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Finding Ways to Cope When You’re Hot, Hot, Hot

Hot flashes and menopausal symptoms after breast cancer

Whether you have reached the age when menopause is a naturally occurring part of the lifecycle, or have been thrown into chemical menopause due to chemotherapy, one thing is certain, hot flashes are no day at the beach (although you may feel very much like you’ve been drenched by a wave).

It used to be thought that hot flashes and night sweats were reserved for women in their early to mid-50s. As science and the medical community began to better understand what we now call peri-menopause, they realized that symptoms often begin much earlier and can be wildly different from woman to woman.

Most women have heard enough about menopause to expect hot flashes and night sweats, but what they may not realize is (and this is the short list) that extreme mood swings, a loss of libido, vaginal dryness, relentless feelings of gloom, doom and dread, panic attacks, heart palpitations, dizziness and vertigo, as well as insomnia are often an additional part of the mix. It’s no wonder that women often feel like they are losing their minds, when in reality what they are experiencing is a diminishing hormonal balance. For women who are undergoing chemotherapy (or have previously undergone this regime) these symptoms can be particularly troublesome and scary.

What breast cancer survivors should know about bioidentical hormones

For the purposes of this article, we are going to focus on purported natural ways for women who have had breast cancer to deal with the basic symptoms associated with peri-menopause and full-blown menopause -- hot flash relief . However, there has been so much conversation and controversy surrounding the safety of “bioidentical hormones” in recent years, we wanted to provide you with just a bit of clarity in that regard as well.

In a 2009 article published by Dr. JoAnn V. Pinkerton (Professor and Vice Chair, Department of Obstetrics and Gynecology, and Director of The Women’s Place Midlife Health Center at the University of Virginia Health System in Charlottesville, Va.) she felt it important to be sure women considering any sort of hormonal therapy realize that:

“Bioidentical hormones are exogenous hormones that are biochemically similar to those produced endogenously by the body or ovaries. These include estrone, estradiol, estriol, progesterone, testosterone, dehydroepiandrosterone (DHEA), and cortisol.

Bioidenticals are not “natural” hormones, although many consumers think they are. In reality, compounded bioidentical hormones and FDA-approved bioidentical hormones all come from the same precursors. They begin as soy products or wild yam and then get converted to the different hormones in a laboratory in Germany before finding their way to the various world markets.

The claim that all bioidentical hormones are bioengineered to contain the same chemical structure as natural female sex hormones is false. As one expert noted, “the term ‘bioidentical’ has become inappropriately synonymous with ‘natural’ or ‘not synthetic’ and should be redefined to correct patient misconceptions.” 1

Identifying the triggers for your private power surges

If fully understanding what causes hot flashes was simple, we’d already have a plethora of possible treatments. Unfortunately, it appears there are probably nearly as many causes and triggers as there are women experiencing the problem. But here are a few of the most common:

  • Consuming  alcohol
  • Drinking products with caffeine
  • Eating spicy foods
  • Being overweight
  • Being stressed
  • Lack of physical activity
  • Smoking or being exposed to cigarette smoke

No surprises here, other than the fact that eliminating these known triggers often does little to help tame the symptoms. Not only that, but it’s interesting to note that while stress is felt to be a strong contributing factor – some of the “fixes” would appear to contribute to stress since women are being asked to deprive themselves -- or see themselves as flawed if they can't quit that glass of wine, toss that latte, shed unwanted pounds or drag themselves to a gym.

It’s important to remember that small steps can lead to major improvements. You don’t want to spend all your time obsessing over what you are doing wrong; simply try to determine what changes are comfortable as a starting point, and build from those. Because it’s a safe assumption if you start off trying to change everything at once, you may not only not obtain the desired result, it might bring on a hot flash! In fact, perhaps that is the bigger message here: be kind to yourself – and right there, you’ve eliminated just a bit of stress.

When we’re talking natural, what about black cohosh, red clover, dong quai and evening primrose oil?

Although much has been written about black cohosh and its ability to alleviate menopausal symptoms, according to Memorial Sloan Kettering it is not clear if black cohosh is beneficial for menopausal symptoms due to conflicting results from various studies. MSK believes there is not enough evidence to support its anti-cancer effects in humans. Patients should use caution as liver failure has been reported from its use.

Perhaps more importantly for breast cancer survivors, they warn: if you currently have, or have been treated for, an estrogen receptor-positive (ER+) cancer, it is still unclear whether black cohosh acts in the same manner as estrogen, and might therefore stimulate growth of these tumors.

Although there has been some evidence that red clover may help to reduce menopausal symptoms, it contains compounds known as isoflavones (also found in soy). In laboratory experiments, red clover extract stimulates the proliferation of estrogen receptor-positive breast cancer cells, indicating that this herb may not be helpful (or even safe) for women with estrogen-sensitive cancers.

Dong quai is an herb used in traditional Chinese medicine to treat menstrual and menopausal symptoms and to 'tonify' blood. Root extracts of dong quai were shown to stop growth of cancer cells in laboratory studies but human data are lacking. A few studies have been done to test effectiveness of dong quai for menopausal symptoms but results are inconclusive.

It’s important for breast cancer survivors to note: Dong quai has estrogen-like effects and it was shown to increase growth of breast cancer cells in laboratory experiments. It may also contain compounds that can cause cancer in high doses.

It appears that evening primrose oil is the least questionable of the popular “natural” remedies, but in actuality, it has not been shown to have any significant impact on hot flashes and other menopausal symptoms. Scientists have not figured out how exactly evening primrose oil exerts its effects, but theorize that it has anti-inflammatory activity. It may be beneficial for patients with mastalgia (breast pain). It may also help those with diabetes, heart disease, cancer, premenstrual syndrome, eczema, or high cholesterol but there is not enough data to support such effects.

So, while we would all love to find something truly natural that effectively pounces on hot flashes, night sweats, heart palpitations, anxiety, etc., to date nothing has been proven both safe and effective.

It is important for the lay community to remember that nearly all pharmaceuticals originate from a naturally occurring source, such as a plant. As an example, aspirin, which is a staple in nearly every medicine chest, originated with the willow tree.

Taming the temperature of your personal summer with acupuncture and meditation

According to ABC News, a 2011 study conducted by the Ankara Training and Research Hospital in Ankara, Turkey, concluded that acupuncture, which treats patients by inserting and manipulating needles in the body, curbs the severity of hot flashes and other menopausal symptoms, largely related to mood.

The authors based their findings on the experience of 53 postmenopausal women. The participants measured their symptoms using a 5-point scale before and after treatment.

Twenty-seven of the women received traditional Chinese acupuncture for 20 minutes, twice a week for 10 weeks. The rest thought they were given acupuncture treatment, but the needles didn't actually penetrate the skin. The women who received real acupuncture showed significant drops in the severity of their hot flashes -- and that's not just true of women in this study.

Dr. Arya Nielsen from the Beth Israel Medical Center Department of Integrative Medicine said acupuncture, which she has been performing for 35 years, is effective for women who are having menopausal symptoms -- and can help provide relief.

"I think women experience fewer hot flashes and less intensity when they have hot flashes, so it returns the quality of life," she said. "This is very significant."  Nielsen said that after a series of treatments, women experiencing menopausal symptoms generally "start to feel much more relaxed -- the anxiety is also associated with hot flashes."

By the second or third treatment, she said, patients come in and say, "Actually I'm not hot flashing during the day anymore, maybe a couple at night, and then that starts to decline as well."

In another 2011 study originally reported by U.S. News and World Report (and shared on the website HealthDay), it was reported that an easy-to-learn meditation technique could help ease the hot flashes, night sweats and insomnia of menopause. This University of Massachusetts research showed that mindfulness training, based on a Buddhist meditation concept, reduced the distress associated with hot flashes and improved physical, psychosocial and sexual functioning.

"The findings are important because hormone replacement therapy, used to treat menopause symptoms in the past, has been associated with health risks," said study author James Carmody, an associate professor of medicine in the division of preventive and behavioral medicine.

About 40 percent of menopausal women suffer from hot flashes and night sweats, which undermine their quality of life, the researchers noted. But since hormone replacement therapy has been linked with an increased risk of heart disease, breast cancer and stroke, Carmody observed that "not only are women looking for alternative treatments, it is an NIH (National Institutes of Health) priority to find behavioral treatments."

Mindfulness therapy helps focus on the present. Practitioners avoid making judgments and simply accept whatever is passing through their mind while focusing on each breath. The technique is not difficult to learn, but requires some discipline in the beginning, experts noted.

The researchers aimed to influence women's reaction to their symptoms, "including psychological distress, social embarrassment and anxiety."

"We wanted to see if we could affect women's resilience in response to these symptoms," Carmody explained. "We were not trying to affect the symptoms themselves, although there was some effect on those as well."

After taking classes once a week for eight weeks, and a full day of training, the training group women had an average decrease of 15 percent in how much their symptoms bothered them vs. 7 percent for the control group. While hot flash intensity did not differ significantly, the training group reported better sleep, and less anxiety and perceived stress.

"The thing that surprised us the most was the effect on sleep," said Carmody, noting that mindfulness training was found to be as effective as hormone replacement therapy in reducing insomnia.

So, it would appear that the take away message when it comes to acupuncture and meditation is that these modalities may very well represent your best bet when it comes to natural ways of approaching hot flashes, night sweats and insomnia.

A few common sense changes you can make right now

It may seem like a no-brainer, but sometimes combating hot flashes is as simple as dressing in layers so you can discard clothing as needed. Combining layers with a fan at your desk or workplace, drinking cold beverages – even opening a window if possible, can all help to decrease your body’s core temperature.

There are a number of companies making moisture-wicking products like sheets and pajamas. Take a look at what’s available to determine what will work for you. If night sweats are a major problem, investing in sheets and clothing to help keep this under control could save you many sleepless and uncomfortable nights.

Deep breathing techniques can shorten hot flashes and make them milder. Teach yourself to start slow, deep breaths as soon as you feel a flash coming on. Take as deep a breath as you can, and hold it a moment before letting it out slowly. Expanding your rib cage can help trigger the parasympathetic nervous system, which calms you down and helps regulate temperature.

Stay hydrated. Your body's cooling system is operating within a narrow margin of error during menopause, and a vital component of managing that system is providing enough water to keep it cool. Having a glass of water by you all day long, and refilling it often are ways to keep you from overheating and to replenish after a personal power surge!

Keep a damp towel or scarf close by so you can place it on your neck when a hot flash hits. This can be one of the quickest and most pleasurable methods available. In the midst of a hot flash, nothing feels much better than a cool, damp cloth.

Carry a spray mister filled with rose water or other fragranced waters in your purse. Spray the mist over the back of the neck. Or dab undiluted lavender essential oil on your wrists or temples.

Find a stylish hand fan and keep it handy! Those Southern Belles may have had the jump on knowing exactly how to coyly fan away a hot flash. Among many other great items for dealing with chemo, the site Cure Diva has a great selection of these sorts of fans.

If you’ve discovered a safe and effective way to either prevent or ease hot flashes (or any of the other symptoms associated with menopause) please share them with us. This is just one more piece of the always-changing survivor landscape in need of continued discussion, insights and sharing.

1. Rosenthal MS. Ethical problems with bioidentical hormone therapy. Int J Impot Res. 2008;20:45-52.