Behavioral therapy may help hot flashes:study

A few sessions of behavioral therapy, even a “self-help” version, may help some women find relief from menopausal hot flashes, according to a British study.

Researchers writing in the journal Menopause said that after six weeks of cognitive behavioral therapy, more than two-thirds of the women who underwent, through group sessions or self-help, had a “clinically significant” drop in problems related to hot flashes and night sweats.

Hormone replacement therapy is considered the most effective treatment of hot flashes, but since hormones have been linked to increased risks of heart disease, blood clots and breast cancer, many women want alternative remedies.

Some antidepressants have been found to cool hot flashes, but “natural products” - such as black cohosh, soy and flaxseed - have generally failed to meet the test of clinical trials.

“These results suggest that cognitive behavioral therapy delivered in group or self-help format is an effective treatment option for women during the menopause transition and postmenopause with problematic hot flashes/night sweats,” wrote senior researcher Myra Hunter, at King’s College London.

Cognitive behavioral therapy is a treatment option for problems ranging from depression to sleep problems to digestive disorders. It aims to change the unhealthy thinking patterns and behaviors that can feed mental or physical symptoms.

What are hot flashes?

Hot flashes are experienced by many women, but not all women undergoing menopause experience hot flashes. A hot flash is a feeling of warmth that spreads over the body, but is often most strongly felt in the head and neck regions. Hot flashes may be accompanied by perspiration or flushing. Hot flashes usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, hot flashes are thought to be due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels.

Hot flashes occur in up to 40% of regularly menstruating women in their forties, so they often begin before the menstrual irregularities characteristic of menopause even begin. About 80% of women will be finished having hot flashes after five years. Sometimes (in about 10% of women), hot flashes can last as long as 10 years.

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

Hunter said the therapy “involves developing helpful, accepting approaches to hot flashes and also using breathing exercises to focus attention away from the flashes and negative thoughts.”

Hunger recruited 140 women who had been having hot flashes and night sweats at least 10 times a week for a month or more, randomly assigning them to either group-based therapy, a self-help version or no treatment.

How hot is hot?
Most women have mild to moderate hot flashes, but about 10–15% of women experience such severe hot flashes that they seek medical attention. For women who have had breast cancer, the number who suffer debilitating hot flashes is probably much higher. Randomized studies provide the most objective data: about 50–75% of women taking tamoxifen will report hot flashes, compared to 25–50% taking placebo.

The faster you go through the transition from regular periods to no periods - the perimenopause or climacteric - the more significant your hot flashes will be. Hot flashes are severe after surgical menopause, and they can also be quite difficult after a chemotherapy-induced medical menopause. If you haven’t been warned about hot flashes, a sudden severe episode can be frightening; you might even confuse the flash with a heart attack.

The intensity of hot flashes accompanying treatment with tamoxifen eventually improves for many women after the first three to six months. Because of the conversion of androstenedione from the adrenal glands into estrone by fat and muscle cells, heavy or muscular women experience less severe hot flashes than thin women. If you smoke, your blood vessels lose some of their ability to radiate heat, so you may suffer more severe hot flashes.

Group therapy sessions took place four times a month. Self-help therapy involved one meeting and a phone call with a psychologist, but otherwise they used a book and CD.

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