There's something about hot flashes-that warm feeling that seems to radiate through your whole body-that can send some women running to the refrigerator to cool down and others, who are lucky enough, to not even be bothered. Some women may even make the transition into menopause without having one hot flash. But for those that face these heat waves, sometimes experiencing them many times a day, relief is at hand.
For the 75 percent of perimenopausal women who experience them, hot flashes are sometimes the worst symptom associated with menopause. Most women feel a sudden wave of heat spread over the body, especially the upper body. Sweating follows, and heart rate increases by seven to 15 beats a minute. As the flash passes, skin temperature gradually returns to normal, but this can take several minutes. If you've ever had a hot flash, you'll know they're no fun, but these flashes are the body's way of reacting (or overreacting!) to internal temperature changes.
What is a Hot Flash?
Some researchers believe hot flashes are related to unstable levels of estrogen that confuse the hypothalamus, the area in the brain that regulates body temperature. The dropping estrogen levels change the way the hypothalamus responds to heat, and tells the body to get rid of it, so the heart pumps faster, blood vessels in the skin dilate, and sweat glands activate to cool you off. Flash!
This sounds like a good theory, but studies find no differences in estrogen levels between women who have hot flashes and those who don't. So why do some women suffer while others stay cool and collected?
"(Post)menopausal women who suffer from hot flashes have a lower-than-normal sweating threshold, thus it's easier to trigger sweating," says Robert Freedman, Ph.D., professor of psychiatry at Wayne State University School of Medicine in Detroit, who has studied thermoregulation and menopause. Fluctuating levels of estrogen trigger hot flashes by decreasing the sweating threshold, he says, although we don't know just how it does this.
Managing Hot Flashes
Lifestyle Changes
Experts advise to first try cooling off with lifestyle changes. For many years, women have passed on the following advice to one another, confident that these strategies helped them reduce the severity of their hot flashes. There is some evidence that small changes such as choosing fabrics that breathe, such as cotton and washable linens, and avoiding turtlenecks can make hot flashes more bearable. The following suggestions will do no harm, often cost nothing, and are just common sense-and can provide relief, particularly for mild hot flashes.
Stay cool. Dress in layers so you can peel clothing off before and during flashes. Keep ice water in an insulated bottle handy for sipping, and use a fan and open windows to keep air flowing.
Identify your triggers. Alcohol, caffeine, sugar, and spicy food trigger hot flashes in certain women. Keep a daily hot flash diary and limit foods and beverages or activities you notice act as triggers.
Stop smoking. This habit is linked to increased hot flashes as well as serious health conditions, such as heart disease, stroke, and cancer. Even passive exposure to smoke has been shown to reduce estrogen levels; cigarette smoke is toxic to the ovaries.
Remain physically active. Exercise is important during the perimenopausal years and beyond, not just for the health benefits, but because studies find it may help reduce hot flashes and improve sleep (provided the exercise is not too close to bedtime).
Reduce stress. Stress is one of the biggest triggers of hot flashes. Some women report fewer hot flashes when they relax by just taking some time out for themselves each day.
Breathe deeply. Slow, deep, rhythmic breathing calms the nervous system, making this one of the simplest, most effective ways to avert hot flashes as they come on or to stop them mid-flash, says Freedman. Inhale deeply, then exhale, trying to make your exhalation as long as your inhalation. Repeat several times as needed. This paced respiration technique has been studied and definitely works for some.
Prescription Hormone Therapy
If you're having flashes severe enough to interfere with your quality of life, you may want some help. Multiple studies have proven that prescription hormone therapy that includes systemic estrogen (levels that circulate in the bloodstream through the body, provided by pills, skin patches, gels, and even one type of a vaginal ring) remains the most effective treatment for hot flashes and often with lower doses than those used in the past. Hormone therapy is the most effective therapy for treating hot flashes but is approved for moderate to severe hot flashes.
Today, estrogen-containing therapy is recommended for the shortest time necessary-and at the lowest effective dose consistent with treatment goals, says Nanette Santoro, M.D., professor and director of the division of reproductive endocrinology at the Montefiore Medical Center in Hartsdale, N.Y.
During perimenopause, a woman who needs contraception plus hot flash relief can choose a combination estrogen-progestin birth control pill, provided she is healthy and doesn't smoke. Progestin-only contraceptives are available for women who can't use estrogen.
Other Prescription Drugs
When hormones are not an option, some other prescription drugs are available to ease hot flashes, although they haven't been approved by the FDA for this use. However, clinical evidence shows that antidepressants such as paroxetine (Paxil(r)/Paxil CR(r)), fluoxetine (Prozac(r)), venlafaxine (Effexor(r)), and desvenlafaxine (Pristiq(r)); the antiseizure medication gabapentin (Neurontin(r)); and the blood pressure medication clonidine (Catapres(r)) can relieve hot flashes in some women.
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