HOT Flashes

Aug 23, 2022

HOT FLASHES

At Menopause Solutions, LLC, we help women in Mount Pleasant, Charleston and the state of South Carolina safely and effectively manage their bothersome symptoms of menopause the most common of which are hot flashes and night sweats.

Due to declining hormone levels, most menopausal women experience the unpleasant occurrence which is referred to as a hot flash (of night sweat, when this occurs at night), and are medically termed vasomotor symptoms.

What does a hot flash feel like?

During a hot flash, a woman experiences an intense feeling of heat, which is perceived as radiating from within her, accompanied by flushing, redness of the face, neck, and chest, and often followed by actual sweating.  The episode can last anywhere from 10 seconds to several minutes after which the woman may feel chilled.  When these episodes occur at nighttime and during sleep, we refer to the symptoms as night sweats. Night sweats can be experienced as mild sweating to waking with one’s night clothes drenched to the point of having to change clothes and even change the bed sheets. Vasomotor symptoms can happen several times an hour, several times a day, or even less than once a day. Some women report that their hot flashes are preceded by a slight but noticeable wave of anxiety, nausea, or chest pressure and then the actual hot flash follows several seconds later.

What causes a hot flash?

Deep in the brain is an area called the hypothalamus and here lives our internal thermostat.  The thermostat is pre-set so that when the body temperature falls below a point, shivering will occur.  Likewise, when the body temperature increases to a certain degree, sweating starts.  These set points differ individually, but among all of us there is a zone at which we feel comfortable and we neither shiver nor sweat, called the thermoneutral zone. 

In menopause, this “happy place” or thermoneutral zone is virtually non-existent, meaning that the menopausal woman will both shiver and sweat with very minor temperature fluctuations.  And therefore, effective treatment of vasomotor symptoms of menopause are those that both avoid temperature fluctuations and widen the thermoneutral zone.

What can I do on my own for hot flashes?

One simple tool is to avoid substances and situations that are known to trigger hot flashes. Common culprits are alcohol (and particularly red wine) and spicy foods.  Stress can trigger a hot flash and while we can’t always avoid stress, slow deep breathing has been shown to effectively reduce the severity of a hot flash triggered by stress (see paced respiration below).  And as most menopausal women know, getting too hot is a common trigger. Dressing in light weight clothing, light colors and few layers are tricks to avoid hot flashes. At night, it’s helpful to avoid too many blankets and equally helpful to set the room’s thermostat a few degrees lower.

Women who smoke tend to have more hot flashes, as do women who are carrying too much weight. The onset of menopausal hot flashes can be a good motivator to start a smoking cessation or weight loss program.

Studies have shown that slow, deep breathing, also known as paced respiration, has been shown effective at reducing the quantity and severity of hot flashes.  Paced respiration is simply slow, deep, and timed breathing at a rate of 6 to 8 breaths per minute.  For example, you would slowly inhale for a count of 4-5 seconds, hold your breath for 4-5 seconds, and then exhale over 4-5 seconds. When practiced for 15 minutes twice a day in addition to at the onset of a hot flashes, paced respiration has been shown to effectively reduce the number and severity of hot flashes in menopausal women.

Are there non-hormonal treatments for hot flashes?

An experienced menopause provider should be able to provide her patient with many non-hormonal options for treatment of hot flashes.  There are over the counter preparations marketed for hot flashes. While most of the are safe, the data on efficacy are lacking.  Most studies show no benefit in taking these over placebo, or sugar pills. Most of these supplements are derived from soy, which is a type of plant estrogen. For women with a history of breast cancer, these should not be used without consulting her physician.

There are many non-hormonal prescription medications which have been shown in well structured studies to effectively minimize hot flashes and night sweats.  Most of these medications are used “off label”, meaning not for their intended purpose, and include many anti-depressants (specifically SSRIs), some medications for nerve pain, and some blood pressure medications.  Any of these would need to be prescribed and managed under the care of a menopause provider.

What is the best way to treat hot flashes?

We know through decades of research that the most effective treatment for hot flashes is hormone replacement therapy. Systemic, estrogen-containing hormone preparations remain the gold standard for treatment of moderate to severe vasomotor symptoms due to menopause.  When prescribed by a knowledgeable and experienced menopause specialist, hormone therapy provides added benefits such as protection from osteoporosis and cardiovascular disease, as well as improvements in insomnia, mood, and vaginal dryness associated with menopause.  In addition, studies now show that for most women aged younger than 60 years or within 10 years of the beginning of menopause, the benefits of hormone replacement therapy outweigh any risk, for treatment of vasomotor symptoms, prevention of osteoporosis, and reduced risk of fracture.

When should I seek help?

When vasomotor symptoms of menopause are adversely affecting quality of life, and the menopausal woman has tried the lifestyle measures mentioned earlier aren’t sufficing, the next step is to contact a board-certified menopause provider to discuss other options.  For most women, the hot flashes and night sweats will resolve with or without treatment, by about 3-7 years into menopause, and therefore any treatment plan is usually just a temporary measure to bridge the gap between the onset of menopause and the time at which the symptoms resolve.  At Menopause Solutions, both Dr. Eustis and Dr. Leach are board-certified menopause specialists and able to meet the needs and exceed the expectations for the treatment of menopause for women in the Mt. Pleasant, Charleston, and  South Carolina area.

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