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Menopause transition
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
Hot flushes appear to originate within the central nervous system in the anterior hypothalamus23 and have been clearly linked to a transient lowered thermoregulatory set point which activates the heat-loss responses of sweating and increased peripheral blood flow24. Thermographic studies have shown the occurrence of actual temperature changes of up to 5 K in the peripheral skin23. Hot flushes may be discrete, self-limiting episodes of up to 3-6 min in duration, or longer experiences lasting up to 1 h or more. They invariably occur with the pulsatile pituitary release of luteinizing hormone (LH). It is also proposed that catecholamine release in the same brain areas provides the link between LH release and hot- flush occurrence.
More than bones: hormone replacement therapy for mind and body
Published in A. R. Genazzani, Hormone Replacement Therapy and Cancer, 2020
For many women who experience episodes of frequent severe hot flushes, these present a persistent and disruptive problem. Often sleep may be disrupted several times a night, resulting in fatigue and irritability during the daytime. The total time during which these hot flushes are experienced may range from a few months to as much as over 40 years, with the majority of women having complaints for a duration of between 2 and 8 years29. Hot flushes are one of the major menopausal complaints for which women seek medical treatment. There is a considerable placebo response of over 50%. Adequate dosages of estrogens, however, reduce the number of hot flushes by over 90% in a dose-dependent way. Dosages of 1 and 2 mg rapidly and extensively alleviate the symptoms within the first 12 weeks. The reduction of hot flushes, however, is more rapid with higher dosages30. For this reason, women suffering severely from hot flushes should receive a higher dose to provide rapid relief. Later, the dose may be reduced, in particular if side-effects occur. As higher estrogen dosages require higher progestogen dosages to protect the endometrium, a combination with a well-tolerated progestogen should be selected.
The Reproductive System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Menopause or climacteric (frequently called "change of life") is a transitional phase in women in which menstruation ceases, usually occurring about age 50, although the age is extremely variable. Not pathologic, menopause nonetheless may be symptomatic, causing hot flushes and sweating, nervousness, depression, and other symptoms; these symptoms are caused by estrogen deficiency and vasomotor responses, so they are often treated with exogenous estrogen. Prematuremenopause refers to cessation of ovarian function before age 40, and artificial menopause follows any medical procedure that "artificially" ends endogenous estrogen production, such as ovariectomy (removal of the ovaries; also called oophorectomy), irradiation of the ovaries, or radium implantation in the uterus.
Bazedoxifene plus conjugated estrogens improve menopausal symptoms in postmenopausal women: a systematic review and meta-analysis
Published in Gynecological Endocrinology, 2022
Beilei Bi, Yi Jiang, Yin Shi, Fan Ruan
Three studies involving 727 participants evaluated the changes of daily number of hot flushes and daily number of moderate or severe hot flushes. The results were shown in Figure 4, significant heterogeneity between these studies were observed, and the random effects model were used (p < 0.00001, I2=98%; p = 0.11, I2=54%). Compared with placebo group, BZA/CE could significantly reduce daily number of hot flushes (p < 0.0001, SMD=-5.89, 95%CI −8.67 to −3.11; p < 0.0001, SMD=-6.36, 95%CI −9.36 to −3.36). In addition, BZA 20 mg/CE 0.625 mg showed better effective in reducing daily number of hot flushes than BZA 20 mg/CE 0.45 mg group (p = 0.0003, SMD = 0.58, 95%CI 0.33 to 0.83). For daily number of moderate or severe hot flushes, the results were shown in Figure 5. BZA/CE could also markedly decrease daily number of moderate or severe hot flushes (p = 0.002, SMD=-4.01, 95%CI −6.58 to −1.45; p = 0.004, SMD=-6.18, 95%CI −10.34 to −2.02). Moreover, BZA 20 mg plus conjugated CE 0.625 mg is better than conjugated estrogens 0.45 mg in decreasing the daily number of moderate or severe hot flushes (p = 0.04, SMD = 2.18, 95%CI 0.90 to 3.46).
Cimicifuga racemosa isopropanolic extract for menopausal symptoms: an observational prospective case–control study
Published in Gynecological Endocrinology, 2021
Maurizio Guida, Antonio Raffone, Antonio Travaglino, Daniele Neola, Sabrina Reppuccia, Maria Borgo, Clorinda Vitale, Andrea Limone, Pietro D’Alessandro, Giulia Massaro, Antonio Mollo
The most important climacteric symptoms are hot flushes and night sweats [28], that we evaluated in Vasomotor Symptoms and Sleep Problems items, respectively. Usually, hot flushes are associated with intense and sudden sweating, chills and palpitations [29]. Symptoms last from few seconds up to 1 h. [30–32]. Prevalence of these symptoms varies between 24% and 93% in peri- and post-menopausal women. [33–37]. Etiology of hot flushes is not completely understood, but several authors propose that it is triggered by a changed thermoregulation set point of the hypothalamus caused by low estrogen levels during menopause [38–39] or their interaction with norepinephrine and serotonin [40]. In accordance with this hypothesis, serotonin 5-HT2A receptors in the hypothalamus showed a significant up-regulation in estrogen fall. In addition, blockage of 5-HT2A, due to use of mirtazapine (5-HT2-5HT3 receptors blocker), decreased frequency and intensity of hot flushes [41]. Hypothalamic thermoregulation is determined also by 5-HT1A, 5-HT1D and 5-HT7 receptors [42–43], and iCR extracts binds to these receptors modulating onset and severity of hot flushes [15–16]. Moreover, due to the high density of 5-HT2A receptors, estrogen fall may be linked to the onset of depressive mood in menopause [44]. In agreement, we found that vasomotor symptoms and sleep problems were the most improved symptoms after iCR treatment, showing a difference higher than two points at the questionnaire.
Menopause, anti-Müllerian hormone and cognition in a cohort of women with persistent symptoms following TBI: a case for future research
Published in Brain Injury, 2021
Melissa Biscardi, Reema Shafi, Nora Cullen, Gillian Einstein, Angela Colantonio
Symptoms typically considered part of menopause may not be specific to this phase of life or specific to the female sex. Weidner and colleagues (29) recently examined symptoms commonly classified as menopausal in both women and men across the lifespan using the MRS. They found that although the overall MRS score was generally higher for women when compared to men, there was no specific peak time for menopause, and symptoms linearly increased for both sexes. In addition, across all physical and psychological symptoms assessed with the MRS, only hot flushes were sex-specific and showed an age-specific maximum prevalence between age 50 and 59 years, indicating it may be considered as a specific menopausal symptom. Other research has also indicated that physical and psychological symptoms may not be specific to the perimenopausal period. For example, in a recent review article, only vaginal dryness and sleep disturbances aligned with menopausal status(31). Consistent with Weidner and colleagues (29), in our study, both WTBIUnder and WTBIOver reported the presence of physical and psychological symptoms typically associated with menopause. The exceptions were hot flushes and vaginal dryness, which were only reported by women WTBIOver. This is consistent with earlier work suggesting hot flushes are a sex and age-specific symptom. (32–36) This suggests that the MRS may be more of a measure of general symptomology versus symptoms specific to the menopausal transition.