HOT FLUSHES - YOUR BURNING QUESTIONS ANSWERED
Updated: Sep 23
Not all women experience the same menopausal symptoms like hot flushes. Some women have no symptoms at all while others experience mild to moderate symptoms and a few have symptoms so severe that they significantly interfere with daily life.
If you have menopause after surgery or menopause after chemotherapy, you may experience more severe symptoms. Consult a member of our team for help if you have any concerns with your physical or emotional symptoms.
As hormone levels shift in the lead-up to menopause, you may experience some of the following physical and emotional symptoms such as hot flushes, night sweats, irregular periods, vaginal dryness, weight gain, sore breasts, increasing PMS, mood swings, a feeling of anxiety and much more.
What are hot flushes?
Hot flushes are waves of heat over the head, neck, chest and arms. Hot flushes may be accompanied by sweating, redness of the face and anxiety, and although they vary in intensity between women, they are always associated with heat. Medically, hot flushes are known as vasomotor symptoms.
The mechanisms behind hot flushes are very complex and not completely understood. Thermoregulation, which controls body temperature, occurs in the hypothalamus, a region of the brain where many hormones and neurotransmitters come together to keep body temperature within a narrow zone.
It's thought the hypothalamus responds to changes in the body's hormone oestrogen levels to elicit a hot flush. It is also believed that without the influence of significant oestrogen levels, the thermoregulatory system becomes extremely sensitive to minor increases in temperature and responds exaggeratedly.
When the body temperature goes up, it dilates blood vessels, creating a wave of heat and often redness in the face, neck, upper chest and arms, and triggering sweat glands to perspire. Heart rate will usually go up. These episodes can last for 2 to 4 minutes and cease once the body temperature drops, sometimes in chills and shivering.
What are perimenopause hot flushes?
Perimenopause hot flushes are hot flushes which are due to changes in oestrogen levels that come about in the perimenopause.
When do hot flushes start, and how long do they last?
Hot flushes usually start in the years before menopause, before periods stop, within the perimenopause.
Generally, most women's hot flashes are approximately six months to two years. However, some women struggle with hot flashes for a lot longer.
What can make hot flushes worse?
Alcohol, caffeine and smoking will often make hot flushes worse. Heavy drinking will trigger hot flushes in many women, and tea, coffee, and other caffeine drinks can trigger hot flushes in others. Smoking is thought to increase the duration of hot flushes.
Women who are suffering from anxiety are more likely to have hot flushes. Anxiety itself will perpetuate a hot flash, making them more intense.
Adverse childhood experiences, poverty, and African American ethnicity are thought to be independent risk factors for longer or more severe hot flushes.
HRT for hot flushes
Hormone replacement therapy(HRT) is the most effective treatment for hot flushes caused by menopause. By stabilising oestrogen levels, the thermoregulatory centre in the hypothalamus is reset, and hot flushes are often the first symptom to get better with HRT in menopause.
Often a low dose of oestrogen can be sufficient to alleviate hot flushes. Bio-identical hormones are not recommended as they are not regulated and have safety concerns. Body-identical hormones are regulated and may be prescribed by GPs and Menopause Specialists.
Are you struggling with symptoms of hot flushes or other signs? Book a complimentary discovery call to find out how we can help.
How long does HRT take to stop hot flushes?
Hot flushes are usually the first symptom to be alleviated by HRT and, in some, will have stopped within days of starting HRT. In other women, the dose of HRT will need to be adjusted before hot flushes stop entirely, and this is usually done at three months.
How to stop hot flushes without HRT?
Not all women want to or can take HRT, sometimes due to a diagnosis of hormone-dependent cancer. For these women, non-hormonal methods can be helpful.
Cognitive Behavioural Therapy (CBT) is the most effective non-hormonal method for controlling symptoms.
If a woman feels the onset of a hot flush, and she thinks that everyone is looking at her and that she can't cope, this leads to feelings of embarrassment, loss of control and anxiety mood. These feelings might then lead to increased tension, palpitations and sweating, intensifying the hot flush experience. Changing negative thoughts to positive thoughts allows a sense of control and prevents flushes from intensifying.
'Oh no, I can't cope' can be changed to, 'Let's see how well I can deal with this one flush at a time.'
'Everyone is looking at me' becomes, 'I will notice my flushes more than others. They may not notice.'
'I am out of control' becomes, 'There are things I can do to take control.'
'They will go on forever' becomes, 'They will gradually reduce over time.'
The threshold for flushing narrows if we are under stress, so reducing stress and relaxation is an integral part of managing hot flushes.
Other non-hormonal medications can also help manage hot flushes. Antidepressants can be helpful, not because the woman is depressed but because the same neurotransmitters also influence hot flushes as those in depression.
However, loss of libido when using antidepressants can be a side effect for many. Some anti-epileptic drugs can also be used for hot flushes, such as Gabapentin. However, at high doses, sedation can be a problem. And clonidine, a blood pressure medication, can be helpful, although less effective than other medications and can cause dizziness.
Any natural remedies for hot flushes?
Women often tried Herbal supplements instead of HRT, but with little evidence-based on varying degrees of success. Phytoestrogen supplements are usually derived from red clover, soy, flaxseed and hops and are likely to be safe unless there is a history of hormone-dependent cancer, in which case caution should be taken when using oestrogenic properties.
Pollen Flower Extract, sold under the name 'Femal' has shown promising results in a small study showing a significant improvement in hot flushes. It may also help with sleep disturbance and nervousness. It does not have any estrogenic properties and is safe for women with a history of breast cancer.
What causes hot flushes apart from menopause?
It's important to consider other causes of hot flushes, especially in women who start having symptoms outside of the perimenopause age. Other causes include excessive alcohol intake, thyroid conditions, cancer, tuberculosis, anxiety, diabetes, sleep apnea and medication side effects.
What causes hot flushes in old age?
It is essential to rule out cancer as a cause of new hot flushes in old age. Lymphoma is a cause of hot flushes and night sweats in old age. This and other cancers must be considered, especially if symptoms start outside of the natural age of menopause.
What causes hot flushes at night?
Hot flushes at night result in night sweats, resulting in drenched nightclothes or sheets. These are caused by the exact mechanism as hot flushes, where the changes in oestrogen levels will affect thermoregulation by the part of our brain called the hypothalamus. This, in turn, triggers a desirable colour and night sweat.
Why do we get hot flushes after eating?
Spicy food can trigger or exacerbate menopausal hot flushes in some, as they can dilate blood vessels and stimulate the nerves that can trigger a hot flush response.
Fluctuations in blood glucose due to a meal can also have the same effect, and blood sugar levels dropping below 60mg/dl are enough to trigger a hot flush in many. Keeping blood sugars stable is an integral part of managing hot flushes and can be achieved by avoiding refining sugars, eating protein with each meal and switching to complex carbohydrates from simple and refined carbohydrates.
When we eat refined sugars, we get a significant peak in blood sugars, followed by a large insulin response, which then results in a substantial drop in blood sugars, which can trigger a hot flush and cause mood swings, cravings, and weight gain.
If you have a persistent change of 7 days or more in the duration of your menstrual cycle, this can be considered a sign of perimenopause at an early stage. If the menstrual interval is 60 days or more, you are likely to be experiencing late perimenopause.
Hormone therapy is most often used for the treatment of common symptoms of menopause, including hot flashes and vaginal discomfort. Changes in your hormones during menopause may affect both your mental health and your physical health.
However, there is no reason for concerns. We are here to assist you on this journey to have a better and normal life like never before.