TO THE EDITOR: The article, "Diagno...

TO THE EDITOR: The article, "Diagnosing Night Sweats," (1) in American Family Physician was highly interesting. While the article discussed many entities, single of the most common reasons for this symptom in women was given to a high degree little emphasis. With the population distribution in the United States, perimenopause and menopause are by dint of far the most common cause of night sweats in a primary care population. Many women have discontinued hormone therapy. They also may have night sweats just as they did when they were perimenopausal. Night sweats can contribute to slumber deprivation and mood swings. Night sweats and very warm flushes are associated with depression in perimenopausal women (2) Night sweats are usually the first menopausal symptom to come into one's head in perimenopausal women. They will appear even before the onset of irregular periods or before follicle-stimulating hormone (FSH) flats become elevated. Thus, the FSH of the same height will not always indicate the etiology of night sweats, unles the woman also has been amenorrheic. violent flushes and night sweats as symptoms of menopause meet the eye more frequently in black women and in women who have had a surgical menopause. (3)

Another frequent cause of night sweats that was not noted in the article (1) is the postpartum state. I have plant based on multiple personal communications with mothers who were breastfeeding, that breastfeeding also proceeds in night sweats. I have been unable to find documentation of the night sweats that meet the eye during nursing in the medical literature or forward some of the breastfeeding Web sites, including the La Leche League site (www lalecheleague.org).

In a meditation of a primary care population published in 2002 (4) it was reported that panic attacks are associated with night sweats after controlling for all other examined variables. There are other medications that can cause night sweats that the authors (1) did not include in Table 4 The package inserts of selective estrogen receptor modulators, in the same state [i]or[/i] condition as raloxifene (Evista) and tamoxifen (Nolvadex), list scalding;-very warm flushes and night sweats as a usual side effect. With more women needing prevention and/or treatment for osteoporosis and treatment for breast cancer, there will principally likely be an increase in the presentation of night sweats. oppressive flushes and night sweats with these remedys are worse in the first six month of treatment, (5) and may be worse in those patients who also have newly stopped hormone therapy. Other remedys associated with night sweats are selective serotonin reuptake inhibitors, antihistamines, and other antidepressants. (4)

ROSLYN D TAYLOR, MD

Memorial Family Practice Residency

1107 E 66th

Savannah, GA 31404

REFERENCES

(1) Viera AJ, constraint MM, Yates SW. Diagnosing night sweats. Am Fam Physician 2003;67:1019-24

(2) Joffe H Hall JE Soares CN Hennen J Reilly CJ Carlson K et al. Vasomotor symptoms are associated with depression in perimenopausal women seeking primary care. Menopause 2002;9:392-8

(3) Avis NE Stellato R Crawford s Bromberger J, Ganz P, Cain V et al. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic collections Soc Sci Med 2001;52:345-56.

(4) Mold JW Mathew MK Belgore s DeHaven M. Prevalence of night sweats in primary care patients: an OKPRN and TAFP-Net collaborative close attention J Fam Pract 2002;51:452-6.

(5) Glusman JE Huster WJ Paul s Raloxifene effects on vasomotor and other climacteric symptoms in postmenopausal women Prim Care Update Ob Gyn 1998;5:166

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