The Basis of Menopausal Vasomotor Symptoms

  • Howard L. Judd

Abstract

In women the most common and characteristic symptom of the climacteric is an episodic disturbance consisting of sudden flushing and perspiration, referred to as a “hot flush or flash.” It has been observed in 65–76% of women who experience a natural or surgical menopause (Hannan, 1927; Neugarten and Kraines, 1965; Jaszmann et al., 1969; Thompson et al., 1973; McKinlay and Jeffreys, 1974). Of those having flushes, 82% will experience the disturbance for more than 1 year (Jaszmann et al., 1969) and 25–85% will complain of the symptom for more than 5 years (Neugarten and Krains, 1969; Thompson et al., 1973).

Keywords

Placebo Estrogen Dopamine Morphine Prostaglandin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bligh, J., 1973, Temperature Regulation in Mammals and Other Vertebrates, North-Holland Publishing, Amsterdam.Google Scholar
  2. Carmel, P. W., Araki, S. and Ferin, M., 1976, Pituitary stalk portal blood collection in rhesus monkeys: Evidence for pulsatile release of gonadotropin-releasing hormone (GnRH), Endocrinology 99:243–248.PubMedCrossRefGoogle Scholar
  3. Casper, R. F., and Yen, S. S. C., 1982, Menopausal flushes: Effect of pituitary gonadotropin desensitization by a potent luteinizing hormone-releasing factor agonist, J. Clin. Endocrinol. Metab. 53:1056–1058.CrossRefGoogle Scholar
  4. Casper, R. F., Yen, S. S. C. and Wilkes, M. M., 1979, Menopausal flushes: A neuroendocrine link with pulsatile luteinizing hormone secretion, Science 205:823–825.PubMedCrossRefGoogle Scholar
  5. Cooper, K. E., Cranston, W. I., and Snell, E. S., 1964, Temperature regulation during fever in man, Clin. Sci. 27:345–356.PubMedGoogle Scholar
  6. Cox, B., and Lomax, P., 1977, Pharmacologic control of temperature regulation, Annu. Rev. Pharmacol. Toxicol. 17:341–353.PubMedCrossRefGoogle Scholar
  7. Crowley, W. F., Jr., and McArthur, J. W., 1980, Simulation of the normal menstrual cycle in Kallman’s Syndrome by pulsatile administration of luteinizing hormone-releasing hormone (LHRH), J. Clin. Endocrinol, Metab. 51:173–175.CrossRefGoogle Scholar
  8. Crowley, W. R., O’Donohue, T. L., Wachslicht, H., and Jacobowitz, D. M., 1978, Effects of estrogen and progesterone on plasma gonadotropins and on catecholamine levels and turnover in discrete brain regions of ovariectomized rats, Brain Res. 154:345–357.PubMedCrossRefGoogle Scholar
  9. DeFazio, J., Meldrum, D., Laufer, L., Vale, W., Rivier, J., Lu, J., and Judd, H., 1983, Induction of hot flashes in premenopausal women treated with a long acting GnRH agonist, J. Clin. Endocrinol. Metab. 56:445–448.PubMedCrossRefGoogle Scholar
  10. DeFazio, J., Verheugen, C., Chetkowski, R., Nass, T., Judd, H. L., and Meldrum, D. R., 1984, The effects of naloxone on hot flashes and gonadotropin secretion in postmenopausal women, J. Clin. Endocrinol. Metab. 58:578–581.PubMedCrossRefGoogle Scholar
  11. DeMorsier, G., and Gauthier, G., 1963, La dysplasie olfacto-genitale, Pathol. Biol. (Paris) 11:1267–1272.Google Scholar
  12. Eskay, R. L., Mical, R. S., and Porter, J. C., 1977, Relationship between luteinizing hormone releasing hormone concentration in hypophysial blood and luteinizing hormone release in intact, castrated and electrochemically-stimulated rats, Endocrinology 100:263–270.PubMedCrossRefGoogle Scholar
  13. Gambone, J., Meldrum, D., Laufer, L., Chang, J., Lu, J., and Judd, H., 1982, Further delineation of hypothalamic dysfunction responsible for menopausal hot flashes. Proc. 29th Annual Meeting Soc. Gynecol. Invest., Dallas, Texas. March 24-27, 1982, Ab. #60.Google Scholar
  14. Hannan, J. H., 1927, The Flushings of the Menopause, Bailliere, Tindall and Cox, London, pp. 1-22.Google Scholar
  15. Houston, M., 1981, Clonidine hydrochloride: Review of pharmacologic and clinical aspects, Prog. Cardiovasc. Dis. 23(5):337–350.PubMedCrossRefGoogle Scholar
  16. Jaszmann, L., Van Lith, N. D., and Zaat, J. C. A., 1969, The perimenopausal symptoms, Med. Gynecol. Sociol. 4:268–276.Google Scholar
  17. Judd, H. L., 1983, Pathophysiology of menopausal hot flushes, in: Neuroendocrinology of Aging (J. Meites, ed.), Plenum Press, New York, pp. 173–202.Google Scholar
  18. Kluger, M. J., 1978, The evolution and adaptive value of fever, Ann. Sci. 66:38–43.Google Scholar
  19. Kobayashi, R. M., Lu, K. H., Moore, R. Y., and Yen, S. S. C., 1978, Regional distribution of hypothalamic luteinizing hormone-releasing hormone in proestrous rats: effects of ovariectomy and estrogen replacement, Endocrinology 102:98–105.PubMedCrossRefGoogle Scholar
  20. Krey, L. C., Butler, W. R., and Knobil E., 1975, Surgical disconnection of the medial basal hypothalamus and pituitary function in the rhesus monkey. I. Gonadotropin secretion, Endocrinology 96:1073–1087.PubMedCrossRefGoogle Scholar
  21. Larsen, I. F., 1977, Hot flashes after hypophysectomy, Br. Med. J. 2:1356.PubMedCrossRefGoogle Scholar
  22. Laufer, L. R., Erlik, Y., Meldrum, D. R., and Judd, H. L., 1982, Effect of clonidine on hot flashes in postmenopausal women, Obstet. Gynecol. 60:583–586.PubMedGoogle Scholar
  23. Leblanc, H., Lachelin, G. C. L., Abu-Fadil, S., and Yen, S. S. C., 1976, Effects of dopamine agonists on LH release in women, J. Clin. Endocrinol. Metab. 44:728–732.Google Scholar
  24. Lightman, S. L., Jacobs, H. S., Maguire, A. K., McGarrick, G., and Jeffcoate, S. L., 1981, Climacteric flushing: clinical and endocrine responses to infusion of naloxone, Br. J. Obstet. Gynecol. 88:919–924.CrossRefGoogle Scholar
  25. Linton, E. A., Bennet, G. W., and Whitehead, S. A., 1979, Prostaglandins and the release of LHRH from hypothalamic synaptosomes, Neuroendocrinology 28:394–401.PubMedCrossRefGoogle Scholar
  26. Lomax, P., and Knox, G. V., 1973, The sites and mechanisms of action of drugs affecting thermoregulation, The Pharmacology of Thermoregulation. San Francisco 1972, Karger, Basel, pp. 146-154.Google Scholar
  27. Mashchak, C. A., Kletzky, O. A., Artel, R., and Mishell, D. R. Jr., 1982, Postmenopausal va-somotor perfusion changes investigated by digital plethysmography and plasma catecholamine levels. Proc. 29th Annual Meeting Soc. Gynecol. Invest., Dallas, Texas, March 24-27, 1982. Ab #277.Google Scholar
  28. McKinlay, S., and Jefferys, M., 1974, The menopausal syndrome, Br. J. Prev. Soc. Med. 28:108–115.PubMedGoogle Scholar
  29. Meldrum, D. R., Erlik, Y., Lu, J. H. K., and Judd, H. L., 1981, Objectively recorded hot flashes in patients with pituitary insufficiency, J. Clin. Endocrinol. Metab. 52:684–687.PubMedCrossRefGoogle Scholar
  30. Meldrum, D. R., Shamonki, I. M., Frumar, A. M., Tataryn, I. V., Chang, R. J., and Judd, H. L., 1979, Elevations in skin temperature of the finger as an objective index of postmenopausal hot flashes: standardization of the techniques, Am. J. Obstet. Gynecol. 135:713–717.PubMedGoogle Scholar
  31. Molnar, G. W., 1975, Body temperatures during menopausal hot flashes, J. Appl. Physiol. 38:499–503.PubMedGoogle Scholar
  32. Mulley, G., Mitchell, J. R. A., and Tattersall, R. B., 1977, Hot flushes after hypophysectomy, Br. Med. J. 2:1062.PubMedCrossRefGoogle Scholar
  33. Neugarten, B. L., and Kraines, R. J., 1965, Menopausal symptoms in women of various ages, Psychosom. Med. 27:266–273.PubMedGoogle Scholar
  34. Pang, C. N., Zimmermann, E., and Sawyer, C. H., 1977, Morphine inhibition of the preovulatory surges of plasma luteinizing hormone and follicle stimulating hormone in the rat, Endocrinology 101:1726–1732.PubMedCrossRefGoogle Scholar
  35. Quigley, M. E., Sheehan, K. L., Casper, R. F., and Yen, S. S. C., 1980, Evidence for increased dopaminergic and opioid activity in patients with hypothalamic hypogonadotropic amenorrhea, J. Clin. Endocrinol. Metab. 50:949–954.PubMedCrossRefGoogle Scholar
  36. Quigley, M. D., and Yen, S. S. C., 1980, The role of endogenous opiates on LH secretion during the menstrual cycle, J. Clin. Endocrinol. Metab. 51:179–181.PubMedCrossRefGoogle Scholar
  37. Reaves, T. A., and Hayward, J. M., 1979, Hypothalamic and extrahypothalamic thermoregulatory centers, in: Body Temperature: Regulation, Drug Effects and Therapeutic Implications (P. Lomax and E. Schonbaum, eds.), Dekker, New York, pp. 39–70.Google Scholar
  38. Reynolds, W. W., Casterlin, M. E. and Covert, J. B., 1974, Behavioral fever in teleost fishes, Nature 259:41–42.CrossRefGoogle Scholar
  39. Satinoff, E., and Cantor, A., 1975, Intraventricular norepinephrine and thermoregulation in rats, in: Temperature Regulation and Drug Action (P. Lomax, E. Schonbaum, and J. Jacob eds.), Karger, Basel, pp. 103–110.Google Scholar
  40. Simpkins, J. W., and Kalra, S. P., 1979, Central site(s) of norepinephrine and LHRH interaction, Fed. Proc. 38:1107.Google Scholar
  41. Snell, E. S., and Atkins, E., 1968, The Mechanisms of Fever, the Biological Basis of Medicine (E. E. Bittar and N. Bittar, eds.), Academic Press, New York, pp. 397–419.Google Scholar
  42. Stubbs, W. A., Jones, A., Edward, C. R. W., Delitala, G., Jeffcoate, W. J., Ratter, S. J., Besser, G. M., Bloom, S. R., and Alberti, K. G. M. M., 1978, Hormonal and metabolic responses to an enkephalin analogue in normal man, Lancet 2:1225–1227.PubMedCrossRefGoogle Scholar
  43. Sturdee, D. W., Wilson, K. A., Pipili, E., and Crocker, A. D., 1978, Physiological aspects of menopausal hot flush, Br. Med. J. 2:79–80.PubMedCrossRefGoogle Scholar
  44. Sturdee, D. W., and Reece, B. L., 1979, Thermography of menopausal hot flushes, Maturitas 1:201–205.PubMedCrossRefGoogle Scholar
  45. Tataryn, I. V., Meldrum, D. R., Lu, K. H., Frumar, A. M., and Judd, H. L., 1979, LH, FSH, and skin temperature during the menopausal hot flash, J. Clin. Endocrinol. Metab. 49:152–154.PubMedCrossRefGoogle Scholar
  46. Tataryn, I. V., Lomax, P., Bajorek, J. G., Chesarek, W., Meldrum, D. R., and Judd, H. L., 1980, Postmenopausal hot flushes: a disorder of thermoregulation, Maturitas 2:101–107.PubMedCrossRefGoogle Scholar
  47. Thompson, B., Hart, S. A., and Durno, D., 1973, Menopausal age and symptomatology in general practice, J. Biol. Sci. 5:71–82.Google Scholar
  48. Venables, R., 1967, Methods in Psychophysiology (C. C. Brown, ed.), Williams and Wilkins, Baltimore, pp. 1–26.Google Scholar
  49. Wehrenberg, W. B., Wardlaw, S. L., Frantz, A. G., and Ferin, M., 1982, β-endorphin in hypophyseal portal blood: variations throughout the menstrual cycle, Endocrinology 111:879–881.PubMedCrossRefGoogle Scholar
  50. Yen, S. S. C., Rebar, R., Vandenberg, G., and Judd, H., 1973, Hypothalamic amenorrhea and hypogonadotropinism: Responses to synthetic LRF, J. Clin. Endocrinol. Metab. 36:811–816.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • Howard L. Judd
    • 1
  1. 1.Department of Obstetrics and Gynecology, School of MedicineUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations