As I stood in a conference room in front of 50 colleagues, answering questions after a presentation, I felt the familiar feeling of a hot flash. “Please, not now,” I bargained with my perimenopausal body. “Don’t put me in the hot seat, literally or figuratively.”
My body rejected the deal. As if the heat was coming from a hot hairdryer, the heat shot up from the center of my chest, just below my collarbones, and spread to my neck. My face burned and sweat broke out everywhere: it dripped from my temples, pooled in the middle of my bra, and ran down my back. In just a few seconds, I went from appearing calm and composed to looking like I was being interrogated by commandos in a military prison.
My friends and I often debate which hot flash scenario is worse: sweating during an important meeting, presentation, or job interview—or sweating through nightgowns and sheets all night while nuclear fusion in our pajamas is hot enough to power cities, birth stars, and rob us of another night’s sleep. There are arguments for both, but everyone agrees that hot flashes are not cool.
What causes menopausal hot flashes, why do they occur and most importantly, how can we prevent them from disrupting our busy lives? We asked two medical experts who help women cope.
What causes hot flashes during menopause?
Alicia Scribner, MD, associate professor of obstetrics and gynecology at the University of Washington School of Medicine, described a hot flash as a “sudden feeling of heat that begins centrally and spreads.” One of her patients described it with more emotion: “She told me that when she had a hot flash, she felt like her whole body was on fire,” Scribner said.
A single hot flash can last five to six minutes. This may seem manageable, but women can have up to 20 hot flashes a day and these can last for an average of seven years.
This leaves women everywhere wondering, “Why is this happening to us? What is it about the transition to menopause that makes our bodies feel like they’re spontaneously combusting?”
Neurologists are getting closer and closer to the answer. The brain’s ability to regulate temperature is closely related to estrogen levels, Dr. Kellyann Niotis, a New York-based neurologist. When estrogen levels fluctuate during perimenopause and drop rapidly after menopause, the brain’s thermostat, the hypothalamus, becomes destabilized.
“When estrogen no longer properly activates this region, the brain misinterprets internal temperature signals and triggers a cascade of events to cool the body: dilation of blood vessels and start of sweat production,” she said.
There is also evidence that a drop in brain glucose levels contributes to hot flashes during menopause. “Estrogen normally helps maintain a stable supply of glucose to the brain. When levels drop, the brain may be more susceptible to these dips—another trigger for hot flashes,” Niotis said.
A part of the brain called the prefrontal cortex, which controls stress reactivity and emotional regulation, can influence how annoying or distressing hot flashes feel. In fact, says Niotis, “women who are under greater perceived stress or anxiety often complain of more frequent and intense hot flashes, even when objective physiological measures such as skin conductance do not differ. In other words, two women can have the same event, but the one who is more emotionally distressed may find it more overwhelming.”
This could clarify how socioeconomic conditions and race influence the hot flash equation. In the US, data shows that black women are more than twice as likely as white women to suffer from hot flashes and are more likely to find them more annoying and disruptive to daily life and sleep. Hispanic women are also more likely to report menopausal hot flashes than white women, although they tend to describe them as less intense and less bothersome.
If hot flashes are disrupting your life, it’s time to seek treatment. “If women feel that their symptoms are affecting their quality of life – their concentration at work, fatigue, energy and sleep – it is important to get help,” Scribner said.
Treatments for hot flashes
Although science has not yet found a cure for hot flashes or a way to prevent them, there are numerous medical and non-medical treatment options.
Hormone therapy (HT) is used to control hot flashes and other menopausal symptoms by replacing estrogen lost during menopause. But for women who do not want to use hormonal treatments or whose risk factors preclude HT, non-hormonal treatments are also available.
A class of drugs called neurokinin receptor antagonists has been approved by the FDA to treat moderate to severe menopausal hot flashes by addressing the chemical imbalance that can lead to hot flashes and night sweats. Other medication options include antidepressants. An antidepressant, paroxetine, has been approved by the FDA to treat hot flashes, but other antidepressants are sometimes prescribed off-label, as are some anti-seizure medications, anticonvulsants, and blood pressure medications.
The jury is out on herbal solutions, Scribner said. “I have heard from some of my patients that they take various herbs and supplements, but there is no good data to support their effectiveness,” Scribner said. However, believing that something is working – the so-called placebo effect – can be helpful in reducing the perception of discomfort. As long as a solution isn’t harmful, Scribner says, “If you believe something will make you feel better, you will benefit from it.”
Lifestyle changes can also be helpful. “Caffeine, alcohol, hot drinks and spicy food have been shown to trigger hot flashes,” Scribner said. But how strongly a person reacts to a possible trigger is highly individual. Scribner encouraged women to observe their personal hot flash patterns and make adjustments based on these findings. She also recommended sleeping in a cool room and using a fan and ice packs at night.
When asked whether hot flashes serve an evolutionary purpose and provide a benefit to menopausal women, Scribner laughed and said she wasn’t aware of it.
But I have a (non-scientific) theory.
My friend, who has suffered from hot flashes for over 10 years, improvised a solution one snowy night. Awake and sweating profusely, she crawled outside and lay down on the terrace, pressing every part of her body against the stone to absorb every inch of soothing coolness into her flushed skin. Her husband, watching her from the window as she lay sprawled on the patio in her nightgown, said she must look crazy to the neighbors. “Not when the neighbors are menopausal,” she told him.
Perhaps this—compassion, empathy, and togetherness among menopausal women—is the purpose of the hot flash. Hot flashes give us the opportunity to watch our neighbor go starfish fishing on her patio or watch our co-worker dump a bag of frozen peas into her bra and think, “Aha! That’s clever.”
Hot flashes will never be cool, but they do make midlife women break out in sweats.
This educational resource was created with support from Bayer, a member of the HealthyWomen Corporate Advisory Council.
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