Cutaneous and hemodynamic responses during hot flashes in symptomatic postmenopausal women

Abstract

Objective-The aim of this study was to test the hypothesis that the postmenopausal hot flash is accompanied by rapid decreases in arterial blood pressure and increases in cutaneous vascular conductance (CVC), as evaluated by continuous measurements of these variables in symptomatic women.Design-Twelve healthy, normotensive, postmenopausal women rested in a temperature-controlled laboratory (26°C) for approximately 90 minutes. The onset of a hot flash was objectively identified as a transient and pronounced elevation of sternal sweat rate (capacitance hygrometry).Results-Twenty-three hot flashes were recorded during the experimental sessions (3.4 ± 1.4 min; range, 1.3-6.5 min). Mean arterial blood pressure decreased 13 ± 2 mm Hg during 11 hot flashes in five participants. Data from these participants, categorized as responders, were analyzed separately from data for those participants whose blood pressure did not change during their hot flashes (n = 7, 12 hot flashes). Heart rate (obtained from an electrocardiogram) significantly increased during the hot flashes, but there was no difference between the responder and nonresponder groups (9 ± 2 vs 10 ± 1 beats/min, respectively; P > 0.05). The increase in CVC was not different between groups at either the forearm (15% ± 3% vs 12% ± 3% maximal CVC, P > 0.05) or sternum (24% ± 5% vs 21% 3% maximal CVC, P > 0.05).Conclusions-These data demonstrate that in a subset of participants, the hot flash is accompanied by a significant reduction in blood pressure, but there is no difference in CVC between these women and women with no drop in blood pressure. KeywordsSkin blood flow; Blood pressure; Hot flash Hot flashes are a primary symptom of female menopause that can seriously disrupt the lives of symptomatic women. 1 Approximately 70% of women experience hot flashes for the first 1 to 5 years after the onset of the menopausal transition. [1][2][3][4] The incidence and severity of symptoms are even higher in women after surgically induced menopause and in female oncology patients. 3,5,6 Hot flashes are typically defined as sudden subjective sensations of heat, frequently accompanied by skin flushing and perspiration, that generally begin in the chest and radiate to the face, head, and arms. 1,4,7,8 Symptomatic women also report a range of additional symptoms during a hot flash, such as anxiety, frustration, embarrassment, nausea, and depression. 1,[8][9][10] Of importance, hot flashes can negatively affect mood, concentration, sleep quality, and sexual function and result in fatigue and stress, 1,11-14 thereby significantly reducing the quality of life and overall health of afflicted women. 2,[14][15][16] Despite the clear disruption that hot flashes cause to the lives of menopausal women, physiological mechanisms associated with hot flashes are not completely understood. Previous research has reported transient increases in hand, calf, and forearm blood flow during hot flashes using plethysmographic techniques.17 The plethysmographic technique, however, provides a d...

Vasomotor symptoms in women and cardiovascular risk markers: Systematic review and meta-analysis

“…Although many studies have reported associations between VMS and adverse cardiovascular risk profile [15,16], others either failed to show such associations [18][19][20][21] or point towards a favorable link between VMS and cardiovascular parameters [22][23][24]. Although the relation between VMS and cardiovascular risk is an area of active inquiry, interpretation of the often conflicting findings remains a challenge.…”

Menopausal hot flush: Is it only a nuisance or also a marker of cardiovascular disease risk?

“…Blood pressure was, however, unchanged indicating that the rise in blood flow to the hand is not a result of a change in systemic arterial pressure, but most likely reflects cutaneous vasodilatation. The increase in skin blood flow during a hot flush episode was recently confirmed with another study [26]. The pattern of change in blood flow through the arm is similar to that seen in response to indirect heating of the body [27], suggesting that the flush may reflect inappropriate activation of the mechanisms for heat loss.…”

“…Therefore, although blood pressure was found to be either unchanged [25], or dropping when measured during a hot flush episode [26,31], the mean blood pressure level in women reporting hot flushes was higher than in those who do not flush [40].…”

“…Additionally, there was no difference in cutaneous vascular resistance between women who had a drop in their blood pressure and those who did not have. This makes the changes in vascular resistance of noncutaneous beds of the former group the most likely explanation for the observed reductions in blood pressure during a hot flush [26]. The fact that, despite the lower blood pressure in the former group, there was no greater increase in heart rate as would be normally expected may imply an impaired baroreflex responsiveness of these women, as previously mentioned [33].…”

“…If this is true, menopausal symptoms may be more severe in women with autonomic neuropathy in whom baroreflex functioning is impaired. More recently, pronounced decreases in blood pressure were also found in another study, in which blood pressure was measured both continuously and intermittently during flushing episodes [26].…”