What to do with troublesome hot flush? / 고신대학교의과대학학술지

Hot flush (hot flush or facial flush) is the most frequent symptom experienced by women of peri-menopausal age. It may appear on women or even men after surgery or chemotherapy. Hot flush is one of the biggest reason for women to undergo hormone replacement therapy (HRT). It also crucially affects various aspects of life quality such as occupation, social life, daily routine and health awareness. The most effective and fundamental remedy for hot flush is HRT. However, a few women is not responsive to HRT and investigation to elucidate other causes of hot flush is warranted, especially in elderly. The contraindications such as breast cancer mandates other modality of treatment. Variety of treatment for hot flush other than HRT will be discussed herein.

Characteristics of Middle Aged Depressed Women with Hot Flushes / 정신신체의학

OBJECTIVES: Middle aged women with depression often experience hot flush symptoms. It is still unclear about the association between depression and hot flush symptoms. Therefore, we investigated hormonal profile, functional somatic symptoms, coping styles and attitude for menopause between depressed women with hot flush and those without hot flush. METHODS: This study included 33 depressed patients with hot flush symptoms and 33 depressed patients without hot flush symptoms. Hot flush was confirmed through prospective daily symptom ratings for a week. Subjects' coping styles were assessed by the stress coping checklist. Somatic symptoms were assessed by the Patient Health Questionnaire-15(PHQ-15). Sex hormonal levels were assayed by a radioimmunoassay. The Brief World Health Organization Quality of Life Assessment Instrument(WHOQOL-BREF) was used to evaluate quality of life. RESULTS: In coping style, depressed women with hot flush symptoms used less ‘problem-centered coping’(13.15±3.17) and ‘search for social support’(11.83±2.84) than those without hot flush symptoms(15.17±3.1, p=0.028 ; 14.25±3.22, p=0.009 ; respectively). Depressed women with hot flush symptoms showed more negative attitude toward post-menopause, but its statistical significance was marginally insufficient(p=0.059). We did not find any group differences in sex hormonal levels and somatic complaints assessed by the PHQ-15. The score of social relationship domain of WHOQOL-BREF was significantly lower in subjects with hot flush symptoms(8.62±2.04) than subjects without hot flush symptoms(9.71±1.65 ; p=0.044). CONCLUSIONS: Among middle aged women with depression, the manifestation of hot flush symptoms was associated with coping styles and attitude for menopausal transition. Hot flush symptoms in depressed women negatively influence quality of life, so clinicians actively perform therapeutic approach in case of depressed patients with hot flush symptoms. In case of depressed patients who present hot flushes, cognitive behavior therapy or stress management might be an effective treatment option in company with antidepressants or hormonal treatment. Later, longitudinal study will be needed to evaluate risk factor, cause and effect associated with hot flush and depression.

Vasomotor symptoms and the homeostatic model assessment of insulin-resistance in Korean postmenopausal women

The aim of this cross-sectional study was to evaluate the association between vasomotor symptoms (VMS) and insulin resistance, which can be postulated by the homeostatic model assessment (HOMA) index. This study involved 1,547 Korean postmenopausal women (age, 45 to 65 years) attending a routine health check-up at a single institution in Korea from January 2010 to December 2012. A menopause rating scale questionnaire was used to assess the severity of VMS. The mean age of participants was 55.22+/-4.8 years and 885 (57.2%) reported VMS in some degree. The mean HOMA index was 1.79+/-0.96, and the HOMA index increased with an increase in severity of VMS (none, mild, moderate and severe) in logistic regression analysis (beta=0.068, t=2.665, P =0.008). Insulin resistance needs to be considered to understand the linkage between VMS and cardiometabolic disorders.

<b>A Case Report of Hot Flush Successfully Treated with Formulations </b><b>for Yin-syndrome</b> / 日本東洋医学雑誌

We report a case of hot flush successfully treated with formulations for yin-syndrome. A 56-year-old female patient experienced hot sensations and sweating on her face post menopause. Her hot flush was improved slightly with kamishoyosan and ryokeijutsukanto, but her symptoms were aggravated whenever she became tired. The patient was reevaluated and her prescription was changed to hachimigan, based on symptoms related to yin-syndrome and hypofunction, and a lack of resistance at the lower abdomen with the abdominal palpation. The patient appeared to respond favorably. However, the patient was easily fatigued and her symptoms returned when she felt tired. Ninjinto was added to the prescription based on the patient's “stuck feeling in pit of the stomach”. Her hot flush resolved and she no longer became tired easily. Although the use of formulations for yang-syndrome are known to be useful for the treatment of hot flush, formulations for yin-syndrome may be effective for the treatment of hot flush depending on the state of the patient.

The Relationship of Hot Flush to Other Menopausal Symptoms and Chronic Disease Related to Menopause / 대한폐경학회지

Hot flush is one of the most commonly reported symptoms during menopause and it is referred to as vasomotor symptoms along with night sweats. I have summarized the current available knowledge on the relationships between hot flush to other menopausal symptoms and the related chronic diseases to menopause in this article.

Characteristics of Adverse Effects When Using High Dose Short Term Steroid Regimen

BACKGROUND AND OBJECTIVES: Although the adverse effect of long term steroid usage is well known, the adverse effect of short term high dose steroid usage has not been studied thoroughly. The purpose of this study was to identify the characteristics of the adverse effects when using a high dose steroid for a short term. We also compared the adverse effect of steroid between in- and out-patients. SUBJECTS AND METHODS: The medical record of 500 patients, who were treated with methylprednisolone 48 mg/day for 1-2 weeks, was retrospectively reviewed. Steroid was prescribed due to SSNHL, Bell's palsy, Ramsay-Hunt syndrome and herpes zoster oticus. The incidence of each adverse effect was analyzed, and also the time point of detection was analyzed. The 500 patients were composed of 250 in-patients and 250 out-patients. The adverse effect was compared between these two groups, as well. RESULTS: Adverse effect of steroid was found in 33.0% of the patients. Among these adverse effects, abdominal discomfort (26.8%) was most common, followed by skin rash (14.7%), swelling (13.4%), and hot flush (6.9%). Abdominal discomfort and hot flush was mostly detected on the first week. Meanwhile, the skin rash was usually detected on the third week. The incidence of adverse effect was significantly higher in the out-patient group. CONCLUSIONS: The incidence of high dose short term steroid treatment may be very high. The patients should be warned about these adverse effects. Monitoring should be performed until 3-4 week, since some adverse effects may not be detected until this time point.

Effect of Vitex agnus-castus on Menopausal Early Symptoms in Postmenopausal Women: A Randomized, Double Blind, Placebo – Controlled Study.

Objective: Postmenopausal women usually experience symptoms related to vasomotor instability due to a decline in estradiol levels. Certain plants have been found to have components that are same in structure and function to female estrogen and progesterone. This study conducted to compare the efficacy of Vitex agnus-castus (Vitex) with placebo in postmenopausal women with hot flashes. Design: Sixty postmenopausal teachers with 45-60 years old participated in a clinical trial conducted in an academic center in Gorgan-Iran. The participants divided in two equal groups randomly and treated with Vitex or placebo, 40 drops per day for 8 weeks. Data collected by using interview, individual characteristics questionnaire and evaluated by Blatt-kapperman’s index at four follow-up visits. Statistical analysis was carried out by using descriptive statistics and multivariable analysis. Results: The difference in frequency of hot flushes between groups was significant at 2nd, 4th, 6th and 8th weeks of intervention (P=0.015, p=0.000, p=0.000 and p=0.000, respectively) and also the decline in the severity of hot flashes in women who received Vitex was more evident on 2nd, 4th, 6th and 8th weeks (p=0.015, p=0.12, p=0.000 and p=0.000, respectively). Furthermore, comparing both study groups the result showed that the difference in Blatt-Kupperman index was not significant on the 2nd week of treatment (p=0.198); however, it was statistically significant between the two groups on the 4th, 6th, and 8th week of treatment (p=0.008, p=0.00 and p=0.00, respectively). Some adverse events recoded between groups were statistically significant (p=0.012). Conclusion: Despite some unimportant adverse events, this study showed that Vitex as a natural therapeutic agent is an effective treatment for the early vasomotor symptoms of postmenopausal women especially in women who have a contraindication to use of female hormones but this recommendation requires to more studies with larger samples.

SSRIs and SNRIs for Management of Hot Flushing / 대한폐경학회지

For postmenopausal women who fear hormone therapy, women 60 years of age with continuous, severe hot flushing or women with a history of breast cancer, we should consider selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs) as therapeutic agents. Base on the results from a meta-analysis and clinical trials regarding hot flushing, paroxetine and the conetrolled-release formultation of paroxetine have been shown to effectively reduce hot flushing by 30~40% and 60~70%, respectively, and 13~41% more reductions as compared to placebo. Venlafaxine reduced hot flushes by 30~60% (133% reductions compared to placebo), and desvenlafaxine reduced hot flushes by 30~70%. Fluoxetine and citalopram were shown to be less effective than paroxetine and venlafaxine, by 20% (113% reductions compared to placebo) and 40~50%, respectively. Sertraline reduced hot flushes 3~18% compared to the placebo group, but was considered ineffective. Citalopram (20 mg), paroxetine (10 mg), venlafaxine (37.5~150 mg), and desvenlafaxine (100~200 mg) not only reduced vasomotor symptoms, but demonstrated additional beneficial outcomes with respect to sleep disturbances, mood, the vigor index, and improved quality of life. Citalopram (20 mg), fluoxetine (20 mg), paroxetine (10 mg), venlafaxine (75~150 mg), and desvenlafaxine (150 mg) are recommended at the corresponding doses after weighing the risks and benefits of these medications. SSRIs and SNRIs were shown to interrupt the conversion of tamoxifen into the active metabolite, endoxifen, and thus SSRIs and SNRIs must not be used in breast cancer patients who are taking tamoxifen. Paroxetine suppressed vasomotor symptoms most potently, followed by fluoxetine, sertraline, citalopram, and venlafaxine.

Study of the Pathophysiology of Hot Flush and Cold Feet by Using an Infrared Thermometer / 日本東洋医学雑誌

[Purpose] We studied the pathophysiology of hot flush and cold feet.[Methods] By using an infrared thermometer, we measured the surface temperature of 98 female patients. We classified the patients into 4 groups : Group A patients without hot flushes or cold feet ; Group B patients with hot flushes but without cold feet ; Group C, patients without hot flushes but with cold feet ; and Group D patients with both hot flushes and cold feet. We measured the surface temperature of their tongues, upper abdomen, lower abdomen, and soles.[Results] The tongue temperature in Group B was significantly higher than that in Group A. The difference in the temperatures between the tongue and upper abdomen in Group B was also significantly greater than that in group A. Groups C and D, on the other hand, showed similar surface temperatures. Then, we examined the relationship between tongue temperatures, and the difference in the temperatures between the tongue and sole (Diff T-S) by using a correlation coefficient test : a significant correlation (r=0.77) was observed in Group C but not in Group D. Next, the patients in Group D were divided into 3 subgroups on the basis of their Diff T-S ; we found that these subgroups were characterized by the constitutionally ordinary symptoms (COS) of “yin and yang” and “deficiency and excess.”[Discussion] The occurrence of hot flush with cold feet was shown to depend on the slope of the body temperature, which was influenced by COS.[Conclusion] The occurrence of hot flush is associated with COS.

Study for Clinical Effects of Byakkokaninjinto on the Patients with Atopic Dermatitis / 日本東洋医学雑誌

We medicated14atopic dermatitis patients who had erythema of the face with byakkokaninjinto. Before prescribing byakkokaninjinto for each patient, a questionnaire on their subjective symptoms or constitutions was carried out. Moreover, in order to evaluate the effect of byakkokaninjinto and the transition of subjective symptoms, such as a hot flushes and thirst of the throat, condition diaries were prepared, and the grade of each symptom was scored by the patients themselves during treatment.These results demonstrated that byakkokaninjinto was effective for patients who had severe hot flushes of the face.

The Effect of black cohosh with St. John's wort (Feramin-Q(R)) on climacteric symptoms: multicenter randomized double-blind placebo-controlled trial / 대한산부인과학회지

OBJECTIVE: Results of several recent randomized clinical trials and epidemiological studies casted many doubts about the validity and safety of conventional hormone therapy for postmenopausal women. More and more women want to try more natural and safe ways of treating their climacteric symptoms. Black cohosh combined with St. John's wort may be effective in climacteric symptoms alternative to hormone therapy. This multicenter randomized double-blind placebo-controlled prospective clinical trial was carried out to evaluate the effect of the combined preparation of black cohosh and St. John's wort, Feramin-Q(R), on the general climacteric symptoms, hot flushes and climacteric depression. METHODS: Total of 80 postmenopausal women having moderate to severe degree of climacteric symptoms were randomly allocated to receive Feramin-Q(R) (n=40) or placebo (n=40) daily for 12 weeks. Fifty eight subjects completed this clinical study. The primary endpoint, the relief of general climacteric symptom and hot flushes were evaluated by measuring Kupperman index and the secondary endpoint, the relief of climacteric depression by Beck Depression Inventory at 4 and 12 weeks of treatment. RESULTS: After 4 and 12 weeks of treatment, Feramin-Q(R) and placebo groups showed significant decline of Kupperman index and BDI scores compared with baseline scores, but Kupperman index and BDI scores between the groups were not significantly different at 12 weeks. The changes of BDI scores between the groups were different at borderline significant level (p=0.07). Hot flush scores of Feramin-Q(R) groups were significantly decreased after 12 weeks of therapy, which showed significantly different at borderline level (p=0.07) from that of placebo. There was no statistical difference in change of hot flush scores from the baseline between the groups after 12 weeks. Among the 45 postmenopausal women with moderate to severe hot flush, Feramin-Q(R) group showed significant decrease of hot flush scores, which was significantly different compared with placebo group at 12 weeks of therapy. There were more patients (86.4%) in Feramin-Q(R) group, who had much more improvement of hot flushes compared with placebo group (54.6%) (P=0.04). CONCLUSION: There were no significant differences between placebo and Feramin-Q(R) groups concerning the effect on general climacteric symptoms and depression but Feramin-Q(R) was significantly more effective than placebo in relieving of hot flush in postmenopausal women with moderate to severe hot flushes. Therefore Feramin-Q(R) seems to be effective alternative for moderate to severe hot flushes.