Smoking, Obesity Worsen Hot Flashes

Studies show promise for relief from classic symptoms

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HealthDay Reporter

FRIDAY, Jan. 31, 2003 (HealthDayNews) -- If you want more control over the hot flashes of menopause, try losing weight and avoiding smoking.

New research conducted at the University of Maryland School of Medicine found that women who have excess body fat, as well as those who smoke, have more frequent and more severe episodes of the troubling flashes.

The research, published in the February issue of Obstetrics and Gynecology, gives new credence to the rapidly growing belief that lifestyle factors play a major role in orchestrating some symptoms of menopause. What doctors don't know right now is whether altering your lifestyle habits -- such as quitting smoking or losing weight -- will make a difference once the symptoms have begun.

"Either scenario is possible, but our study was cross-sectional in nature so we just observed the differences by weight and smoking status," says study author Jodi Flaws. Future research, she says, should determine if stopping smoking or losing weight can help deter the onset of hot flashes or reduce their severity once they have started.

For Dr. Steven Goldstein, the study represents a win-win situation for women: "It adds to the body of evidence that quitting smoking and losing weight is not only good for your heart, good for your lungs, and good for your bones, but it may also make you more comfortable. This study definitely goes in the right direction," says Goldstein, a professor of obstetrics and gynecology at New York University Medical Center.

The new research involved more than 1,000 women suffering from hot flashes. Each answered a highly detailed questionnaire designed to detail their hot flash experiences, as well as provide information on weight, smoking, diet, and several other lifestyle factors.

As the answers were analyzed, one finding continued to appear: Women who smoked had a much higher incidence of hot flashes -- more than twice that of the nonsmokers. What's more, the study found the more cigarettes a woman smoked, the greater the severity of her hot flashes.

Obese women -- those with a body mass index (BMI), a measurement of the level of body fat, of 30 or greater -- were twice as likely to be troubled by hot flashes than women with a BMI under 25.

If you can't quit smoking or give up your chips and dip, there's more hope on the horizon. A second study in the journal reveals that ultra-low doses of the anti-convulsion drug gabapentin may help control hot flashes, without any of the troubling side effects now linked to hormone replacement therapy (HRT).

Here, researchers from the University of Rochester found that after just 12 weeks of low daily doses of gabapentin, women experienced a 45 percent reduction in the frequency of their hot flashes and a 54 percent reduction in the combined effects of both flash frequency and severity. The control group -- which took a placebo pill -- reported less than a 30 percent change in their hot flash symptoms.

The benefits were not without some side effects for about 50 percent of the women. Among the most common were sleepiness (20 percent), dizziness (13 percent), and rash or mild swelling (6 percent). In most instances, however, problems disappeared several weeks into treatment, with an encouraging 81 percent of the women requesting to continue treatment after the study ended.

Researchers say they aren't sure how or why gabapentin works, but they suspect it may interact with calcium in brain cells, encouraging changes in the central nervous system that are linked to hot flashes.

The study's lead author is listed as "inventor" on a new patent that is owned by the University of Rochester for the use of gabapentin for the treatment of hot flashes. Although he is entitled to a portion of any funds earned by the drug for this purpose, no revenues have been generated to date.

In a third study in the current issue of Obstetrics and Gynecology, doctors from the University of South Florida and Washington University in St. Louis offer new hope for women suffering from both vaginal dryness and the risk of osteoporosis by proving two popular menopausal treatments can be safely combined.

Those treatments are the bone-building drug raloxifene and low-dose estrogen creams used in the vagina to combat the tissue shrinkage and dryness associated with menopause.

Because raloxifene affects the way estrogen is used by certain cells in the body, the common belief was that it could also interfere with the ability of any estrogen-based cream to provide relief. In fact, doctors even suspected that nonhormonal vaginal creams might not work as well when used in conjunction with raloxifene.

Now, at least some of the doubt has been erased. The new study of 187 women -- half of whom were given raloxifene and half a placebo -- found no difference in the ability of either type of vaginal cream to control symptoms of dryness. Both groups of women found relief from low-dose estrogen creams as well as nonhormonal vaginal creams, with no increased risk of side effects. The new study was supported by a grant from Eli Lilly and Co., the maker of raloxifene.

More information

For more information on alternative treatments for hot flashes and other symptoms of menopause, visit the North American Menopause Society.. To learn more about treatments for osteoporosis, check out the National Library of Medicine.

SOURCES: Jodi Flaws, Ph.D., associate professor, Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore; Steven Goldstein, M.D., professor, obstetrics and gynecology, New York University Medical Center, New York; February 2003 Obstetrics and Gynecology

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