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|What Is A Hot Flash?
Nearly 75 percent of women entering perimenopause experience hot flashes, which is why flashing is often considered one of the first early symptoms of menopause (along with irregular periods). In 10 to 15 percent of cases, symptoms are so severe that women seek medical treatment. It is important to note that a hot flash is a symptom, and not a medical condition, so it does not automatically require treatment. A hot flash occurs suddenly and lasts anywhere between 30 seconds and a few minutes. The woman feels an intense heat which starts at the chest and flows up the neck to the face. It is usually accompanied by perspiration, which can result in anything from moisture on the upper lip to leaving the bed sheets soaked. It is also the most common side effect of hysterectomy, whether or not the woman has had her ovaries removed.
What Is A Hot Flush?
If a hot flash causes the face to turn flushed and pink, it becomes known as a hot flush. In most instances a hot flash is accompanied by a hot flush.
When Is It NOT A Hot Flash?
Some women entering menopause find their body temperature rises and they feel warm all the time and they tend to perspire more easily than they did in the past. When they enter a confined or stuffy room they feel the urge to open the window for air and assume this is a hot flash. In many instances it is not. All that has happened is the rise in room temperature has pushed them over the edge from warm to sweating.If you are overheating regularly but are not flashing, there may be another reason for your sudden heat intolerance. Obese women for example often feel overheated in the summer months. But what if you are flashing and are too young for menopause? Many women with diabetes discover that the condition has damaged their autonomic nervous system which is responsible for body temperature and perspiration. An under active or overactive thyroid can cause similar problems. If the cause of flashes is unclear a blood test is usually the most accurate diagnostic method. The sample can be used for testing for menopause by checking hormone levels and testing for other conditions such as thyroid levels, blood sugar and possible infections.
Some cancers and severe infections are associated with hot flashes. Flashing may also be a side effect of some medications. It could however also be a sign of premature menopause in young women.
What Are The Causes?
Declining levels of the female hormone estrogen seems to be the main culprit. The sudden drop in estrogen alarms the brain which assumes something is wrong with the body. It responds by sending out a burst of norepinephrine (adrenaline). This is the flight or response hormone that prepares the body for action by increasing blood flow around the body. This action causes that sweaty feeling. Declining levels of estrogen also affect the thermostat region of the brain called the hypothalamus. Until menopause the hypothalamus, with the help of estrogen, works efficiently by cooling the body when necessary and warming it up when cold. Without estrogen, or with fewer supplies of the hormone, menopausal women become much more sensitive to temperature changes – changes which they may not even have noticed in the past. You may ask but why me? Why am I suffering but my sister isn't? The reason is that some women have more sensitive internal thermostats than others. If you are fortunate enough not to experience hot flashes it is likely that your thermostat is able to function on a lower dose of estrogen. Read also about the effects of menopause on the body, and check out our list of books on menopause for some self-help guides.
According to a study by the University of Pennsylvania, women with the highest levels of anxiety and stress report nearly 5 times as many hot flashes as less stressed women. Women who experience moderate anxiety suffered 3 times as many flashes as women with normal levels of stress. Take our online stress test to check your levels. Read also about the dangers of stress on the body.
Sometimes coffee, eating spicy foods, drinking alcohol, smoking cigarettes or wearing tight fitting clothes can trigger an episode. Some women even find that they can control flashes by identifying and the avoiding their personal triggers.
What Is The Treatment?
Short-Term Hormone Therapy
Traditionally hormone therapy (HT), taken by a pill or transdermal patch is considered the standard treatment for hot flashes and other menopause symptoms. HT is available as estrogen alone (estrogen replacement therapy) or combined with progesterone. Generally these medications can reduce incidences of flashes by up to 90 percent. However there are some associated risks which were uncovered by long-term studies from the Women's Health Initiative (WHI). It was discovered that combined estrogen and progesterone pills increased the incidence of heart attacks in women, breast cancer and stroke in women. Estrogen alone however had its own risks which included a higher incidence of womb cancer in postmenopause where a woman had not had a hysterectomy operation. That said, many doctors consider the risks of a low dose treatment of hormone therapy in the short term (5 to 10 years) as having minuscule health risks. It also has the added benefit of helping with the problems of a low libido in menopause as well as hair loss and skin problems in menopause. A woman suffering average levels of flashes may be prescribed HT for 2 to 3 years until symptoms subside. More severe cases may be extended for 5 or 6 years. Ultimately, the decision to take HT or not will always be the patient’s one.
Some antidepressants are prescribed by doctors 'off-label' for treating flashing. Off label means that the drug has been approved by the FDA for treating a disorder, but not the one you are suffering. Studies into selective serotonin reuptake inhibitors (SSRI's), a class of drugs for treating depression (see menopause depression), show that low dosages can reduce the occurrences of hot flashes. Those most tested include Effexor, Paxil and Prozac. The disadvantage is that many women may not be comfortable taking antidepressants when they are not depressed (see Depression in Menopause for symptoms). Furthermore, as the drugs do not contain estrogen, they will not have any positive benefit on other menopause symptoms such as vaginal dryness (atrophy), skin or bone health. Women taking Tamoxifen to treat breast cancer or to reduce the risks of occurrences should not take Paxil as it has been shown to lower the effects of tamoxifen. The two most commonly prescribed SSRIs for hot flashes are:
Most doctors start the dose at 17.5 mg to 37 mg per day (the dose for treating depression or anxiety disorder is 75-225 mg).
Gradually this can be increased to a maximum of 75 mg a day if needed. Studies show that dosages over 150 mg a day do not give additional benefit relative to hot flashes.
Paxil (Paroxetine HCl)
The dose starts between 10 and 12.5 mg per day. This can be gradually increased to 25 mg. There are no studies which indicate the optimum duration for the therapy so how long you take it should be the assessed and discussed with your doctor.
Belladonna preparations appear to help some women cope with hot flashes and it is approved by the FDA treating for menopausal symptoms.
The main risk is that it has potential for addiction and abuse because it contains a barbiturate.
It can also cause drowsiness, dry mouth and dizziness.
The common dosage is 1-2 tablets per day.
Clonidine Hydrochloride (Catapres)
This drug is typically prescribed to treat hypertension but it was found to also reduce the frequency and severity of hot flashes. Studies support its effectiveness but benefits are smaller than those seen with HRT. It may be an option for women who cannot tolerate hormone or SSRI treatments. It is applied daily as a transdermal patch of 0.1 mg. The dose can be increased to 0.2 to 0.3 mg per day if required. It can also be taken as a pill in a dosage of 0.1 to 0.4 mg per day.
Megestrol acetate or megace is a synthetic type of progesterone hormone which was found to reduce hot flashes in women with breast cancer. However its association with weight gain is unlikely to make it a popular choice. (See also: Weight gain during menopause).
Gabapentin or Neurontin is commonly prescribed to treat epilepsy, but it also appears to be moderately effective at high dosages in treating flashes. It is started at a low dose such as 100 mg per day. This can be increased gradually to 300 mg, 3 times a day. The greatest results are achieved in women taking the dose of 900 mg a day. Side effects include fluid retention, drowsiness and dizziness.
See Overview: Menopause Treatment
There are alternatives for those who wish to avoid the medication route, such as herbal supplements. However as health supplements are not controlled by the FDA their effectiveness, even ingredients and potency can vary from manufacturer to manufacturer. Furthermore, as they are not stringently tested, their long-term effects are not known.
These are plant phytoestrogens which are found naturally in soy foods. They may convert to equol in a woman’s body, a sort of weak-estrogen, although they do not convert in all. Research shows that Asian women who eat more soy than American women suffer lower rates of hot flashes and breast cancer. If you are considering this route, is better to eat soy foods rather than taking a supplement.
Some research indicates that black cohosh may reduce hot flashes as well as vaginal dryness and depression in menopausal women. The most popular over the counter brand is Remifemin which has been tested and approved by Germany’s federal health commission for use up to 6 months to relieve hot flashes. Side effect includes stomach upset and nausea. It should not be taken if you are taking HRT or medications for high blood pressure.
Evening Primrose Oil
A botanical supplement, some women report reduced incidences of hot flashes when they take it. There is no scientific evidence to support claims at this time. There is however more evidence to support taking vitamin E supplements (800 IU every day for 4 weeks).
What Are Night Sweats?
When hot flashes occur at night-time as a woman sleeps, this is known as night sweats. As we fall asleep our body temperature drops. This is not normally a problem, but reduced levels of estrogen in menopause cause the brain to overreact, so it cranks up the temperature. This results in a hot flash which is then followed by sweats when the brain triggers the sweat glands into action to cool the body down again. You wake up hot and wet and then go cold.
Preventing Night Sweats
Wear socks to bed. When we warm up the extremities of the body like the hands and feet our body temperature becomes more stable.
Sleep with a fan in the bedroom.Wear natural fiber bedclothes like cotton. And buy cotton sheets rather than synthetics.
Consider buying a chill-pillow - such as one by Chillow. These are like mini-pillows which you place over your existing pillow. They stay permanently cool and help give a more soothing and relaxing sleep. They cost about $25.