Standing in front of 50 colleagues in the conference room, I was taking questions after the presentation when I felt the familiar tremors of a hot flashes. “Please, not now,” I bargained with my menopausal body. “Don’t put me on the hot seat both literally and figuratively.”
My body rejected the deal. As if coming from a hot hair dryer, the heat shot up from the center of my chest, just below my collarbone, and spread down my neck. My face burned and sweat broke out everywhere: dripping from my temples, pooling in the center of my bra and running down my back. Within seconds, I go from looking calm and collected to looking like I’m being interrogated by a commando 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 relentlessly through the night in nightgowns and sheets, nuclear fusion in our pajamas hot enough to power cities, birth stars, and rob us of another night’s sleep. There are arguments for both, but everyone agrees hot flashes aren’t cool.
What causes menopausal hot flashes, why do they happen, and most importantly, how can we stop them from interrupting our busy lives? We asked two medical experts who help women cope.
What causes menopausal hot flashes?
Alicia Scribner, MDassociate professor of obstetrics and gynecology at the University of Washington School of Medicine, described a hot flush as “a sudden sensation of heat that starts centrally and spreads.” One of her patients described it more poignantly: “She told me that when she gets hot flashes, she feels like her whole body is 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 can continue for an average of seven years.
This leads women everywhere to ask, “Why does this happen to us? What is it about going through menopause that causes our bodies to feel like they’re spontaneously combusting?”
Neuroscientists are getting closer to the answer. The brain’s ability to regulate temperature is closely related to estrogen levels, he said Kellyann Niotis, MDneurologist based in New York. When estrogen levels fluctuate during perimenopause, then drop rapidly after menopause, the brain’s thermostat, hypothalamusit is destabilized.
“When estrogen no longer activates this region properly, the brain misreads internal temperature cues and triggers a cascade of events to cool the body: dilation of blood vessels and initiation of sweat production,” he said.
There is also evidence that drops in brain glucose levels contribute to menopausal hot flashes. “Estrogen usually helps maintain stability glucose delivery to the brain, so when levels drop, the brain can be more vulnerable to these dips—another trigger for hot flashes,” Niotis said.
A part of the brain called prefrontal cortexwhich governs stress reactivity and emotional regulation, can shape how bothersome or bothersome hot flashes feel. In fact, Niotis said, “Women who experience more stress or anxiety often report more frequent and more intense hot flashes even when they are objective. physiological Measures such as skin conductance do not differ. In other words, two women may have the same event, but the one under greater emotional stress may experience it as more overwhelming.”
This may clarify how socioeconomic conditions and race affect the hot flash equation. In the US, data show that black women are more than twice as likely to experience frequent hot flashes compared to white women, and more likely to report them as more bothersome and disruptive to daily life and sleep. Hispanic women also report more frequent hot flashes at menopause than white women, although they tend to describe them as less intense and less bothersome.
If your life is being disrupted by your hot flashes, it’s time to seek treatment. “If women feel their symptoms are affecting their quality of life — their focus at work, fatigue, energy and sleep — it’s important to get help,” Scribner said.
Treatments for hot flashes
Although science has yet to find a cure for hot flashes, or a way to prevent them, there are many medical and non-medical options.
Hormone therapy (HT) it works to control hot flashes and other menopausal symptoms by replacing the estrogen that is lost in menopause. But for women who don’t want to take hormone treatments, or for those whose risk factors prevent HT from being an option, there are non-hormonal treatments.
A class of drugs called neurokinin receptor antagonists are FDA-approved to treat moderate to severe hot flashes in menopause by addressing the chemical imbalance that can lead to hot flashes and night sweats. Other drug options include antidepressants. One antidepressant, paroxetine, is FDA-approved to treat hot flashes, but other antidepressants are sometimes prescribed off-label, as are some anticonvulsants, anticonvulsants, and blood pressure medications.
The jury is out on herbal solutions, Scribner said. “I’ve heard from some of my patients that they’re taking different herbs and supplements, but there’s no good evidence to support their effectiveness,” Scribner said. However, believing something works — known as the placebo effect — can help reduce the perception of discomfort. As long as a solution isn’t harmful, Scribner said, “if you think something makes you feel better, you’re going to get that benefit from it.”
Lifestyle changes can also help. “Caffeine, alcohol, hot drinks and spicy foods have been shown to trigger hot flashes,” Scribner said. But how a person reacts to a potential trigger is very personal. Scribner urged women to notice their personal 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 if hot flashes serve an evolutionary purpose that provides a benefit to menopausal women, Scribner laughed and said she wasn’t aware of one.
But I have a (non-scientific) theory.
My friend, who has been experiencing hot flashes for over 10 years, improvised a solution one snowy night. Awake and sweating profusely, she went outside and lay down on the patio, pressing every part of her body against the stone to soak up every inch of soothing coolness on her reddened skin. Her husband, watching her from the window as she lay on the patio in her nightgown, said she must look crazy to the neighbors. “Not if the neighbors are menopausal,” she told him.
Maybe that—sympathy, empathy, and community among menopausal women—is what hot flashes are all about. Hot flashes allow us to observe our neighbor fishing in her backyard or watch our coworker dump a bag of frozen peas down her bra and think, “Aha! That’s smart.”
Hot flashes will never be cool, but they do create a sweaty sisterhood for middle-aged women.
This educational resource was created with the support of Bayer, a member of the HealthyWomen Corporate Advisory Council.
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