Foiling Intractable Hot Flashes
Relief May Be A Simple Five-Minute Procedure
Hot flashes, while uncomfortable and annoying, typically do not cause more than momentary discomfort. Most women in the US experience at least mild hot flashes during perimenopause and menopause. Almost all women who have induced menopause due to hysterectomy or chemotherapy treatment for breast cancer suffer at some point from hot flashes and/or their overnight counterpart, night sweats.
Caused by a decrease in hormone levels, hot flashes are not indicative of a medical problem, but are simply the body’s reaction to changes in estrogen levels. Many women simply get through them with no medical intervention or significant lifestyle change. Others find relief through using a variety of nonprescription treatments and coping strategies. These may include:
Dietary changes (eating more healthfully, limiting alcohol intake, taking Vitamin B complex and Vitamin E)
Smoking cessation
Staying cool (using fans, wearing natural fiber clothing, dressing in layers)
Exercising
Reducing stress
Utilizing relaxation techniques
Some women find it necessary, due to the disruption hot flashes cause in their lives, to seek medical intervention. One of the most successful treatments has been menopausal hormone therapy (MHT),which is very effective for most women who use this method. Because hot flashes are caused by decreased levels of estrogen, this treatment alleviates the problem because it replaces the hormones that are naturally declining in the body
However, concern about potential side effects and risk of long-term use detracts from the benefits of menopausal hormone therapy. Some women experience a higher risk of blood clots, heart disease, stroke, breast or ovarian cancer, and dementia when exposed to prescribed estrogens. Using the lowest dose possible for the shortest amount of time will help to decrease these risks, but the dosage and time will affect each woman differently. Although MHT has very good results, some patients may not want to run the risks of developing other problems in the future. Other women cannot use the MHT option because they may harbor an estrogen-positive cancer.
Hot Flashes Treatments
Some additional medical options for treating hot flashes include the blood pressure medicine Clonidine and antidepressants that are selective serotonin reuptake inhibitors (SSRI). Clonidine has been shown to have a 50% response rate, although in one study women who received a placebo also showed a 45-50% reduction in hot flashes—about the same as with the drug.
Some patients have side effects to SSRIs, including nervousness (jittery) and elevated temperature. As is the case with many treatments, the side effects seem to be as bad or worse than the problem you’re trying to treat.
For a small number of women for whom these and other common treatments either don’t work or are not an option, suffering from hot flashes becomes more than an annoyance—it affects their daily life and causes disruption to their sleep, which in combination can create a vicious cycle of frustration, exhaustion, and mental duress.
Another option exists, however.
Dr. Ben Taimoorazy of Beverly Hills Migraine and Pain Management Institute explains that a new treatment for hot flashes is really not a “new” procedure at all, but is a coincidental result of a procedure commonly performed to alleviate a variety of pain disorders, specifically those that affect only one side of the head or upper extremities. Physicians found that women who had received this treatment for pain from issues such as shingles or complex regional pain syndrome (CRPS) no longer had hot flashes after being treated. Specific studies have since taken place, and the procedure began being used as a treatment for intractable hot flashes about a year ago.
The procedure, a Stellate Ganglion Block (SGB), is done under x-ray with the patient lightly sedated. The nerve that connects the insular cortex of the brain and the stellate ganglion in the neck is anesthetized using a small needle and a small amount of local anesthetic. The medication itself lasts only for a few hours, but the relief from hot flashes lasts 9-12 months.
“Ninety to one hundred percent of patients have 100% relief from hot flashes for about a year with only one injection and without other medication or side effects,” says Dr. Benjamin Taimoorazy.
Researchers have found that decreased amounts of estrogen cause the increase production of nerve growth factor in the insular cortex of the brain, which results in increased amounts of norepinephrine. Norepinephrine is the insular cortex is higher in patients with hot flashes, so decreasing the amount of nerve growth factor and thus blocking the production of norepinephrine produced in the brain using a small amount of anesthesia by performing a SGB, results in the elimination of hot flashes for the patient.
Dr. Taimoorazy recommends trying routine management strategies for hot flashes first, “but if those don’t work, and especially for the 10-15% or women who have tried everything or for various reasons cannot use other treatment methods, this procedure can be very beneficial.”
