19/04/2019

Menopause-related hot flashes and night sweats can last for years

After shoveling for days, breaking up ice dams, and now shivering in this week’s frigid temperatures, I wouldn’t mind sitting in a sauna for a bit. A new report in JAMA Internal Medicine makes this pastime even more appealing: regularly spending time in a sauna may help keep the heart healthy and extend life.

Researchers from the University of Eastern Finland tracked 2,300 middle-aged men for an average of 20 years. They categorized the men into three groups according to how often they used a sauna each week. The men spent an average of 14 minutes per visit baking in 175° F heat. Over the course of the study, 49% of men who went to a sauna once a week died, compared with 38% of those who went two to three times a week and just 31% of those who went four to seven times a week. Frequent visits to a sauna were also associated with lower death rates from cardiovascular disease and stroke.

The results don’t surprise Dr. Thomas H. Lee, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital and founding editor of the Harvard Heart Letter. “The cardiovascular effects of sauna have been well documented in the past. It lowers blood pressure, and there is every reason to believe that its effects are good for blood vessels,” says Dr. Lee.

Earlier studies have shown that regular sauna bathing may benefit people with risk factors for heart disease, such as high cholesterol, high blood pressure, and diabetes. It’s generally safe and likely beneficial for people with mild heart failure, but may not be so hot for those with unstable angina or a recent heart attack.

The researchers were quick to state that because of the unique properties of Finnish saunas, their results aren’t applicable to steam baths and hot tubs. Finnish saunas are wood-lined rooms, usually heated by a stove topped with stones. The air inside the sauna is very hot and dry, although sauna bathers periodically add water to the stones to produce a vapor known as “loyly.”
The sauna’s place in Finnish life

Sauna use is deeply embedded in Finnish culture. A nation of 5.5 million people, Finland has as many saunas as television sets — around 3.3 million. Most of the saunas are in people’s homes, although they’re also standard amenities in offices and factories. Saunas are accessible to Finns of every walk of life, so it’s unlikely that the study participants who used saunas often were already at lower risk of dying early because they were better off socioeconomically.

The researchers also emphasize that the very nature of the Finnish sauna is designed to reduce stress. The sauna has been a gathering place for family and friends for centuries. And sauna etiquette, which frowns upon swearing or discussing controversial topics while bathing, is instilled in Finns during childhood.

In fact, Finns may spend even more time in the sauna than they do exercising. While most Finns visit a sauna at least once a week, only about half of Finnish men and a third of Finnish women between 18 and 65 meet the World Health Organization exercise guidelines, which recommend the equivalent of 30 minutes of moderate-intensity physical activity five days a week. The Finnish researchers suggest that saunas may provide some cardiovascular conditioning because the high temperatures can drive heart rates to levels often achieved by moderate-intensity physical exercise.

So is sitting in a sauna the equivalent of exercising? “I don’t know that I would substitute a sauna for exercise. But exercising and then taking a sauna seems like a very healthy routine,” Dr. Lee says.
If you want to try a sauna

Although saunas haven’t become a cultural institution in the United States, many gyms, Y’s, Jewish Community Centers, and health clubs have them. If you’re intrigued about the prospect of ending your workout in a sauna and want to learn more about sauna etiquette or get instructions for building your own sauna, visit the North American Sauna Society website. The No Nuts Moms Group website lists some of the young people who have died from food allergies — many from peanut allergy — going back to 1986. The lengthy list is a sad reminder that a peanut allergy can cause a severe and sometimes deadly allergic reaction. Parents who have a child who is allergic to peanuts do many things to keep him or her out of harm’s way.

A study published online today in The New England Journal of Medicine offers some hope for parents of infants who may be headed toward a peanut allergy. That hope is peanuts.

For the study, an international team of researchers recruited infants who had an egg allergy or eczema, an allergic disorder that affects the skin. Both are indicators that a child is prone to a peanut allergy. The children were randomly divided into two groups. The parents in one group were asked to make sure their children didn’t eat any peanuts, peanut butter, or other peanut-based products until age five. Parents in the other group were asked to give their children a peanut-based snack called Bamba or peanut butter three times a week until age five.

The results were surprising and dramatic. A peanut allergy developed in 1.9% of children who ate Bamba or peanut butter, compared with 13.7% of those who didn’t eat peanuts. One explanation for this difference is that the children who ate peanuts early developed what is called immune tolerance to them. Their young immune systems adapted to the proteins in peanuts so that they did not react to them.

The researchers got the idea for this trial from a previous study of theirs. They knew that Israeli children are typically fed peanuts much earlier in life than British children. So they compared peanut allergies in Jewish children living in Israel with those in Jewish children living in London. Peanut allergies were 10 times higher in the British children than in the Israeli children.

In an unrelated study, a team from the Jaffe Food Allergy Institute at Kravis Children’s Hospital at Mount Sinai in New York City presented similar findings on Sunday at the annual meeting of the American Academy of Allergy Asthma and Immunology in Houston. They showed that a wearable patch that gradually exposes the body to small amounts of peanut protein may be effective in easing the allergy. After wearing the patch for a year, people with peanut allergies could tolerate the equivalent of four peanuts at a time. The patch, called Viaskin, is made by DBV Technologies, which funded the study.

What does this new work mean for parents? If an infant is allergy-prone, it may be a good idea to ask his or her pediatrician about skin-prick testing for peanut allergy. If adding peanuts to the child’s diet early is feasible, the New England Journal of Medicine study suggests that such a strategy may prevent a peanut allergy down the line. And while the Viaskin results are still preliminary, if further research bears out these results, this approach could be a lifesaver. How long do hot flashes last? It used to be said that menopause-related hot flashes fade away after six to 24 months. But for many women, hot flashes and night sweats often last seven years and may go on for 11 years or more.

The hormonal roller coaster that comes with the end of a woman’s childbearing years can trigger a range of hot flash symptoms. Up to 80% of women going through menopause experience hot flashes. Hot flashes, also known as vasomotor symptoms, are often described as a sudden sensation of heat in the chest, face, and head followed by flushing, perspiration, and sometimes chills. When a hot flash occurs during sleep, it can be accompanied by a drenching sweat. Such night sweats make it difficult to get a good night’s rest.The estimates of the duration of these symptoms come from the Study of Women’s Health Across the Nation (SWAN), a long-term study of women of different races and ethnicities who are in the menopausal transition. They were published in JAMA Internal Medicine.

“The data from this study confirm what many women already know firsthand. Hot flashes can go on for years and take a toll on a woman’s health and well-being,” says Dr. JoAnn Manson, professor of women’s health at Harvard Medical School and professor of epidemiology at Harvard School of Public Health.
The SWAN researchers found that some women are more likely to deal with long-term hot flashes than others. Women who had their first hot flashes before their menstrual periods ended had hot flashes for an average of nine to 10 years. When hot flashes didn’t start until after the last menstrual period, the average duration was only about three and a half years. But even on the short end of the spectrum, that’s a long time to deal with hot flashes and night sweats.
Women in the SWAN study who experienced hot flashes for a longer time tended to be current or former smokers, overweight, stressed, depressed, or anxious. Ethnicity also played a role. African American women reported the longest duration of hot flashes (averaging more than 11 years), while Japanese and Chinese women had hot flashes for about half that time.
The “reality check” the SWAN study provides on hot flashes should encourage women to seek solutions. If hot flashes and night sweats are really bothering you, don’t put up with them. Talk with your doctor about treatment options.

The most effective hot flashes treatment is estrogen-based hormone therapy, though it comes with several downsides. “While hormone therapy is very effective at relieving hot flashes, longer-term treatment carries an increased risk for breast cancer, and women at older ages have higher risks of stroke, blood clots, and other health problems. So it’s important that women explore a full range of treatment options — especially women likely to have persistent hot flashes,” advises Dr. Manson.

Several non-hormonal medications can also provide r hot flashes treatment and relief from night sweats. These include some types of antidepressants, some drugs commonly prescribed for nerve pain, and some high blood pressure medications. As with any medication, it’s best to opt for the lowest dose that effectively relieves your symptoms, and to take it for the shortest amount of time possible.

For some women, self-help measures can help ease hot flashes. These include deep-breathing exercises when a hot flash starts; dressing in layers; lowering the thermostat; staying away from caffeine, alcohol, hot beverages, and spicy foods; stress reduction techniques like meditation and mindfulness; and doing your best to stay cool in general.

A free mobile app called MenoPro, developed by Dr. Manson and her colleagues at the North American Menopause Society, helps women understand their treatment options and work with their healthcare providers to find the best approach for them. The app is currently available for iPhones and iPads. More information is available at the North American Menopause Society website.

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