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Hot Flashes

During peri-menopause (the phase leading up to menopause), you may feel a sudden and very intense heat. This uncomfortable feeling is known as a hot flash (also known as “hot flush” and “vasomotor symptom”) and it can be accompanied by skin flushing, sweating and a rapid heartbeat. Hot flashes pass within a few minutes and are experienced by approximately 80% of women during their peri-menopause transition. Recent research has found that most women that have vasomotor symptoms, will experience it over the course of roughly 7.5 years. The onset is usually in a woman’s mid forties during peri-menopause and, up to 30% of women may still be experiencing it well into their sixties. 

Approximately 80% of women experience hot flashes

If a hot flash occurs at night, it is referred to as a night sweat. You may wake from a deep sleep suddenly, sweating profusely, stuck in a tangled mess of sweaty sheets and feeling disoriented. Not surprisingly night sweats can cause significant sleep disruption.

Together, hot flashes and night sweats are referred to, in medical terms, as vasomotor symptoms. Vasomotor symptoms eventually cease on their own and strictly speaking don’t require any specific treatment. However, given the severe impact on the quality of life it has, most women seek treatment that can help make the symptoms more manageable and improve quality of life. Hormonal treatment is very effective with studies showing 75% of women no longer having any VMS symptoms, and the remainder seeing a significant improvement in severity and frequency of episodes.

The Lowdown on Hot Flashes and Night Sweats

Why does this happen, how does it impact you, how is it diagnoses and common triggers/ risk profiles.

Hot flashes and night sweats occur due to body temperature dysfunction caused by changes in gonadal hormones. It is not fully understood how the gonadal hormone changes take place during the phases of menopause but essentially what it means is that your fluctuating hormones cause your “hypothalamus” (the part in your brain that is responsible for regulating temperature), to randomly think your core body temperature has spiked and needs to be cooled down. So it starts the normal processes of signaling your blood vessels to dilate in order to release heat: what will follow is a quick increase in blood flow, most notably to your chest, neck and face, your heart will start pumping faster and of course your sweat glands will open. Final result is that you feel and look like you just finished a (very intense!) work-out

Sudden feelings of excessive heat, day or night, may cause a significant impact on a woman’s ability to continue with her daily activities. Depending on the severity of her condition and a woman’s occupation, symptoms can cause debilitating scenarios. If night sweats are frequent, poor sleep and feelings of excessive daytime fatigue are likely.

A study from 2020 found a strong relationship between vasomotor and mood symptoms in Chinese women progressing from peri-menopause through natural menopause.

Diagnosis of vasomotor symptoms is performed through patient self-reporting. As it is a common symptom for many women during menopause, it is easily diagnosed without the need for an in-person doctor’s visit.

There is a direct correlation between stress levels and the occurrence of vasomotor symptoms, so efforts to treat underlying stress triggers may provide relief. Additionally, factors like smoking, and being overweight are thought to put a woman at greater risk. For some women VMS can be triggered by a long list of external factors, among them caffeine, alcohol, spicy foods, and hot weather.

Physical health

What is normal?

We hate to break it to you, but there is no normal when it comes to Vasomotor Symptoms. Some women have one every hour through the day and night for three years, while others average one a day for fifteen years. Wait what 15 years? Yes, many women continue to have hot flashes or night sweats well into their post menopausal years.

Just as the length of time you’re saddled with night sweats can’t be predicted, it is also difficult if not impossible to anticipate when they will happen. Some women will have predictable hot flashes triggered by certain events, while others experience hot flashes at absolutely random times.

Prevention and Treatment

Learn more about your options for prevention, management and treatment of Vasomotor Symptoms. This is not an exhaustive list of the treatment options available, but a good start.

The most effective treatment for vasomotor symptoms is Hormone Replacement Therapy (HRT) in the form of Estradiol. For women who are not able to tolerate hormone-based medicine, there are a few other effective alternatives like Paroxetine (SSRI antidepressant). In addition, there are over-the-counter products and holistic measures that may help to reduce the impact and frequency of vasomotor symptoms. There is no clinical evidence supporting claims that any type of supplement is effective in reducing vasomotor symptoms. 

Although there is no clear agreement regarding the efficacy of diet changes for mitigation of vasomotor symptoms, there is widespread anecdotal and cultural evidence of the following recommended practices:

  • Soy (plant estrogen or “phytoestrogen”)
  • Mediterranean diet (fruits and vegetables, whole grains, seafood, nuts and legumes, olive oil focus)

Physical activity is not directly related to treatment of hot flashes, however maintaining a healthy weight and cardiovascular system during menopause is vital for a woman.

Stress is a known trigger for hot flashes, and finding ways to reduce stress in your life could have a meaningful impact in reducing the impact your VMS have on the quality of your life.

A study from 2011 found that Mindfulness-based stress reduction (MBSR) may be clinically significant in reducing the degree of bother that women experience from VMS, and may also significantly improve quality of sleep, anxiety and overall perceived stress.

The local pharmacy or health store will likely have a variety of supplements that claim to offer some type of relief from vasomotor symptoms. However, there is no clinical evidence supporting claims that any type of supplement is effective in reducing or controlling vasomotor symptoms, with the exception of vitamin E.‍

There is reasonably strong scientific evidence that Vitamin E can reduce hot flashes by one a day, and there are no known side effects.

There are a couple of over-the-counter products or do it yourself options available to help manage the VMS and can provide immediate relief:

  • Selecting moisture-wicking clothes and dress in layers
  • Use of a handheld fan for self-regulated cooling 
  • Room temperature controls - especially for sleep and work environments 

For night sweats: 

  • use special cooling sheets and/ or sheets made of breathable fabric such as cotton and linen
  • provide different bedding for individuals sharing the bed - much easier and quicker to change a single duvet cover than a double!
  • Have a hand-held fan next to your bed to help you quickly cool down
  • Moisture wicking nightwear can help - sleep in a sports shirt, who cares if it helps!
  • Paroxetine - an SSRI (selective serotonin reuptake inhibitors) a type of antidepressants can reduce the occurrence of hot flashes and their severity. This low dose SSRI helps by increasing the level of serotonin in your brain, by inhibiting the reuptake of serotonin into your neurons (which is caused by the decline in Estrogen). US Food and Drug Administration (FDA) and the Health Sciences Authority (HSA) in Singapore have both approved the use of paroxetine in treatment of hot flashes but caution regarding side effects and drug combinations.
  • Venlafaxine - an SNRI (serotonin norepinephrine reuptake inhibitor) also inhibits the reuptake of serotonin into your neurons and thereby increases serotonin in your brain.
  • Escitalopram (SSRI) may be effective in improving the quality of sleep, if night sweats are causing clinical sleep dysfunction.
  • Gabapentinoids (antiseizure drugs) and clonidine (high-blood pressure medication) have early research indicating that they may be effective in reducing severity and frequency of VMS, and particularly night sweats
  • Estradiol- a type of Hormone Replacement Therapy (HRT) and the most effective treatment for VMS currently available. HRT does exactly as the name indicates; it replenishes (or replaces) the hormones (estrogen and progesterone) that your body is naturally starting to produce less of as you transition into menopause. Studies have shown that HRT eliminates VMS completely for 75% of women that take them, and drastically reduces both the severity and frequency for the remaining 25%. HRT is more frequently prescribed as a woman gets closer to the end of peri-menopause and the beginning of post-menopause. 
  • Contraceptives - Low dose contraceptives are also prescribed in order to reduce fluctuations in hormone levels due to menopause. While HRT provides a woman with additional hormones, low dose contraceptives suppress current hormone levels and keeps the level consistent. 

FAQs

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