Menopausal hot flashes: Mechanisms, endocrinology, treatment

Abstract

Hot flashes (HFs) are a rapid and exaggerated heat dissipation response, consisting of profuse sweating, peripheral vasodilation, and feelings of intense, internal heat. They are triggered by small elevations in core body temperature (Tc) acting within a greatly reduced thermoneutral zone, i.e., the Tc region between the upper (sweating) and lower (shivering) thresholds. This is due in part, but not entirely, to estrogen depletion at menopause. Elevated central sympathetic activation, mediated through α2-adrenergic receptors, is one factor responsible for narrowing of the thermoneutral zone. Procedures which reduce this activation, such as paced respiration and clonidine administration, ameliorate HFs as will peripheral cooling. HFs are responsible for some, but not all, of the sleep disturbance reported during menopause. Recent work calls into question the role of serotonin in HFs.

Progesterone for treatment of symptomatic menopausal women

“…This is followed by narrowing of the thermoneutral zone to nearly zero, a heat dissipation response 15 and rapidly increased galvanic skin response. VMS episodes are associated with massive release of neuroendocrine, cytokine and stress hormones 31 and thus may have a clinical 'aura' of weakness, dizziness or nausea, especially in perimenopausal women. Recent evidence suggests that the hypothalamic control processes involved in the pulsatility of gonadotropin releasing hormone may relate to VMS.…”

Vasomotor Symptoms Monitoring with a Commercial Activity Tracking Watch

“…), and more. Multiple studies have characterized hot flashes in premenopausal and menopausal women using self reported methods, laboratory polysomnographic recording, and some specially designed devices 3 . However, it is difficult for an individual to track and accurately report nighttime vasomotor symptoms without the aid of a physiological monitoring device 3 .…”

“…Multiple studies have characterized hot flashes in premenopausal and menopausal women using self reported methods, laboratory polysomnographic recording, and some specially designed devices 3 . However, it is difficult for an individual to track and accurately report nighttime vasomotor symptoms without the aid of a physiological monitoring device 3 . Emerging commercial and custom devices with EDA meters will greatly facilitate the nighttime monitoring of hot flashes for individuals for more informative longitudinal studies of conditions with associated vasomotor symptoms.…”

Role of serotonergic system in thermoregulation in rats

“…In addition to these findings, since the relationships between 5-HT and Tb and stress connected with depression 55,56) , hot flash 57,58) , and synthetic narcotic drugs like MDMA [59][60][61] are attracting attention, further research is needed.…”