The American Journal of Medicine
Volume 118, Issue 12, Supplement 2 , Pages 124-130 , 19 December 2005

Hot flashes: behavioral treatments, mechanisms, and relation to sleep

  • Robert R. Freedman, PhD

      Affiliations

    • Corresponding Author InformationReprint requests should be addressed to Robert R. Freedman, PhD, Department of Psychiatry and Behavioral Neurosciences and Department Obstetrics and Gynecology, Wayne State University School of Medicine, C. S. Mott Center, 275 East Hancock Street, Detroit, Michigan 48201.

References 

  1. Avis NE , Crawford SL , McKinlay SM . Psychosocial, behavioral, and health factors related to menopause symptomatology . Womens Health . 1997;3:103–120
  2. Feldman BM , Voda A , Groseth E . The prevalence of hot flash and associated variables among perimenopausal women . Res Nurs Heath . 1985;8:261–268
  3. Kronenberg F . Hot flashes (epidemiology and physiology) . Ann N Y Acad Sci . 1990;592:52–86
  4. Gold EB , Sternfield B , Kelsey JL , et al.   Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age . Am J Epidemiol . 2000;152:463–473
  5. Whiteman MK , Staropoli CA , Lengenberg PW , McCarter RJ , Kjerulff KH , Flaws JH . Smoking, body mass, and hot flashes in midlife women . Obstet Gynecol . 2003;101:264–272
  6. Freedman RR . Hot flash trends and mechanisms [editorial] . Menopause . 2002;9:151–152
  7. Jessen AB , Toubro S , Astrup A . Effect of chewing gum containing nicotine and caffeine on energy expenditure and substrate utilization in men . Am J Clin Nutr . 2002;77:1442–1447
  8. Freedman RR . Biochemical, metabolic, and vascular mechanisms in menopausal hot flushes . Fertil Steril . 1998;70:332–337
  9. Molnar GW . Body temperature during menopausal hot flashes . J Appl Physiol . 1975;38:499–503
  10. Kronenberg F , Cote LJ , Linkie DM , Dyrenfurth I , Downey JA . Menopausal hot flashes (thermoregulatory, cardiovascular, and circulating catecholamine and LH changes) . Maturitas . 1984;6:31–43
  11. Tataryn IV , Lomax P , Bajorek JG , Chesarek W , Meldrum DR , Judd HL . Postmenopausal hot flushes (a disorder of thermoregulation) . Maturitas . 1980;2:101–107
  12. Ginsburg J , Swinhoe J , O’Reilly B . Cardiovascular responses during the menopausal hot flush . Br J Obstet Gynaecol . 1981;88:925–930
  13. Freedman RR . Laboratory and ambulatory monitoring of menopausal hot flashes . Psychophysiology . 1989;26:573–579
  14. Freedman RR , Woodward S , Norton D . Laboratory and ambulatory monitoring of menopausal hot flushes (comparison of symptomatic and asymptomatic women) . J Psychophysiol . 1992;6:162–166
  15. de Bakker IPM , Everaerd W . Measurement of menopausal hot flushes (validation and cross-validation) . Maturitas . 1996;25:87–98
  16. Carpenter JS , Andrykowski MA , Freedman RR , Munn R . Feasibility and psychometrics of an ambulatory hot flash monitoring device . Menopause . 1999;6:209–215
  17. Askel S , Schomberg DW , Tyrey L , Hammond CB . Vasomotor symptoms, serum estrogens, gonadotropin levels in surgical menopause . Am J Obstet Gynecol . 1976;126:165–169
  18. Stone SC , Mickal A , Rye F , Rye PH . Postmenopausal symptomatology, maturation index, and plasma estrogen levels . Obstet Gynecol . 1975;45:625–627
  19. Hutton JD , Jacobs HS , Murray MAF , James VHT . Relation between plasma oesterone and oestradiol and climacteric symptoms . Lancet . 1978;1:678–681
  20. Freedman RR , Dinsay R . Clonidine raises the sweating threshold in symptomatic but not in asymptomatic postmenopausal women . Fertil Steril . 2000;74:20–23
  21. Freedman RR , Roehrs TA . Lack of sleep disturbance from menopausal hot flashes . Fertil Steril . 2004;82:138–144
  22. Freedman RR , Subramanian M . Effects of symptomatic status and the menstrual cycle on hot flash-related thermoregulatory parameters . Menopause . 2005;12:156–159
  23. Schindler AE , Muller D , Keller E , Goser R , Runkel F . Studies with clonidine (Dixarit) in menopausal women . Arch Gynecol . 1979;227:341–347
  24. Casper RF , Yen SSC , Wilkes MM . Menopausal flushes (a neuroendocrine link with pulsatile luteinizing hormone secretion) . Science . 1979;205:823–825
  25. DeFazio J , Meldrum DR , Laufer L , et al.   Induction of hot flashes in premenopausal women treated with a long-acting GnRH agonist . J Clin Endocrinol Metab . 1983;56:445–448
  26. Casper RF , Yen SSC . Menopausal flushes (effect of pituitary gonadotropin desensitization by a potent luteinizing hormone releasing factor agonist) . J Clin Endocrinol Metab . 1981;53:1056–1058
  27. Meldrum DR , Erlik Y , Lu JKH , Judd HL . Objectively recorded hot flushes in patients with pituitary insufficiency . J Clin Endocrinol Metab . 1981;52:684–687
  28. Mulley G , Mitchell RA , Tattersall RB . Hot flushes after hypophysectomy [case report] . BMJ . 1977;2:1062
  29. Lightman SL , Jacobs HS , Maguire AK , McGarrick G , Jeffcoate SL . Climacteric flushing (clinical and endocrine response to infusion of naloxone) . Br J Obstet Gynaecol . 1981;88:919–924
  30. DeFazio J , Vorheugen C , Chetkowski R , Nass T , Judd HL , Meldrum DR . The effects of naloxone on hot flashes and gonadotropin secretion in postmenopausal women . J Clin Endocrinol Metab . 1984;58:578–581
  31. Tepper R , Neri A , Kaufman H , Schoenfield A , Ovadia J . Menopausal hot flushes and plasma β-endorphins . Obstet Gynecol . 1987;70:150–152
  32. Freedman RR , Woodward S . Elevated α2-adrenergic responsiveness in menopausal hot flushes (pharmacologic and biochemical studies) . In:  Lomax P ,  Schönbaum E editor. Thermoregulation (The Pathophysiological Basis of Clinical Disorders) . Basel: Karger; 1992;p. 6–9
  33. Freedman RR . Biochemical, metabolic, and vascular mechanisms in menopausal hot flushes . Fertil Steril . 1998;70:1–6
  34. Clayden JR , Bell JW , Pollard P . Menopausal flushing (double blind trial of a non-hormonal medication) . BMJ . 1974;1:409–412
  35. Laufer LR , Erlik Y , Meldrum DR , Judd HL . Effects of clonidine on hot flushes in postmenopausal women . Obstet Gynecol . 1982;60:583–589
  36. Freedman RR , Woodward S , Sabharwal SC . Adrenergic mechanism in menopausal hot flushes . Obstet Gynecol . 1990;76:573–578
  37. Etgen AM , Ansonoff MS , Quesada A . Mechanisms of ovarian steroid regulation of norepinephrine receptor-mediated signal transduction in the hypothalamus (implications for female reproductive physiology) . Horm Behav . 2001;40:169–177
  38. Savage MV , Brengelmann GL . Control of skin blood flow in the neutral zone of human body temperature regulation . J Appl Physiol . 1996;80:1249–1257
  39. Freedman RR , Norton D , Woodward D , Cornelissen G . Core body temperature and circadian rhythm of hot flashes in menopausal women . J Clin Endocrinol Metab . 1995;80:2354–2358
  40. Freedman RR , Woodward S . Core body temperature during menopausal hot flushes . Fertil Steril . 1996;65:1141–1144
  41. Carpenter JS , Gilchrist JM , Chen K , Gautam S , Freedman RR . Hot flashes, core body temperature, and metabolic parameters in breast cancer survivors . Menopause . 2004;11:375–381
  42. Freedman RR . Laboratory and ambulatory monitoring of menopausal hot flashes . Psychophysiology . 1989;26:573–579
  43. Freedman RR , Krell W . Reduced thermoregulatory null zone in postmenopausal women with hot flashes . Am J Obstet Gynecol . 1999;181:66–70
  44. Freedman RR . Core body temperature variation in symptomatic and asymptomatic postmenopausal women (brief report) . Menopause . 2002;9:399–401
  45. Brück K , Zeisberger E . Adaptive changes in thermoregulation and their neuropharmacological basis . In:  Schönbaum E ,  Lomax P editor. Thermoregulation (Physiology and Biochemistry) . New York: Pergamon; 1990;p. 255–307
  46. Germaine LM , Freedman RR . Behavioral treatment of menopausal hot flashes (evaluation by objective methods) . J Consult Clin Psychol . 1984;52:1072–1079
  47. Freedman RR , Woodward S . Behavioral treatment of menopausal hot flushes (evaluation by ambulatory monitoring) . Am J Obstet Gynecol . 1992;167:436–439
  48. Freedman RR , Woodward S , Brown B , Javaid JI , Pandey GN . Biochemical and thermoregulatory effects of behavioral treatment for menopausal hot flashes . Menopause . 1995;2:211–218
  49. Irvin JH , Domar AD , Clark C , Zuttermeister PC , Friedman R . The effects of relaxation response training on menopausal symptoms . J Psychosom Obstet Gynecol . 1996;17:202–207
  50. Aiello EJ , Yasui Y , Tworoger SS , et al.   Effects of a yearlong, moderate-intensity exercise intervention on the occurrence and severity of menopause symptoms in postmenopausal women . Menopause . 2004;11:382–388
  51. Ueda M . A 12-week structured education and exercise program improved climacteric symptoms in middle-aged women . J Physiol Anthropol Appl Human Sci . 2004;23:143–148
  52. Lindh-Åstrand L , Nedstrand E , Wyon Y , Hammar M . Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomized to physical activity or estrogen therapy . Maturitas . 2004;48:97–105
  53. Ivarsson T , Spetz A-C , Hammar M . Physical exercise and vasomotor symptoms in postmenopausal women . Maturitas . 1998;29:139–146
  54. Sternfeld B , Quesenberry CP , Husson G . Habitual physical activity and menopausal symptoms (a case-control study) . J Womens Health . 1999;8:115–123
  55. Li C , Samsioe G , Borgfeldt C , Lidfeldt J , Agardh CD , Nerbrand C . Menopause-related symptoms (what are the background factors? A prospective population-based cohort study of Swedish women (The Women’s Health in Lund Area Study)) . Am J Obstet Gynecol . 2003;189:1646–1653
  56. McKinlay SM , Jefferys M . The menopausal syndrome . Br J Prev Soc Med . 1974;28:108–115
  57. Ballinger CB . Subjective sleep disturbance in the menopause . J Psychosom Res . 1976;20:509–513
  58. Bungay GT , Vessey MP , McPherson CK . Study of symptoms in middle life with special reference to the menopause . BMJ . 1980;19:181–183
  59. Hunter M , Battersby R , Whitehead M . Relationships between psychological symptoms, somatic complaints and menopausal status . Maturitas . 1986;8:217–228
  60. Anderson E , Hamburger S , Liu JH , Rebar RW . Characteristics of menopausal women seeking assistance . Am J Obstet Gynecol . 1987;156:428–433
  61. Matthews KA , Wing RR , Kuller LH , Meilahn EN , Kelsey SF . Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women . J Consult Clin Psychol . 1990;38:345–351
  62. Hunter M . The south-east England longitudinal study of the climacteric and postmenopause . Maturitas . 1992;14:117–126
  63. Holte A . Influences of natural menopause on health complaints (a prospective study of healthy Norwegian women) . Maturitas . 1992;14:127–141
  64. Shaver JLF , Paulsen VM . Sleep, psychological distress, and somatic symptoms in perimenopausal women . Fam Pract Res J . 1993;13:373–384
  65. Avis NE , Brambilla D , McKinlay SM , Vass K . A longitudinal analysis of the association between menopause and depression . Ann Epidemiol . 1994;4:214–220
  66. Baker A , Simpson S , Dawson D . Sleep disruption and mood changes associated with menopause . J Psychosom Res . 1997;43:359–369
  67. Kuh DL , Wadsworth M , Hardy R . Women’s health in midlife (the influence of the menopause, social factors and health in earlier life) . Br J Obstet Gynaecol . 1997;104:923–933
  68. Owens JF , Matthews KA . Sleep disturbance in healthy middle-aged women . Maturitas . 1998;30:41–50
  69. Kravitz HM , Ganz PA , Bromberger J , Powell LH , Sutton-Tyrrell K , Meyer PM . Sleep difficulty in women at midlife (a community survey of sleep and the menopausal transition) . Menopause . 2003;10:19–28
  70. Young T , Rabago D , Zgierska A , Austin D , Finn L . Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin cohort study . Sleep . 2003;26:667–672

 The opinions offered at the National Institutes of Health (NIH) State-of-the Science Conference on Management of Menopause-Related Symptoms and published herein are not necessarily those of the National Institute on Aging (NIA) and the Office of Medical Applications of Research (OMAR) or any of the cosponsoring institutes, offices, or centers of the NIH. Although the NIA and OMAR organized this meeting, this article is not intended as a statement of Federal guidelines or policy.Publication of the online supplement was made possible by funding from the NIA and the National Center for Complementary and Alternative Medicine of the NIH, US Department of Health & Human Services.Research conducted by Dr. Freedman was supported by MERIT Award No. R37-AG05233 and by Grant No. MH-63089 from the National Institutes of Health.

PII: S0002-9343(05)00904-6

doi: 10.1016/j.amjmed.2005.09.046

The American Journal of Medicine
Volume 118, Issue 12, Supplement 2 , Pages 124-130 , 19 December 2005

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