Imagine the scene. You’re sitting in the office, when all of a sudden you begin to feel warm—too warm. You remove your jacket and wipe the sweat from your forehead. When your hot flash finally recedes, there’s little comfort to be had—you know there will be several more before the day is out.
For the 75 percent of perimenopausal American 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 7 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 regulating its temperature.
What’s the Cause? We don’t know the exact cause of hot flashes, but researchers believe they’re 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?
“Menopausal women who suffer from hot flashes have a lower-than-normal sweating threshold, thus it’s easier to trigger sweating,” says Robert Freedman, PhD, professor of psychiatry at Wayne State University School of Medicine, who has studied thermoregulation and menopause. Estrogen apparently triggers 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. Although many of these suggestions are not well supported by scientific research (largely because these aren’t patentable treatments, no one is willing to invest funds in conducting the studies), they will do no harm and cost nothing—and they may 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 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; 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).
Lose weight. “A high body mass index is directly related to hot flash frequency,” says Freedman, perhaps because of increased insulation from body fat, which elevates core body temperatures.
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 TherapyWhatever the reason, 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. Systemic estrogen therapy is the only FDA-approved therapy for treating hot flashes. It 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, MD, 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 DrugsWhen hormones are not an option, other prescription drugs are available to ease hot flashes, although they haven’t been approved by the FDA for this use. Nonetheless, clinical evidence shows that the antidepressants paroxetine (Paxil®), fluoxetine (Prozac®), and venlafaxine (Effexor®); the antiseizure medication gabapentin (Neurontin®); and the blood pressure medication clonidine (Catapres®) can relieve hot flashes in some women.
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