Doctors' Notes: Summer puts focus on hot flashes
University of Toronto
Summer can be very rough for women going through menopause. Almost everyone experiences hot flashes, and in 20 per cent of women, they’re quite severe, meaning they can occur multiple times a day and all night long.
Unfortunately, the latest research has shown that hot flashes don’t go away as quickly as we used to think. Half of women still experience them 10 years into menopause, and for 10 to 15 per cent, it’s still happening at age 70, albeit in a much less severe form. That’s why it’s important for your quality of life to do what you can to tame these sudden spikes in body temperature — especially now.
Fortunately, researchers now know the area in the brain responsible for hot flashes, and not surprisingly it’s connected to the drop in estrogen that occurs during menopause. All women are born with a certain number of eggs and cells around them that produce estrogen. As we lose eggs, we also lose this profoundly influential hormone. Many people don’t realize that estrogen isn’t just related to pregnancy; it’s used in every part of the body: throughout the reproductive system, in the heart, brain, bladder, gut, bones and joints.
That’s why symptoms of menopause are so widespread. Some of the most common ones include depression, plummeting sex drive, sleep problems, achy joints, bladder problems, painful sex and so much more. Most can be treated, but I want to focus on hot flashes in this column, because these are probably the most common around menopause.
Knowing more about what causes hot flashes can help us to avoid them as much as possible — and it will help scientists develop more effective treatments, and hopefully some day, a cure.
We now know there are cells in our bodies that directly connect to the heat-sensing area in the brain. This area is almost like a thermostat where the sensitivity to heat changes depending on circumstances. It is probable that the decrease in estrogen during menopause makes this heat-sensing function far more sensitive. The thermostat shoots up with very minimal triggers. It helps to avoid those triggers, which include heat, stress, alcohol, spicy foods and, based on anecdotal experience, coffee.
You may wonder why hot flashes cause such profound sweating, especially at night. Many of my patients wake up completely drenched, and need to change their clothing more than once. When the body tries to cool itself, the heart rate increases and there are changes in the autonomic nervous system, all of which stimulate this cooling mechanism. As well, some women’s bodies overcompensate for the heat and create a chill.
Because the nervous system is in overdrive, some women with hot flashes also feel a nasty burning sensation, anxiety attacks, heart palpitations, and even a sense of doom, and nausea. The sweating and symptoms can last minutes to hours — and some women suffer up to 40 a day.
Hot flashes, which are the trigger for all of this, have been trivialized in past, and even laughed at — but we take this symptom seriously now. Women with really bad hot flashes that start before menopause and persist have an increased risk of heart disease, possibly because of reactive blood vessels.
Fortunately, there’s much you can do to treat hot flashes. Aside from avoiding the food-based triggers, women with mild symptoms can dress in layers and lower the room temperature.
Try using cold packs on your neck, and sleep with a “chillow” (pillow filled with ice). Cognitive Behavioural Therapy and hypnosis help. You’ll still have the flash, but these techniques help you to be less bothered by it. Antidepressants have some effect on hot flashes, and are most often used in women who can’t use hormones. An antiseizure drug called Gabapentin also works at the brain level, and is especially useful for flashes at night. Clonidine, an older remedy, may also produce beneficial effects.
But the best treatment is the one I sometimes have the most trouble convincing women to try — hormone replacement therapy. This works 90 per cent of the time, and it’s fast. Women who try it often thank me for giving them their lives back. And despite what you may have heard, for healthy women aged 50 to 59 — who are going through the worst symptoms of menopause — there’s no increased risk of heart disease or breast cancer for the first five years of use. In the largest randomized study on hormone therapy, the Women’s Health Initiative, there were three additional cases of breast cancer for one thousand women who used combination hormone therapy for five years. For women of the same age who had had a hysterectomy and took estrogen alone for five years there were actually 2.5 fewer cases of breast cancer per thousand than in women who used placebo.
If you’re suffering from hot flashes or other symptoms of menopause, please know that you don’t have to live with them, or suffer in silence. Start with a visit to your family doctor to discuss the right treatments. If you’re still not feeling better, ask for a referral to an ob/gyn. The majority of women can be significantly benefited from the appropriate therapies prescribed for the appropriate length of time in order to improve their quality of life.
Wendy Wolfman is a professor in the Department of Obstetrics and Gynaecology, and Director of the Mount Sinai Menopause Clinic and the Premature Ovarian Insufficiency Unit.Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine.