潮熱：修订间差异

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<!--They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from 2 to 30 minutes for each occurrence. -->
<!--They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from 2 to 30 minutes for each occurrence. -->


{{medref}}
== Signs and symptoms ==
Hot flashes, a common symptom of [[menopause]] and [[perimenopause]], are typically experienced as a feeling of intense heat with [[Perspiration|sweating]] and rapid [[Heart rate|heartbeat]], and may typically last from two to thirty minutes for each occurrence, ending just as rapidly as they began. The sensation of heat usually begins in the face or chest, although it may appear elsewhere such as the back of the neck, and it can spread throughout the whole body. Some women feel as if they are going to faint. In addition to being an internal sensation, the surface of the skin, especially on the face, becomes hot to the touch. This is the origin of the alternative term "hot flush", since the sensation of heat is often accompanied by visible reddening of the face. Excessive flushing can lead to [[rosacea]].

The hot-flash event may be repeated a few times each week or every few minutes throughout the day. Hot flashes may begin to appear several years before menopause starts and last for years afterwards. Some women undergoing menopause never have hot flashes. Others have mild or infrequent flashes. The worst sufferers experience dozens of hot flashes each day. In addition, hot flashes are often more frequent and more intense during hot weather or in an overheated room, the surrounding heat apparently making the hot flashes themselves both more likely to occur, and more severe.

Severe hot flashes can make it difficult to get a full night's sleep (often characterized as [[insomnia]]), which in turn can affect mood, impair concentration, and cause other physical problems. When hot flashes occur at night, they are called "night sweats". As [[estrogen]] is typically lowest at night, some women get night sweats without having any hot flashes during the daytime.<ref>{{cite web | author = University of Glasgow | authorlink = University of Glasgow | title = Doctors seek the key to understanding hot flushes | work = University News (Archive of news) | publisher = University of Glasgow | date = 24 October 2007 | url = http://www.gla.ac.uk/news/archiveofnews/2007/october/headline_50212_en.html | accessdate = 19 April 2013}}</ref>

=== Young women ===
If hot flashes occur at other times in a young woman's menstrual cycle, then it might be a symptom of a problem with her [[pituitary gland]]; seeing a doctor is highly recommended. In younger women who are surgically menopausal, hot flashes are generally more intense than in older women, and they may last until natural age at menopause.<ref name="Menopause on About.com">{{cite web | last = About.com | title = Menopause | publisher = About.com | date = n.d. | url =http://adam.about.net/reports/Menopause.htm | accessdate = 19 April 2013}}</ref>

=== Men ===
Hot flashes in men could have various causes. It can be a sign of low testosterone.<ref>{{cite web | last = Bunyavanich | first = Supinda | title = Low Testosterone Could Kill You | work = ABC News | publisher = ABC News Internet Ventures | date = 6 June 2007 | url = http://abcnews.go.com/Health/ActiveAging/story?id=3247773#.UXKwlcWhhCI | accessdate = 20 April 2013}}</ref> Another is [[andropause]], or "male menopause".<ref name="livestrong.com">{{cite web | last = Holley | first = Casey L. | title = 5 Things You Need to Know About the Causes of Hot Flashes in Men | work = Livestrong.com | publisher = Demand Media Inc. | date = 11 August 2011 | url = http://www.livestrong.com/article/9770-need-causes-hot-flashes-men/ | accessdate = 20 April 2013}}</ref> Men with [[prostate cancer]] or [[testicular cancer]] can also have hot flashes, especially those who are undergoing hormone therapy with [[antiandrogens]], also known as androgen antagonists, which reduce testosterone to castrate levels.<ref>{{cite web | title = What to Expect During Therapy | work = Lupron Depot | publisher = Abbott Laboratories | url =http://www.lupronadvancedprostatecancer.com/about-lupron-depot/what-to-expect-during-therapy.cfm | accessdate = 20 April 2013}}</ref> There are also other ailments and even dietary changes which can cause it.<ref name="livestrong.com"/> Men who are [[castrated]] can also get hot flashes.<ref>{{cite web | title = Hot Flashes In Men -- Mayo Clinic Researchers Describe A Treatment | work = ScienceDaily | publisher = Science Daily LLC | date = 19 October 2004 | url = http://sciencedaily.com/releases/2004/10/041019085808.htm | accessdate = 20 April 2013}}</ref><ref>{{cite journal | last = Engstrom | first = Christine A. | last2 = Kasper | first2 = Christine E. | title = Physiology and Endocrinology of Hot Flashes in Prostate Cancer | journal = American Journal of Men's Health | volume = 1 | issue = 1 | pages = 8–17 | publisher = Sage Publications | date = March 2007 | url = http://jmh.sagepub.com/content/1/1/8.abstract | doi = 10.1177/1557988306294162 | accessdate = 20 April 2013}}</ref><ref>{{cite web | last = Anitei | first = Stefan | title = Men Can Experience Hot Flashes, Just Like Women in Menopause | work = Softpedia | publisher = Softpedia | date = 16 April 2007 | url = http://news.softpedia.com/news/Men-Can-Experience-Hot-Flashes-Like-Menopause-Women-52030.shtml | accessdate = 20 April 2013}}</ref>

=== Types ===
Some menopausal women may experience both standard hot flashes and a second type sometimes referred to as "slow hot flashes" or "ember flashes". The standard hot flash comes on rapidly, sometimes reaching maximum intensity in as little as a minute. It lasts at full intensity for only a few minutes before gradually fading.

Slow "ember" flashes appear almost as quickly but are less intense and last for around half an hour. Women who experience them may undergo them year round, rather than primarily in the summer, and ember flashes may linger for years after the more intense hot flashes have passed.

== Mechanism ==
Research on hot flashes is mostly focused on treatment options. The exact cause and [[pathogenesis]], or causes of [[vasomotor]] symptoms (VMS)—the clinical name for hot flashes—has not yet been fully studied.<ref>{{cite journal | last = Utian | first = Wulf H. | title =Recent Developments in Pharmacotherapy for Vasomotor Symptoms | journal =Current Obstetrics and Gynecology Reports | volume =1 | issue =2 | pages =43–49 | publisher = Current Science Inc. | date = 2012-06-01 | url = http://www.springerlink.com/content/575766r8kxr11rwk/ | issn = 2161-3303 | doi = 10.1007/s13669-012-0009-4 | accessdate = 17 April 2013}}</ref><ref name="pmid12440557">{{cite journal | last =Shanafelt | first = Tait D. | last2 = Barton | first2 = Debra L. | last3 = Adjei | first3 = Alex A. | last4 = Loprinzi | first4 = Charles L. | title =Pathophysiology and Treatment of Hot Flashes | journal = Mayo Clinic Proceedings | volume = 77 | issue = 11 | pages = 1207–1218 | publisher = Elsevier Inc. | date = November 2002 | doi = 10.4065/77.11.1207| pmid = 12440557}}</ref> There are hints at reduced levels of estrogen as the primary cause of hot flashes.<ref name="Gannon1985">{{cite book|author=Linda Gannon|title=Menstrual Disorders and Menopause: Biological, Psychological, and Cultural Research|url=https://books.google.com/books?id=3slsAAAAMAAJ|accessdate=19 April 2013|year=1985|publisher=Praeger|isbn=978-0-03-003878-5}}</ref> There are indications that hot flashes may be due to a change in the hypothalamus's control of temperature regulation.<ref>{{cite journal | last = Anna-Clara | first = Spetz | last2 = Zetterlund | first2 = Eva-Lena | last3 = Varenhorst | first3 = Eberhard | last4 = Hammar | first4 = Mats | title = Incidence and Management of Hot Flashes in Prostate Cancer | journal = The Journal of Supportive Onocology | volume = 1 | issue = 4 | pages =263–273 | publisher = BioLink Communications | location = |date=November–December 2003 | url =http://www.oncologypractice.com/jso/journal/articles/0104263.pdf | accessdate = 19 April 2013}}</ref>

== Treatment ==

=== Hormone replacement therapy ===
[[Hormone replacement therapy (menopause)|Hormone replacement therapy]] may relieve many of the symptoms of menopause. However, oral HRT may increase the risk of breast cancer, stroke, and dementia and has other potentially serious short-term and long-term risks.<ref>{{cite web | author = U.S. Food and Drug Administration | authorlink = Food and Drug Administration | title = FDA Updates Hormone Therapy Information for Post Menopausal Women | work = FDA News Release (Archived content) | publisher = U.S. Food and Drug Administration | date = 10 February 2004 | url = http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108243.htm | accessdate = 19 April 2013}}</ref><ref>{{cite journal | last = Rossouw | first = Jacques E. | title = Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women | journal = JAMA | volume = 288 | issue = 3 | pages = 321–3 | publisher = The American Medical Association | date = July 2002 | url = http://jama.jamanetwork.com/article.aspx?articleid=195120 | accessdate = 21 September 2014|doi=10.1001/jama.288.3.321 | pmid=12117397}}</ref> Since the incidence of cardiovascular disease in women has shown a rise that matches the increase in the number of post menopausal women, recent studies have examined the benefits and side effects of oral versus transdermal application of different estrogens and found that transdermal applications of estradiol may give the vascular benefits lowering the incidences of cardiovascular events with less adverse side effects than oral preparations.<ref>{{cite journal | last = Serock | first = Michelle R. | title = Modulators of vascular sex hormone receptors and their effects in estrogen-deficiency states associated with menopause. | journal = Recent Patents on Cardiovascular Drug Discovery | volume = 3 | issue = 3 | pages = 165–86 | publisher = Bentham Science | date = Nov 2008 | url = http://www.eurekaselect.com/83481/article | accessdate = 29 September 2014 | doi=10.2174/157489008786263970}}</ref><ref>{{cite journal | last = Løkkegaard | first = Ellen | title = Hormone therapy and risk of myocardial infarction: a national register study. | journal = European Heart Journal | volume = 29 | issue = 21 | pages = 2660–8 | publisher = Oxford Journals | date = Nov 2008 | url = http://www.eurekaselect.com/83481/article | accessdate = 29 September 2014 | doi=10.1093/eurheartj/ehn408}}</ref>

Women who experience troublesome hot flashes are advised by some to try alternatives to hormonal therapies as the first line of treatment. If a woman chooses hormones, they suggest she take the lowest dose that alleviates her symptoms for as short a time as possible.<ref>http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118624.htm</ref> The US Endocrine Society concluded that women taking hormone replacement therapy for 5 years or more experienced overall benefits in their symptoms including relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes.<ref>{{cite journal | last = Santen | first = Richard J. | title = Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement | journal = JCEM | volume = 9 | issue = 7 | pages = S1 | publisher = The Endocrine Society | date = July 2010 | url = http://press.endocrine.org/doi/abs/10.1210/jc.2009-2509?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed | accessdate = 29 September 2014 | doi=10.1210/jc.2009-2509}}</ref>

When estrogen as estradiol is used transdermally as a patch, gel, or pessary with micronized progesterone this may avoid the serious side effects associated with oral estradiol HRT since this avoids first pass metabolism ([[Drug metabolism|Phase I drug metabolism]]).<ref>{{cite journal|last1=L'Hermite|first1=M|title=HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT.|journal=Climacteric : the journal of the International Menopause Society|date=Aug 2013|volume=16 Suppl 1|pages=44–53|pmid=23848491|doi=10.3109/13697137.2013.808563}}</ref> Women taking bioidentical estrogen, orally or transdermally, who have a uterus must still take a progestin or micronized progesterone to lower the risk of endometrial cancer. A French study of 80,391 postmenopausal women followed for several years concluded that estrogen in combination with micronized progesterone is not associated with an increased risk of breast cancer.<ref>{{cite journal | last = Fournier | first = Agnès | title = Use of Different Postmenopausal Hormone Therapies and Risk of Histology- and Hormone Receptor–Defined Invasive Breast Cancer. | journal = Journal of Clinical Oncology | volume = 26 | issue = 8 | pages = 1260–8 | publisher = American Society of Clinical Oncology | date = March 2008 | url = http://jco.ascopubs.org/content/26/8/1260.full.pdf+html | accessdate = 29 September 2014 | doi=10.1200/jco.2007.13.4338}}</ref> The natural, plant-derived progesterone creams sold over the counter contain too little progesterone to be effective. Wild yam (''Dioscorea villosa'') extract creams are not effective since the natural progesterone present in the extract is not bioavailable.<ref>{{cite web | author = Harvard Women’s Health Watch | authorlink = Harvard Women’s Health Watch | title = What are bioidentical hormones? | work = Harvard Women’s Health Watch | publisher = Harvard Women’s Health Watch | date = August 2006 | url = http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm | accessdate = 20 September 2014}}</ref>

=== Selective estrogen receptor modulators ===
[[Selective estrogen receptor modulators|SERMs]] are a category of compounds that act selectively as agonists or antagonists on the estrogen receptors throughout the body. [[Tamoxifen]], a drug used in the treatment of some types of [[breast cancer]] and which can cause hot flashes as a side effect,<ref name="Mincey_2000">{{cite journal |vauthors=Mincey BA, Moraghan TJ, Perez EA |title = Prevention and treatment of osteoporosis in women with breast cancer|journal= Mayo Clin Proc |volume= 75 |issue= 8 |pages= 821–9 |year= 2000 | doi = 10.4065/75.8.821|pmid= 10943237}}</ref> and [[raloxifene]]<ref name=Label>[http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/022042lbl.pdf Raloxifene label] Last updated 09/2007]</ref> are examples of SERMS. Menerba, a botanically derived selective estrogen receptor beta agonist currently under development by [[Bionovo]], works like a SERM, but only activates on the estrogen receptor beta.<ref>{{Cite journal
| doi = 10.1016/j.coph.2010.09.009| title = Regulation of Specific Target Genes and Biological Responses By Estrogen Receptor Subtype Agonists|date=December 2010 | author1 = D.C. Leitman | author2 = S. Paruthiyil | author3 = O.I. Vivar | author4 = E.F. Saunier | author5 = C.B. Herber | author6 = I. Cohen | author7 = M. Tagliaferri | author8 = T.P. Speed| journal = Current Opinion in Pharmacology| pages=629–636 | volume = 10 | issue = 6| pmid = 20951642| pmc = 3010356}}</ref>

The soy-derived [[dietary supplement]] [[Femarelle]] may act as a SERM.<ref name=Bedell2014review>{{cite journal | author = Bedell S ''et al.'' | date = Jan 2014 | title = The pros and cons of plant estrogens for menopause | url = | journal = J Steroid Biochem Mol Biol. | volume = 139 | issue = | pages = 225–36 | doi = 10.1016/j.jsbmb.2012.12.004 | pmid = 23270754 }}</ref>

=== Selective serotonin reuptake inhibitors ===
[[Selective serotonin reuptake inhibitors|SSRIs]] are a class of pharmaceuticals that are most commonly used in the treatment of [[Depression (mood)|depression]]. They have been found as efficient in alleviating hot flashes.<ref name="pmid14740790">{{cite journal|last=Sicat|first=BL|author2=Brokaw, DK|title=Nonhormonal alternatives for the treatment of hot flashes.|journal=Pharmacotherapy|date=January 2004|volume=24|issue=1|pages=79–93|pmid=14740790|doi=10.1592/phco.24.1.79.34812}}</ref> On 28 June 2013 FDA approved Brisdelle (low-dose paroxetine mesylate) for the treatment of moderate-to-severe vasomotor symptoms (e.g. hot flashes and night sweats) associated with menopause. Paroxetine became the first and only non-hormonal therapy for menopausal hot flashes approved by FDA.<ref>{{cite news|title=FDA NEWS RELEASE: FDA approves the first non-hormonal treatment for hot flashes associated with menopause|author=Food and Drug Administration|date=28 June 2013|publisher=FDA|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm359030.htm}}</ref>

=== Clonidine ===
[[Clonidine]] is a blood pressure-lowering medication that can be used to relieve menopausal hot flashes when hormone replacement therapy is not needed or not desired. For hot flashes, clonidine works by helping reduce the response of the blood vessels to stimuli that cause them to narrow and widen.<ref>{{Cite web|title = Apo-Clonidine - Uses, Side Effects, Interactions - Drug Factsheets - C-Health|url = http://chealth.canoe.com/drug_info_details.asp?brand_name_id=701|website = chealth.canoe.com|accessdate = 2015-12-21}}</ref> While not all women respond to clonidine as a hot flash medication, it can reduce hot flashes by 40% in some peri-menopausal women.<ref>{{Cite web|url = http://www.medscape.org/viewarticle/570671|title = What Patients Need to Know About Hot Flashes|date = |website = Medscape|publisher = }} {{subscription required|date=October 2016}}</ref>

=== Isoflavones ===
[[Isoflavones]] are commonly found in [[legume]]s such as soy and red clover. The two soy isoflavones implicated in relieving menopausal symptoms are [[genistein]] and [[daidzein]], and are also known as [[phytoestrogens]]. The half life of these molecules is about eight hours, which might explain why some studies have not consistently shown effectiveness of soy products for menopausal symptoms.{{Citation needed|date=March 2009}} Although red clover (''Trifolium pratense'') contains isoflavones similar to soy, the effectiveness of this herb for menopausal symptoms at relatively low concentrations points to a different mechanism of action.<ref>{{cite journal |author1=Nissan Hani P. |author2=Lu Jian |author3=Booth Nancy L. |author4=Yamamura Henry I. |author5=Farnsworth Norman R. |author6=Wan Z. Jim | year = 2007 | title = A red clover (Trifolium pratense) phase II clinical extract possesses opiate activity | url = | journal = Journal of Ethnopharmacology | volume = 112 | issue = | pages = 207–210 | doi=10.1016/j.jep.2007.02.006 | pmid=17350196}}</ref>

=== Other phytoestrogens ===
It is believed {{By whom?|date=May 2013}} that dietary changes that include a higher consumption of [[phytoestrogens]] from sources such as soy, red clover, ginseng, and yam may relieve hot flashes.
* [[Ginseng]]: Very few studies exist on the effect of ginseng for relief of menopausal symptoms. In a large double-blinded randomized controlled trial, reduction in hot flashes was not statistically significant but showed a strong trend towards improvement.<ref>{{cite journal |vauthors=Wiklund IK, Mattsson LA, Lindgren R, Limoni C | year = 1999 | title = Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic post-menopausal women: a double-blind, placebo-controlled trial | url = | journal = Int J Clin Pharmacol Res. | volume = 19 | issue = | pages = 89–99 }}</ref> Lack of statistical significance suggests future research, but does not meet the scientific bar for ginseng to be deemed effective.
* [[Flaxseed]]: There have also been several clinical trials using flaxseed. Flaxseed is the richest source of [[lignan]]s, which is one of three major classes of phytoestrogen.<ref>{{cite journal |vauthors=Basch E, Bent S, Collins J, etal | year = 2007 | title = Flax and flaxseed oil (Linum usitatissimum): a review by the Natural Standard Research Collaboration | url = | journal = J Soc Integr Oncol | volume = 5 | issue = 3| pages = 92–105 | doi=10.2310/7200.2007.005}}</ref> Lignans are thought to have estrogen agonist and antagonist effects as well as antioxidant properties. Flaxseed and its lignans may have potent anti-estrogenic effects on estrogen receptor positive breast cancer and may have benefits in breast cancer prevention efforts.<ref name="pmid17289903">{{cite journal | last = Jugenström | first = Malin Bergman | last2 = Thompson | first2 = Lilian U. | last3 = Dabrosin | first3 = Charlotta | title = Flaxseed and Its Lignans Inhibit Estradiol-Induced Growth, Angiogenesis, and Secretion of Vascular Endothelial Growth Factor in Human Breast Cancer Xenografts ''In vivo'' | journal = Clinical Cancer Research | volume =13 | issue = 3 | pages =1061–1067 | publisher = American Association for Cancer Research | date = 1 February 2007 | doi = 10.1158/1078-0432.CCR-06-1651 | pmid = 17289903}}</ref><ref name="Dietary Lignan Intake">{{cite journal | last = Touillaud | first = Marina S. | last2 = Thiébaut | first2 = Anne C. M. | last3 = Fournier | first3 = Agnès | last4 = Niravong | first4 = Maryvonne | last5 = Boutron-Ruault | first5 = Marie-Christine | last6 = Clavel-Chapelon | first6 = Françoise | title = Dietary Lignan Intake and Postmenopausal Breast Cancer Risk by Estrogen and Progesterone Receptor Status | journal = [[Journal of the National Cancer Institute]] | volume = 99 | issue = 6 | pages = 475–486 | publisher = Oxford University Press | date = 21 March 2007 | url = http://jnci.oxfordjournals.org/content/99/6/475.full.pdf+html | issn = 1460-2105 | doi = 10.1093/jnci/djk096 | accessdate = 20 April 2013}}</ref> One recent study done in France, looked at four types of lignans, including that found in flaxseed (Secoisolariciresinol) in a prospective cohort study to see if intake predicted breast cancer incidence.<ref name="Dietary Lignan Intake"/> The authors report lowered risk of breast cancer among over 58,000 postmenopausal women who had the third highest quartile of lignan intake. There have been a few small pilot studies that have tested the effect of flaxseed on hot flashes. Currently there is a large study sponsored by the National Cancer Institute that is ongoing, but not accepting any new participants.<ref>{{cite web | title = Flaxseed in Treating Postmenopausal Women With Hot Flashes Who Have a History of Breast Cancer or Other Cancer or Who Do Not Wish to Take Estrogen Therapy | work = ClinicalTrials.gov | publisher = U.S. National Institute of Health | date = November 2010 | url = http://clinicaltrials.gov/ct2/show/NCT00956813#wrapper | accessdate = 20 April 2013}}</ref> The rationale for the study is that estrogen can relieve the symptoms of menopause, but can also cause the growth of breast cancer cells. Flaxseed may reduce the number of hot flashes and improve mood and quality of life in postmenopausal women not receiving estrogen therapy.

=== Lifestyle changes ===
According to the North American Menopause Society (NAMS)<ref>
{{cite web
|url=http://www.menopause.org/for-women/menopause-take-time-to-think-about-it/consumers/2012/09/26/a-meno-menu-6-simple-instructions-for-a-healthy-diet
|title=A Menopause Menu: 6 Simple Instructions for a Healthy Diet
}}</ref>

=== Acupuncture ===
[[Acupuncture]] has been suggested to reduce incidence of hot flashes in women with breast cancer and men with prostate cancer, but the quality of evidence is low.<ref>{{cite journal|last=Frisk|first=Jessica W.|author2=Hammar, Mats L. |author3=Ingvar, Martin |author4= Spetz Holm, Anna-Clara E. |title=How long do the effects of acupuncture on hot flashes persist in cancer patients?|journal=[[Supportive Care in Cancer]]|date=30 January 2014|volume=22|issue=5|pages=1409–1415|doi=10.1007/s00520-014-2126-2|url=http://link.springer.com/article/10.1007%2Fs00520-014-2126-2}}</ref><ref>{{cite journal|author1=MS Lee |author2=KH Kim |author3=BC Shin |author4=E Ernst |title=Acupuncture for treating hot flushes in men with prostate cancer: a systematic review|journal=Supportive Care in Cancer|date=July 2009|volume=17|issue=7|pages=763–70|pmid=19224253|doi=10.1007/s00520-009-0589-3}}</ref>

== Epidemiology ==
It has been speculated that hot flashes are less common among [[Asian women]].<ref>{{cite journal|last=Messina|first=Mark|author2=Claude Hughes|title=Efficacy of Soyfoods and Soybean Isoflavone Supplements for Alleviating Menopausal Symptoms Is Positively Related to Initial Hot Flush Frequency|journal=Journal of Medicinal Food|year=2003|volume=6|page=2|publisher=Mary Ann Liebert, Inc.|doi=10.1089/109662003765184697}}</ref><ref name="pmid7925751">{{cite journal|last=Lock|first=Margaret|title=Menopause in cultural context|journal=Experimental Gerontology|date=May–August 1994|volume=29|issue=3–4|pages=307–317|publisher=Elsevier Inc.|doi=10.1016/0531-5565(94)90011-6|pmid=7925751}}</ref>
==中醫觀點==
==中醫觀點==
{{medref}}
'''潮热'''为[[中医学]]病症，发热起伏如潮水之涨退有时。
'''潮热'''为[[中医学]]病症，发热起伏如潮水之涨退有时。
本症有虚实之分：实者为阳盛所致，如热病过程中，有日晡潮热、谵语、腹满而硬、脉沉实有力等症，治宜泄热、通腑为主；虚者为阴虚所致，如疲劳，有两颧发赤、手足心热、盗汗等，治宜滋阴清热。
本症有虚实之分：实者为阳盛所致，如热病过程中，有日晡潮热、谵语、腹满而硬、脉沉实有力等症，治宜泄热、通腑为主；虚者为阴虚所致，如疲劳，有两颧发赤、手足心热、盗汗等，治宜滋阴清热。
== See also ==
* [[Hypoglycemia]] (low blood sugar) can cause similar symptoms

==References==
{{Reflist|30em}}
==External links==
* [http://www.mayoclinic.com/health/hot-flashes/DS01143 Hot flashes] on Mayo Clinic website
* [http://www.medicinenet.com/hot_flashes/article.htm Hot Flashes] on MedicineNet
* [http://www.patient.info/doctor/Hot-Flushes.htm Hot Flushes] on Patient.info<!-- Citations can be derived from this article -->

{{DEFAULTSORT:Hot Flash}}
[[Category:Menopause]]
{{醫學小作品}}
{{醫學小作品}}
{{portal bar|醫學|性|藥理學}}
{{portal bar|醫學|性|藥理學}}

2017年7月16日 (日) 15:50的版本

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。
  关于与「潮熱」標題相近或相同的条目页，請見「发热_(消歧義)」。
Hot flash
类型潮紅[*]
肇因climacteric[*]
分类和外部资源
醫學專科婦科學（Gynecology）
[编辑此条目的维基数据]

潮热（英語：hot flash）多发于女性更年期时，因為體內的雌二醇減少而引起臉紅、皮膚發紅（因尷尬、發熱等原因）（英语：Flushing (physiology)）的一种生理症狀。 導致潮熱的因素可能不只一種，然而常見的因素是：於更年期時，體內的荷爾蒙下降而引起。 遇到潮熱的人大多會感受到燥熱、多汗和心跳快速等，而且每次潮熱大概會持續2~30分鐘不等。

Signs and symptoms

Hot flashes, a common symptom of menopause and perimenopause, are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes for each occurrence, ending just as rapidly as they began. The sensation of heat usually begins in the face or chest, although it may appear elsewhere such as the back of the neck, and it can spread throughout the whole body. Some women feel as if they are going to faint. In addition to being an internal sensation, the surface of the skin, especially on the face, becomes hot to the touch. This is the origin of the alternative term "hot flush", since the sensation of heat is often accompanied by visible reddening of the face. Excessive flushing can lead to rosacea.

The hot-flash event may be repeated a few times each week or every few minutes throughout the day. Hot flashes may begin to appear several years before menopause starts and last for years afterwards. Some women undergoing menopause never have hot flashes. Others have mild or infrequent flashes. The worst sufferers experience dozens of hot flashes each day. In addition, hot flashes are often more frequent and more intense during hot weather or in an overheated room, the surrounding heat apparently making the hot flashes themselves both more likely to occur, and more severe.

Severe hot flashes can make it difficult to get a full night's sleep (often characterized as insomnia), which in turn can affect mood, impair concentration, and cause other physical problems. When hot flashes occur at night, they are called "night sweats". As estrogen is typically lowest at night, some women get night sweats without having any hot flashes during the daytime.[1]

Young women

If hot flashes occur at other times in a young woman's menstrual cycle, then it might be a symptom of a problem with her pituitary gland; seeing a doctor is highly recommended. In younger women who are surgically menopausal, hot flashes are generally more intense than in older women, and they may last until natural age at menopause.[2]

Men

Hot flashes in men could have various causes. It can be a sign of low testosterone.[3] Another is andropause, or "male menopause".[4] Men with prostate cancer or testicular cancer can also have hot flashes, especially those who are undergoing hormone therapy with antiandrogens, also known as androgen antagonists, which reduce testosterone to castrate levels.[5] There are also other ailments and even dietary changes which can cause it.[4] Men who are castrated can also get hot flashes.[6][7][8]

Types

Some menopausal women may experience both standard hot flashes and a second type sometimes referred to as "slow hot flashes" or "ember flashes". The standard hot flash comes on rapidly, sometimes reaching maximum intensity in as little as a minute. It lasts at full intensity for only a few minutes before gradually fading.

Slow "ember" flashes appear almost as quickly but are less intense and last for around half an hour. Women who experience them may undergo them year round, rather than primarily in the summer, and ember flashes may linger for years after the more intense hot flashes have passed.

Mechanism

Research on hot flashes is mostly focused on treatment options. The exact cause and pathogenesis, or causes of vasomotor symptoms (VMS)—the clinical name for hot flashes—has not yet been fully studied.[9][10] There are hints at reduced levels of estrogen as the primary cause of hot flashes.[11] There are indications that hot flashes may be due to a change in the hypothalamus's control of temperature regulation.[12]

Treatment

Hormone replacement therapy

Hormone replacement therapy may relieve many of the symptoms of menopause. However, oral HRT may increase the risk of breast cancer, stroke, and dementia and has other potentially serious short-term and long-term risks.[13][14] Since the incidence of cardiovascular disease in women has shown a rise that matches the increase in the number of post menopausal women, recent studies have examined the benefits and side effects of oral versus transdermal application of different estrogens and found that transdermal applications of estradiol may give the vascular benefits lowering the incidences of cardiovascular events with less adverse side effects than oral preparations.[15][16]

Women who experience troublesome hot flashes are advised by some to try alternatives to hormonal therapies as the first line of treatment. If a woman chooses hormones, they suggest she take the lowest dose that alleviates her symptoms for as short a time as possible.[17] The US Endocrine Society concluded that women taking hormone replacement therapy for 5 years or more experienced overall benefits in their symptoms including relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes.[18]

When estrogen as estradiol is used transdermally as a patch, gel, or pessary with micronized progesterone this may avoid the serious side effects associated with oral estradiol HRT since this avoids first pass metabolism (Phase I drug metabolism).[19] Women taking bioidentical estrogen, orally or transdermally, who have a uterus must still take a progestin or micronized progesterone to lower the risk of endometrial cancer. A French study of 80,391 postmenopausal women followed for several years concluded that estrogen in combination with micronized progesterone is not associated with an increased risk of breast cancer.[20] The natural, plant-derived progesterone creams sold over the counter contain too little progesterone to be effective. Wild yam (Dioscorea villosa) extract creams are not effective since the natural progesterone present in the extract is not bioavailable.[21]

Selective estrogen receptor modulators

SERMs are a category of compounds that act selectively as agonists or antagonists on the estrogen receptors throughout the body. Tamoxifen, a drug used in the treatment of some types of breast cancer and which can cause hot flashes as a side effect,[22] and raloxifene[23] are examples of SERMS. Menerba, a botanically derived selective estrogen receptor beta agonist currently under development by Bionovo, works like a SERM, but only activates on the estrogen receptor beta.[24]

The soy-derived dietary supplement Femarelle may act as a SERM.[25]

Selective serotonin reuptake inhibitors

SSRIs are a class of pharmaceuticals that are most commonly used in the treatment of depression. They have been found as efficient in alleviating hot flashes.[26] On 28 June 2013 FDA approved Brisdelle (low-dose paroxetine mesylate) for the treatment of moderate-to-severe vasomotor symptoms (e.g. hot flashes and night sweats) associated with menopause. Paroxetine became the first and only non-hormonal therapy for menopausal hot flashes approved by FDA.[27]

Clonidine

Clonidine is a blood pressure-lowering medication that can be used to relieve menopausal hot flashes when hormone replacement therapy is not needed or not desired. For hot flashes, clonidine works by helping reduce the response of the blood vessels to stimuli that cause them to narrow and widen.[28] While not all women respond to clonidine as a hot flash medication, it can reduce hot flashes by 40% in some peri-menopausal women.[29]

Isoflavones

Isoflavones are commonly found in legumes such as soy and red clover. The two soy isoflavones implicated in relieving menopausal symptoms are genistein and daidzein, and are also known as phytoestrogens. The half life of these molecules is about eight hours, which might explain why some studies have not consistently shown effectiveness of soy products for menopausal symptoms.[來源請求] Although red clover (Trifolium pratense) contains isoflavones similar to soy, the effectiveness of this herb for menopausal symptoms at relatively low concentrations points to a different mechanism of action.[30]

Other phytoestrogens

It is believed [誰說的？] that dietary changes that include a higher consumption of phytoestrogens from sources such as soy, red clover, ginseng, and yam may relieve hot flashes.

  • Ginseng: Very few studies exist on the effect of ginseng for relief of menopausal symptoms. In a large double-blinded randomized controlled trial, reduction in hot flashes was not statistically significant but showed a strong trend towards improvement.[31] Lack of statistical significance suggests future research, but does not meet the scientific bar for ginseng to be deemed effective.
  • Flaxseed: There have also been several clinical trials using flaxseed. Flaxseed is the richest source of lignans, which is one of three major classes of phytoestrogen.[32] Lignans are thought to have estrogen agonist and antagonist effects as well as antioxidant properties. Flaxseed and its lignans may have potent anti-estrogenic effects on estrogen receptor positive breast cancer and may have benefits in breast cancer prevention efforts.[33][34] One recent study done in France, looked at four types of lignans, including that found in flaxseed (Secoisolariciresinol) in a prospective cohort study to see if intake predicted breast cancer incidence.[34] The authors report lowered risk of breast cancer among over 58,000 postmenopausal women who had the third highest quartile of lignan intake. There have been a few small pilot studies that have tested the effect of flaxseed on hot flashes. Currently there is a large study sponsored by the National Cancer Institute that is ongoing, but not accepting any new participants.[35] The rationale for the study is that estrogen can relieve the symptoms of menopause, but can also cause the growth of breast cancer cells. Flaxseed may reduce the number of hot flashes and improve mood and quality of life in postmenopausal women not receiving estrogen therapy.

Lifestyle changes

According to the North American Menopause Society (NAMS)[36]

Acupuncture

Acupuncture has been suggested to reduce incidence of hot flashes in women with breast cancer and men with prostate cancer, but the quality of evidence is low.[37][38]

Epidemiology

It has been speculated that hot flashes are less common among Asian women.[39][40]

中醫觀點

潮热为中医学病症，发热起伏如潮水之涨退有时。 本症有虚实之分：实者为阳盛所致，如热病过程中，有日晡潮热、谵语、腹满而硬、脉沉实有力等症，治宜泄热、通腑为主；虚者为阴虚所致，如疲劳，有两颧发赤、手足心热、盗汗等，治宜滋阴清热。

See also

References

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  23. ^ Raloxifene label Last updated 09/2007]
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External links

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