Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0600142 (hot flushes)
 1,242 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

More than 1 million women are expected to reach menopause each year, many of whom will experience hot flushes and other neuropsychological symptoms that may diminish their quality of life. Hot flushes are the core symptoms that reflect the brain's response to the changing hormonal milieu of the menopause transition, particularly to the rapidly fluctuating and falling levels of estradiol. The physical symptoms of hot flushes and the associated changes in sleep, mood, and cognition will lead many women to seek medical care. It is critical to understand the interrelationship of hot flushes and other neuropsychological symptoms of the menopause transition so that treatment priorities can be established. For example, if sleep disruption explains most daytime neuropsychological problems in women with hot flushes, treating insomnia should be considered a priority. Alternatively, mood, cognition, and quality of life may be disturbed independent of sleep problems. In such a situation, each symptom should be evaluated separately from any assessment of sleep. As recent data from the WHI establish the risks of long-term HRT use, concern about using HRT, even as a short-term intervention, has increased substantially. Although HRT remains the first-line treatment for hot flushes, the WHI findings have drawn attention to nonhormonal treatments of hot flushes and other menopausal symptoms. Growing evidence to support the efficacy of serotonergic antidepressants and other psychoactive medications in the treatment for hot flushes suggests that nonhormonal interventions will prove important alternatives to HRT. As further evidence of the benefits of psychoactive medications for menopausal symptoms is established, the choice between using hormonal and nonhormonal therapies for management of menopausal symptoms will continue to evolve.
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PMID:Assessment and treatment of hot flushes and menopausal mood disturbance. 1456 98

That gonadal steroids influence the limbic system and that they affect neurotransmitter activity is undisputed. Because of these known actions, and because ET and HT alleviate hot flushes and resultant sleep disturbances, they may improve mood and sense of well-being in healthy climacteric women. However, estrogen plus progestin did not decrease depressive symptoms in the WHI, the largest double-blind, placebo-controlled trial of hormone replacement yet performed. In addition, although several studies have suggested efficacy in this regard, neither ET nor HT has been proved to be therapeutic for major depression in perimenopausal and menopausal women. Certainly, further studies are needed on the potential of estrogen as an antidepressant. Based on current evidence, however, one cannot prescribe ET or HT as primary treatment for major depression in good conscience. When treating patients far this serious problem, one cannot rely on theory and the desire that it be borne out. As Sigmund Freud wrote: "Thus we call a belief an illusion when a wish-fulfillment is a prominent factor in its motivation, and in doing so we disregard its relation to reality, just as the illusion itself set, no store by verification". Since the initial publication of the results of the WHI, clinicians have learned to be cautious when making decisions about therapy that has not been proved in randomized controlled trials. In addition, attention has shifted away from potential global effects of ET and HT toward more specific management of each specific clinical sequela of menopause. If major depression is to be addressed in this way, SSRIs become first-line therapy, with TCAs considered second-line because of reduced tolerability. ET and HT may be added separately as appropriate, and may be helpful on an individual basis. Indeed, treatment for major depression in any person, male or female, at any age, is best chosen based on life situation and the neuropsychology of the condition, and not based on gender alone.
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PMID:Gonadal steroids, selective serotonin reuptake inhibitors, and mood disorders in women. 1462 31

Since the diffusion of the WHI's trial and MWS results, which reported a negative risk/benefit balance of hormone therapy, the management of postmenopausal women has deeply changed over the last 2-3 years. In particular, for the prevention of osteoporosis, the use of other efficient agents tends now to be more widely recommended rather than estrogens. The SERMs with raloxifene are new molecules that have estrogen agonist effects on bone and estrogen antagonist or neutral effects on endometrial and breast tissue. The efficacy of raloxifene to inhibit postmenopausal bone loss as well as to reduce the incidence of vertebral fractures has been demonstrated in women at high risk for osteoporosis through a large randomized placebo-controlled trial involving several thousands of postmenopausal women (MORE trial). Furthermore, the extraskeletal effects of raloxifene might represent an advantage for a global management approach of postmenopausal women, although to date, its exclusive indication is namely the prevention of osteoporosis. However, the estrogen antagonist effects of raloxifene on breast tissue as well as its good safety profile with regard to both the endometrium and the risk of heart diseases are likely to make raloxifene of particular interest for women around the age of 60 years old. Adverse events associated with raloxifene only included an increase in the absolute risk of venous thromboembolism in a comparable manner as with estrogen therapy. Also, its lack of efficacy in reducing hot flushes or preventing vaginal dryness may limit its use in young symptomatic postmenopausal women. Also, its lack of reimbursement in women with no prior fragility fracture must be taken into account.
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PMID:[Raloxifene in postmenopausal women]. 1648 22