDA approved for the treatment of hot flashes, are recommended for the management of hot flashes in a woman taking tamoxifen.[rx] Other options for women with a history of breast cancer include gabapentin and clonidine.[rx]
• Oxybutynin – Oxybutynin is a pill or patch most often used to treat urinary conditions like overactive bladder. It may also help relieve hot flashes in some women. Side effects can include dry mouth, dry eyes, constipation?, nausea?, and dizziness.
• Clonidine – Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth, and constipation?.

Natural Remedies

Some people prefer to use natural or alternative remedies to treat their hot flashes.

• One option is acupuncture. A 2016 study of 209 women experiencing four or more menopause symptoms a day found that acupuncture significantly reduced their menopause symptoms, including hot flashes and night sweats.
• Herbs and supplements touted as menopause remedies are also sold at many drugstores. You should check with your doctor before taking any herbs and supplements because they can sometimes interfere with the medications you’re currently taking.
• Below are herbs and supplements that are sometimes used for symptoms of menopause. Research on them has been inconclusive. Larger, higher-quality studies are needed.

Black cohosh

• Native to North America, the black cohosh root is one of the most popular herbal remedies for hot flashes. Research is mixed, with some studies indicating that it helps ease symptoms and others indicating that it has no noticeable effect.
• Its side effects are mild, but you shouldn’t use it if you have liver disease.

Dong quai

• Dong quai is a plant native to East Asia. It’s sometimes taken alongside black cohosh. Very few studies have looked specifically at its effect on menopause. The studies that do exist concluded that its effects were insignificant.
• You shouldn’t use it if you take blood thinners such as warfarin (Coumadin).

Evening primrose oil

Evening primrose oil is extracted from a flower.

• A small 2013 study of menopausal women found that over the course of 6 weeks, two 500-milligram doses could lead to significant improvements in hot flashes.
• Study participants saw a 39 percent improvement in frequency, a 42 percent improvement in severity, and a 19 percent improvement in duration. By all measures, evening primrose oil was more effective than the placebo.
• Earlier studies concluded that there wasn’t enough evidence of its benefits for menopausal women.

It may interfere with blood thinners and some psychiatric medications.

Soy isoflavones

• Isoflavones are chemical compounds that mimic the effects of estrogen. Research from 2014 found that soy isoflavones could have modest effects on menopausal hot flashes, reducing them by up to 25.2 percent.
• However, they’re a slow-acting remedy. It took soy isoflavones 13.4 weeks to reach half of their maximum effects. By comparison, it took estradiol only 3.09 weeks.

LifeStyle

Lifestyle change or place or weather change may help to reduce hot flash

• Lifestyle changes such as exercise – layering clothes, maintaining lower room temperature, drinking cool drinks, and avoiding caffeine and alcohol are reasonable to consider for the management of VMS even if there aren’t conclusive studies proving their efficacy.[rx]
• Nonmedicated and integrative medical – treatments of hot flashes, but research is growing in the integrative medicine field. Integrative medical treatments, including breathing exercises, relaxation techniques, changes in diet, yoga, acupuncture, reflexology, and hypnosis, could provide some relief in the treatment of vasomotor symptoms.[rx]
• Bath and swarmed swimming – regularly may help to erase the hot flash
• Deep breathing Exercise  – In several researchers found that relaxation breathing exercise and paced respiration all refer to a method used to reduce stress. It involves breathing in (inhaling) deeply and breathing out (exhaling) at an even pace. Do this for several minutes while in a comfortable position. You should slowly breathe in through your nose. With a hand on your stomach right below your ribs, you should first feel your stomach push your hand out, and then your chest should fill. Slowly exhale through your mouth, first letting your lungs empty and then feeling your stomach sink back. You can do this almost anywhere and several times during the day, whenever you feel stressed. You can also try this if you feel a hot flash beginning or if you need to relax before falling asleep.
• Nerve block procedure – A procedure known as stellate ganglion block has shown promise for treating moderate to severe hot flashes, but more research is needed. It involves injecting an anesthetic into a nerve cluster in the neck. The treatment has been used for pain? management. Side effects include pain? and bruising at the injection site.
• dressing in layers, even on the coldest days, so you can adjust your clothing to how you’re feeling
• sipping ice water at the start of a hot flash
• keeping a fan on while you sleep
• lowering the room temperature
• wearing cotton clothes and using cotton bed sheets
• keeping an ice pack on your bedside table
• avoiding spicy foods
• limiting how much alcohol you drink
• limiting hot beverages and caffeine
• stopping smoking
• using stress reduction techniques, such as yoga, meditation, or guided breathing
• avoiding high fat and high sugar foods

Prevention

Hot flashes related to menopause cannot be prevented. However, the following lifestyle changes may help to make hot flashes less severe or less frequent:

• Drink a glass of cool water at the beginning of a hot flash. This seems to lessen discomfort in some women. Also, be sure to drink enough water, usually six to eight glasses per day.
• Avoid drinking beverages that contain caffeine or alcohol, since these can make hot flashes more uncomfortable.
• Cut down on red wine, chocolate, and aged cheeses. They contain a chemical that can trigger hot flashes by affecting the brain’s temperature control center.
• Don’t smoke. Smoking can make hot flashes worse.
• Wear loose, comfortable clothing made of cotton to help absorb perspiration.
• Dress in layers, so that you can remove some clothing if you suddenly feel hot.
• Lower your home thermostat to keep your house cool. At work, open a window or use a small portable fan.
• At night, use lightweight blankets that can be removed if hot flashes wake you up.
• Regular vigorous exercise during which endorphins are produced may also decrease hot flashes.

Overall

• Hot flashes are the most prevalent vasomotor symptom that presents during perimenopause.
• The only FDA approved nonhormonal prescription? medication to treat hot flashes is low dose paroxetine of 7.5mg daily.
• Nonhormonal nonprescription therapies, including black cohosh, red clover isoflavones, soy extract, and Chinese herbs, are not effective.
• The Women’s Health Initiative (WHI) found that combined HT raises the risk of breast cancer, venous thromboembolism, stroke?, is not cardioprotective, and does not decrease the risk of mortality.
• The evidence is lacking to support the safety, effectiveness, and superiority of compounded bioidentical hormones over conventional hormone therapy.
• Although some SSRIs and SNRIs are safe and effective in the treatment of hot flashes in patients with breast cancer, caution is necessary when used with tamoxifen. Gabapentin and clonidine can be alternatives in these patients.