Gynecology Book

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Vasomotor Symptoms of Menopause

Aka: Vasomotor Symptoms of Menopause, Hot Flashes, Hot Flushes, Flushing
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  1. See Also
    1. Night Sweats
    2. Hyperhidrosis
  2. Epidemiology
    1. Vasomotor symptoms occur in 85% of perimenopausal women
      1. Starts 1-2 years before Menopause
      2. Continues for up to 5 years
  3. Differential Diagnosis
    1. Medications
      1. Isoniazid
      2. Disulfiram reaction
        1. Griseofulvin
        2. Flagyl
        3. Chlorpropamide
        4. Chloral Hydrate
      3. Niacin
      4. Hydralazine
      5. Calcitonin
      6. Aspirin sensitive
      7. Procardia
      8. Capsaicin
      9. MAO inhibitor when taken with Tyramine (beer, cheese)
    2. Medication withdrawal
      1. Clonidine
      2. Alpha-Methyldopa
    3. Pheochromocytoma
    4. Carcinoid
    5. Mastocytosis in Leukemia
      1. Histamine and Prostaglandin D Release
      2. Hypotensive episodes
      3. Dermatographia
    6. VIP-oma or WDHA: Diarrhea, Hypokalemia, achlorhydria
    7. Menopausal Flushing
    8. Emotional blushing
    9. Food and Environmental Stimuli
      1. Monosodium glutamate
      2. Thermal stimuli
      3. Ethanol (worse with Rosacea, Carcinoid, Mastocytosis)
      4. Scombroid Fish Poisoning: Tuna, Mahi-mahi, Mackerel
    10. Syndrome obscure in women
      1. Characteristics
        1. Telangiectasia
        2. Urticaria
        3. Flushing
        4. Peptic Ulcer Disease
        5. Diarrhea
      2. Increased blood and urine histamine
      3. Not associated with mastocytosis or Carcinoid
  4. Management: General
    1. Wear cool clothing
    2. Use a fan
    3. Drink cool liquids and eat cold foods
    4. Regular Exercise has mixed results
      1. Original study supported Exercise as effective
        1. Ivarsson (1998) Maturitas 29:139-46
      2. Recent study does not show benefit in Hot Flushes
        1. Aiello (2004) Menopause 11:382-8
    5. Avoid Exacerbating food products
      1. Caffeine
      2. Alcohol in excess
      3. Spicy food
      4. Dietary Fat intake
        1. Associated with Hot Flushes in postmenopause
        2. Riley (2004) J Gen Intern Med 19:740-6
    6. Vitamin Supplementation
      1. Vitamin B6 may be helpful
      2. Vitamin E is no more effective than Placebo
    7. Other measures associated with decreased symptoms
      1. Tobacco Cessation
      2. Yoga
      3. Massage
      4. Meditation
      5. Leisurely bath
      6. Weight loss
        1. Associated with less Hot Flushes in Perimenopause
        2. Riley (2004) J Gen Intern Med 19:740-6
  5. Management: Medications
    1. Estrogen Replacement Therapy
      1. Relieves symptoms in 80-90% of patients
    2. Progestin
      1. Progesterone transdermal cream (20 grams/day)
        1. Leonetti (1999) Obstet Gynecol 94:225-8
      2. Megestrol acetate (Megace) 20 mg PO bid
        1. Relieves symptoms ~50% of cases
      3. Medroxyprogesterone acetate (Provera) 20 mg orally daily
        1. Relieves symptoms ~50% of cases
    3. Clonidine 0.1 - 0.2 mg PO qhs (or transdermal patch)
      1. (1994) JCO 12:155
    4. Selective Serotonin Reuptake Inhibitors
      1. SSRIs shown to be effective
        1. Venlafaxine (Effexor)
          1. Dose: 12.5 mg orally twice daily or 75 mg orally at bedtime
          2. (1998) J Clin Oncol 16:2377
          3. Loprinzi (2000) Lancet 356:2059-63
        2. Paroxetine (Paxil CR) 12.5 to 25 mg PO qd
          1. Stearns (2003) JAMA 289:2827-34
        3. Fluoxetine (Prozac)
          1. Loprinzi (2002) J Clin Oncol 20:1578-83
      2. SSRIs not found to be effective
        1. Citalopram (Celexa)
        2. Sertraline (Zoloft)
        3. Suvanto-Luukkonen (2005) Menopause 12:18-26
    5. Gabapentin (Neurontin) 300 mg PO tid
      1. Guttuso (2003) Obstet Gynecol 101:337-45
    6. Bellergal-S 100
      1. Small risk of addiction
    7. Aldomet 250 mg PO bid
  6. Management: Herbals and Dietary Supplements
    1. Possible benefit
      1. Black Cohosh
        1. Hernandez (2003) Maturitas 44:S59-65
    2. Variable evidence for benefit
      1. Soy Isoflavones or Phytoestrogens (see Soy Protein)
        1. Faure (2002) Menopause 9:329-34
        2. Han (2002) Obstet Gynecol 99:389-94
        3. Nikander (2003) Obstet Gynecol 101:1213-20
    3. Unlikely benefit
      1. Dong Quai (No better than Placebo)
      2. Evening Primrose Oil
      3. Red Clover
        1. Tice (2003) JAMA 290:207-14
      4. Vitamin E slightly better than Placebo
        1. Barton (1998) J Clin Oncol 16:495-500
  7. References
    1. Carroll (2006) Am Fam Physician 73:457-67
    2. Israel (1997) Pharmacotherapy 17:970-84
    3. Morelli (2002) Am Fam Physician 66(1):129-34
    4. Shanafelt (2002) Mayo Clin Proc 77:1159-63

Flushing (C0016382)

Definition (NCI) A disorder characterized by episodic reddening of the face.
Definition (MSH) A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process.
Definition (NCI) A sudden reddening of the face.
Concepts Sign or Symptom (T184)
MSH D005483
ICD9 782.62
ICD10 R23.2
SnomedCT 206902002, 158255000, 238810007, 20255002, 271811009
English Flushings, FLUSHES, FACIAL FLUSHING, FLUSHING, SKIN FLUSHED, [D]Flushing, [D]Flushing (context-dependent category), cutaneous vascular engorgement, flushing reaction, skin reddening, sudden redness of skin (symptom), skin flushing as symptom, sudden redness of skin, [D]Flushing (situation), sudden redness of skin primarily involving face, flushing, facial flushing, sudden redness of skin primarily involving face (symptom), Flushed face, Flushing of face, Facial flushing, Flushed, Flushed skin, Skin flushed, Flushing [Disease/Finding], face flushed, flushing face, flushed, face flushing, flushing of face, flushing facial, flush face, skin flush, facial flush, flushed skin, face flush, flush, flushes, reddened skin, flushed face, Flush, Face goes red, Flushes, Face goes red (finding), Flushing (disorder), Flushing
Dutch plotseling rood gezicht, plotseling rood wordend gezicht, plotseling rode huid, plotselinge 'roodheid gezicht, huid plotseling rood, blozend, Opvliegingen [flushes], overmatig blozen, Blozen
French Rougeurs du visage, Rougeur de la peau, Aspect congestionné, Bouffées vasomotrices au visage, BRUSQUE ROUGEUR DE LA PEAU, ROUGEUR CONGESTIVE, Bouffée congestive, Rougeur de la face, Rougeur du visage, Bouffées congestives, Bouffées vasomotrices
German geroetetes Gesicht, Gesichtsroetung, geroetete Haut, Gesichtserroetung, Haut geroetet, geroetet, FLUSH, Gesichtsroetung [Flush], HAUTGEFAESSERWEITERUNG, Hitzegefuehl, Flushing
Italian Faccia arrossata, Cute arrossata, Arrossato, Vampate alla faccia, Rossore facciale, Rossore
Portuguese Ruborizado, Pele ruborizada, Face ruborizada, AFRONTAMENTO, RUBOR SUBITO DA PELE, Rubificação Facial, Ruborização Facial, Vermelhidão Facial, Enrubescimento da Pele do Rosto, Enrubescimento, Rubidez Facial, Afrontamento, Rubor
Spanish Congestión facial, Piel enrojecida, Enrojecido, Cara enrojecida, Rubefacción de la cara, [D]rubefacción (categoría dependiente del contexto), [D]Flushing, PIEL, ENROJECIMIENTO, RUBEFACION, Enrojecimiento de la Cara, Rubor Facial, Rubicundez Facial, Rubefaccion Facial, Rubefacción Facial, Enrojecimiento de la Piel, Acaloramiento, [D]rubefacción (situación), [D]rubefacción, enrojecimiento facial (hallazgo), enrojecimiento facial, rubor (trastorno), rubor, Rubefacción, Enrojecimiento, Rubor
Japanese 顔面潮紅, 潮紅, 皮膚潮紅, ｶﾞﾝﾒﾝﾁｮｳｺｳ, ﾁｮｳｺｳ, ﾋﾌﾁｮｳｺｳ
Swedish Rodnad
Czech zrudnutí, Zrudlá kůže, Zrudnutí, Zrudnutí obličeje, Zrudlá tvář, Zrudlý
Finnish Flushing
Russian PRILIV KROVI, POKRASNENIE, KROVI PRILIV, КРОВИ ПРИЛИВ, ПРИЛИВ КРОВИ, ПОКРАСНЕНИЕ
Korean 홍조
Croatian ZARUMEN
Polish Wypieki na twarzy, Nagłe zaczerwienienie twarzy, Uderzenie krwi do głowy
Hungarian Kipirulás, Bőr kipirult, Kipirult arc, Kipirult, Kipirult bőr, Arc kipirulása, Arcpír
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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