Hot Flashes – A New Perspective

Hot Flash YouTube Video

Hot Flash YouTube Video

Every woman’s menopausal symptoms are different. Hot flashes affect about 85% of women during the years immediately before and after menopause. Some women have night sweats, which are hot flashes that occur while sleeping and can be disruptive to sleep and not to mention the need to get up and change clothes or sheets.

Fill out the Hot Flash Questionnaire

Hot flashes typically last between 1-5 minutes. The hot flash is described as a hot sensation that radiates through the body, particularly the upper body. There is an increase in heart rate, sweating, and peripheral vasodilatation (flushing). Hot flash frequency increases during peri-menopause and continues for an unknown length of time. All Hot Flashes involve the vasomotor system. Physicians never use the term vasomotor unless they are a specialist.

VMS hot flash

Fig. 1: Vasomotor Symptoms of Hot Flashes

vasomotor-blood-supply

Fig. 2: Autonomic Vasomotor Control of the Blood Supply

Vasomotor Hot Flashes

Vasomotor symptoms (VMS) or (hot flashes and night sweats), are often the cardinal symptoms of menopause. VMS are episodes of profuse heat accompanied by sweating and flushing, experienced predominantly around the head, neck chest and upper back. VASOMOTOR SYMPTOMS (VMS) VMS symptoms are the main reason why women seek out medical attention. They occur in more than 75 percent of postmenopausal women. Those symptoms include:

  • Hot flashes
  • Dry skin
  • Itchy, crawling sensation on skin
  • Sleep issues
  • A sudden feeling of warmth spreading through your upper body and face
  • A flushed appearance with red, blotchy skin
  • Rapid heartbeat
  • Perspiration, mostly on your upper body
  • Feeling chilled as the hot flash subsides

 Hormone Replacement Treatment

Hormone Replacement Therapy is the most common medication available to relieve hot flashes. Short-term use of low-dose estrogen may be prescribed, with or without progesterone. If a woman still has her uterus, estrogen is prescribed together with progesterone to decrease the small risk of uterine cancer. In theory, Estrogen used alone causes growth of the uterine lining but adding progesterone prevents or decreases this growth, thereby decreasing the risk of developing uterine cancer. If your uterus was removed, then only estrogen is required.

Functional Perspective of Hormone Replacement Therapy

Here is a couple of little factoids on hormones. Hormone replacement hormones do not stay as that hormone (Fig. 3). Hormones convert into the next down-stream hormone, i.e. progesterone will eventually convert into Testosterone, Estrone, Estradiol, or Estriol when a level specific to you is met.  Hormones exert some influence on blood vessel diameter, i.e. increased blood flow to the uterus during pregnancy, decreased blood flow during menstruation but they are not limited to only the uterus. They can affect all areas of the body, i.e. headaches. Hormones are no longer linked to just sex. Hormones are now being recognized as playing a role in the immune system (Fig.1). In fact, the hormone etiocholanolone with the specific purpose of stimulating the immune system is now being recognized. Estrogens tend to have a stimulatory effect on the immune system, while progesterone, testosterone and estriol (E3) tends to have suppressive effects.

Etiocholanolone hormone pathway

FIg. 3: Hormone pathway. Enzymes (blue) convert hormone into next downstream hormone.

Because of potential side effects and dangers of hormone therapy, many women choose not to use estrogen in any form. Estriol (E3) is now thought to reduce the inflammation and is being prescribed for autoimmunity. However, this is a play on estriols (E3) true role in pregnancy. During pregnancy, E3 suppresses the immune system to prevent miscarriage, increases uterine lining growth for proper blood supply and intestinal permeability for proper nutrition to the baby. If you are having possible autoimmune issues, do you want to take a hormone that will grow your uterine lining (fibroids) and increase gut permeability (leaky gut)?

 Anti-depression Drugs for Hot Flashes

Many are seeking nonhormonal remedies for their hot flashes, and the medical community are starting to prescribe antidepressants that are effectively reducing these symptoms. Some studies are reporting antidepressant medication to be more effective than Hormone Replacement Therapy for relief of vasomotor Hot Flashes. These alternative medications that help decrease the intensity of hot flashes include:

  •  Vasomotor control: Clonidine (Catapres),
  •  Neurotransmitter support:
    •  GABA: Gabapentin (Neurontin), or antidepressants such as
    • Serotonin-Norepinephrine Reuptake Inhibitor: Venlafaxine (Effexor),
    • Selective Serotonin Reuptake Inhibitor: Paroxetine (Paxil), fluoxetine (Prozac) and sertraline (Zoloft).

Because of potential side effects, many may choose not to do the antidepressant route. Most are aware of the sex hormones (progesterone, estrogens and testosterone), stress hormones (cortisol, and DHEA), and Thyroid hormones (TSH, T4, T3, etc.). While the gastrointestinal (secretin, ghrelin, etc.) and inflammatory hormones (etiocholanolone, leukotrienes, prostaglandins, etc.) are overlooked. There are a few new theories surrounding the causes of hot flashes (Fig. 1):

  •  Inflammatory Hormone Hot Flash: One of the theories suggests that hot flashes are preceded by an etiocholanolone surge, which may trigger the hot flash.
  • Neurotransmitter Hot Flash: There is increasing evidence that both norepinephrine and serotonin (5-HT) are associated with the communication and modulation of the temperature control maintained by the brain, which is why antidepressants are now being used.

Functional Perspective for Inflammatory Hormone and Neurotransmitter Support

Here is the dirty little secret about antidepressants: They only work on the abdominal brain in the abdominal compartment (Fig. 2). They cannot cross the blood brain barrier to the cranial brain. Antidepressants – SSRIs, SNRIs work by blocking or influencing the abdominal brain neurotransmitters. Knowing that neurotransmitter support controls hot flashes provides a means to develop a program specific to your neurotransmitter imbalance and finally getting you relief from them. To maintain homeostasis, the body has two avenues of communication: hormones and neurons. Hormones travel throughout the body through the blood and act exclusively on their receptors found in specific organs. Inflammatory hormones are used to ignite the inflammatory process like a spark lighting a flame. Whereas neurotransmitters deliver their message to a precisely targeted tissue in the body through the abdominal nervous system.

The two avenues communicate with each other using neurotransmitters – inhibitory and stimulatory. The organs in the abdominal compartment (Fig. 2) receive greater control through hormones than nerves. The Vasomotor system controls delivery of hormones through the blood supply to the primarily parasympathetic innervated organs in the abdominal compartment. Neurotransmitters control the diameter of the blood vessels hormones travel through.

Fill out the Hot Flash Questionnaire

To take a spin on the quote of men having two brains but only enough blood for one. The sympathetic and parasympathetic must work in conjunction with each other because there is only enough blood to run one system at a time.

This is a rather simplistic view of a complex system. Perhaps a better analogy would be a house with a family living in it. Some of you may have experienced the reaction that occurs while in the shower and someone flushes the toilet. For a short period of time, you feel a ‘hot flash’ with the shower water getting hot for a short period of time. There is not enough cold water flow to maintain balance in the shower system.

The water supply must support multiple areas of the house. What happens when the washing machine, dishwasher, shower and/or baths are all done at the same time. Not only does the water flow slow down but the water heater also can not keep up with the demand. The washing machine and dishwasher are start-em and forget-em systems. You can deal with clothes and dishes that are clean enough. However, the only systems that get noticed are the showers or baths.

The water lines in the house are distinctly different from the blood vessels in your body. The water lines are always the same size. Blood vessels constrict (get smaller) in diameter in the abdominal compartment and dilate (get larger) in the muscle while exercising to provide the needed oxygen and nutrients to the muscles. The opposite occurs during digestion. If a person is Sympathetic dominant (Fig. 2), blood vessels in the abdomen are constricted, decreasing the blood flow to the organs that require hormone for proper function. This reduces the chances that hormones can make it to their specific organ.

 Neuro-Endo-Immune Connection

The human body consists of multiple systems that communicate to maintain homeostasis and health. The coordinated interconnectedness of the nervous, endocrine, and immune systems is often overlooked when considering care for hot flashes. Nevertheless, hot flashes hinge on the existence of neurotransmitters, hormones, and cytokines, which are essential chemical signals that mediate when hot flashes occur. Collectively, these systems constitute the Neuro-Endo-Immune (NEI) Supersystem.

Taking a closer look at the role the NEI supersystem plays in hot flashes, there are several important hormone-neurotransmitter interactions and three axes at which much hormone-neurotransmitter-cytokine interaction occurs; including the hypothalamic-pituitary-adrenal (HPA) axis, the hypothalamic-pituitary-thyroid (HPT) axis, and the hypothalamic-pituitary-gonadal (HPG) axis. This is best measured through lab testing. The results will them assist in developing a specific supplement protocol to control the imbalances causing the hot flashes.Fill out the Hot Flash Questionnaire Call 530-615-4083 for more information.

2 thoughts on “Hot Flashes – A New Perspective

  1. Pingback: Melatonin Suppresses Thyroid Hormones | Living Wellness

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