Behavioral treatment of menopausal hot flushes: Evaluation by ambulatory monitoring Robert R. Freedman, PhD, and Suzanne Woodward, PhD Detroit, M ichigan OBJECTIVES: We attempted to develop an effective behavioral treatment for menopausal hot flushes and to determine the active behavioral components of this procedure . STUDY DESIGN: Thirty-three women with frequent menopausa l hot flushes were randomly assigned to receive eight sessions of training in paced respiration, muscle relaxation , or a-wave electroencephalographic biofeedback (placebo control). Hot flushes were objectively measured by means of 24-hour ambulatory monitoring of the sternal skin conductance level. RESULTS: Subjects undergoing paced respiration had significant reductions in hot flush frequency and respiration rate, as well as increases in tidal volume. CONCLUSION: Paced respiration training may be a useful treatment alternative for the reduction of hot flushes in women who cannot tolerate hormone replacement therapy . (AMJ Oasrsr GVNECOL 1992;167:436-9.)
Key words: Hot flush , menopause, relaxation, sympathetic nervou s system
Hot flushes are the mo st commo n sym ptom of the climacteric and occur in the vast majority of menopau sal women. Although hormone replacement therapy is an effective treatmen t for hot flushe s. it ma y be contraindicated for some wom en who have an increased risk of cancer. Central sym pathetic activation is increased in women with hot flushes , ' ·3 and agents such as c1onidine , which inhibit this activation, have been shown to am eliorate hot flushes in some studies.v" Behavioral relaxation methods have been shown to reduce sympathetic activity in normal subjects?" and in some clinical groups." In a pilot study" we showed that a combination of progressive muscle rel axation exercises and slow, deep breathing red uced the incidence of self-reported hot flush es by abo ut 50%. Since two treatment procedures were combined in that study. it was not possible to determine which component was responsible for the therapeutic effect. Therefore in the current investigation, the muscle relaxation and paced respiration exercises were ad ministered to two separate groups. a-Wave electroencephalographic biofeedback was chosen as the placebo control procedure becau se it elicits subj ective reports of relaxation without its physiologic effects. I' We also sou ght to objectively determine From the Lafayette Clinic and the Department of Psychiatry, Wayne State University School of Medicine. Supported by research grant AG-05233 from the National Institute . on Aging. Received for publication October 17, 1991; reoised January 28, 1992; accepted February 13, 1992. . . Reprint requests: Dr. RobertR. Freedman, LafayetteClinic, 951 E. Lafayette, Detroit, MI 48207 . 611/37263
436
the effects of the treatments with the use of 24-hour ambulato r y monitoring of the sternal skin conductance level. This measure has been shown to correlate highly with patients' reports of hot flush es. 13. I
Key words: Hot flush , menopause, relaxation, sympathetic nervou s system
Hot flushes are the mo st commo n sym ptom of the climacteric and occur in the vast majority of menopau sal women. Although hormone replacement therapy is an effective treatmen t for hot flushe s. it ma y be contraindicated for some wom en who have an increased risk of cancer. Central sym pathetic activation is increased in women with hot flushes , ' ·3 and agents such as c1onidine , which inhibit this activation, have been shown to am eliorate hot flushes in some studies.v" Behavioral relaxation methods have been shown to reduce sympathetic activity in normal subjects?" and in some clinical groups." In a pilot study" we showed that a combination of progressive muscle rel axation exercises and slow, deep breathing red uced the incidence of self-reported hot flush es by abo ut 50%. Since two treatment procedures were combined in that study. it was not possible to determine which component was responsible for the therapeutic effect. Therefore in the current investigation, the muscle relaxation and paced respiration exercises were ad ministered to two separate groups. a-Wave electroencephalographic biofeedback was chosen as the placebo control procedure becau se it elicits subj ective reports of relaxation without its physiologic effects. I' We also sou ght to objectively determine From the Lafayette Clinic and the Department of Psychiatry, Wayne State University School of Medicine. Supported by research grant AG-05233 from the National Institute . on Aging. Received for publication October 17, 1991; reoised January 28, 1992; accepted February 13, 1992. . . Reprint requests: Dr. RobertR. Freedman, LafayetteClinic, 951 E. Lafayette, Detroit, MI 48207 . 611/37263
436
the effects of the treatments with the use of 24-hour ambulato r y monitoring of the sternal skin conductance level. This measure has been shown to correlate highly with patients' reports of hot flush es. 13. I
