My hot flash "aura" makes sense now., Norepinephrine appears to be the culprit Options

[SandraSmith]

I've noticed that I have an "aura" before my hot flashes, a consistent pair of symptoms that appear a minute or so before I feel the heat. My heart beats faster and I feel pressure all over my body, including my head, which I attribute to increased blood pressure even though I have not yet done any actual measurements. (I have a cuff at home, I should use it !) Sometimes I feel these symptoms throughout and after the flash as well. One night I woke up with a hot flash and my heart was racing, pounding !, and it frightened me !

And then I read this:

Although estrogen withdrawal is thought to be the central change that leads to hot flashes, accumulating evidence suggests that complex neuroendocrine pathways involving norepinephrine, estrogen, testosterone, serotonin, and endorphins all play a role in regulating the thermoregulatory center and are possible sites where dysfunction may occur. Blood levels of norepinephrine are increased both before and during hot flashes, and norepinephrine can increase core body temperature and induce a heat-loss response.

http://www.medscape.com/viewarticle/466850_2

Norepinephrine (a.k.a., noradrenaline) causes increased heart rate and blood pressure, among other things !

Someone started a thread about Clonidine, a drug to treat hypertension. One of its actions is to inhibit norepinephrine release. But of course it has other actions as well, so whether or not it's appropriate for treating hot flashes is not clear. Venlaxafine (Effexor) is a norepinephrine reuptake inhibitor as well as being an SSRI, so it too could help with hot flashes, but like Clonidine it has other actions and may not be truly appropriate. I have seen no info yet which states or even implies that hot flashes are physiologically damaging.

Regarding "estrogen withdrawal":

Estrogen withdrawal rather than low circulating estrogen levels seems to be the central change that leads to hot flashes. According to one working model of the pathogenesis of hot flashes, estrogen withdrawal leads to decreased levels of endorphin and catecholestrogen (a metabolic by-product of estrogen) and culminates in increased hypothalamic release of norepinephrine and serotonin. Norepinephrine and serotonin lower the set point in the thermoregulatory nucleus; this allows heat loss mechanisms to be triggered by subtle changes in core body temperature. In this model, endorphins play a key role in the regulation of norepinephrine release, and agents that increase estrogen and endorphin levels or that decrease central norepinephrine release would be expected to reduce hot flashes.

http://www.cmaj.ca/cgi/content/full/170/1/39

[SandraSmith]

Hmmmm, now that I think about it, it doesn't make sense that venlaxafine would work, it inihibits the reuptake of norepinephrine so the end result would be more norepinephrine, right ?

[Sariah]

Yes, norepinephrine seems to kick in to make up for a deficit of other hormones that are involved in keeping metabolism normal. When my ferritin levels were low, I was having scary adenraline-like surges (not flashes) where my heart would race and I'd feel very wired and scared. Getting the ferritin levels up stopped that. Low iron decreases metabolism, so the body compensates by sending out adrenaline to make up for it.

These type of surges are common with hypothyroidism also, causing panic and anxiety, and I also experienced them when my thyroid was low and unmedicated. Again, the norepi kicked in to compensate for the low metabolism of hypothyroidism.

It also happens with low cortisol. I also was Dx with adrenal fatigue and during that time without meds I experience them also. Taking the hydrocortisone stopped the norepi release.

My body just seems to be prone to respond with increased norepi any time my metabolism slows .

Vliet talks about the increased release of norepi when sex hormone levels fall.

So apparently norepi is the fall-back hormone when the other ones are not doing their job, for whatever reason.

[SandraSmith]

Wow, very interesting. I'm interested in ways to reduce this norepinephrine rush I find the pre-heat symptoms even more obnoxious than the heat ! I *just* had a flash and my head actually throbbed for a couple of seconds ! Maybe I just need to up my estradiol dose. I'm using a rather small amount right now. It probably wouldn't hurt me to take an iron supplement.

[Floater]

Sandra, remember too that it takes a few weeks to fee the full benefits of estrogel therapy. Even though I had an immediate benefit, as in more energy, better sense of well being, I didn't feel the full benefits for about 3 weeks. I would give yourself 2 full weeks at your current dose of Estrogel, then increase it if you are still having those horribly unpleasant hot flashes.

And for whatever the reason Effexor DOES help prevent hot flashes in many many women who take it. It was an unexpected benefit when prescribed to menopausal women - the developers had not expected that reaction.

From all the articles you have posted recently regarding hot flashes, you must be suffering from them quite badly? I am down to maybe one very very mild flash a day, generally late in the evening....and occasionally one first thing in the morning. I use my whole estrogel dose in the AM, so I am guessing the estrogen is dropping off by late evening and early morning. It is interesting to note, I don't have them during the night while I sleep....or if I do they don't awaken me.

[SandraSmith]

You're right, I should wait to alter my dose. I forgot about that. Thank you for reminding me.

I'm still having several flashes per day and night. I would estimate 8 per day. None are making me sweat, some are so mild I hardly notice them.

But today is different from the others in that I'm having more of that pre-flash pressure feeling. I just got done with my worst flash of the day, the heat wasn't so bad but the pressure feeling lasted many many minutes and I was very uncomfortable ! When the heat finally arrived I felt an entire-body sense of relief and relaxation. But now just a few minutes later the pressure feeling is back. I wish I had my BP cuff here, I'd take a measurement ! I feel like I'm going to get a massive headache soon. I wonder if ibuprofen would help now, before the headache sets in.

[Sariah]

You're right, I should wait to alter my dose. I forgot about that. Thank you for reminding me.

I'm still having several flashes per day and night. I would estimate 8 per day. None are making me sweat, some are so mild I hardly notice them.

But today is different from the others in that I'm having more of that pre-flash pressure feeling. I just got done with my worst flash of the day, the heat wasn't so bad but the pressure feeling lasted many many minutes and I was very uncomfortable ! When the heat finally arrived I felt an entire-body sense of relief and relaxation. But now just a few minutes later the pressure feeling is back. I wish I had my BP cuff here, I'd take a measurement ! I feel like I'm going to get a massive headache soon. I wonder if ibuprofen would help now, before the headache sets in.

Sandra,
I'm getting the feeling your dose could be too high. I could be wrong, but perhaps cut it down for a few days and see what happens.

[SandraSmith]

I could skip my dose this evening and see if that doesn't help. At worst I'll be up a dozen times in the middle of the night, but I foresee a relatively easy day at work tomorrow so I should be able to get through it sleep-deprived. :-)

You know, I'm really glad I didn't start the Prometrium when I started the Estrogel, because I would have a hard time figuring out which product is responsible. And then it might turn out that my own estradiol is still dropping and it's not the products at all. I actually believe it is the latter case, but I'll go without Estrogel tonight and see what happens.

[SandraSmith]

Just an update here ....

Last night I noticed that my symptoms were getting worse, more pressure, more frequent and more intense hot flashes. So rather than forego the Estrogel, I applied it, a petite pea sized glob. Let me tell you, within 10 minutes I felt a rush of relief. The pressure went away. I slept quite well, I did wake up in the middle of the night a few times but nothing major. I slept for 8 hours !!!

I used a pea sized glob this morning and although I feel the pressure my hot flashes are minimal. I feel less pressure when I walk around, more when I'm just sitting at my desk.

I have a sinus infection, it started before I started using the Estrogel. I had a bloody nose this morning. I suspect some of my ill feeling is coming from that. But I'm sure more is just from the fact that I'm becoming menopausal. I hope it doesn't get much worse than this !! My sister said she had a year and a half of hot flashes. :-/ She didn't use HRT but feels so dragged out, and she gained so much weight (she was never overweight so this is really unusual), I've convinced her to give it a try. She's been in contact with Bellevue and has a doc appt today.

[Floater]

Sandra

I realize you are getting many differing opinions here, but it sure sounds to me like your are very estrogen deficient and your body is gobbling up the little you are giving it. I don't think "less" is the answer. Plus if I am not mistaken you have been using a progesterone for some time now, with no estrogen? You are probably out of balance with the E being too low, which is why you feel such immediate relief on the E. Hang in there and be consistant with the Estrogel. It is too soon to start messing with your dosage. After 2 weeks of consistant use, decide if you need more (I doubt you are going to need less). If you adjust it at 2 weeks, wait other 2 weeks before making another adjustment.

Your hot flashes are a good indicator, when they stop you have reached your minimum requirement....and some say you need more than that to get optimal benefits. I haven't tried going over the amount I need to prevent flashes. I am kind of scared to. I guess I should go get a blood test and see what my estradiol level IS.

[SandraSmith]

You are correct. I started using Pro-Gest in Feb or Mar 2007 and used it nearly every month, and I continue to use it.

I'm beginning to think you're right, that rush of relief I felt last night was eye opening. I had the same thought that you stated, I'm gobbling up what is coming in.

I am currently using approx 1/2 dose or less per day, split into morning and evening applications almost exactly 12 hours apart to try to get a more steady state.

I will take your advice and just continue to use this amount through 2 weeks, unless I develop some major problem.

Today I feel very good, hardly any flashing at all and so minimal I'm not even adjusting my clothing. Mentally I feel good. I feel that pressure but I decided to handle it by getting up and walking around more frequently. I should be drinking more water anyway, I'll make more trips to the water fountain.

This is ALL so exciting and kind of scary too ! I've read a lot, been preparing for nearly 2 years to use estradiol, and now I'm doing it. Once again I want to thank you and the others who have been using this stuff before me and can give me good advice ! It's worth so much !

[FoxyRoxy]

You are correct. I started using Pro-Gest in Feb or Mar 2007 and used it nearly every month, and I continue to use it.

I'm beginning to think you're right, that rush of relief I felt last night was eye opening. I had the same thought that you stated, I'm gobbling up what is coming in.

I am currently using approx 1/2 dose or less per day, split into morning and evening applications almost exactly 12 hours apart to try to get a more steady state.

I will take your advice and just continue to use this amount through 2 weeks, unless I develop some major problem.

Today I feel very good, hardly any flashing at all and so minimal I'm not even adjusting my clothing. Mentally I feel good. I feel that pressure but I decided to handle it by getting up and walking around more frequently. I should be drinking more water anyway, I'll make more trips to the water fountain.

This is ALL so exciting and kind of scary too ! I've read a lot, been preparing for nearly 2 years to use estradiol, and now I'm doing it. Once again I want to thank you and the others who have been using this stuff before me and can give me good advice ! It's worth so much !

Sandra can I ask what you mean by that pressure feeling?? Am I right in remembering a while ago you supposedly tested high for Estrogen, if so was this via saliva or blood tests?? It's so hard to know which hormone we need for whatever symptoms we are suffering. I have tried the P cream, persevered with it for 6 months but ditched it after it gave me the worst anxiety I've ever had in my life amongst other problems which I am still suffering with to this day and I haven't used it for over 2 yrs now. I have had a couple of hormone blood tests and both showed normal/high Progesterone level and lowish Estrogen level. My body hates hormones (couldn't even tolerate the BCP years ago) so I am reluctant to try this but my holistic doctor does prescribe bi-est in a very low dose. In your quest for knowledge on this stuff have you discovered there is any pattern to when it's most likely that the Estrogen levels will drop off considerably during the day? I feel like I have a pattern to when I feel really bad like all of a sudden my hormones have dipped and it's around the same times each day. It's a feeling like something has ****** the air right out of my solar plexus area and I get this awful sinking feeling and feel quite emotional for a short time. Also when the hormones dip would it be feasible that the adrenaline would kick in to compensate to try and stimulate the adrenal glands to pump out something to compensate?? My worst time of the month for all this happening is between days 4 through to day 13 of my cycle. I have increased headaches now too, it's almost an everyday occurance now and the lightheadedness (head and ear pressure at times) and anxiety has increased also since I have weaned off my AD (Doxepin). It seems like the AD might have leveled some of the hormone stuff out a wee bit while I was on it but it gave me other terrible side effects so I decided enough was enough and it had to go.

I'm scared to go the Estrogen route as there is a family history of breast cancer on my dads side and I had a breast lump (fatty tissue) 3 yrs ago which scared me so I am very wary now. But I can't go on much longer like this either if low Estrogen is the reason for it all as I am only 42 and could have years and years of all this to suffer through yet .

Rox

[Duch]

Sandra

I'm in a bit of a rush, and didn't have time to read this entire thread, but look at that chart.... the estrogen withdrawl leads to an increase in NE. Effexor inhibits the reuptake of NE, or as you observed increases the bioavailability of NE, that's why Effexor works. My dr put me on it (after clonidine) and it did reduce the heat by --- hard to quantify the intensity, but it wasn't as hot --- the duration was reduced about 40% (I would flush 72 hours straight).

The bad news is this is a hideous drug for some people. For severely depressed people, it can be a God-send, but some people are on the drug for years. When it ceases doing its job, they cannot get off the stuff. I took this for 23 days, and it was sheer hell the last 15 days. I would exhaust every other option before I'd even try this stuff.

[SandraSmith]

It still doesn't make sense to me ... if the release of norepinephrine causes increased heart rate and increased BP, then why doesn't the increase in availability of NE due to reuptake inhibition cause increased heart rate and increased BP ?? Am I wrong to think more NE => faster heartbeat and higher BP ??? Apparently so, but I can't yet figure it out.

Rox, by pressure I mean this physical sense that my BP has increased, I feel it all throughout my body. It feels like I'm exerting myself when I am not. My BP always measures normal in the docs' offices. It was last measured on Oct 29. I get the feeling before a hot flash sets in, though now that I'm supplementing estradiol I feel it much less. I really do think it's the NE.