A quick web search for personal experiences relating to the hot flashes of menopause finds many stories:
“I suddenly seem to ignite from my core, with intense heat rippling outward, until my skin almost burns — hot flashes are driving me crazy.”
“I have not had a proper night’s sleep for five years so am constantly drained.” “Mine starts with the same feeling as fear. It's a quick burst of heat and nerve endings igniting, like in fear.”
For anyone who has never experienced a hot flash like these women, it is difficult to understand the seriousness of the condition and how it affects the one experiencing them. About 80 per cent of women in menopause experience sudden, uncontrollable flashes of heat that can be unbearable. Many women experience these for short periods up to two years but the average is much higher.
Women who first get hot flashes after their final period average 3.4 years of duration; those who start before they stop menstruating have them for an average of 12 years. Hot flashes may last only a minute or two, or as long as an hour. And this can happen 20 times a day or more.
The exact cause of hot flashes is not well understood but there is evidence that changes in the part of the brain that regulates body temperature (the hypothalamus) is involved. If the hypothalamus mistakenly senses that a woman is too warm, it starts a chain of events to cool her down. Blood flow increases to the skin in an attempt to dissipate body heat. Then there will be perspiration (let’s be honest, it’s sweat) in an effort to cool the body down. At the same time, heart rate might increase. And the hot flash may be followed by a cold chill.
What sets off a hot flash varies but several factors can encourage them. Triggers can include:
- A too-warm room
- Feeling stressed
- Hot beverages
- Spicy foods
- Second-hand smoke
One obvious ‘solution’ is to avoid the triggers listed above, but that might not be enough. There are a number of strategies to consider that do not include drugs.
Lower levels of estrogen during menopause are thought to increase the activity in the body’s sympathetic nervous system (part of the autonomic nervous system which also activates the ‘fight or flight’ response) which is involved in regulating the body’s core temperature. Thus, relaxation techniques can be helpful including guided imagery and progressive muscle relaxation. Paced breathing may also help. It involves ultra-slow breathing (six breaths a minute for 15 minutes ideally twice a day).
Cognitive behavioural therapy can increase a woman’s understanding of what is happening to her body during hot flashes. It aims to counter negative thoughts and behaviours and to develop coping strategies that build a sense of control and lessen the impact.
Other strategies include yoga which can help relieve stress and the psychological symptoms associate with hot flashes. Hypnosis has also shown promise: a large study in 2013 found that it could reduce the frequency and intensity of hot flashes. While some women turn to acupuncture, there is insufficient evidence to recommend it. However, because studies have found similar results from both actual and sham acupuncture, it is probable that there is also a placebo effect. Being active (walking, running, cycling, etc) can also reduce stress which may positively impact frequency or severity of hot flashes.
For some women, drug-based treatments are an option. This can include hormone-replacement therapy. There are also non-hormone drugs such as anti-depressants (SSRIs) which have been found to be effective in treating hot flashes in women who do not have depression.
Whatever your situation, none of these treatments will cure your hot flashes. At best they offer relief from symptoms. Consulting a healthcare professional to discuss your options is a good first step. It may be difficult to imagine now, but one day hot flashes will fade away on their own and recede (we hope) from memory.
Written by Dr. Paul Martiquet, Medical Health Officer for Rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.