Blog of the Society for Menstrual Cycle Research

Of Hot Flushes, Lie Detectors, and Stress

March 7th, 2010 by Elizabeth Kissling

Guest Post by Jerilynn C. Prior, Centre for Menstrual Cycle and Ovulation Research

A hot flush causes failure on a lie detector test! The same galvanic skin response (in simple terms—clammy skin) is positive in both. Why? Because—with every flush—there is massive dogs’ breakfast of neurotransmitters and brain stress hormones released. These are the same brain chemicals that are produced as we struggle to create a plausible falsehood. Both arise from a fundamental, brain pathway that mediates both our physical and emotional responses to “threats” (be they nutritional, emotional, physical or some combination of stressors).

Some years ago a psychologist from London Ontario showed that menopausal women’s hot flushes were increased by stressful environment (1). Menopausal women who regularly experienced eight hot flushes a day attended two randomly-ordered 4-hour sessions a week apart. During the sessions they had flushes objectively documented by galvanic skin response. When they were forced to experience a chaotic environment, loud noises, unpleasant videos and bright lights, each of these women experienced more hot flushes; they did not in the alternative calm and pleasant session (1). Likewise, the large Study of Women Across the Nation showed that perimenopausal women who reported “trouble paying for basics” (like food and shelter) had more hot flushes than did those with economic and social security (2).

Given these fundamental relationships between hot flushes and stress, it is no wonder that “paced respiration,” “yoga breathing,” mindfulness meditation, the relaxation response, acupuncture, exercise training and many other techniques that reduce our central reaction to stress will decrease night sweats and hot flushes.

I totally agree with Janet Carpenter that women are eager to find non-pharmaceutical ways to decrease the number and intensity of night sweats and hot flushes (collectively called vasomotor symptoms, or VMS for short).  However, to put into perspective the new research being done by the investigators at the School of Nursing at Indiana University, we need to realize that the first randomized controlled trial of “yoga breathing” for VMS was published in 1984 (3) and followed in 1991 by a similar study using objective VMS measures (4). Subsequently, studies of acupuncture (5-8), relaxation (9) and relaxation plus other therapies (10) all show that they are better than placebo at decreasing VMS. [Editor’s note: As she stated in the Indianapolis Star interview published March 4, 2010, Dr. Carpenter is building upon previous research. She did not claim to invent the concept of managing hot flashes with breathing techniques.]

The research on hot flushes and our central stress response is just beginning. But the average 25-50% improvement in VMS in those taking placebos in trials of soy beverage (11) or hormone therapy (12) are evidence that believing a treatment is therapeutic is pretty effective all by itself.

Bioidentical Balderdash

January 1st, 2010 by Chris Hitchcock

The bioidentical hormone therapy industry has been getting a bad rap lately in the US, and this press release is an example of why. Among other things, the writer confuses estrogen and progesterone, in one paragraph saying their product is a “safe and scientifically-proven, all-natural estrogen delivery cream[]“, and in the next describing it as a “natural progesterone cream” (emphasis is mine). Moreover, the press release springboards from another estrogen-positive press release that claims that estrogen may be the cure for female depression, citing an ob/gyn author of a book, and promoting a soon-to-be-launched web page.

So, in one breath the product is an estrogen delivery cream that will help with low estrogen, but in the next breath (on the linked product page) it is argued that it will help with estrogen that is too high (which is more accurate). The product website emphasizes that  it is “without dangerous pharmaceuticals”:

This remarkable product contains NO risky synthetic estrogens or progestins. [Product] Cream is similar to the progesterone your body naturally produces, so there are no worries about dangerous interactions or nasty side effects.

It’s been said that there are no side effects, there are just effects. It is odd to marry this claim that their product won’t have nasty side effects (because it is like the progesterone in your body) with the claim that progesterone cream will balance out the nasty effects of your own high estrogen levels.

Progesterone cream may well be better tolerated, but just because it’s natural, doesn’t make it so.

And, interestingly, despite being anti-big Pharma, the article adopts the pharmaceutical industry’s language of menopause as “estrogen deficiency” that has been so helpful to those who would market “hormone replacement therapy” as a cure for all female ageing. As is still common, it is assumed that perimenopause (the transition leading up to the last period) is a time of dropping estrogen. There’s also the assumption that the challenging issues of midlife are necessarily hormonal (rather than multi-faceted, including not only biological changes, but also cultural views of ageing, social context, socioeconomic issues, divorce-related poverty, even spiritual and psychological development).

It’s unfortunate that bioidentical has come to be associated with fuzzy thinking and poorly supported claims, because there are good, solid, well-researched arguments in favour of using naturally occurring molecules for therapy, particularly for hot flushes and night sweats. We’re analyzing data from the first randomized placebo-controlled trial of oral micronized progesterone for hot flushes and night sweats in early menopause, and we should have some data later this year to report.

It’s also worth noting that other countries do it differently – Canadians can buy progesterone cream such as this, but they do it with a prescription, at a specified dose, and for a particular issue. And people who try to sell it over the counter in a health store are prosecuted.


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Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.