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To the Editor: In her Clinical Crossroads article about a 60-year-old woman trying to discontinue hormone replacement therapy (HRT), Dr Grady¹ did not mention behavioral interventions. My colleagues and I have found that slow, deep, abdominal breathing reduces hot flash frequency by about 50% in symptomatic, postmenopausal women.^2-4 The results of these studies were documented with physiological recordings of hot flashes, in addition to patient self-reports.

Hot flashes may be triggered by small elevations in core body temperature acting within a reduced thermoneutral zone.^5-6 When core temperature reaches the thresholds for sweating and peripheral vasodilation, a hot flash occurs. Therefore, procedures that reduce core body temperature, such as lowering ambient temperature and drinking cold liquids, may also reduce the occurrence of hot flashes.

Robert R. Freedman, PhD
Departments of Obstetrics and Gynecology and Psychiatry and Behavioral Neurosciences
Wayne State University School of Medicine
Detroit, Mich

1. Grady D. A 60-year-old woman trying to discontinue hormone replacement therapy. JAMA. 2002;287:2130-2137. FREE FULL TEXT 2. Germaine LM, Freedman RR. Behavioral treatment of menopausal hot flashes: evaluation by objective methods. J Consult Clin Psychol. 1984;52:1072-1079. FULL TEXT | ISI | PUBMED 3. Freedman RR, Woodward S. Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am J Obstet Gynecol. 1992;167:436-439. ISI | PUBMED 4. Freedman RR, Woodward S, Brown B, et al. Biochemical and thermoregulatory effects of behavioral treatments for menopausal hot flashes. Menopause. 1995;2:211-218. 5. Freedman RR, Norton D, Woodward S, et al. Core body temperature and circadian rhythm of hot flashes in menopausal women. J Clin Endocrinol Metab. 1995;80:2354-2358. ABSTRACT 6. Freedman RR, Krell W. Reduced thermoregulatory null zone in postmenopausal women with hot flashes. Am J Obstet Gynecol. 1999;181:66-70. FULL TEXT | ISI | PUBMED

To the Editor: In her . . . [Full Text of this Article]

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