Louise Chang, MD
Intense heat starts in your chest and rises to your neck and head. Beads of sweat grow until perspiration run down your face. It’s a hot flash due to menopause, and it’s a loooong five minutes until it passes.
Multiply that by 20 or 30 and you can call it a day.
Doctors theorize that hot flashes and night sweats happen as a result of changing estrogen levels. Fortunately, there are plenty of ways to beat the heat and excessive sweating of menopause.
Hot flashes are one of the most common signs of perimenopause, the years leading up to menopause. Menopause, when your period stops for good, typically happens between age 45 and 55.
Some women experience the heat and flushing of hot flashes without sweating, while others sweat so much they need a change of clothes. When hot flashes happen at night, leaving you and your sheets drenched, they’re called night sweats.
For about 75% of women, hot flashes and night sweats are a fact of life during perimenopause and menopause. A lucky minority won’t experience them at all. Some women will experience only mild hot flashes.
But for 25% - 30% of women, hot flashes and night sweats will be severe enough to interfere with quality of life, says Valerie Omicioli, MD, clinical assistant professor of obstetrics, gynecology, and reproductive science and a certified menopause practitioner at the University of Maryland School of Medicine in Baltimore.
A single hot flash can last anywhere from one to five minutes and may occur a few times a week for some women or daily for others. When hot flashes are severe, they may strike four or five times an hour or 20 to 30 times a day, Omicioli says.
Ellen Sarver Dolgen, Coronado, Calif.-based author of Shmirshky: The Pursuit of Hormone Happiness, found her life thrown upside down when perimenopause began in her late 40s. Her first hot flash happened while she was in a business meeting with all men.
“I felt a flush of heat come over me but I didn’t want to pay much attention to it,” she told WebMD. But when she stood up she felt sweat dripping down the inseam of her pants. “Thank goodness I carry a big purse because I think it makes my hips look smaller,” she says. She used her purse to hide the wet mark on her pants as she left the meeting. “It was absolutely mortifying.”
Doctors think hot flashes and night sweats are a result of fluctuating or decreasing estrogen levels. When menstrual cycles finally stop, estrogen levels drop fairly dramatically, Omicioli says.
The drop may impact a part of the brain that regulates body temperature. We all have a thermal neutral zone, which means our body temperature stays stable even when the temperature around us changes slightly. Theoretically, a drop in estrogen levels may narrow the thermal neutral zone, so that small changes in outside temperature cause a rise in body heat.
Your body is programmed to keep your core temperature the same, so when the air temperature rises, blood pours into blood vessels (vasodilation) in your skin. You’ll become flushed and start to sweat.
Sweating is your body’s way of cooling off and keeping your core temperature stable, says Carolyn Alexander, MD, associate director of the residency program for the department of obstetrics and gynecology at Cedars-Sinai Medical Center in Los Angeles.
There are a couple of other theories about why menopause and excessive sweating tend to go hand in hand.
Some changes to your regular routine may help cool hot flashes.
Work on your weight. Women who are overweight or obese are more likely to have frequent hot flashes, Omicioli says. A study of 338 overweight or obese women found that those who lost weight over 6 months had a bigger improvement in hot flashes than those who didn’t lose weight.
Exercise. Although studies haven’t been conclusive, it’s thought that regular physical exercise lowers hot flash frequency.
Stop smoking. Several studies have linked smoking to hot flashes. One study found that heavy smokers were four times more likely to have hot flashes than women who never smoked.
Include soy in your diet. According to the National Center for Complemetary and Alternative Medicine, results of studies showing that soy reduces hot flashes has been inconsistent. To see if it works for you, you might try adding two to three servings of soy to your diet, Omicioli says. Try soybeans, tofu, tempeh, or miso.
Stock up on tanks and cardigans. Wear lightweight clothes and dress in layers so you can shed heavier clothing when a hot flash strikes. Wearing a material at night that wicks away moisture may help you sleep
Control the air temperature. Lower the heat, run the air conditioning, open a window, or run a fan during the day and while you sleep.
Keep a cool drink by your side. Sipping a tall glass of ice water may help you keep your body temperature down. “We usually tell women to drink a lot of fluids and don’t get dehydrated,” Alexander says.
Pay attention to potential triggers. Alcohol, caffeine, and spicy food may trigger hot flashes in some women.
Relax. The stress hormone cortisol may make women more sensitive to hot flashes, Omicioli says. Take some deep belly breaths when you feel stressed or try yoga and meditation.
Some women find relief with lifestyle changes, but others need more. The most important thing to remember: talk to your doctor and think about all of the possibilities for treatment, says Mary Lake Polan, MD, PhD, adjunct professor of obstetrics and gynecology at Columbia University School of Medicine in New York City.
Finding a treatment that works for you is a highly individual thing. “I tell patients to keep trying,” Polan says. Sooner or later you’ll find relief from hot flashes and night sweats.
Hormone therapy. Hormone therapy is the most effective way to treat hot flashes, but the Women's Health Initiative study found an increased risk for heart disease, blood clots, and stroke, and an increase in breast cancer when women took oral estrogen and progestin long-term, Omicioli says. The increased heart disease risk was in older women who were 10 or more years postmenopausal, she says.
But there’s emerging evidence that non-oral forms of estrogen -- a cream, gel, patch, or ring -- may have safety advantages in reducing risk of blood clots and stroke, Omicioli says.
The WHI study didn’t find an increased risk of breast cancer in women who took estrogen alone, Omicioli says. The study also looked at one dose of oral estrogen and synthetic progestin. “There may be a lower risk with progesterone vs. synthetic progestin,” she says.
The benefits and risks should be weighed with your doctor. If you decide to choose hormone therapy, the FDA recommends taking low-dose hormones for the shortest time consistent with treatment goals.
Other options. If hormones aren’t an option, there are other treatments that may help. Studies have found that antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) may improve hot flashes. These medications work for hot flashes at a slightly lower dose than if you were taking them for depression, Polan says.
Gabapentin (Neurontin), and anti-seizure medication, and clonidine (Catapres), used to treat high blood pressure, are also sometimes prescribed for hot flashes.
The supplement black cohosh may also help some women reduce hot flashes, although the results of scientific studies have been mixed.
For other supplements, including DHEA, dong quai, ginseng, kava, red clover, and soy, there's no conclusive evidence that they help manage menopausal symptoms. Research into the safety and effectiveness of supplements is ongoing. Because supplements can cause side effects and interact with medications, it is important to talk to your doctor if you are thinking about using them.
Whether your hot flashes are mild, moderate, or severe, there is help. Dolgen recommends going to a menopause specialist, which is what helped her finally find relief.
SOURCES:Valerie Omicioli, MD, clinical assistant professor of obstetrics, gynecology, and reproductive science and a certified menopause practitioner at the University of Maryland School of Medicine, Baltimore.MedlinePlus: “Menopause.”American Congress of Obstetricians and Gynecologists, Pause web site: “Beat the Heat.”Mayo Clinic web site: “Hot Flashes.”Ellen Sarver Dolgen, Coronado, Calif.-based author of Shmirshky: The Pursuit of Hormone Happiness.Carolyn Alexander, MD, associate director of the residency program for the department of obstetrics and gynecology and faculty member of the division of reproductive endocrinology and infertility at Cedars-Sinai Medical Center, Los Angeles.Huang, Alison J., Archives of Internal Medicine, July 12, 2010; vol. 170; pp 1161-1167.Daley, A. Cochrane Database Systematic Reviews, May 11, 2011; Issue 5.Cochran, Chrissy J., Obstetrics & Gynecology, November 2008; vol. 112; pp 1037-1044.Mary Lake Polan, MD, PhD, adjunct professor of obstetrics and gynecology at Columbia University School of Medicine in New York City.Carroll, Dana G., American Family Physician, February 1, 2006; vol. 73; pp 457-464.Department of Health and Human Services web site: “Questions and Answers About the WHI Postmenopausal Hormone Therapy Trials.”Loprinzi, C. Journal of Clinical Oncology, June 10, 2009; vol. 27; pp 2831-2837.
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