Trending Clinical Topic: Hot Flashes

Ryan Syrek


October 22, 2021

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Key findings from studies presented at the North American Menopause Society (NAMS) 2021 Annual Meeting helped drive interest in this week's top trending clinical topic. Hot flashes affect 3 out of 4 women and can last 7-10 years, according to Stephanie Faubion, MD, MBA, director of the Mayo Clinic Women's Health Clinic in Jacksonville, Florida. Research presented by Faubion and colleagues at the conference showed that women with migraines are more likely to experience severe hot flashes than women without such headaches (see Infographic below).

The study included cross-sectional data from 3308 women, ranging in age from 45 to 60 years, with an average age of 53 years. Most were White (95%) and had at least some college (93%). Just over one quarter of the women (27%) reported a history of migraine, and these women's Menopause Rating Scale scores were an average of 1.36 points greater than those among women without a history of migraine (P < .001). Researchers adjusted their findings to account for body mass index, menopause status, smoking status, depression, anxiety, current use of hormone therapy, and presence of low back pain within the past year.

Nonhormonal treatments for hot flashes were also discussed at NAMS 2021. Although hormone therapy remains the most effective management option for many women, Faubion detailed alternative therapies in various stages of development. One of these is oxybutynin, an antimuscarinic, anticholinergic agent currently used to treat overactive bladder and overactive sweating. Although research found a 60% reduction in hot flash frequency with oxybutynin compared with placebo, potential long-term cognitive effects remain a concern. Faubion also discussed estetrol (E4), a naturally occurring estrogen with selection action in tissues that is produced by the fetal liver and crosses the placenta. It was recently approved as an oral contraceptive under the name Estelle and is also under investigation as a postmenopausal regimen. Other agents being studied include NK3 antagonists, which aim to exploit the recent discovery that kisspeptin, neurokinin B, and dynorphin (KNDy) neurons may play an important role in the etiology of vasomotor symptoms.

A separate study presented at NAMS 2021 showed that women with a history of polycystic ovary syndrome (PCOS) are more likely to experience somatic and urogenital symptoms after menopause but are no more likely to experience severe hot flashes than are women with similar characteristics. PCOS and vasomotor symptoms are each risk factors for cardiovascular disease; thus, researchers wanted to determine whether they were linked to one another, which may indicate that they are markers for the same underlying mechanisms that increase heart disease risk. The lack of an association, however, raises questions about how much each of these conditions might independently increase cardiovascular risk.

In terms of potentially modifiable risk factors for hot flashes, another study presented at NAMS 2021 found that women who are inactive and going through menopause are more likely to have frequent, severe nighttime hot flashes. Findings showed that sedentary behavior predicted objective and concordant hot flashes in women aged 44-55 years, independently of time spent participating in moderate to vigorous physical activity. The authors hope that the research will help improve evidence-based lifestyle recommendations for women experiencing hot flashes.

From key associations to treatment and prevention, findings across the spectrum of this common symptom resulted in this week's top trending clinical topic.

Read more clinical information on menopause.


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