the menopause

HOT FLASHES AND NIGHT SWEATS WHAT HAPPENS? Hot flashes are extremely common, affecting up to 80 percent of perimenopausal women. Mild hot flashes can be a nuisance, but severe hot flashes can be life-altering, affecting things like your ability to attend social events, do your job confidently, and sleep well. Hot flashes start with a sudden feeling of warmth. The blood vessels in the skin dilate to allow blood to surge to the skin’s surface, making the skin hot. This is the same response the body uses to cool off on a hot day or after vigorous exercise. But with a hot flash, this response is triggered by normal activities or, seemingly, by nothing at all! A mild hot flash may feel uncomfortably warm, but a severe flash feels stifling and can be accompanied by sweating, rapid heart rate, and heart palpitations, then it may be followed by chills. If your face and neck turn red, this event is sometimes called a hot flush. When hot flashes occur at night, they’re called night sweats and can make it hard to sleep. A typical hot flash lasts one to five minutes. Afterward, you may feel fine, or you may feel tired, confused, cold, and soaked. Frequency and duration vary considerably. Some women experience a few hot flashes per year, whereas others experience 20 or more daily. For most women, hot flashes persist for two to three years, but many experience them for 10 years or more, even after menstruation has stopped. Women who are younger when they have their first hot flash are more likely to experience them for a longer period. WHY? The body’s temperature regulation system is influenced by ovarian hormones, and decreasing levels of estrogen make you more sensitive to subtle temperature changes. This means that slight increases in temperature or other triggers, like stress or spicy food, cause an overdramatic response. Your body thinks you are overheating, and the hot flash is its misguided attempt to cool you down. Temperature modulation is part of the autonomic nervous system, which controls bodily processes that operate automatically, such as breathing, sweating, heart rate, and blood vessel constriction and dilation. Hot flashes are a sign of autonomic nervous system dysregulation. Consequently, a woman who has hot flashes is at increased risk for other conditions involving autonomic nervous system dysfunction, including heart palpitations (see here), heart attack (see here), and stroke (see here). Although all women experience declining estrogen levels, not all women experience hot flashes. Obesity and smoking are both known risk factors for severe hot flashes. Physical activity reduces the risk.

Avoiding triggers—For mild hot flashes, you can try to avoid common triggers such as stress, caffeine, alcohol, spicy foods, tight clothing, hot temperatures, and cigarette smoke. Cooling methods—Many women like to keep cold water and a fan available at all times. Breathing—Slow, deep breathing seems to lessen the severity of hot flashes by calming the autonomic nervous system. Acupuncture—Acupuncture may help. Hormone therapy—Hormone therapy is a recommended and usually the most effective treatment for hot flashes. If your hot flashes are severe and hormones aren’t an option, your doctor may prescribe medication.

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