Browsing by Subject "Hot Flashes"
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Item Carbon Dioxide Challenge and Hot Flashes(Office of the Vice Chancellor for Research, 2013-04-05) Dorsey, Sarah E.; Carpenter, Janet S.Little is known about the pathophysiology of menopausal hot flashes, although there appear to be many similarities between hot flashes and panic attacks. While hot flashes occur at random and are difficult to study, there is a method of testing panic attacks. A Carbon Dioxide (CO2) Challenge is a validated method that has been used to induce panic attacks in a laboratory setting. The aim of this study is to test whether a CO2 Challenge using inhalations of 20% and 35% CO2 can provoke a hot flash in menopausal women. We hypothesize that women who have many hot flashes each day (4+) will have a hot flash when exposed to the increased concentration of CO2 using this challenge. Six healthy women attended a study session lasting ninety minutes. In this placebo controlled, cross-over study, women inhale room air, 20% CO2 for 40 seconds, rest for 15 minutes, and 35% CO2 using a double-breath vital capacity inhalation. Anxiety was measured on a numeric rating scale (NRS) and a State Trait Anxiety Inventory (STAI). Most participants have reported a hot flash within minutes of the CO2Challenge. There have been no significant changes in anxiety during the study. Findings provide evidence of the proposed link between hot flashes and panic.Item Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in women with hot flashes(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2015-11) Otte, Julie L.; Rand, Kevin L.; Landis, Carol A.; Paudel, Misti L.; Newton, Katherine M.; Woods, Nancy; Carpenter, Janet S.; IU School of NursingOBJECTIVE: Women, especially those with hot flashes, report poor sleep quality during various stages of the menopausal transition and postmenopause. Sleep measurements vary widely because of the copious instruments available. The Pittsburgh Sleep Quality Index (PSQI) is a frequently used questionnaire that produces a single score for sleep quality. This one-factor structure has not received consistent support in the literature. The goal of this analysis was to determine the best factor structure of the PSQI in women with hot flashes. METHODS: A confirmatory factor analysis was conducted on PSQI baseline data from three randomized controlled clinical trials enrolling perimenopausal and postmenopausal women with hot flashes (N = 849) from the Menopause Strategies: Finding Lasting Answers for Symptoms and Health network. Several a priori factor models were compared. RESULTS: One-factor and two-factor models did not fit the data. A three-factor model comprising sleep efficiency, perceived sleep quality, and daily disturbance showed good fit; however, the sleep medication item was dropped because of poor fit and low rates of sleep medication use. The three-factor model was examined in African-American and white subsamples and was found to be similar in both groups; however, two items showed small group differences in strength as indicators. CONCLUSIONS: Sleep quality in midlife women with hot flashes, as measured by the PSQI, seems to comprise three correlated factors. Minor measurement differences detected between groups are of research interest but do not necessitate different scoring practices. Additional research is needed to further define sleep quality and its associations with health-related outcomes.Item Efficacy of yoga for vasomotor symptoms: a randomized controlled trial(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2014-04) Newton, Katherine M.; Reed, Susan D.; Guthrie, Katherine A.; Sherman, Karen J.; Booth-LaForce, Cathryn; Caan, Bette; Sternfeld, Barbara; Carpenter, Janet S.; Learman, Lee A.; Freeman, Ellen W.; Cohen, Lee S.; Joffe, Hadine; Anderson, Garnet L.; Larson, Joseph C.; Hunt, Julie R.; Ensrud, Kristine E.; LaCroix, Andrea Z.; IU School of NursingOBJECTIVE: This study aims to determine the efficacy of yoga in alleviating vasomotor symptoms (VMS) frequency and bother. METHODS: This study was a three-by-two factorial, randomized controlled trial. Eligible women were randomized to yoga (n = 107), exercise (n = 106), or usual activity (n = 142), and were simultaneously randomized to a double-blind comparison of ω-3 fatty acid (n = 177) or placebo (n = 178) capsules. Yoga intervention consisted of 12 weekly 90-minute yoga classes with daily home practice. Primary outcomes were VMS frequency and bother assessed by daily diaries at baseline, 6 weeks, and 12 weeks. Secondary outcomes included insomnia symptoms (Insomnia Severity Index) at baseline and 12 weeks. RESULTS: Among 249 randomized women, 237 (95%) completed 12-week assessments. The mean baseline VMS frequency was 7.4 per day (95% CI, 6.6 to 8.1) in the yoga group and 8.0 per day (95% CI, 7.3 to 8.7) in the usual activity group. Intent-to-treat analyses included all participants with response data (n = 237). There was no difference between intervention groups in the change in VMS frequency from baseline to 6 and 12 weeks (mean difference [yoga--usual activity] from baseline at 6 wk, -0.3 [95% CI, -1.1 to 0.5]; mean difference [yoga--usual activity] from baseline at 12 wk, -0.3 [95% CI, -1.2 to 0.6]; P = 0.119 across both time points). Results were similar for VMS bother. At week 12, yoga was associated with an improvement in insomnia symptoms (mean difference [yoga - usual activity] in the change in Insomnia Severity Index, 1.3 [95% CI, -2.5 to -0.1]; P = 0.007). CONCLUSIONS: Among healthy women, 12 weeks of yoga class plus home practice, compared with usual activity, do not improve VMS frequency or bother but reduce insomnia symptoms.Item Estrogen receptor genotypes influence hot flash prevalence and composite score before and after tamoxifen therapy.(ASCO, 2008-12-20) Jin, Yan; Hayes, Daniel F.; Li, Lang; Robarge, Jason D.; Skaar, Todd C.; Philips, Santosh; Nguyen, Anne; Schott, Anne; Hayden, Jill; Lemler, Suzanne; Storniolo, Anna Maria; Flockhart, David A.; Stearns, VeredPURPOSE: Hot flashes are common and frequently lead to drug discontinuation among women prescribed tamoxifen. We determined whether genetic polymorphisms in estrogen receptors (ESRs) alpha and beta (ESR1 and ESR2, respectively) are associated with tamoxifen-induced hot flashes. PATIENTS AND METHODS: We determined ESR1 PvuII and XbaI and ESR2-02 genotypes in 297 women who were initiating tamoxifen. One-week hot flash diaries were collected to calculate a hot flash score (frequency x severity) before and 1, 4, 8, and 12 months after starting tamoxifen. RESULTS: Approximately 80% of 297 participants reported hot flashes before or during the first year of tamoxifen. After 4 months of tamoxifen, premenopausal women who did not receive adjuvant chemotherapy had a four-fold increase in hot flash score (from 5.9 to 23.6; P = .003) compared with a 1.17-fold increase (from 19.6 to 23; P = .34) in those who received chemotherapy. In premenopausal women, increased number of ESR1 PvuII and XbaI CG alleles was associated with higher baseline hot flash scores compared with those who had other haplotypes (P = .0026). At 4 months, postmenopausal women with ESR1 PvuII CC and ESR2-02 GG genotypes had 4.6 times increases in hot flash scores than other postmenopausal women (56 v 12; P = .0007). Women who had the ESR2-02 AA genotype were significantly less likely to experience tamoxifen-induced hot flashes than women who carried at least one ESR-02 G allele (hazard ratio, 0.26; 95% CI, 0.10 to 0.63; P = .001). CONCLUSION: Knowledge of menopausal status, prior chemotherapy, and ESR genotype may help predict which women are most likely to suffer hot flashes during tamoxifen treatment.Item Evaluating the role of serotonin in hot flashes after breast cancer using acute tryptophan depletion.(Wolters Kluwer, 2009) Carpenter, Janet S.; Yu, Menggang; Wu, Jingwei; Von Ah, Diane; Milata, Jennifer; Otte, Julie L.; Johns, Shelley; Schneider, Bryan; Storniolo, Anna Maria; Salomon, Ronald; Desta, Zeuresenay; Cao, Donghua; Jin, Yan; Philips, Santosh; Skaar, Todd C.OBJECTIVE: Among women with breast cancer, hot flashes are frequent, severe, and bothersome symptoms that can negatively impact quality of life and compromise compliance with life-saving medications (eg, tamoxifen and aromatase inhibitors). Clinicians' abilities to treat hot flashes are limited due to inadequate understanding of physiological mechanisms involved in hot flashes. Using an acute tryptophan depletion paradigm, we tested whether alterations in central serotonin levels were involved in the induction of hot flashes in women with breast cancer. METHODS: This was a within-participant, double-blind, controlled, balanced, crossover study. Twenty-seven women completed two 9-hour test days. On one test day, women ingested a concentrated amino acid drink and encapsulated amino acids (no tryptophan) according to published procedures that have been shown to have specific effects on serotonin within 4.5 to 7 hours. On the other test day, women ingested a control drink. Serial venous blood sampling and objective hot flash monitoring were used to evaluate response to each condition. RESULTS: Response to acute tryptophan depletion was variable and unexplained by use of selective serotonin reuptake inhibitors, antiestrogens, breast cancer disease and treatment variables, or genetic polymorphisms in serotonin receptor and transporter genes. Contrary to our hypothesis, hot flashes were not worsened with acute tryptophan depletion. CONCLUSIONS: Physiologically documented and self-reported hot flashes were not exacerbated by tryptophan depletion. Additional mechanistic research is needed to better understand the etiology of hot flashes.Item Menopause and Big Data: Word Adjacency Graph Modeling of Menopause-Related ChaCha® Data(Wolters Kluwer, 2017-07) Carpenter, Janet S.; Groves, Doyle; Chen, Chen X.; Otte, Julie L.; Miller, Wendy; School of NursingOBJECTIVE: To detect and visualize salient queries about menopause using Big Data from ChaCha. METHODS: We used Word Adjacency Graph (WAG) modeling to detect clusters and visualize the range of menopause-related topics and their mutual proximity. The subset of relevant queries was fully modeled. We split each query into token words (ie, meaningful words and phrases) and removed stopwords (ie, not meaningful functional words). The remaining words were considered in sequence to build summary tables of words and two and three-word phrases. Phrases occurring at least 10 times were used to build a network graph model that was iteratively refined by observing and removing clusters of unrelated content. RESULTS: We identified two menopause-related subsets of queries by searching for questions containing menopause and menopause-related terms (eg, climacteric, hot flashes, night sweats, hormone replacement). The first contained 263,363 queries from individuals aged 13 and older and the second contained 5,892 queries from women aged 40 to 62 years. In the first set, we identified 12 topic clusters: 6 relevant to menopause and 6 less relevant. In the second set, we identified 15 topic clusters: 11 relevant to menopause and 4 less relevant. Queries about hormones were pervasive within both WAG models. Many of the queries reflected low literacy levels and/or feelings of embarrassment. CONCLUSIONS: We modeled menopause-related queries posed by ChaCha users between 2009 and 2012. ChaCha data may be used on its own or in combination with other Big Data sources to identify patient-driven educational needs and create patient-centered interventions.Item Metabolic activity in the insular cortex and hypothalamus predicts hot flashes: an FDG-PET study(OUP, 2012-09) Joffe, Hadine; Deckersbach, Thilo; Lin, Nancy U.; Makris, Nikos; Skaar, Todd C.; Rauch, Scott L.; Dougherty, Darin D.; Hall, Janet E.CONTEXT: Hot flashes are a common side effect of adjuvant endocrine therapies (AET; leuprolide, tamoxifen, aromatase inhibitors) that reduce quality of life and treatment adherence in breast cancer patients. Because hot flashes affect only some women, preexisting neurobiological traits might predispose to their development. Previous studies have implicated the insula during the perception of hot flashes and the hypothalamus in thermoregulatory dysfunction. OBJECTIVE: The aim of the study was to understand whether neurobiological factors predict hot flashes. DESIGN: [18F]-Fluorodeoxyglucose (FDG) positron emission tomography (PET) brain scans coregistered with structural magnetic resonance imaging were used to determine whether metabolic activity in the insula and hypothalamic thermoregulatory and estrogen-feedback regions measured before and in response to AET predict hot flashes. Findings were correlated with CYP2D6 genotype because of CYP2D6 polymorphism associations with tamoxifen-induced hot flashes. OUTCOME MEASURES: We measured regional cerebral metabolic rate of glucose uptake (rCMRglu) in the insula and hypothalamus on FDG-PET. RESULTS: Of 18 women without hot flashes who began AET, new-onset hot flashes were reported by 10 (55.6%) and were detected objectively in nine (50%) participants. Prior to the use of all AET, rCMRglu in the insula (P ≤ 0.01) and hypothalamic thermoregulatory (P = 0.045) and estrogen-feedback (P = 0.007) regions was lower in women who reported developing hot flashes. In response to AET, rCMRglu was further reduced in the insula in women developing hot flashes (P ≤ 0.02). Insular and hypothalamic rCMRglu levels were lower in intermediate than extensive CYP2D6 metabolizers. CONCLUSIONS: Trait neurobiological characteristics predict hot flashes. Genetic variability in CYP2D6 may underlie the neurobiological predisposition to hot flashes induced by AET.Item SOMATOSENSORY AMPLIFICATION AND MENOPAUSAL SYMPTOMS IN BREAST CANCER SURVIVORS AND MIDLIFE WOMEN(Elsevier, 2014-05) Carpenter, Janet S.; Igega, Christele M.; Otte, Julie L.; Burns, Debra S.; Yu, Menggang; Wu, Jingwei; IU School of NursingOBJECTIVES Somatosensory amplification is the experience of sensing everyday bodily sensations as intense, agitating, and unpleasant. Using data from menopausal breast cancer survivors and midlife women without cancer, the study purposes were to (1) explore the psychometric properties of the Somatosensory Amplification Scale and (2) to describe somatosensory amplification and its relationship to menopausal symptoms of hot flashes, mood and sleep disturbance. STUDY DESIGN This was a cross-sectional, descriptive, correlational study using demographic, e-diary, and questionnaire data from 99 breast cancer survivors and 138 midlife women. MAIN OUTCOME MEASURES Somatosensory amplification, hot flashes (frequency, severity, bother, interference, perceived control), mood, and sleep. RESULTS Cronbach’s alphas for the scale were low. When an 8-item version of the scale was evaluated, alphas improved and item-total correlations remained strong or improved. Midlife women and breast cancer survivors did not have significantly different somatosensory amplification total or item scores after adjusting for group differences in demographics. Somatosensory amplification was significantly correlated with hot flash interference, perceived control over hot flashes, and mood and sleep disturbance in both groups but the patterns of correlations differed slightly between groups and depending on whether the 10-item or 8-item scale was used. CONCLUSION Somatosensory amplification may be a relevant concept to assess in relation to the menopausal symptom experience of midlife women with and without breast cancer as it may represent a potential intervention target to improve the menopausal symptom experience.Item Surgical Model of Menopause Symptoms: GABA’S Role in Anxiety and Hot Flashes(Office of the Vice Chancellor for Research, 2013-04-05) Frink, AnnaMenopause is the permanent cessation of the primary functions of the human ovaries: the ripening and release of the ova, and the release of hormones that create the uterine lining. The transition from a reproductive to non-reproductive state is a result of a reduction in sex hormone production by the ovarian follicular cells due to their degeneration. For some women, the accompanying signs of and effects that can occur during the menopause transition years can significantly disrupt their daily activities and sense of well-being; symptoms include vasomotor instability (hot flashes and night sweats), anxiety, and sleep disruption. Unfortunately, animal modeling to understand these symptoms, particularly “hot flashes” has been limited and lacks predictive and construct validity. We have developed a novel model of “hot flashes” by injecting a 3 mg/kg (intraperitoneal administration) dose of the anxiogenic drug FG-7142 (a partial inverse agonist at the benzodiazepine site on the GABAA receptor) following bilateral ovariectomy. Previous work in our lab has determined that this injection elicits a rapid, 9° Celsius increase in tail skin temperature (the indicator of the “hot flash” response in a rat) in ovariectomized rats but not in sham-operated control rats. However, the neural sites that mediate this response are unknown. We hypothesized that there are significant differences in either the anatomical sites involved in the “hot flash” response in ovariectomized rats or the extent of activation of the same neural sites. To test this hypothesis, female rats were either bilaterally ovariectomized or sham-ovariectomized; following recovery, rats were given a 3 mg/kg dose of FG-7142 or vehicle and perfused 90 min later. Tissue was processed and stained for the immediate early gene product c-fos. It was determined that the ovariectomized rats had a hyperactive response in the hypothalamic brain region associated with anxiety and thermoregulation (i.e., dorsal medial hypothalamus).