To set the stage for our new hot flash study enrolling here at Cedar Health, we talked with our women’s health principal investigator, Dr. Sooyeon Choi. Dr. Choi is a practicing physician at Walnut Hill OBGYN in addition to her PI duties here at Cedar Health. Her passion for women’s health and advancing treatment for female-related health conditions are the driving force behind her decision to get involved in research. Hot flashes are the hallmark symptom of menopause, and there are still many questions to be answered about how they are caused and why some women get them more severe than others. We spoke with Dr. Choi about some of these questions.
Tell us a little bit about your role. What motivates you to participate in clinical research?
Dr. Choi: As a Principal Investigator, I am responsible for overseeing, managing, and conducting clinical research with integrity and dependability to generate high quality and reproducible results. This is important as clinical trials are the primary ways to determine if a new treatment is safe and effective in people. Clinical trials also help discover new ways to detect, diagnose, and reduce the chance of developing the disease. Ultimately, clinical research helps advance medical knowledge and patient care. This is what motivates me to partake in clinical research! I went into medicine to help others and improve lives. I do this on a small scale with the patients I encounter, but clinical research takes this marginal impact to a much larger scale. It helps our future generations lead healthier lives, and I am thankful for the opportunity to partner in this scientific discovery and advancement.
Why do hot flashes in some women last longer than others?
Dr. Choi: Duration of hot flashes in an individual is variable from a median of 4 years but up to >10 years after onset. There is accumulating data that a small percentage of patients continue to have hot flashes even into their late menopause years (>20 years beyond menopause). Because the pathophysiology of a hot flash is not fully understood and is likely related to multiple factors, the reason for the longer duration of hot flashes in some women is not known. However, there are known risk factors that predict the duration of hot flashes. Women with more frequent vasomotor symptoms in pre-menopause or early peri-menopause experience a longer total duration of symptoms. Compared with women of other racial groups, African American and Hispanic women also have hot flashes for a more extended period. Additional factors related to a longer duration of hot flashes include obesity, low socioeconomic status, smoking, higher depressive symptoms, and anxiety at first reported vasomotor symptoms.
What are some things you, as a doctor, can recommend women can do at home to help remedy hot flashes?
Dr. Choi: Women with mild hot flashes can do simple behavioral measures such as using fans, dressing in layers of clothing that can be removed easily, lowering room temperature, avoiding triggers (spicy food, alcohol, caffeine, stressful situations), smoking cessation, losing weight, hydrating with cold water, aerobic exercises and taking low dose vitamin E. Complementary therapies such as phytoestrogens and herbal remedies (i.e. black cohosh, gingko biloba, ginseng, St. John’s wart, Chinese herbs) with or without acupuncture are being used as alternative therapies. However, none of these complementary therapies are regulated by the FDA. Because these have not been tested for safety, efficacy, or purity, complementary botanicals and natural products are not currently recommended to treat hot flashes.
If hormones are the gold-standard treatment for hot flashes, why are research studies needed for hot flashes?
Dr. Choi: Systemic hormone therapy is the most effective therapy for hot flashes associated with menopause. However, hormones carry risks as observed in the Women’s Health Initiative (WHI) Study in 2002. Risks include venous thromboembolism, stroke, pulmonary embolism, coronary heart disease, and breast cancer. Re-analysis of the WHI study and follow up studies show the risks vary based on the woman’s age and whether the woman is on a combined estrogen/progesterone or estrogen-only therapy. Younger women who initiate hormone therapy may have less risk and more potential benefits than was suggested. Also, newer versions of hormones are now available that may reduce risks associated with hormones, but studies are needed to evaluate these more modern treatments’ long-term safety.
Are we any closer to understanding the cause of hot flashes?
Dr. Choi: Due to the increased awareness and impact hot flashes have on the quality of women’s lives, interest in hot flashes has grown in recent years. Changes in reproductive hormones, genetic variation in hormone biosynthesis and metabolizing enzymes, neurons in the hypothalamus, and environmental factors have been identified as contributors to hot flashes’ pathogenesis. However, a definitive etiology for hot flashes is still not known. Further research is needed to better understand the mechanism of hot flashes in order to develop a more targeted therapy.
Hot flashes can be overwhelming, and the need to continually improve ways to manage them remains a vital goal for our team here at Cedar Health. When you decide to participate in women’s health clinical research studies, you help ensure future women have effective and safe ways to treat conditions like hot flashes. To learn more about how you can get involved in our hot flash studies, call (214) 253-8170, or visit our website for more information.