Dietary intake and menopausal symptoms in postmenopausal women: a systematic review.

Despite literature pointing to a relation between dietary intake and menopausal symptoms, most studies have evaluated either only supplements or only specific nutrients or foods. Therefore, this study aimed to provide a systematic review of the literature regarding the association between dietary intake and menopausal symptoms in postmenopausal women. A systematic search was conducted across PubMed/Medline, Web of Science, Scopus, and Embase to identify studies published between 2009 and 2019. We identified 3828 studies; after screening, 73 studies were reviewed and 19 of these investigated nutrient and food intake and eating patterns associated with the intensity of menopausal symptoms. Studies evaluating diet quality or dietary patterns showed an association between lower intensity of psychological symptoms, sleep disorders, and vasomotor, urogenital, and somatic symptoms and higher consumption of vegetables, whole grains, and unprocessed foods. Also, the intensity of these symptoms is associated with high-processed foods, saturated fats, and sugars. Regarding nutrient and/or specific food, the studies indicated an association between caffeine intake and type of fat intake and the intensity of menopausal symptoms. Dietary intake was found to be associated with the severity of menopausal symptoms; however, evidence for the association between dietary intake and menopausal symptoms is inconsistent and inconclusive, and is provided by a small number of studies.

Applicability of auriculotherapy in cancer patients: an integrative literature review. / Aplicabilidade da auriculoterapia em pacientes oncológicos: revisão integrativa da literatura.

OBJECTIVE: To analyze scientific evidence in the literature on the use of auriculotherapy to relieve symptoms related to cancer and/or its treatment. METHOD: An integrative literature review based on: MEDLINE, CINAHL, LILACS, SCOPUS and COCHRANE in the last five years in English, Portuguese and Spanish. Inclusion criteria primary studies with the central theme. Exclusion criteria opinion articles, reviews and experience reports. RESULTS: The search resulted in 435 publications, but only 11 remained after applying four selection stages. An analysis of the study designs showed that three of them (27.5%) had a high level of evidence, three (27.5%) had moderate, four (36%) had low and one (9%) had a very low level. The evaluated outcomes were related to the following symptoms: pain, constipation, nausea and vomiting, hot flashes, dyspnea, fatigue and insomnia. Moreover, 100% of the publications exposed positive effects of auriculotherapy in oncology. CONCLUSION: Auriculotherapy in cancer patients improves symptoms, and this practice was considered a safe and acceptable intervention. However, it is necessary to expand studies to obtain more favorable evidence since only 3 studies presented a high level of evidence.

Is calcitonin gene-related peptide a modulator of menopausal vasomotor symptoms?

PURPOSE: Calcitonin gene-related peptide (CGRP) is a neuropeptide widely distributed in the central and peripheral nervous systems, which is known as a potent vasodilator. Postmenopausal women who experience hot flushes have high levels of plasma CGRP, suggesting its involvement in menopausal vasomotor symptoms. METHODS: In this review, we describe the biochemical aspects of CGRP and its effects associated with deficiencies of sexual hormones on skin temperature, vasodilatation, and sweating as well as the possible peripheral and central mechanisms involved in these events. RESULTS: Several studies have shown that the effects of CGRP on increasing skin temperature and inducing vasodilatation are potentiated by a deficiency of sex hormones, a common condition of postmenopausal women. Additionally, the medial preoptic area of the hypothalamus, involved in thermoregulation, contains over 25-fold more CGRP-immunoreactive cells in female rodents compared with male rodents, reinforcing the role of female sex hormones on the action of CGRP. Some studies suggest that ovarian hormone deficiency decreases circulating endogenous CGRP, inducing an upregulation of CGRP receptors. Consequently, the high CGRP receptor density, especially in blood vessels, amplifies the stimulatory effects of this neuropeptide to raise skin temperature in postmenopausal women during hot flushes. CONCLUSIONS: The duration of the perception of each hot flush in a woman is brief, while local reddening after intradermal administration of α-CGRP persists for 1 to 6 h. This contrast remains unclear.

Effectiveness of Traditional Chinese Acupuncture versus Sham Acupuncture: a Systematic Review.

OBJECTIVE: to identify and synthesize the evidence from randomized clinical trials that tested the effectiveness of traditional Chinese acupuncture in relation to sham acupuncture for the treatment of hot flashes in menopausal women with breast cancer. METHOD: systematic review guided by the recommendations of the Cochrane Collaboration. Citations were searched in the following databases: MEDLINE via PubMed, Web of Science, CENTRAL, CINAHL, and LILACS. A combination of the following keywords was used: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, and vasomotor symptoms. RESULTS: a total of 272 studies were identified, five of which were selected and analyzed. Slight superiority of traditional acupuncture compared with sham acupuncture was observed; however, there were no strong statistical associations. CONCLUSIONS: the evidence gathered was not sufficient to affirm the effectiveness of traditional acupuncture compared with sham acupuncture. OBJETIVO: identificar e sintetizar as evidências oriundas de ensaios clínicos randomizados que testaram a efetividade da acupuntura tradicional chinesa em relação à sham acupuntura para o tratamento dos fogachos em mulheres com câncer de mama no climatério. MÉTODO: revisão sistemática guiada pelas recomendações da Colaboração Cochrane. A busca foi realizada nas bases de dados: MEDLINE via PubMed, Web of Science, CENTRAL Cochrane, CINAHL e LILACS. Adotou-se a combinação dos descritores: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, vasomotor symptoms. RESULTADOS: foram identificados 272 estudos, sendo 5 selecionados e analisados. Foi observada discreta superioridade da acupuntura tradicional em relação à sham, entretanto, sem fortes associações estatísticas. CONCLUSÕES: as evidências obtidas não foram suficientes para afirmar quanto à efetividade da acupuntura tradicional em relação à sham. OBJETIVO: Identificar y sintetizar la evidencia de un ensayo clínico aleatorizado que examinó la eficacia de la acupuntura tradicional en relación a la acupuntura sham para el tratamiento de sofocos en las mujeres menopáusicas con cáncer de mama. MÉTODO: Revisión sistemática guiada por las recomendaciones de la Colaboración Cochrane. Las referencias bibliográficas se buscaron en las siguientes bases de datos: MEDLINE vía PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL y LILACS. Se utilizó una combinación de las siguientes palabras clave: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, vasomotor symptoms. RESULTADOS: Se identificó un total de 272 estudios, cinco de los cuales fueron seleccionados y analizados. Se encontró una ligera superioridad de la acupuntura tradicional comparada con la acupuntura sham; sin embargo, no se encontraron asociaciones estadísticas fuertes. CONCLUSIONES: La evidencia obtenida no fue suficiente para confirmar la eficacia de la acupuntura tradicional comparada con la acupuntura sham.

Effectiveness of Traditional Chinese Acupuncture versus Sham Acupuncture: a Systematic Review / Efetividade da Acupuntura Tradicional Chinesa versus Sham Acupuntura: revisão sistemática / Eficacia de la Acupuntura Tradicional China frente a la Acupuntura Sham: una revisión sistemática

ABSTRACT Objective: to identify and synthesize the evidence from randomized clinical trials that tested the effectiveness of traditional Chinese acupuncture in relation to sham acupuncture for the treatment of hot flashes in menopausal women with breast cancer. Method: systematic review guided by the recommendations of the Cochrane Collaboration. Citations were searched in the following databases: MEDLINE via PubMed, Web of Science, CENTRAL, CINAHL, and LILACS. A combination of the following keywords was used: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, and vasomotor symptoms. Results: a total of 272 studies were identified, five of which were selected and analyzed. Slight superiority of traditional acupuncture compared with sham acupuncture was observed; however, there were no strong statistical associations. Conclusions: the evidence gathered was not sufficient to affirm the effectiveness of traditional acupuncture compared with sham acupuncture.

RESUMO Objetivo: identificar e sintetizar as evidências oriundas de ensaios clínicos randomizados que testaram a efetividade da acupuntura tradicional chinesa em relação à sham acupuntura para o tratamento dos fogachos em mulheres com câncer de mama no climatério. Método: revisão sistemática guiada pelas recomendações da Colaboração Cochrane. A busca foi realizada nas bases de dados: MEDLINE via PubMed, Web of Science, CENTRAL Cochrane, CINAHL e LILACS. Adotou-se a combinação dos descritores: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, vasomotor symptoms. Resultados: foram identificados 272 estudos, sendo 5 selecionados e analisados. Foi observada discreta superioridade da acupuntura tradicional em relação à sham, entretanto, sem fortes associações estatísticas. Conclusões: as evidências obtidas não foram suficientes para afirmar quanto à efetividade da acupuntura tradicional em relação à sham.

RESUMEN Objetivo: Identificar y sintetizar la evidencia de un ensayo clínico aleatorizado que examinó la eficacia de la acupuntura tradicional en relación a la acupuntura sham para el tratamiento de sofocos en las mujeres menopáusicas con cáncer de mama. Método: Revisión sistemática guiada por las recomendaciones de la Colaboración Cochrane. Las referencias bibliográficas se buscaron en las siguientes bases de datos: MEDLINE vía PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL y LILACS. Se utilizó una combinación de las siguientes palabras clave: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, vasomotor symptoms. Resultados: Se identificó un total de 272 estudios, cinco de los cuales fueron seleccionados y analizados. Se encontró una ligera superioridad de la acupuntura tradicional comparada con la acupuntura sham; sin embargo, no se encontraron asociaciones estadísticas fuertes. Conclusiones: La evidencia obtenida no fue suficiente para confirmar la eficacia de la acupuntura tradicional comparada con la acupuntura sham.

[Clinical practice guideline. Diagnosis and treatment of postmenopausal and perinemopausia]. / Guía de práctica clínica. Diagnóstico y tratamiento de la perimenopausia y la posmenopausia.

Post-menopause is the period of life where a deep decline occurs in circulating estrogen levels, inducing the appearance of psycho and somatic symptoms. The classification to understand the chronology of reproductive aging in women (known as STRAW) determines the clinical and endocrine changes contemplating menstrual cycles, symptoms, measurements of FSH, LH, inhibin B, anti-Mullerian hormone , and follicular account. The diagnosis of menopause is established by the absence of menstruation for 12 months or more. The most frequent clinical manifestations of the climacteric syndrome transition to menopause are menstrual disorders, vasomotor symptoms (flushes and/or sweats) and genitourinary manifestations. The assessment of women in the peri- or postmenopause aims to develop: cervicovaginal cytology , lipid profile , serum glucose, basal Mammography at least a year before, pelvic ultrasound, urinalysis, serum TSH, Densitometry in patients older than 60 years if there is no recourse can be applied and FRAX. Drug therapy for the treatment of disorders of the transition to menopause or menopause is divided into: hormone therapy (HT) based estrogens and progestin hormone not being the most recommended the serotonin reuptake inhibitors and norepinephrine, clonidine, gabapentin or veralipride.

La posmenopausia es el periodo de la vida en el que ocurre un profundo descenso en las concentraciones circulantes de estrógenos, lo cual induce la aparición de los síntomas psico y somáticos. La clasificación para entender la cronología del envejecimiento reproductivo en la mujer (reconocida como STRAW) determina los cambios clínicos y endocrinos a partir de examinar los ciclos menstruales, los síntomas, las mediciones de FSH, LH, inhibina B, hormona antimulleriana y la cuenta folicular. El diagnóstico de menopausia se establece por la ausencia de menstruación por 12 meses o más. Las manifestaciones clínicas más frecuentes del síndrome climatérico o transición a la menopausia son los trastornos menstruales, los síntomas vasomotores (bochornos o sudoraciones) y las manifestaciones genitourinarias. La evaluación de la mujer en la peri o la postmenopausia contempla la realización de citología cervicovaginal, perfil de lípidos, glucosa sérica, mastografía basal (por lo menos un año antes), ultrasonido pélvico, examen general de orina, TSH sérica, densitometría (ver la Guía de práctica clínica de osteoporosis) en pacientes mayores de 60 años (y si no se cuenta con el recurso se puede aplicar el FRAX). El tratamiento farmacológico para las alteraciones de la menopausia (o de la transición a esta) se divide en: tratamiento hormonal (TH) con base en estrógenos o progestágenos, y tratamiento no hormonal; los más recomendados son los inhibidores de recaptura de serotonina y norepinefrina, clonidina, gabapentina o veraliprida.

Risk of long-term hot flashes after natural menopause: evidence from the Penn Ovarian Aging Study cohort.

OBJECTIVE: This study aims to estimate the risk of hot flashes relative to natural menopause and to evaluate the associations of hormone levels, behavioral variables, and demographic variables with the risk of hot flashes after menopause. METHODS: We performed annual assessment of 255 women who were premenopausal at baseline and reached natural menopause within 16 years of follow-up. RESULTS: The prevalence of moderate/severe hot flashes increased in each premenopausal year, reaching a peak of 46% in the first 2 years after the final menstrual period (FMP). Hot flashes decreased slowly after menopause and did not return to premenopausal levels until 9 years after the FMP. The mean (SD) duration of moderate/severe hot flashes after the FMP was 4.6 (2.9) years (for any hot flashes, 4.9 [3.1] y). One third of women at 10 years or more after menopause continued to experience moderate/severe hot flashes. African-American women (obese and nonobese) and obese white women had significantly greater risks of hot flashes compared with nonobese white women (interaction, P = 0.01). In multivariable analysis, increasing follicle-stimulating hormone levels before the FMP (P < 0.001), decreasing estradiol (odds ratio, 0.87; 95% CI, 0.78-0.96; P = 0.008), and increasing anxiety (odds ratio, 1.05; 95% CI, 1.03-1.06; P < 0.001) were significant risk factors for hot flashes, whereas higher education levels were protective (odds ratio, 0.66; 95% CI, 0.47-0.91; P = 0.011). CONCLUSIONS: Moderate/severe hot flashes continue, on average, for nearly 5 years after menopause; more than one third of women observed for 10 years or more after menopause have moderate/severe hot flashes. Continuation of hot flashes for more than 5 years after menopause underscores the importance of determining individual risks/benefits when selecting hormone or nonhormone therapy for menopausal symptoms.

Gonadal hormone levels and platelet tryptophan and serotonin concentrations in perimenopausal women with or without depressive symptoms.

INTRODUCTION: The etiology of depressive symptoms associated with the transition to menopause is still unknown; hormonal changes, serotonergic system or insomnia, could be a trigger to depressive symptomatology. The aim of the present study was to evaluate gonadal hormonal levels, platelet serotonin concentrations and platelet tryptophan concentrations in a group of depressed perimenopausal women and their healthy counterparts. METHODS: A total of 63 perimenopausal women between 45 and 55 years old were evaluated; of these, 44 were depressed patients, and 19 were perimenopausal women without depression. The instruments that were applied included the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Depression Rating Scale (HDRS) and the Green Climacteric Scale (GCS); gonadal hormone levels and platelet tryptophan and serotonin concentrations were measured in all participants. Differences in hormonal levels and tryptophan and serotonin concentrations were evaluated with respect to specific symptoms, such as insomnia, hot flashes, nervousness, depressed mood and loss of interest. RESULTS: No differences between groups were observed with respect to hormonal levels and tryptophan and serotonin concentrations; mean sleep hours and insomnia were significantly correlated with platelet tryptophan concentrations. CONCLUSIONS: In this sample, all symptoms of depression could not be explained by platelet tryptophan and serotonin concentrations and hormonal levels; differences were observed only when we evaluated insomnia and hot flashes.

Menopause or climacteric, just a semantic discussion or has it clinical implications?

Climacteric and menopause are two terms that are indistinctly used to name clinical expected events related to the decline in ovarian function. Thus, in the literature and in clinical settings we read and hear 'menopausal symptoms' or 'climacterics symptoms'. Globally, the term menopause is much more frequently used than climacteric but, before we use either one, we should consider that 'menopause' is referring to a specific event, the cessation of menses, and 'climacteric' to gradual changes of ovarian function that start before the menopause and continue thereafter for a while. In the premenopause period, hormonal changes will take place that are associated with symptoms, which deteriorate the quality of life, and with metabolic changes which increase the risk of chronic diseases. Therefore, the word climacteric ('steps' in Greek) seems more adequate to refer to the symptoms and chronic diseases associated with the gradual decrease of ovarian function, and we should leave the term 'menopause' only for naming the event of cessation of menstruation that will happen later as the consequence of the decline in ovarian activity. This differentiation has clinical importance, because it implies that, during the premenopausal period, the impact that the decrease in estrogen has on the health status of women must be assessed and, if it is pertinent, we should indicate lifestyle changes, hormonal therapy, hypolipidemic drugs, etc. It does not seem proper to wait for the cessation of menstrual bleeding before some intervention is started. The decay of women's health starts many years before menopause and prevention of its consequences is a must for us, the clinicians.

Paullinia cupana para o controle de fogachos em pacientes com câncer de mama: um estudo piloto / Paullinia cupana for control of hot flashes in breast cancer patients: a pilot study

OBJETIVO: Avaliar se a Paullinia cupana diminui o número e a gravidade dos fogachos em mulheres após diagnóstico de câncer de mama. MÉTODOS: Estudo piloto prospectivo fase II realizado com mulheres que sobreviveram ao câncer de mama, que completaram o tratamento pelo menos 3 meses antes e que apresentavam ao menos 14 episódios de fogachos por semana. Utilizando o desenho de Simon para que a primeira etapa fosse considerada positiva, ao menos 9 de 15 mulheres deveriam ter a gravidade dos fogachos diminuída em pelo menos 50%. As pacientes receberam 50mg do extrato seco de Guaraná oralmente 2 vezes por dia por 6 semanas. Foram avaliadas, a gravidade e a frequência dos fogachos. RESULTADOS: Dezoito pacientes iniciaram o tratamento com Paullinia cupana e 15 completaram o estudo. Três pacientes deixaram o estudo imediatamente após iniciarem o tratamento em razão de dificuldade na participação e não adesão. Das 15 pacientes que completaram o estudo, 10 obtiveram diminuição de mais de 50% dos índices de gravidade de fogachos. Durante as 6 semanas de tratamento, diminuições estatisticamente significativas foram observadas tanto no número de fogachos (p=0,0009), quanto nos índices de gravidade (p<0,0001). Paullinia cupana foi bem tolerada, e não houve relato de toxicidade como causa de saída do estudo. CONCLUSÕES: Paullinia cupana pareceu promissora para o controle de fogachos. Estudos mais extensivos são necessários.

OBJECTIVE: To evaluated whether Paullinia cupana decrease number and severity of hot flashes in breast cancer survivors. METHODS: This was a prospective phase II pilot study. We studied female breast cancer survivors who had completed the cancer treatment 3 months previously and who were experiencing at least 14 hot flashes per week. At least 9 of the 15 patients were required to have a decrease of at least 50% in hot flash severity score in keeping with the Simon Design. Patients received 50mg of dry extract of Paullinia cupana orally twice a day for 6 weeks. We assessed both frequency and severity of hot flashes. RESULTS: A total of 18 patients started the Paullinia cupana treatment, and 15 completed the study. Three patients left the study immediately after starting the treatment because of personal difficulties in participation or noncompliance. Of the 15 patients who completed the study 10 had a decrease of more than 50% in hot flash severity scores. During the 6 weeks of treatment, statistically significant decreases were seen in both numbers of hot flashes (p=0.0009) and severity scores (p<0.0001). Paullinia cupana was well tolerated, and there were no instances of discontinuation because of toxicity. CONCLUSIONS: Paullinia cupana appears promising for controlling hot flashes. More extensive studies seem warranted.

Paullinia cupana for control of hot flashes in breast cancer patients: a pilot study.

OBJECTIVE: To evaluated whether Paullinia cupana decrease number and severity of hot flashes in breast cancer survivors. METHODS: This was a prospective phase II pilot study. We studied female breast cancer survivors who had completed the cancer treatment 3 months previously and who were experiencing at least 14 hot flashes per week. At least 9 of the 15 patients were required to have a decrease of at least 50% in hot flash severity score in keeping with the Simon Design. Patients received 50mg of dry extract of Paullinia cupana orally twice a day for 6 weeks. We assessed both frequency and severity of hot flashes. RESULTS: A total of 18 patients started the Paullinia cupana treatment, and 15 completed the study. Three patients left the study immediately after starting the treatment because of personal difficulties in participation or noncompliance. Of the 15 patients who completed the study 10 had a decrease of more than 50% in hot flash severity scores. During the 6 weeks of treatment, statistically significant decreases were seen in both numbers of hot flashes (p=0.0009) and severity scores (p<0.0001). Paullinia cupana was well tolerated, and there were no instances of discontinuation because of toxicity. CONCLUSIONS: Paullinia cupana appears promising for controlling hot flashes. More extensive studies seem warranted.

Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women.

OBJECTIVE: To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post-menopausal Brazilian women. DESIGN: Observational study conducted by the selection and inclusion of 5968 Brazilian women after menopause. The following variables were analyzed in this study: time at menopause; the relationship between age at menarche and age at menopause; vasomotor symptoms compared with age at the time of menopause and the time of menopause; Kupperman menopausal index (KMI) versus total time of menopause; body mass index (BMI) compared to the time of menopause, vasomotor symptoms, and KMI total score. We used the Chi-square test, and the significance level was set at 5%. RESULTS: The age at natural menopause ranged from 41 to 62 years (mean 48.1 ± 4.07 years). A younger age at menopause was associated with a high intensity of vasomotor symptoms. These symptoms were more intense in the first 5 years of menopause and decreased with time. The KMI total also decreased with time after menopause, with the exception of arthralgia, myalgia, and insomnia, which did not tend to improve over time. In addition, the vasomotor symptoms and total KMI were more frequent with increasing BMI. CONCLUSIONS: Our results suggested that the age of menopause and BMI may influence the intensity of vasomotor symptoms.

[Lifestyles and quality of life of post menopausal women]. / Síntomas climatéricos y calidad de vida de usuarias de consultorios de atención primaria de salud, Santiago.

BACKGROUND: During menopause the quality of life of women can be seriously deteriorated and influenced by lifestyles. AIM: To assess the prevalence of menopausal symptoms and their relationship with lifestyles and quality of life. MATERIAL AND METHODS: The Menopause Rating Scale (MRS), a survey that measures menopausal symptoms and has questions related to lifestyles, was applied to 1023 women aged 54 ± 6 years (range 45 to 64 years), consulting in primary health care clinics. A multiple linear regression analysis was used to evaluate the association between menopausal symptoms and lifestyle. RESULTS: Fifty six percent of women did not have a paid work, 64% were nonsmokers and 90% did not perform any physical exercise. The most frequent menopausal symptoms referred were muscle and joint ailments (85%) followed by mental and physical exhaustion (80%). Sedentary women, smokers or those who did not to have time for leisure activities showed worst quality of life scores. CONCLUSIONS: Postmenopausal women with unhealthy lifestyles had the lower quality of life scores and more menopausal symptoms.

Síntomas climatéricos y calidad de vida de usuarias de consultorios de atención primaria de salud, Santiago / Lifestyles and quality of life of post menopausal women

Background: During menopause the quality of life of women can be seriously deteriorated and influenced by lifestyles. Aim: To assess the prevalence of menopausal symptoms and their relationship with lifestyles and quality of life. Material and Methods: The Menopause Rating Scale (MRS), a survey that measures menopausal symptoms and has questions related to lifestyles, was applied to 1023 women aged 54 ± 6years (range 45 to 64years), consulting in primary health care clinics. A multiple linear regression analysis was used to evaluate the association between menopausal symptoms and lifestyle. Results: Fifty six percent of women did not have a paid work, 64 percent were nonsmokers and 90 percent did not perform any physical exercise. The most frequent menopausal symptoms referred were muscle and joint ailments (85 percent) followed by mental and physical exhaustion (80 percent). Sedentary women, smokers or those who did not to have time for leisure activities showed worst quality of life scores. Conclusions: Postmenopausal women with unhealthy lifestyles had the lower quality of life scores and more menopausal symptoms.

Non-hormonal interventions for hot flushes in women with a history of breast cancer.

BACKGROUND: Hot flushes are common in women with a history of breast cancer. Hormonal therapies are known to reduce these symptoms but are not recommended in women with a history of breast cancer due to their potential adverse effects. The efficacy of non-hormonal therapies is still uncertain. OBJECTIVES: To assess the efficacy of non-hormonal therapies in reducing hot flushes in women with a history of breast cancer. SEARCH STRATEGY: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, PsycINFO (August 2008) and WHO ICTRP Search Portal. We handsearched reference lists of reviews and included articles, reviewed conference proceedings and contacted experts. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing non-hormonal therapies with placebo or no therapy for reducing hot flushes in women with a history of breast cancer. DATA COLLECTION AND ANALYSIS: Two authors independently selected potentially relevant studies, decided upon their inclusion and extracted data on participant characteristics, interventions, outcomes and the risk of bias of included studies. MAIN RESULTS: Sixteen RCTs met our inclusion criteria. We included six studies on selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitors, two on clonidine, one on gabapentin, two each on relaxation therapy and homeopathy, and one each on vitamin E, magnetic devices and acupuncture. The risk of bias of most studies was rated as low or moderate. Data on continuous outcomes were presented inconsistently among studies, which precluded the possibility of pooling the results. Three pharmacological treatments (SSRIs and SNRIs, clonidine and gabapentin) reduced the number and severity of hot flushes. One study assessing vitamin E did not show any beneficial effect. One of two studies on relaxation therapy showed a significant benefit. None of the other non-pharmacological therapies had a significant benefit. Side-effects were inconsistently reported. AUTHORS' CONCLUSIONS: Clonidine, SSRIs and SNRIs, gabapentin and relaxation therapy showed a mild to moderate effect on reducing hot flushes in women with a history of breast cancer.

Terapia não-hormonal no manejo das ondas de calor no climatério / Non-hormonal therapy in the management of hot flushes in climateric

A menopausa, ponto máximo do climatério, é um evento acompanhado frequentemente por sintomas vasomotores, podendo ter um impacto significativo na qualidade de vida da mulher. A maioria das mulheres experimentará fogachos em algum momento de suas vidas com frequência e intensidade variáveis. Apesar das inúmeras teorias, a fisiopatologia exata dos fogachos ainda não é conhecida. Existem muitas opções de terapias farmacológicas hormonais e não-hormonais, até intervenções não-farmacológicas, e escolher a melhor opção de tratamento para cada mulher envolve o conhecimento dos possíveis riscos e benefícios de cada tratamento, necessitando de individualização na conduta. O tratamento hormonal (estrogênio e/ou progesterona) ainda é a opção mais utilizada, o qual se tem mais estudos realizados com esta modalidade de tratamento, resultando em uma redução de 80 a 90% dos fogachos, entretanto, cada vez mais são procuradas terapias alternativas. O manejo não-hormonal com melhores resultados tem sido conseguido com a classe dos antidepressivos mais recentes, a qual compreende vários inibidores seletivos da recaptação da serotonina, alguns fornecendo redução de cerca de 60% dos fogachos. Este artigo procurou avaliar as opções de terapias não-hormonais disponíveis para o controle dos sintomas climatéricos, seus efeitos colaterais e mecanismos de ação.

Menopause, the highest point of climateric, is frequently followed by vasomotor symptoms and may case a large impact in women's quality of life. The majority of women will experience episodes of hot flushes at various frequencies and intensities during their lives. Despite many theories about the physiopathology of hot flushes, the exact cause is still unknown. Different treatments for climacteric symptoms are available, such as hormonal and non-hormonal therapies, and non-pharmacological intervention also becomes an option. Choosing the best treatment requires ample knowledge of each therapy risks and benefits, and it is necessary to individualize the treatment for each woman. The hormonal therapy (estrogens and/or progestins) is still the most applied option. Accomplished studies about this kind of treatment demonstrated that it can reduce the intensity of hot flushes from 80 up to 90%; however, more and more women are searching for alternative therapies. The non-hormonal therapy with the best result involves the most recent class of antidepressant drugs, which includes many selective serotonin reuptake inhibitors, some of them reducing hot flushes up to 60%. This article aimed at evaluating non-hormonal therapy options available to control climacteric symptoms, their side effects and mechanism of action.

Evaluation of core and surface body temperatures, prevalence, onset, duration and severity of hot flashes in men after bilateral orchidectomy for prostate cancer.

OBJECTIVE: To assess the prevalence, onset, duration and severity of hot flashes in men after bilateral orchidectomy (BO) for prostate cancer, to evaluate body temperature changes during hot flashes and to determine whether an elevated temperature within a few days after BO can be caused by deprivation of androgen. MATERIALS AND METHODS: Patients (n = 101) were questioned about the characteristics of their hot flashes after BO for prostate cancer. A subgroup of these men (n = 17) were instructed to record their oral and forehead temperatures during and at fixed intervals between hot flashes daily for 4 weeks. RESULTS: The mean age was 71.6 years, mean follow-up after BO was 33.2 months. Hot flashes were reported by 87 men (86%) with previous spontaneous remission in 9 (10%). The median time between BO and the onset of hot flashes was 21 days (range 1-730), median number of hot flashes 3 per day (range 1-20), and median duration was 120 seconds (range 5 to 1800). There was no significant difference between median oral (36.4(o) C) and forehead (36.0(o) C) temperature in the normal state, but during hot flashes the median forehead temperature (37.0(o) C) was higher than the oral temperature (36.5(o) C) (p = 0.0004). Both median oral and forehead temperatures were higher during hot flashes (36.5(o) C and 37.0(o) C) than in the normal state (36.4(o) C and 36.0(o) C, respectively) (p < 0.0001). During hot flashes, the oral temperature was 38(o) C to 40(o) C in only 3.2% of 593 readings in 17 patients. CONCLUSIONS: The median oral and forehead temperatures are higher during hot flashes than in normal periods. Oral temperature elevation > 38(o) C within days after a BO is unlikely to be the result of androgen deprivation alone.