1. Cooling down the Hot
flushes /flashes
Cooling down the Hot
flushes /flashes
Dr. Kawita Bapat

3. HOT FLASES /FLUSHES
 Whatever the cause, the effects can include a
rise in skin temperature in the cheeks,
forehead, upper arms, chest, abdomen, back,
calves, thighs and fingers
 with increased blood flow in the hands,
calves, and forearms.
 The increase in heat causes blood vessels just
under the skin surface to dilate - get bigger -
resulting in the classic florid cheek look
associated with hot flushes.

4. Hot flushes
 Sensation of intense
heat, sweating, flushin
g,
 Lasts for five to 10 min
 Main reason to seek
medical help for the
menopause
 Ahead of night sweats
and mood and sleep
disturbances.

5. thermostat — the
Levels of hypothalamus. at the
Estrogen fall base of brain regulates brain gets the
body temperature and ‘wrong message’
other basic processes. thinks that the
body is too
hot, creating
measures such as
extremely uncomfortable sweating and heat
horrible
embarrassing lasting loss (through the
from 3 to 5 min experience of
waking up at skin) to try to cool
many times a day down the inside of
night drenched
can last for years the body.
in sweat
through the menopausal
transition.
menopause is inevitable
the mind also has a major influence
over the body
and can be hypnotically trained to cool
down hot flashes.

7. Hot Flash Rates
Menstrual Status % Reporting Hot Flashes
Premenopausal* ~10%
Perimenopausal† ~30% to 85%
Recently postmenopausal ~20% to 90%
4 years postmenopause ~20% to 60%
* Menstruationwithin the 3 prior months with no change in regularity of cycle.
†3 to 11 months of amenorrhea or increased menstrual irregularity.
1. McKinlay SM et al. Maturitas. 1992;14:103-115.
2. Kronenberg F. Ann N Y Acad Sci. 1990:592:52-86.
3. Nachtigall LE. Clin Obstet Gynecol. 1998;41:921-927

11. What works, what might, and what doesn't
 Hormone therapy
 Trials show it is effective
 According to a report from Thomas
Jefferson University, an analysis of 24
trials, which included 3,329
women, showed a 75.3 per cent drop
in the frequency of hot flushes
experienced each week, and an 87
per cent reduction in severity of
symptoms.

12. Hormone Replacement Therapy
 Some women love it  others hate it
 Some women won’t  others won’t consider
touch it stopping it.
 But no matter how you  it remains the only
fell about estrogen, government approved
drug therapy in the
United States

13. Estrogens and Hot Flushes
 Higher doses
 associated with higher rates of response
 associated with more rapid response
 Response depends on bioavailability and
reaching adequate serum-tissue-receptor
levels
 BOTTOM LINE: More is better

14. Four types of estrogens
Human Estrogens Synthetic Estrogens.
Estradiol, strongest one  manufactured in chemical plants
 Estrone less active  resemble human and non-human
 Estriol 10 percent as active as estrogens.
estradiol
Non-Human Estrogen Plant-Based Estrogens.
 phytoestrogens.
 conjugated estrogens or CE.
 mixture of at least 10 estrogens  Some act like an estrogen
 obtained from natural sources,  others act like an anti-estrogen,
 typically, the urine of pregnant  commonly found in foods such as
mares. soy, flaxseed, red clover

15. Women's HOPE Study
Change in Number of Hot Flushes Over 12 Weeks
(n = 241)
12
12 Placebo Placebo
0.625 0.625/2.5
Adjusted Mean Daily Number*
Adjusted Mean Daily Number*
10 0.45/2.5
10 0.45
0.3 0.45/1.5
8 8 0.3/1.5
6 6
4 4
2 2
0 0
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Week Week
*Adjusted for baseline.
Mean hot flushes at baseline = 12.3 (range 11.3–13.8).
Analyses included women who recorded taking study medication and had at least 7 moderate-to-severe
flushes/week or at least 50 flushes per week at baseline.
Utian WH, et al. Fertil Steril. 2001;75:1065-79. Used with permission.

16. HRT
 Personal decision
 needs to be individualized
 detailed discussion
 personal needs
 wants and desires
 Symptoms hoping to alleviate
 risks explained
 alternatives exist

18. Sign of the Times - Menopausal Sayings
 ★ I was going to send in a suggestion...but I can't
remember what it was :
 ★ Everyone around you is freezing cold, you have your
personal fan turned on to turbo cool.
 ★You don't know whether to laugh or cry, sometimes you
do both!

20. Phyto Soya
 Twice a day
 mimic the hormones oestrogen.
 A study of published in the journal Menopause in 2002
found it reduced hot flushes in 60 per cent
 Expert opinion ‘There is some evidence to support the
effectiveness of isoflavones, but not all the studies are
conclusive and some are small.
 Rating: 5/10

22. Black cohosh
 one-a-day tablets
 member of the buttercup family
 side-effects digestive upsets and itchy skin
 Expert opinion : ‘Black cohosh is the most
extensively tested of all the herbal products for
the menopause, but most of these studies have
been small. It has been found to be effective for
some women.’
 Rating: 4/10

23. Lady Care magnet
 This small magnet is attached to the front of the underwear, and
is ideally worn all day
 It is thought to have an effect on the part of the nervous system
that affects heart rate and perspiration.
 A study of 35 women last year who wore it found that 70 per cent
of them reported an improvement in hot flushes and night
sweats.
 Expert opinion : ‘how this would help overcome a fall in hormone
levels. If it does have any benefit, then it is down to placebo
effect.’
 Rating: 2/10

24. Single bed cooling pad
 This is a pad filled with a gel that delivers a
cooling effect.
 Around the size of a small blanket (70cm by
90cm), it absorbs the heat from the body and
requires no batteries or mains electricity, and can
be used again and again.
 Expert opinion : ‘Anything that is cooling may
help women having a hot flush. Normally they
have to leap out of bed and have a cold shower
or a drink, so this may help.
 Rating: 4/10

25. 7. GABAPENTIN
 Drug for migrain

26. RED CLOVER
 one tablet daily
 traditionally used
 One small study, commissioned by the
manufacturer, and involving 69 women, found
that taking this reduced the number of hot
flushes experienced by two-thirds.
 EXPERT OPINION : ‘There is very little evidence
to suggest that THIS does actually work.’
 Rating: 2/10

27. Traditional Chinese herbs
 weak estrogen-like activity
 Jiawei Qing'e Fang
 EXPERT OPINION current findings
suggest that Jiawei Qing'e Fang has
benefits beyond the placebo
 Rating 5/10

28. Primrose oil
 one or two tablets daily
 help with ‘hormonal balance’.

 EXPERT OPINION: ‘Evening primrose oil is taken
for many hormonal complaints such as the
menopause and PMT despite there being
virtually no evidence that it works.
 ‘This does though also contain isoflavones which
maybe of benefit to some – but no more than a
placebo pill would be.’
 Rating: 3/10

29. Vitex Agnus Castus
 Nature’s Best
 flowering plant chasteberry fruit.
 It was shown to stabilise hormone levels, reduce
hot flushes and lessen vaginal dryness in a
German study of 100 women published in
Menopause in 2009.
 EXPERT OPINION : ‘One trial did show that this
had some benefit, but this was quite small. It
needs more research.’
 Rating: 3/10

32. 10 COOL ways to stop
hot flushes in tracts

33. 1. Dress for success
 Dress in layers
 Easy care fabrics
 Loose fitting clothes
 Comfy style
 Wardrobe planning

34. 2.BREATHE
 Deep breathing shortens
the time of hot flushes
 Abdominal breathing
halve the number of
attacks
 Slow & deep breathe
 Expand rib cage
 Train ahead of time.

35. 3.COOL THE ROOM
 Open the windows
 Air-conditioner/fan
 Constant cool
temperature

36. 4.AVOID THE HOT SPOT
 Stay away from
outdoor places
 No sun bathing
 Avoid hot tubs
 Sauna and steam bath
cautiously

37. 5.STAY HYDRATED
 Plenty of water
throughout day
 Keep glass of water by
self
 15-20 Glass /day
 Water is important for
functioning
 ‘WATER GLASS HABIT’

38. 6.EAT TO BEAT THE HEAT
 Turn down the spices
 Hot & spicy food-flash
maker.
 Avoid hot drinks &
alcohol.
 Pay attention to own
food----

39. 6. EXERCISE
 30 minutes / day
 Walk/
run/ride/any-
other

40. 7.HORMONE HELP
 Short course
 Estrogen is still
most effective.

41. 8. Other medications possibilities
 Anti -
depressents.
 Anti -
hypertensives
 Anti –seizures
 Drug of
migraine
Gabapentin

42. 9. Flaxseed
 40 grms of
ground flax seed/
 Decreased joint
& muscle pain.

43. 10. Herbal hot flashes remedies
 Vitamin-E
 Yam phyto-
estrogen
 Black cohosh
 Red clover
 Chinese herbs

45. Some suggestions as conclusion
 Lifestyle non-HRT approaches include:
 Drink plenty of water daily (8 glasses or more)
 Daily exercise (walking 30 minutes is great)
 Yoga classes ( Kundalini Yoga best)
 Meditate daily – even 1 to 5 minutes at first
and work way up to longer.
 Keeping the mind calm and silent works
wonders.

46. MEDITATION
Learn to Relax
stress, emotional or physical by
releasing adrenaline into.
blood flow to increase, body
temperature to rise.
Hot flashes are a response to an
increase in body temperature, and
thus stress can cause to feel flush.
That’s why stress-reduction
techniques are among the
recommended home remedies for
hot flashes. Think yoga, deep
breathing, and meditation.

47. Some suggestions as conclusion
 Mindfulness-Based Stress Reduction mindfulness exercises.
 Acupuncture –
 Avoid caffeine, spicy foods and alcohol
 Carry a cool wipe
 Herbal approaches
 vitamin D3 supplement

48. Some suggestions as conclusion
Non-HRT prescription meds such as:
 SSRI antidepressants
 SNRI antidepressants.
 anti-seizure medication
 Clonidine

50. Some suggestions as conclusion
 HRT with low Estrogens.
 Tailor made and designer HRT
 With persistence and patience