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“НАШЕ ЖИТТЯ”, ЖОВТЕНЬ 2011 29 HOT FLASHES by Ihor Magun, MD, FACP “Hot flashes” are dreaded words that resonate in women all around the world; they refer to sensations that can make everyday life difficult and that most would prefer not to experience. What exactly are hot flashes and what is the physiology surrounding t his condition? Many abnormal hormonal conditions can produce hot flashes, but by far the most common cause is due to menopause. Physical manifestations are sudden feelings of intense warmth (blushing) or just profuse sweating (mostly on the upper body) fol lowed by a chill. A typical hot flash has the duration of one to five minutes. Some women experience a rapid heartbeat (palpitations), a feeling of pressure in the head, dizziness, faintness, or weakness. The frequency with which these symptoms manifest th emselves can vary from several times a day to only a few times per week. They can occur at night, interrupting sleep and leading to chronic insomnia, which in turn leads to depression and anxiety. The exact cause of hot flashes is not known. Low estrogen, as seen in all women in menopause, is not the only factor, as many women in menopause with low estrogen do not experience any symptoms. However, one theory focuses on the hypothalamus, our body's thermostat. It is located at the base of the brain. Lower es trogen levels appear to disrupt in some women the hypothalamic function, triggering the hallmark symptoms. There are risk factors which seem to universally either trigger or exacerbate the symptoms. These include smoking, increased alcohol intake, high bod y mass index (obesity) as well as inactivity. Ethnicity plays a role. Hot flashes are seen more frequently in African American women than in women of European descent. Interestingly, women of Asian descent have a lower incidence than white European women. To reduce symptoms, look at your life - style and incorporate changes. Some women know their "triggers." These may include hot (temperature) beverages/soups, spicy foods, caffeine, alcohol, cigarettes, hot weather or an overheated house. Dressing in layers can be helpful as it enables you to adjust quickly to environments with fluctuating temperatures. Since estrogen appears to be the main player in the symptoms, it would seem logical to just replace it. There has been quite a lot of controversy over the pos sible risks of estrogen replacement, such as increase in uterine cancer and breast cancer, propensity for developing blood clots as well as negative effects on the heart. Severe cases do require use of estrogen replacement, with careful monitoring of poten tial problems. However, it is no longer the "go - to treatment of choice." Alternative prescription treatments advocate the use of low doses of anti depres - sants, anti - seizure medications, or certain specific blood pressure medications. The use of herbal med ications, especially black cohosh, dong quai, or kava, has not been helpful. In fact, they can have harmful side effects and drug interactions in those individuals already taking prescription medications. Evaluation for other hormonal disorders should be i n the differential diagnosis — including those of the thyroid gland which can mimic the same symptoms as the ones caused by menopause. Hot flashes are not pleasant and can be quite frustrating. Approximately eighty percent of women suffer from them before, d uring, or after menopause. Most hot flashes taper off with time. Many have only a few episodes and never recur. Speak with your physician about your concerns and note your triggers, especially those that pertain to your lifestyle. Many women do find that l ifestyle changes have a positive impact on their symptoms. This may improve other aspects of your life better than any pill you can swallow. In order to change, we must be sick and tired of being sick and tired.
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