Demystifiying Menopause

Part 3: Is It Hot in Here? Hot Flashes

Perimenopause and menopause have many symptoms, but the one symptom most people can identify is the hot flash. It is experienced by 75 to 80 percent of women. In early perimenopause, about 40 percent of women have hot flashes. By late perimenopause and into menopause (after your menses stops), 60 to 80 percent have hot flashes.

A hot flash is a sensation of heat in the upper chest, neck and face that will spread throughout the body. It will usually last 2 to 4 minutes. Hot flashes are caused by the improper dilation of blood vessels at the surface of the skin. Estrogen withdrawal causes this thermoregulatory dysfunction in the hypothalamus. Studies have shown that premenopausal women will have similar body reactions to core body temperature changes of 0.4°C, but starting in perimenopause, this process happens with lower temperature changes. Other symptoms associated with hot flashes can include blushing, profuse sweating, occasional palpitations, chills, shivering, and feelings of anxiety. Hot flashes are also more common at night (“night sweats”) than during the day. These nighttime hot flashes are a major contributor to poor sleep during perimenopause and menopause. Why do hot flashes happen? Science is still trying to answer that question.

What is known are some risk factors - obesity, smoking, reduced physical activity, being of Latina or African American decent, or certain genetic variations. It has also been shown that socioeconomic stressors such as having less than a high school education or trouble paying for bills is linked to more hot flashes. Granted risk factors are not a guarantee or cause; it simply means that an association has been noted by studies. On average, women experience hot flashes over 7 to 8 years, about 5 of these years after the final menstrual period. The Penn Ovarian Aging Study found about 30 percent of women continued to have moderate to severe hot flashes for over 10 years. One study by Huang et al. (2008) showed a small percentage of women continued having hot flashes for more than 20 years after menopause.

Given hot flashes are the most common complaint during perimenopause and post-menopause, what can be done to treat them? Treatment depends on the individual, their preferences, health history and the severity of the hot flashes. Lifestyle adjustments and avoiding triggers is a good first step for mild to moderate hot flashes. Known triggers include - hot weather/heat, smoking, caffeine, spicy food, alcohol, tight clothing and stress. Using fans, cooling pillows, wearing loose clothing in layers made of natural fibers like cotton and avoiding exercising in the heat can help. Weight loss may be beneficial for reducing the frequency or severity of hot flashes. Additionally, reducing stress by practicing meditation, yoga, tai chi or other mindfulness and stress-reducing activities appear to improve symptoms.

If cutting out coffee and stress reduction is not enough to reduce the quantity or intensity of hot flashes, prescription therapy may be considered. Prescription treatments have two main categories - hormonal verse nonhormonal. With hormonal treatment, options include combination estrogen and progestin treatment or estrogen alone. Contraindications for hormonal therapy including an individual’s personal history of or being high risk for breast cancer, heart disease (heart attack), blood clots or stroke. Nonhormonal therapy may including treatment with antidepressants, anti-seizure meds, or other meds. Alternative therapies can include cognitive-behavioral therapy, hypnosis, stellate ganglion block, acupuncture or herbal supplements.

Want to know more about these different treatment options? Check back soon for Part 4 of Demystifying Menopause.

Kate Bender is a dual-certified Psychiatric Mental Health and Adult Nurse Practitioner. She knows, firsthand, life is messy and hard. Sometimes people need support and help from a professional. When working with Kate, your mental health will be compassionately addressed in a manner that honors your mind, body, and spirit. She lives with her family on the shoreline in Old Saybrook, Connecticut.