Menopausal hot flushes revisited

Vasomotor symptoms are generally recognized as one of the most common symptoms, or signs, of the menopause, together with menstrual cycle changes. The etiology of hot flushes is unknown, although several mechanisms have been implicated. The reduction in hot flushes with estrogen replacement therapy suggests a hormonal etiology. However, the levels of estrogens do not appear to correlate with hot flushes. It seems more likely that the rate of change of plasma estrogen concentrations influences the thermoregulatory system via the hypothalamus. During the past few decades, remedies for the treatment of hot flushes have advanced from simple sedatives and purgatives to the use of ovarian extracts and, finally, to pharmacological estrogen preparations. In view of the contraindications and side-effects of estrogens and progestogens in postmenopausal women, however, there is a need to consider treatments other than hormone replacement for the relief of hot flushes.