Menopausal hot flushes and night sweats: where are we now?

Objective An overview of the current knowledge on the etiology and treatment of vasomotor symptoms in postmenopausal women. Materials and methods Acknowledged experts in the fi eld contributed a brief assessment of their areas of interest which were combined and edited into the fi nal manuscript. Results Women around the world experience vasomotor symptoms as they enter and complete the menopause transition. Vasomotor symptoms, specifi cally hot fl ushes, 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 fl ushes. Of the other interventions investigated, selective serotonin and selective norepinephrine reuptake inhibitors and gabapentin show effi cacy greater than placebo. Objective monitoring of hot fl ushes 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 fl ushes have recently been associated with increased cardiovascular risks and a lower incidence of breast cancer, but these data require confi rmation. 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 fl ushes indicates that placebo has little to no effect on their improvement. Subjective assessments of hot fl ushes in clinical trials may be inaccurate based on objective measurement of the frequency of hot fl ushes. Based on preliminary reports, women experiencing hot fl ushes have an increased risk of cardiovascular disease and a reduced incidence of breast cancer. [ABSTRACT FROM AUTHOR]