As I was standing in the conference room in front of about 50 colleagues and taking questions after the presentation, I felt a familiar burning sensation. “Please, don’t do it now.” I negotiated my pre- and post-menopausal body. “Don’t put me in the hot seat, literally or figuratively.”
My body refused to make a deal. Heat rose from the center of my chest, just below my collarbone, as if from a hot hair dryer, and spread to my neck. My face was hot and sweat was pouring out everywhere. Water was dripping from my temples, pooling in the center of my bra and running down my back. In just a few seconds, I went from looking calm and collected to looking like I was being interrogated by commandos in a military prison.
My friends and I often discuss which hot flash scenario is worse. Whether you’re sweating during an important meeting, presentation, or job interview, or sweating through your pajamas and sheets all night long, nuclear fusion in your pajamas is hot enough to power cities, birth stars, and rob us of another night’s sleep. There is debate about one or the other, but everyone agrees that hot flashes are not good.
What causes menopausal hot flashes, why do they occur, and most importantly, how can you stop them from interfering with your busy life? We asked two medical experts who help women cope.
What causes menopausal hot flashes?
Dr. Alicia Scribner, associate professor of obstetrics and gynecology at the University of Washington School of Medicine, describes hot flashes as “a sudden hot flash that starts in the center and spreads out.” One of her patients described it even more movingly. “She said that when she gets hot flashes, it feels like her whole body is on fire,” Scribner said.
Individual hot flashes may last 5 to 6 minutes. Although it may seem manageable, women can experience up to 20 hot flashes a day and they can last for an average of seven years.
This leaves women everywhere asking, “Why does this happen to us? What is it about the menopausal transition that makes our bodies feel like they’re on fire naturally?”
Neurologists are working to find answers. The brain’s ability to regulate temperature is closely tied to estrogen levels, says New York neurologist Dr. Kellyann Niotis. When estrogen levels fluctuate during menopause and then decline rapidly after menopause, the hypothalamus, the brain’s thermostat, becomes unstable.
“When estrogen no longer properly activates this area, the brain misreads internal temperature signals and triggers a cascade of events to cool the body: It dilates blood vessels and begins producing sweat,” she said.
There is also evidence that decreased brain glucose levels contribute to menopausal hot flashes. “Estrogen normally helps maintain steady glucose delivery to the brain, so when levels drop, the brain can become more susceptible to these plunges, which is another trigger for hot flashes,” Niotis said.
A part of the brain called the prefrontal cortex, which controls stress reactivity and emotional regulation, determines how disruptive or painful hot flashes feel. In fact, Niotis says, “Women who are more stressed or anxious often report more frequent and more intense hot flashes, even when objective physiological measures such as skin conductance do not differ. In other words, two women can experience the same event, but the more emotionally strained woman may experience it as more overwhelming.”
This can clarify how socioeconomic conditions and race factor into the hot flash equation. Data from the United States show that black women are more than twice as likely as white women to experience frequent hot flashes and are more likely to report that they are more bothersome and disruptive to their daily lives and sleep. Hispanic women also report menopausal hot flashes more frequently than white women, but tend to describe them as less intense and less destructive.
If hot flashes are interfering with your life, it’s time to seek treatment. “It’s important for women to get help if they feel their symptoms are affecting their quality of life (concentration at work, fatigue, energy, sleep),” Scribner said.
Hot flash treatment
Although science has not yet found a cure or prevention for hot flashes, there are many medical and non-medical treatment options.
Hormone therapy (HT) is effective in controlling hot flashes and other menopausal symptoms by replacing the estrogen lost with menopause. However, for women who do not wish to undergo hormonal treatment or who cannot choose HT due to risk factors, non-hormonal treatments are also available.
A class of drugs called neurokinin receptor antagonists are approved by the FDA to treat moderate to severe menopausal hot flashes by correcting the chemical imbalance that can cause hot flashes and night sweats. Other medication options include antidepressants. One type of antidepressant, paroxetine, is FDA-approved to treat hot flashes, but other antidepressants are sometimes prescribed off-label, as are some antiseizure drugs, antispasmodics, and blood pressure medications.
The jury is out on herbal solutions, Scribner said. “I have heard from some patients that they are taking various herbs and supplements, but there is no good data to support their effectiveness,” Scribner said. However, believing that something is working, known as the placebo effect, can help reduce perceptions of discomfort. As long as the solution isn’t harmful, Scribner says, “If you think something makes you feel good, you’ll benefit from it.”
Lifestyle changes may also help. “Caffeine, alcohol, hot drinks, and spicy foods have been shown to cause hot flushes,” Scribner said. However, how a person reacts to potential triggers is very personal. Scribner urged women to observe their individual hot flash patterns and make adjustments based on that insight. He also recommended sleeping in a cool room and using a fan and ice packs at night.
When asked whether hot flashes served an evolutionary purpose in benefiting postmenopausal women, Scribner laughed and said she didn’t know of one.
But I have a (non-scientific) theory.
A friend of mine who has suffered from hot flashes for over 10 years came up with an impromptu solution one snowy night. Waking up and sweating profusely, she crawled outside and lay down on the terrace, pressing every part of her body against the stone, soaking up the soothing coolness on her flushed skin. Her husband watched her from the window as she lay on the terrace in her pajamas and said she must look crazy to the neighbors. “Not if your neighbor is in menopause.” she said to him.
Maybe this is the compassion, empathy, and empathy of menopausal women. Hot flashes can make you think, “Aha! Clever,” as you observe your neighbor fishing for starfish on the patio or your co-worker stuffing a bag of frozen peas into her bra.
Hot flashes are never cool, but they create the sisterhood of sweat for middle-aged women.
This training material was created with support from Bayer, a member of the HealthyWomen Corporate Advisory Board.
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