keesan
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response 210 of 480:
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Oct 30 23:18 UTC 2003 |
The next posting is a very long one about hot flashes including the fact that
they can be worse after chemotherapy and if you are thin.
[A friend who will be taking tamoxifen after radiation for breast cancer
told me about this site.]
All About Hot Flashes
If you've had one, there's no mistaking it: the sudden, intense, hot
feeling on your face and upper body, perhaps preceded or accompanied
by a rapid heartbeat and sweating, nausea, dizziness, anxiety,
headache, weakness, or a feeling of suffocation. Some women experience
an "aura," an uneasy feeling just before the hot flash, that lets them
know what's coming. The flash is followed by a flush, leaving you
reddened and perspiring. You can have a soaker or merely a moist upper
lip. A chill can lead off the episode or be the finale.
What causes them
Hot flashes are mostly caused by the hormonal changes of menopause,
but can also be affected by lifestyle and medications. A diminished
level of estrogen has a direct effect on the hypothalamus, the part of
the brain responsible for controlling your appetite, sleep cycles, sex
hormones, and body temperature. Somehow (we don't know how), the drop
in estrogen confuses the hypothalamus--which is sometimes referred to
as the body's "thermostat"--and makes it read "too hot."
The brain responds to this report by broadcasting an all-out alert to
the heart, blood vessels, and nervous system: "Get rid of the heat!"
The message is transmitted by the nervous system's chemical messenger,
epinephrine, and related compounds: norepinephrine, prostaglandin,
serotonin. The message is delivered instantly. Your heart pumps
faster, the blood vessels in your skin dilate to circulate more blood
to radiate off the heat, and your sweat glands release sweat to cool
you off even more.
This heat-releasing mechanism is how your body keeps you from
overheating in the summer, but when the process is triggered instead
by a drop in estrogen, your brain's confused response can make you
very uncomfortable. Some women's skin temperature can rise six degrees
Centigrade during a hot flash. Your body cools down when it shouldn't,
and you are miserable: soaking wet in the middle of a board meeting or
in the middle of a good night's sleep.
Who gets them
Eighty-five percent of the women in the United States experience hot
flashes of some kind as they approach menopause and for the first year
or two after their periods stop. Between 20 and 50% of women continue
to have them for many more years. As time goes on, the intensity
decreases.
If you have had breast cancer, your hot flashes can follow the same
pattern as for women in general, or they can be more intense and last
longer, particularly if menopause was premature, or if you are taking
tamoxifen and your body hasn't adjusted to it. Rarely, women may not
have hot flashes until they stop taking tamoxifen--an unpleasant
surprise. In these women, tamoxifen develops an unusual estrogen-like
ability to combat hot flashes.
There is considerable variation in time of onset, duration, frequency,
and the nature of hot flashes, whether you've had breast cancer or
not. An episode can last a few seconds or a few minutes, occasionally
even an hour, but it can take another half hour for you to feel
yourself again. The most common time of onset is between six and eight
in the morning, and between six to ten at night.
How hot is hot?
Most women have mild to moderate hot flashes, but about 10-15% of
women experience such severe hot flashes that they seek medical
attention. For women who have had breast cancer, the number who suffer
debilitating hot flashes is probably much higher. Randomized studies
provide the most objective data: about 50-75% of women taking
tamoxifen will report hot flashes, compared to 25-50% taking placebo.
The faster you go through the transition from regular periods to no
periods--the peri-menopause or climacteric--the more significant your
hot flashes will be. Hot flashes are severe after surgical menopause,
and they can also be quite difficult after a chemotherapy-induced
medical menopause. If you haven't been warned about hot flashes, a
sudden severe episode can be frightening; you might even confuse the
flash with a heart attack.
The intensity of hot flashes accompanying treatment with tamoxifen
eventually improves for many women after the first three to six
months. Because of the conversion of androstenedione from the adrenal
glands into estrone by fat and muscle cells, heavy or muscular women
experience less severe hot flashes than thin women. If you smoke, your
blood vessels lose some of their ability to radiate heat, so you may
suffer more severe hot flashes.
Beating the heat naturally
The best way to beat a hot flash is naturally. Hot flashes have a lot
to do with the low levels of estrogen in your body, but other factors
can cause your temperature control to go out of whack. Instead of
estrogen therapy, look at less drastic measures first, partly because
estrogen therapy is not known to be safe for women with a history of
breast cancer--but also because you should always begin with the least
aggressive approach to treating your menopausal symptoms.
Avoiding triggers
If you can identify the things that trigger your hot flashes, you've
made the first step in getting the upper hand. Keep a record of when
they occur and what you were eating or doing, or how you were feeling
at the time. Many women find that stress tops the charts as a trigger.
Was that hot flash in the boardroom a random hit, or were you feeling
under pressure at the time? Was it a full day of pressure without a
break?
Solution: Ease the pressure. Give yourself more time to plan your
work, to rehearse your presentation, to deliver your assignments, to
arrive where you're going. If you are doing a series of presentations,
give yourself a chance to relax and cool off between sessions. And
plan your schedule so you avoid meetings or decision making when
you're most likely to be in a sweat.
Other hot flash triggers:
* alcohol
* caffeine
* diet pills
* spicy food
* hot food
* hot tubs
* saunas
* hot showers
* hot beds
* hot rooms
* hot weather
* smoking.
Hot flash survival tips
* Dress in layers, so you can peel off one layer after another as
you get warmer.
* Don't wear wool, don't wear synthetics, and be wary of silk. That
leaves cotton, linen, rayon, and more cotton. (Look at the bright
side: You'll save on cleaning bills, and you can stop worrying
about moths.)
* Avoid turtlenecks. Stick to open-neck shirts.
* Keep ice water at hand that you can sip to cool down your insides.
* Where possible, lower the thermostat. Maybe it's time for a decent
air conditioner or a ceiling fan. Or maybe you'd prefer one of
those little hand-held battery-operated fans or the foldable kind
you flutter in front of your face. You can find perfectly adequate
paper fans for about a dollar.
* Wear cotton pajamas or a nightgown. If you perspire a lot at
night, your nightclothes are easier to change than the sheets.
* Use cotton sheets only, not synthetics.
* Get a bigger bed if you and your partner are on different heat
planets but you still want to stay in close orbit.
* Take cool shower before bed.
* Try a mild medication like Tylenol
* Arrive at meetings early so that you can get the coolest seat.
* Use your freezer liberally. A number of women talked about opening
the freezer at home (or in the supermarket) and sticking their
head in when a hot flash hits.
Lifestyle changes to alleviate hot flashes
Exercise: Increasing your level of activity (for example, taking the
stairs instead of the elevator) can reduce hot flashes and have a
positive impact on just about every other symptom attributed to
menopause and growing older, including:
* insomnia
* mood swings
* eroded self-image
* loss of libido
* fatigue
* elevated cholesterol levels
* heart, bone, and muscle health.
Exercise also increases endorphin levels, increasing your threshold
for pain.
Relaxation and stress reduction: It isn't unusual to have trouble
dealing with stress, especially if you've undergone treatment for
breast cancer. You may find that one of the following techniques will
help you minimize the devastating effects of stress on your body:
* relaxation exercises
* breathing exercises
* meditation
* visualization
* massage
* hypnosis
* yoga
* biofeedback techniques.
Changing your diet: Over time, a low-fat diet helps some women with
hot flashes. Losing excess weight helps, but losing too much weight,
or being too thin, can worsen symptoms. As you consider other food
changes, keep in mind that natural doesn't mean harmless. Herbal
remedies and soy preparations may work because of their plant
estrogens, but you can't assume that just because an estrogen comes
from a plant it's a safe remedy.
Chinese medicine: Chinese medicine has a long tradition of treating
hot flashes. There are all kinds of hot flashes, and the Chinese have
descriptions for all of them. Before treating you, a Chinese doctor
takes a full history and performs a complete physical, with particular
attention to your tongue and your pulse. He or she then determines
whether you're suffering from a "hot" menopause or a "cold" menopause.
If you have gone through a surgical or medical menopause, Chinese
herbs are usually not considered strong enough to eliminate your
menopausal hot flashes, but they can help.
Chinese medicine usually involves:
* acupuncture, which moves your Xi (your inner wind, energy, or
spirit). For every woman who's skeptical about this approach,
there's a woman who's found acupuncture helpful for hot flashes.
* herbology, in which many different herbs are cooked together to
make a tea customized to your particular symptoms. Common to all
Chinese herbal mixes is dong quai, thought to be a plant estrogen.
More plant estrogens that women have found effective in treating
hot flashes over the centuries can be found in ginseng, evening
primrose oil, licorice root, red raspberry leaves, sarsaparilla,
spearmint, damiana, motherwort, chasteberry (also known as Vitex),
[44]black cohosh, and wild yams. These herbal remedies, Chinese
and other, may be effective at reducing hot flashes but, again,
their relative safety in women who have had breast cancer is not
known. Avoiding, or using plant estrogens with great caution, is
best, and never try them without telling your doctor. Even leading
Chinese medicine practitioners caution women not to self-treat
with Chinese herbs.
Vitamins: Some women find that taking vitamin E every day (800 I.U.,
range 400-1000) helps. Actually, a placebo works almost as well. The
National Cancer Institute's/National Surgical Adjuvant Breast and
Bowel Project's Tamoxifen Breast Cancer Prevention Trial also
recommends vitamin E, or one of the following: vitamin B6, 200-250
milligrams daily, and Peridin-C (containing antioxidants), two tablets
taken three times daily. If vitamin E helps you, great, but if you
have significant hot flashes, you will probably need something more
effective.
Relieving hot flashes with medications
If you have tried these lifestyle, nutritional, and alternative
medicine recommendations, and they have not helped, you may feel
compelled to go on to stronger remedies, available only through your
physician.
Blood pressure-lowering medication
Blood pressure-lowering medications such as clonidine (Catapres-TTS,
0.1-mg patch applied once weekly) and Aldomet (250 mg twice daily) can
lessen the severity and frequency of hot flashes. They modify how the
blood vessels respond to the brain's command to give off heat quickly.
These drugs must be prescribed and adjusted carefully by your doctor.
Antidepressants
Low-dose antidepressant medication may help forestall a hot flash by
rebalancing or intercepting the chemicals in the brain that transmit
the hot flash alarm, epinephrine and serotonin.
Effexor (venlafaxine) can reduce hot flashes by about 50% in nearly
60% of women with breast cancer according to a study done by Dr.
Charles Loprinzi at the Mayo Clinic. Improvement happened relatively
quickly: 80% of the eventual decrease in hot flashes occurred within
the first week of taking the medication. Side effects, when they were
noted, were mild. The dose used was 12.5 milligrams taken twice daily.
A more recent study showed that some women may need a higher total
dose of 75 milligrams daily to get significant relief.
Extended-release preparations are available. Paxil (paroxetine) works
in a similar way to Effexor and is a good alternative. Some women
tolerate Paxil better. Its recommended dose is 10 mg once a day for
the first week, then 20 mg once a day thereafter.
Mild sedatives
Bellergal-S simmers down overactive chemical activity in the brain.
Taken occasionally, once or twice a day, it can be quite safe and
effective--but not with alcohol. (It contains belladonna,
phenobarbital, and an ergotamine.) Phenobarbital can cause drowsiness
and, if you use it regularly, you can develop a dependency for it.
Progesterone-like products
Megace (megesterol acetate) can reduce hot flashes in approximately
80% of women who take it, and it is also considered a treatment for
breast cancer when taken in high doses continuously. Megace is usually
started at 40 milligrams daily, and it may take a few weeks to start
to work. After a month the dose is adjusted up or down. The maximum
dose is 80 milligrams per day. Those who reap its benefits and can
tolerate its side effects (fluid retention and bloating) may do well
on this medication.
Estrogen therapy
[45]Menopausal hormone therapy, or estrogen therapy, is probably the
most effective way to relieve hot flashes, but its use is highly
controversial in women who have had breast cancer.
Most physicians would not recommend estrogen therapy to remedy severe
tamoxifen-related hot flashes because estrogen is not known to be safe
for women who have had breast cancer, and may reduce tamoxifen's
effectiveness. Estrogen therapy may also add to the potential side
effects from these combined drugs--such as blood clots forming and
traveling to the lung, and increased risk of endometrial cancer.
However, if your hot flashes are severe and you have not had adequate
relief from lifestyle modifications or non-hormonal remedies and
medications, your doctor may suggest a limited course of low-dose
menopausal hormone therapy to ease your transition into menopause.
The therapy should last only several months, depending on the degree
of your symptoms, tapering off over the last month. Dr. John Eden of
the Royal Hospital for Women in Paddington, Australia, studied
simultaneous estrogen replacement and tamoxifen therapies in women
beyond menopause. The study showed no short-term problem from combined
side effects. The Eastern Cooperative Oncology Group (ECOG) is trying
to launch a study that combines the two drugs. Share this information
with your doctor, and decide together what you want to do.
This page was last modified on March 26, 2003
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