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Myra S. Hunter - One of the best experts on this subject based on the ideXlab platform.
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The menopausal Hot Flush: a review
Climacteric : the journal of the International Menopause Society, 2017Co-Authors: David W. Sturdee, Myra S. Hunter, Pauline M. Maki, Pratima Gupta, Jenifer Sassarini, J. C. Stevenson, Mary Ann LumsdenAbstract:The Hot Flush is the most characteristic and often the most distressing symptom of the menopause. It is a unique feature and yet the mechanism and health implications are still not fully understood. This review summarizes some of the current thoughts on factors contributing to Flushing, the physiological, vascular and neuroendocrine changes associated with Flushing and the possible cardiovascular and other health implications for women experiencing Hot Flushes. Therapy is not discussed.
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the Hot Flush beliefs and behaviour scale for men hfbbs men undergoing treatment for prostate cancer
Maturitas, 2014Co-Authors: Myra S. Hunter, Evgenia Stefanopoulou, Christopher F Sharpley, Omar Yousaf, Vicki Bitsika, David ChristieAbstract:Abstract Objective Hot Flushes and night sweats (HFNS) are commonly experienced by men receiving treatment for prostate cancer. Cognitive behavioural therapy (CBT) has been found to be an effective treatment for HFNS in women, but cognitions and behavioural reactions to HFNS in men are under-researched. This study describes the development of the HFNS beliefs and behaviour scale for men. Methods HFNS beliefs and behaviour items were generated from a qualitative study, from pilot interviews with men with prostate cancer and HFNS, and from scales used for women. 118 men with prostate cancer, aged above 18, English-speaking, who had minimum of seven HFNS weekly for at least 1 month, completed the initial measure, and measures of HFNS frequency, problem rating, anxiety and depression (HADS). Principal components analyses with orthogonal rotation determined the most coherent solution. Results Exploratory factor analysis culminated in a 17-item HFNS beliefs and behaviour scale for men (HFBBS-Men) with three subscales: (1) HFNS social context and sleep, (2) Calm/Acceptance, (3) Humour/Openness. The subscales had reasonable internal consistency (Cronbach alpha 0.56–0.83). Validity was supported, by correlations between subscale 1, HFNS frequency, problem-rating and mood; men with locally advanced cancer more likely to adopt Calm/Acceptance and those with metastatic cancer Humour/Openness. Conclusions Preliminary analysis of the HFBBS-Men suggests that it is a psychometrically sound instrument, grounded in men's experiences. As a measure of cognitive and behavioural reactions to HF/NS, the HFBBS-Men should increase understanding of the mediators of outcomes of psychological interventions, such as CBT.
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an international menopause society study of climate altitude temperature ims cat and vasomotor symptoms in urban indian regions
Climacteric, 2014Co-Authors: Evgenia Stefanopoulou, David W. Sturdee, Pratima Gupta, Duru Shah, R Shah, Myra S. HunterAbstract:AbstractObjective To examine the relationships between climate (season, temperature, humidity), lifestyle, health, mood and beliefs and experience of Hot Flushes and night sweats amongst mid-aged women living in eight urban Indian centers.Methods A total of 717 peri- and postmenopausal women, aged 45–55 years, from urban centers in different regions of India were included. Data were collected during both summer and winter months. Participants completed questionnaires eliciting information about sociodemographics, Hot Flushes (prevalence, frequency and problem-rating), health and lifestyle (body mass index, diet, exercise, alcohol use), mood (Women's Health Questionnaire) and attributions and beliefs (Menopause Representations Questionnaire).Results The prevalence of vasomotor symptoms was low, with 34% of the sample reporting Hot Flushes and/or night sweats. Seasonal variation in temperature was not associated with Hot Flush prevalence, frequency or problem rating. Hot Flush prevalence was mainly associat...
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the Hot Flush behavior scale a measure of behavioral reactions to menopausal Hot Flushes and night sweats
Menopause, 2011Co-Authors: Myra S. Hunter, Beverley Ayers, Melanie SmithAbstract:AbstractObjective: There is increasing interest in the development of nonmedical treatments for menopausal Hot Flushes(HF) and night sweats (NS) and some evidence that cognitive behavioral interventions reduce their impact. How-ever, the behavioral component of HF/NS is underresearched. This article describes the development of the HotFlush Behavior Scale (HFBehS), a measure of the behavioral strategies that women use in response to HF/NS, andreports on the reliability, validity, and factor structure of the scale.Methods: Behavioral items were generated from the empirical literature and qualitative studies based on in-depthinterviews, with the aim of reflecting common behaviors related to HF/NS. A total of 140 women who had HF/NScompleted the initial measure. Principal components analyses were applied to the data, with orthogonal rotation, todetermine the most coherent and interpretable solution.Results: Exploratory factor analysis culminated in an 11-item measure comprising three dimensions: behavioralavoidance, practicalcoolingbehaviors, andpositive behavioral strategies. TheHot FlushBeliefsScale subscales hadreasonable internal consistency, with > values ranging from 0.59 to 0.76. Validity was supported through correla-tions with measures of HF/NS problem rating and frequency and cognitive measures (HF/NS beliefs).Conclusions: Preliminary analysis of the HFBehS reveals it to be a psychometrically sound instrument. TheHFBehS isgroundedin women’s experiencesandcan beusedas ameasure of behavioral reactionsto HF/NS as wellas enabling more rigorous evaluation of psychological interventions.Key Words: Hot Flushes Y Night sweats Y Vasomotor symptoms Y Behavior Y Beliefs Y Cognitive behaviortherapy.
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The Hot Flush Beliefs Scale: a tool for assessing thoughts and beliefs associated with the experience of menopausal Hot Flushes and night sweats.
Maturitas, 2008Co-Authors: Melanie J. Rendall, Laura M. Simonds, Myra S. HunterAbstract:Abstract Objectives Approximately 15–20% of women experience their Hot Flushes and night sweats as problematic. There is some evidence that cognitive appraisals may help explain individual variation, and that cognitive behaviour therapy can alleviate related distress. This paper describes the development of the Hot Flush Beliefs Scale (HFBS), a questionnaire to assess women's appraisals, and reports on the reliability, validity and factor structure of the scale. Methods An initial pool of 63 items was generated from several sources: empirical literature, clinicians’ views, and in-depth interviews, with the aim of reflecting common thoughts and beliefs about Flushes and sweats. A total of 103 women, aged 41–64 years completed the initial measure. Principal components analysis and principal axis factoring were applied to the data, with both orthogonal and oblique rotation to determine the most coherent and interpretable solution. Results Exploratory factor analysis culminated in a 27-item measure comprising three dimensions: beliefs about self in social context; beliefs about coping with Hot Flushes; beliefs about coping with night sweats/sleep. The HFBS was internally consistent, with subscale alphas ranging from 0.78 to 0.93, and test–retest reliability 0.74–0.78. Validity was supported through correlations with other measures of mood and menopause beliefs. Conclusions Preliminary analysis of the HFBS reveals it to be a psychometrically sound instrument. The HFBS has the benefit of being grounded in women's experiences and shows initial promise as a tool to aid further clinical and theoretical understanding of the impact of Hot Flushes and night sweats.
Sebastian Mirkin - One of the best experts on this subject based on the ideXlab platform.
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changes in bone mineral density are correlated with bone markers and reductions in Hot Flush severity in postmenopausal women treated with bazedoxifene conjugated estrogens
Menopause, 2013Co-Authors: J C Gallagher, Harry Shi, Sebastian Mirkin, Arkadi ChinesAbstract:OBJECTIVE A post hoc exploratory analysis was conducted to examine correlations between changes in bone density, bone markers, and Hot Flushes after the treatment of postmenopausal women with bazedoxifene (BZA)/conjugated estrogens (CE). METHODS In a 2-year phase 3 study, 3,397 postmenopausal women were randomized to BZA 10 mg/CE 0.45 mg, BZA 20 mg/CE 0.45 mg, BZA 40 mg/CE 0.45 mg, BZA 10 mg/CE 0.625 mg, BZA 20 mg/CE 0.625 mg, BZA 40 mg/CE 0.625 mg, raloxifene 60 mg, or placebo. In this analysis, bone density changes at 2 years were compared with baseline levels of the bone markers serum C-telopeptide and osteocalcin. Correlations between changes in bone density and changes in 12-week Hot Flush composite scores in symptomatic women were also analyzed. RESULTS Treatment with BZA 20 mg/CE 0.45 mg or BZA 20 mg/CE 0.625 mg increased lumbar spine bone density more in women with higher bone resorption and formation, categorized by baseline levels of C-telopeptide and osteocalcin (P < 0.001, both BZA/CE doses). With placebo, larger decreases in lumbar spine bone density were seen in the highest tertile of serum C-telopeptide. There was no correlation between changes in total hip bone density and baseline bone markers. There were significant correlations between percent change in Hot Flush score at week 12 and percent changes in lumbar spine (r = -0.31, P = 0.006) and total hip (r = -0.23, P = 0.044) bone densities at month 24. CONCLUSIONS With 2-year BZA/CE treatment, women with larger increases in lumbar spine and total hip densities also have higher baseline bone markers. Early reductions in Hot Flush score (12 wk) are predictive of long-term increases in bone density (24 mo).
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Hot Flush symptom free days with bazedoxifene conjugated estrogens in postmenopausal women
Climacteric, 2013Co-Authors: J. Racketa, Arkadi Chines, Sebastian MirkinAbstract:ABSTRACTObjective The aim of this study was to examine the number of Hot Flush symptom-free days in symptomatic postmenopausal women treated with bazedoxifene/conjugated estrogens (BZA/CE).Methods In this 12-week, randomized, double-blind, placebo-controlled, phase-3 study, 322 postmenopausal women aged 40–65 years with an intact uterus who had ≥ seven moderate-to-severe daily Hot Flushes (or ≥ 50 per week) were randomized to BZA 20 mg/CE 0.45 or 0.625 mg or placebo. Subjects recorded the incidence and severity of Hot Flushes on daily diary cards. In this secondary analysis, the number of days per week without Hot Flushes from baseline to week 12 was determined. The percentage of women who experienced no Hot Flushes at week 12 was also evaluated.Results From baseline to week 12, the number of days per week without moderate-to-severe Hot Flushes or without any Hot Flushes steadily increased for women treated with BZA 20 mg/CE 0.45 or 0.625 mg versus placebo. In addition, the rate of increase in days per we...
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Hot Flush symptom-free days with bazedoxifene/conjugated estrogens in postmenopausal women
Climacteric : the journal of the International Menopause Society, 2012Co-Authors: J. Racketa, Arkadi Chines, Sebastian MirkinAbstract:ABSTRACTObjective The aim of this study was to examine the number of Hot Flush symptom-free days in symptomatic postmenopausal women treated with bazedoxifene/conjugated estrogens (BZA/CE).Methods In this 12-week, randomized, double-blind, placebo-controlled, phase-3 study, 322 postmenopausal women aged 40–65 years with an intact uterus who had ≥ seven moderate-to-severe daily Hot Flushes (or ≥ 50 per week) were randomized to BZA 20 mg/CE 0.45 or 0.625 mg or placebo. Subjects recorded the incidence and severity of Hot Flushes on daily diary cards. In this secondary analysis, the number of days per week without Hot Flushes from baseline to week 12 was determined. The percentage of women who experienced no Hot Flushes at week 12 was also evaluated.Results From baseline to week 12, the number of days per week without moderate-to-severe Hot Flushes or without any Hot Flushes steadily increased for women treated with BZA 20 mg/CE 0.45 or 0.625 mg versus placebo. In addition, the rate of increase in days per we...
David A Low - One of the best experts on this subject based on the ideXlab platform.
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is core temperature the trigger of a menopausal Hot Flush
Menopause, 2019Co-Authors: Helen Jones, Tom G Bailey, David Barr, Rebekah A I Lucas, Craig G Crandall, David A LowAbstract:Objective:Menopausal Hot Flushes negatively impact quality of life and may be a biomarker of cardiovascular and metabolic disease risk; therefore understanding the physiology of Hot Flushes is important. Current thinking is that a small elevation (∼0.03-0.05C) in core temperature surpasses a sweating threshold (that is reduced in the menopause), sweating is activated, and a Hot Flush ensues. Nevertheless, more recent studies examining thermoregulatory control question whether core temperature per se can explain the trigger for a Hot Flush. The primary aim of this study was to assess the contribution of increases in core temperature on the occurrence of menopausal Hot Flushes.Methods:For this purpose, 108 Hot Flushes were objectively assessed in a laboratory setting in 72 symptomatic postmenopausal women (aged 45.8±5.1 years; body mass index 25.9±4.5kg/m) from five previously reported studies. Women rested, wearing a tube-lined suit (or trousers), which was perfused with 34C water. A subset then underwent mild heat stress (48°C water). Sweat rate, skin blood flow, blood pressure, heart rate, skin, and core temperature were measured continuously throughout. A Hot Flush was objectively identified during rest (spontaneous Hot Flush) or mild heating as an abrupt increase in sternal sweat rate. Further, a subset of symptomatic postmenopausal women (n=22) underwent whole-body passive heating for 60 minutes to identify core temperature thresholds and sensitivities for sweat rate and cutaneous vasodilation, which were compared to a subset of premenopausal women (n=18). Data were analyzed using t tests and/or general linear modeling, and are presented as mean (95% confidence interval).Results:In the 20 minutes before a spontaneous Hot Flush, core temperature increased by 0.03±0.12C (P<0.05), but only 51% of Hot Flushes were preceded by an increase in core temperature. During mild heating, 76% of Hot Flushes were preceded by an increase in core temperature. The temperature thresholds for sweating were similar, but the vasodilatory threshold was higher in postmenopausal compared with premenopausal women (37.1±0.2 vs 36.8±0.3°C; P=0.06).Conclusion:We provide new evidence that menopausal Hot Flushes are unlikely triggered by an increase in core temperature. These findings provide important information about the physiology of Hot Flushes that have implications for treatment and management options for menopausal Hot Flushes.
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Exercise training reduces the acute physiological severity of post-menopausal Hot Flushes
The Journal of physiology, 2015Co-Authors: Tom G Bailey, David A Low, Timothy N. Cable, Nabil Aziz, Gregory Atkinson, Daniel J. Cuthbertson, Helen JonesAbstract:A Hot Flush is characterised by feelings of intense heat, profuse elevations in cutaneous vasodilatation and sweating, and reduced brain blood flow. Exercise training reduces self-reported Hot Flush severity, but underpinning physiological data are lacking. We hypothesised that exercise training attenuates the changes in cutaneous vasodilatation, sweat rate and cerebral blood flow during a Hot Flush. In a preference trial, 18 symptomatic post-menopausal women underwent a passive heat stress to induce Hot Flushes at baseline and follow-up. Fourteen participants opted for a 16 week moderate intensity supervised exercise intervention, while seven participants opted for control. Sweat rate, cutaneous vasodilatation, blood pressure, heart rate and middle cerebral artery velocity (MCAv) were measured during the Hot Flushes. Data were binned into eight equal segments, each representing 12.5% of Hot Flush duration. Weekly self-reported frequency and severity of Hot Flushes were also recorded at baseline and follow-up. Following training, mean Hot Flush sweat rate decreased by 0.04 mg cm(2) min(-1) at the chest (95% confidence interval 0.02-0.06, P = 0.01) and by 0.03 mg cm(2) min(-1) (0.02-0.05, P = 0.03) at the forearm, compared with negligible changes in control. Training also mediated reductions in cutaneous vasodilatation by 9% (6-12%) at the chest and by 7% (4-9%) at forearm (P 0.05). Training attenuated Hot Flush MCAv by 3.4 cm s(-1) (0.7-5.1 cm s(-1), P = 0.04) compared with negligible changes in control. Exercise training reduced the self-reported severity of Hot Flushes by 109 arbitrary units (80-121, P < 0.001). These data indicate that exercise training leads to parallel reductions in Hot Flush severity and within-Flush changes in cutaneous vasodilatation, sweating and cerebral blood flow.
Helen Jones - One of the best experts on this subject based on the ideXlab platform.
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is core temperature the trigger of a menopausal Hot Flush
Menopause, 2019Co-Authors: Helen Jones, Tom G Bailey, David Barr, Rebekah A I Lucas, Craig G Crandall, David A LowAbstract:Objective:Menopausal Hot Flushes negatively impact quality of life and may be a biomarker of cardiovascular and metabolic disease risk; therefore understanding the physiology of Hot Flushes is important. Current thinking is that a small elevation (∼0.03-0.05C) in core temperature surpasses a sweating threshold (that is reduced in the menopause), sweating is activated, and a Hot Flush ensues. Nevertheless, more recent studies examining thermoregulatory control question whether core temperature per se can explain the trigger for a Hot Flush. The primary aim of this study was to assess the contribution of increases in core temperature on the occurrence of menopausal Hot Flushes.Methods:For this purpose, 108 Hot Flushes were objectively assessed in a laboratory setting in 72 symptomatic postmenopausal women (aged 45.8±5.1 years; body mass index 25.9±4.5kg/m) from five previously reported studies. Women rested, wearing a tube-lined suit (or trousers), which was perfused with 34C water. A subset then underwent mild heat stress (48°C water). Sweat rate, skin blood flow, blood pressure, heart rate, skin, and core temperature were measured continuously throughout. A Hot Flush was objectively identified during rest (spontaneous Hot Flush) or mild heating as an abrupt increase in sternal sweat rate. Further, a subset of symptomatic postmenopausal women (n=22) underwent whole-body passive heating for 60 minutes to identify core temperature thresholds and sensitivities for sweat rate and cutaneous vasodilation, which were compared to a subset of premenopausal women (n=18). Data were analyzed using t tests and/or general linear modeling, and are presented as mean (95% confidence interval).Results:In the 20 minutes before a spontaneous Hot Flush, core temperature increased by 0.03±0.12C (P<0.05), but only 51% of Hot Flushes were preceded by an increase in core temperature. During mild heating, 76% of Hot Flushes were preceded by an increase in core temperature. The temperature thresholds for sweating were similar, but the vasodilatory threshold was higher in postmenopausal compared with premenopausal women (37.1±0.2 vs 36.8±0.3°C; P=0.06).Conclusion:We provide new evidence that menopausal Hot Flushes are unlikely triggered by an increase in core temperature. These findings provide important information about the physiology of Hot Flushes that have implications for treatment and management options for menopausal Hot Flushes.
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Exercise training reduces the acute physiological severity of post-menopausal Hot Flushes
The Journal of physiology, 2015Co-Authors: Tom G Bailey, David A Low, Timothy N. Cable, Nabil Aziz, Gregory Atkinson, Daniel J. Cuthbertson, Helen JonesAbstract:A Hot Flush is characterised by feelings of intense heat, profuse elevations in cutaneous vasodilatation and sweating, and reduced brain blood flow. Exercise training reduces self-reported Hot Flush severity, but underpinning physiological data are lacking. We hypothesised that exercise training attenuates the changes in cutaneous vasodilatation, sweat rate and cerebral blood flow during a Hot Flush. In a preference trial, 18 symptomatic post-menopausal women underwent a passive heat stress to induce Hot Flushes at baseline and follow-up. Fourteen participants opted for a 16 week moderate intensity supervised exercise intervention, while seven participants opted for control. Sweat rate, cutaneous vasodilatation, blood pressure, heart rate and middle cerebral artery velocity (MCAv) were measured during the Hot Flushes. Data were binned into eight equal segments, each representing 12.5% of Hot Flush duration. Weekly self-reported frequency and severity of Hot Flushes were also recorded at baseline and follow-up. Following training, mean Hot Flush sweat rate decreased by 0.04 mg cm(2) min(-1) at the chest (95% confidence interval 0.02-0.06, P = 0.01) and by 0.03 mg cm(2) min(-1) (0.02-0.05, P = 0.03) at the forearm, compared with negligible changes in control. Training also mediated reductions in cutaneous vasodilatation by 9% (6-12%) at the chest and by 7% (4-9%) at forearm (P 0.05). Training attenuated Hot Flush MCAv by 3.4 cm s(-1) (0.7-5.1 cm s(-1), P = 0.04) compared with negligible changes in control. Exercise training reduced the self-reported severity of Hot Flushes by 109 arbitrary units (80-121, P < 0.001). These data indicate that exercise training leads to parallel reductions in Hot Flush severity and within-Flush changes in cutaneous vasodilatation, sweating and cerebral blood flow.
Joel Bobula - One of the best experts on this subject based on the ideXlab platform.
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Hot Flush frequency and severity at baseline as predictors of time to transient and stable treatment success pooled analysis of two ce bza studies
Menopause, 2017Co-Authors: Joann V. Pinkerton, Andrew G. Bushmakin, Barry S. Komm, Joel Bobula, Joanne Lavenberg, Lucy AbrahamAbstract:AbstractObjective:To evaluate the impact of baseline Hot Flush frequency and severity on time to symptom improvement during treatment with conjugated estrogens/bazedoxifene (CE/BZA).Methods:Data were pooled through week 12 from two randomized placebo-controlled trials (SMART-1 and SMART-2) of nonhys
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time to transient and stable reductions in Hot Flush frequency in postmenopausal women using conjugated estrogens bazedoxifene
Menopause, 2017Co-Authors: Joann V. Pinkerton, Andrew G. Bushmakin, Lucy Abraham, Barry S. Komm, Joel BobulaAbstract:OBJECTIVE This post hoc analysis estimates time to transient and stable reductions in Hot Flush frequency in postmenopausal women using conjugated estrogens/bazedoxifene. METHODS In the 12-week Selective estrogens, Menopause, And Response to Therapy (SMART)-2 trial of conjugated estrogens/bazedoxifene 0.45 mg/20 mg and 0.625 mg/20 mg, women with at least seven moderate/severe Hot Flushes per day or 50 per week at screening recorded frequency of moderate/severe Hot Flushes in diaries. Nonparametric models and SAS Proc Lifetest were used to estimate median times to various degrees of transient reductions (first day with improvement) and stable reductions (first day with improvement maintained through study's end) in Hot Flush frequency. RESULTS Treatment produced transient Hot Flush reductions of 40% to 100% and stable reductions of 30% to 100% significantly faster than placebo. Median time to a transient 50% reduction was 8 days for conjugated estrogens/bazedoxifene 0.45 mg/20 mg, 9.5 for 0.625 mg/20 mg, and 10 for placebo; median time to a stable 50% reduction was 9, 10, and 38 days. Median time to a transient 90% reduction was 32 and 22.5 days for 0.45 mg/20 mg and 0.625 mg/20 mg, and median time to a stable 90% reduction was 83 and 29 days, respectively; median times to transient/stable 90% reductions were not reached during the 12-week study in the placebo group. CONCLUSIONS Although not all women using conjugated estrogens/bazedoxifene achieve permanent elimination of Hot Flushes, the frequency is likely to be substantially reduced during the first week to month. Women can expect approximately 50% reduction in Hot Flush frequency after about 8 to 10 days, and sustained improvement with continued treatment.
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Time to transient and stable reductions in Hot Flush frequency in postmenopausal women using conjugated estrogens/bazedoxifene.
Menopause (New York N.Y.), 2017Co-Authors: Joann V. Pinkerton, Andrew G. Bushmakin, Lucy Abraham, Barry S. Komm, Joel BobulaAbstract:OBJECTIVE This post hoc analysis estimates time to transient and stable reductions in Hot Flush frequency in postmenopausal women using conjugated estrogens/bazedoxifene. METHODS In the 12-week Selective estrogens, Menopause, And Response to Therapy (SMART)-2 trial of conjugated estrogens/bazedoxifene 0.45 mg/20 mg and 0.625 mg/20 mg, women with at least seven moderate/severe Hot Flushes per day or 50 per week at screening recorded frequency of moderate/severe Hot Flushes in diaries. Nonparametric models and SAS Proc Lifetest were used to estimate median times to various degrees of transient reductions (first day with improvement) and stable reductions (first day with improvement maintained through study's end) in Hot Flush frequency. RESULTS Treatment produced transient Hot Flush reductions of 40% to 100% and stable reductions of 30% to 100% significantly faster than placebo. Median time to a transient 50% reduction was 8 days for conjugated estrogens/bazedoxifene 0.45 mg/20 mg, 9.5 for 0.625 mg/20 mg, and 10 for placebo; median time to a stable 50% reduction was 9, 10, and 38 days. Median time to a transient 90% reduction was 32 and 22.5 days for 0.45 mg/20 mg and 0.625 mg/20 mg, and median time to a stable 90% reduction was 83 and 29 days, respectively; median times to transient/stable 90% reductions were not reached during the 12-week study in the placebo group. CONCLUSIONS Although not all women using conjugated estrogens/bazedoxifene achieve permanent elimination of Hot Flushes, the frequency is likely to be substantially reduced during the first week to month. Women can expect approximately 50% reduction in Hot Flush frequency after about 8 to 10 days, and sustained improvement with continued treatment.