title: Menopausal hot flushes and night sweats: where are we now?
abstract: OBJECTIVE
  An overview of the current knowledge on the etiology and treatment of vasomotor symptoms in postmenopausal women.
  
  
  METHODS
  Acknowledged experts in the field contributed a brief assessment of their areas of interest which were combined and edited into the final manuscript.
  
  
  RESULTS
  Women around the world experience vasomotor symptoms as they enter and complete the menopause transition. Vasomotor symptoms, specifically hot flushes, are caused by a narrowing of the thermoneutral zone in the brain. This effect, although related to estrogen withdrawal, is most likely related to changes in central nervous system neurotransmitters. Peripheral vascular reactivity is also altered in symptomatic women. Estrogen replacement therapy is the most effective treatment for hot flushes. Of the other interventions investigated, selective serotonin and selective norepinephrine reuptake inhibitors and gabapentin show efficacy greater than placebo. Objective monitoring of hot flushes indicates a robust improvement with hormone replacement therapy but little to no change with placebo. These data suggest that the subjective assessment of responses to therapy for vasomotor symptom results in inaccurate data. Hot flushes have recently been associated with increased cardiovascular risks and a lower incidence of breast cancer, but these data require confirmation.
  
  
  CONCLUSIONS
  Vasomotor symptoms are experienced by women of all ethnic groups. They are caused by changes in the central nervous system associated with estrogen withdrawal and are best treated with estrogen replacement therapy. Objective monitoring of hot flushes indicates that placebo has little to no effect on their improvement. Subjective assessments of hot flushes in clinical trials may be inaccurate based on objective measurement of the frequency of hot flushes. Based on preliminary reports, women experiencing hot flushes have an increased risk of cardiovascular disease and a reduced incidence of breast cancer.
authors.affiliation: Eastern Virginia Medical School, Norfolk, VA 23507, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Archer
authors.forename: D W
authors.initials: DW
authors.lastname: Sturdee
authors.forename: R
authors.initials: R
authors.lastname: Baber
authors.forename: T J
authors.initials: TJ
authors.lastname: de Villiers
authors.forename: A
authors.initials: A
authors.lastname: Pines
authors.forename: R R
authors.initials: RR
authors.lastname: Freedman
authors.forename: A
authors.initials: A
authors.lastname: Gompel
authors.forename: M
authors.initials: M
authors.lastname: Hickey
authors.forename: M S
authors.initials: MS
authors.lastname: Hunter
authors.forename: R A
authors.initials: RA
authors.lastname: Lobo
authors.forename: M A
authors.initials: MA
authors.lastname: Lumsden
authors.forename: A H
authors.initials: AH
authors.lastname: MacLennan
authors.forename: P
authors.initials: P
authors.lastname: Maki
authors.forename: S
authors.initials: S
authors.lastname: Palacios
authors.forename: D
authors.initials: D
authors.lastname: Shah
authors.forename: P
authors.initials: P
authors.lastname: Villaseca
authors.forename: M
authors.initials: M
authors.lastname: Warren
mesh_terms: D000328:Adult; D001833:Body Temperature Regulation; D001921:Brain / Q000502:physiology; D001943:Breast Neoplasms; D002318:Cardiovascular Diseases; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000502:physiology; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013546:Sweating; D014666:Vasomotor System
chemical_list: D004967:Estrogens; D018377:Neurotransmitter Agents