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.

Reference List

1. Swartzman LC, Edelberg R, Kemmann E. Impact of stress on objectively recorded menopausal hot flushes and on flush report bias. Health Psychology 1990;9:529-45.
2. Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am.J.Epidemiol. 2000;152:463-73.
3. Germaine LM, Freedman RR. Behavioral treatment of menopausal hot flashes: evaluation by objective methods. J Consult Clin Psychol. 1984;52(6):1072-9.
4. Freedman RR, Woodward S. Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am.J.Obstet.Gynecol. 1991;167:436-9.
5.  Wyon Y, Lindgren R, Lundeberg T, Hammar M. Effects of acupuncture on climacteric symtpoms, quality of life and urinary excretion of neuropeptides among postmenopausal women. Menopause 1995;2(1):3-12.
6. Hammar M, Frisk J, Grimas O, Hook M, Spetz AC, Wyon Y. Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: a pilot study. J Urol. 1999;161(3):853-6.
7.  Borud EK, Alraek T, White A, Fonnebo V, Eggen AE, Hammar M et al. The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial. Menopause 2009;16(3):484-93.
8.  Zhou J, Qu F, Sang X, Wang X, Nan R. Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized Chinese Women: A Randomized Controlled Trial. Evid.Based.Complement Alternat.Med 2009.
9. Wijma K, Melin A, Nedstrand E, Hammar M. Treatment of menopausal symptoms with applied relaxation: a pilot study. J.Behav.Ther.Exp.Psychiatry 1997;28(4):251-61.
10.  Ganz PA, Greendale GA, Petersen L, Zibecchi L, Kahn B, Belin TR. Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Natl.Cancer Inst. 2000;92(13):1054-64.
11.  Van Patten CL, Olivotto IA, Chambers GK, Gelman KA, Hislop TG, Templeton E et al. Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. J.Clin.Oncol. 2002;20:1449-55.
12. MacLennan A, Lester S, Moore V. Oral estrogen replacement therapy versus placebo for hot flushes: a systematic review. Climacteric. 2001;4(1):58-74.