Gynecology Book

http://www.fpnotebook.com/

Vasomotor Symptoms of MenopauseAka: Hot Flashes, Hot Flushes, Flushing

Advertisement

  1. See Also
    1. Night Sweats
    2. Hyperhidrosis
  2. Epidemiology
    1. Vasomotor symptoms occur in 85% of perimenopausal women
      1. Starts 1-2 years before Menopause
      2. Continues for up to 5 years
  3. Differential Diagnosis
    1. Medications
      1. Isoniazid
      2. Disulfiram reaction
        1. Griseofulvin
        2. Flagyl
        3. Chlorpropamide
        4. Chloral Hydrate
      3. Niacin
      4. Hydralazine
      5. Calcitonin
      6. Aspirin sensitive
      7. Procardia
      8. Capsaicin
      9. MAO inhibitor when taken with Tyramine (beer, cheese)
    2. Medication withdrawal
      1. Clonidine
      2. Alpha-methyldopa
    3. Pheochromocytoma
    4. Carcinoid
    5. Mastocytosis in Leukemia
      1. Histamine and Prostaglandin D Release
      2. Hypotensive episodes
      3. Dermatographia
    6. VIP-oma or WDHA: Diarrhea, Hypokalemia, achlorhydria
    7. Menopausal flushing
    8. Emotional blushing
    9. Food and Environmental Stimuli
      1. Monosodium glutamate
      2. Thermal stimuli
      3. Ethanol (worse with Rosacea, Carcinoid, Mastocytosis)
      4. Scombroid Fish Poisoning: Tuna, Mahi-mahi, Mackerel
    10. Syndrome obscure in women
      1. Characteristics
        1. Telangiectasia
        2. Urticaria
        3. Flushing
        4. Peptic Ulcer Disease
        5. Diarrhea
      2. Increased blood and urine histamine
      3. Not associated with mastocytosis or Carcinoid
  4. Management: General
    1. Wear cool clothing
    2. Use a fan
    3. Drink cool liquids and eat cold foods
    4. Regular Exercise has mixed results
      1. Original study supported Exercise as effective
        1. Ivarsson (1998) Maturitas 29:139
      2. Recent study does not show benefit in hot flushes
        1. Aiello (2004) {a 8352} 11:382
    5. Avoid Exacerbating food products
      1. Caffeine
      2. Alcohol in excess
      3. Spicy food
      4. Dietary fat intake
        1. Associated with hot flushes in postmenopause
        2. Riley (2004) J Gen Intern Med 19:740
    6. Vitamin Supplementation
      1. Vitamin B6 may be helpful
      2. Vitamin E is no more effective than Placebo
    7. Other measures associated with decreased symptoms
      1. Tobacco Cessation
      2. Yoga
      3. Massage
      4. Meditation
      5. Leisurely bath
      6. Weight loss
        1. Associated with less hot flushes in Perimenopause
        2. Riley (2004) J Gen Intern Med 19:740
  5. Management: Medications
    1. Estrogen Replacement Therapy
      1. Relieves symptoms in 80-90% of patients
    2. Progestin
      1. Progesterone transdermal cream (20 grams/day)
        1. Leonetti (1999) Obstet Gynecol 94:225
      2. Megestrol acetate (Megace) 20 mg PO bid
        1. Relieves symptoms ~50% of cases
      3. Medroxyprogesterone acetate (Provera) 20 mg orally daily
        1. Relieves symptoms ~50% of cases
    3. Clonidine 0.1 - 0.2 mg PO qhs (or transdermal patch)
      1. (1994) JCO 12:155
    4. Selective Serotonin Reuptake Inhibitors
      1. SSRIs shown to be effective
        1. Venlafaxine (Effexor)
          1. Dose: 12.5 mg orally twice daily or 75 mg orally at bedtime
          2. (1998) J Clin Oncol 16:2377
          3. Loprinzi (2000) Lancet 356:2059
        2. Paroxetine (Paxil CR) 12.5 to 25 mg PO qd
          1. Stearns (2003) JAMA 289:2827
        3. Fluoxetine (Prozac)
          1. Loprinzi (2002) J Clin Oncol 20:1578
      2. SSRIs not found to be effective
        1. Citalopram (Celexa)
        2. Sertraline (Zoloft)
        3. Suvanto-Luukkonen (2005) {a 8352} 12:18
    5. Gabapentin (Neurontin) 300 mg PO tid
      1. Guttuso (2003) Obstet Gynecol 101:337
    6. Bellergal-S 100
      1. Small risk of addiction
    7. Aldomet 250 mg PO bid
  6. Management: Herbals and Dietary Supplements
    1. Possible benefit
      1. Black Cohosh
        1. Hernandez (2003) Maturitas 44:S59
    2. Variable evidence for benefit
      1. Soy Isoflavones or Phytoestrogens (see Soy Protein)
        1. Faure (2002) {a 8352} 9:329
        2. Han (2002) Obstet Gynecol 99:389
        3. Nikander (2003) Obstet Gynecol 101:1213
    3. Unlikely benefit
      1. Dong Quai (No better than Placebo)
      2. Evening Primrose Oil
      3. Red Clover
        1. Tice (2003) JAMA 290:207
      4. Vitamin E slightly better than Placebo
        1. Barton (1998) J Clin Oncol 16:495
  7. References
    1. Carroll (2006) Am Fam Physician 73:457
    2. Israel (1997) Pharmacotherapy 17:970
    3. Morelli (2002) Am Fam Physician 66(1):129
    4. Shanafelt (2002) Mayo Clin Proc 77:1159

Flushing (C0016382)

Definition (MSH)A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process.
Definition (NCI)A sudden reddening of the face.
ConceptsSign or Symptom (T184)
ICD9782.62
MSHD005483
Englishcutaneous vascular engorgement, Face goes red, FACIAL FLUSHING, Flush, Flushes, Flushing, flushing reaction, Flushings, SKIN FLUSHED, skin reddening
Spanishenrojecimiento facial, rubor
Parent ConceptsSkin symptom (C0586407), [D]Pallor and flushing NOS (C0159038), Signs and Symptoms (C0037088), Integumentary System Signs and Symptoms (C1334192), Skin Diseases, Vascular (C0162819), Complexion changes (C0455815), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CST, DXP, ICD9CM, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree