Hotflashes Flashcards
How it starts
May initially cluster around menses during late reproductive years; Increase in early transition and through late transition and early menopause
Risk Factors
●Obesity – wt loss might reduce hot flashes.
●Smoking
●Reduced physical activity.
●Socioeconomic factors – Obtaining less than a high school education and having difficulty paying for basics
●Hormonal concentrations – Annual serum (FSH) levels, when collectively modeled longitudinally, are associated with both the prevalence and frequency of VMS.
●Ethnic factors – AA women report more frequent hot flashes than Caucasian women, and Japanese and Chinese women report less.
●Genetic variants – Women who have variations in the gene that codes for tachykinin receptor 3 (TACR3) are more likely to experience hot flashes than women without those variations. Neurokinin B (NKB) (a hypothalamic neuropeptide) and its receptor (NK3R) are also thought to be associated with vasomotor symptoms as TACR3 is the gene that encodes NK3R, and peripheral infusion of NKB induces hot flashes in postmenopausal women.
Pathophysiology
Hot flashes are mediated by thermoregulatory dysfunction at the level of the hypothalamus and are induced by estrogen withdrawal.
Severity of hot flashes
Mild: do not interfere with usual activities; moderate: interfere somewhat with usual activities; severe: so bothersome that usual activities cannot be performed
Clinical manifestations of hot flashes
sudden sensation of heat centered on the upper chest and dace that rapidly becomes generalizes; lasts from 2-4 minutes; is often associated with profuse perspiration and occasionally palpitations, and is sometimes followed by chills, shivering, and a feeling of anxiety.
Other causes of sweating
carcinoid syndrome, medications, hyperthyroidism, infection, and malignancy
Effect on sleep
HFs can disrupt sleep; night sweats are more common during first 4 hours of sleep
Treatment of mild HFs
weight loss, cognitive behavior therapy (CBT), vitamin E, and hypnosis; stellate ganglion block; layering of clothes and avoidance of triggers
Treatment of moderate to severe HFs
menopausal hormonal therapy
Contraindications for hormonal therapy
Hx BCA, CHD, VTE or stroke, or those at moderate or high risk for these complications
Bazedoxifene/conjugated estrogen
Duavee 0.45 mg CEE/20 mg bazedoxifene
This combination is used for VMS and osteoporosis prevention. Benefit: decrease in progesterone like SE including breast tenderness. It provides endmetrial protection. Risk of VTE is decreased
Estrogen + IUD (levonorgestrel)
Can be used but LT safety has not been demonstration; systemic absorption occurs and may be associated with increased risk or BCA
SSRIs/SNRIs
Low dose paroxetine at 7.5 mg/day can be used in women not taking tamoxifen
Citalopram 20mg
Venlafaxine 37.5 mg/day can be used but has more acute toxicity & w/d symptoms
Desvenlafaxine
Anti-epileptics
Gabapentin for night sweats. 900 mg/day (300 TID)
Pregabalin: 300 mg/day
Clonidine: 0.1 to 1mg/day
Anticholinergic
Oxybutynin 5-10 mg
