Menopause Mondays: What’s New, Hot Flash?

Ellen Dolgen

The weather was not hot. In fact, it was a beautiful spring day, and I was wearing a lightweight pantsuit. All of a sudden, I felt a flush of heat come over my entire body. Perspiration began dripping from my head trailing between my breasts creeping all the way down to the inner seams of my pants. It looked like I had just come from a Bikram yoga class, but instead I was in a business meeting!

I was no longer going to be able to ignore that nagging suspicion that something was going on with my body. Now, I and everyone around me had a clear sign of what was happening to me. I was in perimenopause.

I have blogged about hot flashes before, frankly, who hasn't? Hot flashes are one of the most frequent, dramatic, and alarming symptoms of perimenopause and menopause. I find it an amazing sign of women's resilience that we've found a way to laugh at this often-debilitating condition. I've heard all of the hot flash jokes. Hot flashes have been compared to power surges, brief tropical vacations, localized global warming, incineration, demonic possession, nuclear meltdowns, and your inner child playing with matches. Since hot flashes can possibly last for several years before and after your last period, the trick is to find strategies to calm that wayward inner child before she burns the house down.

Approximately 2/3 of all menopausal women will experience hot flashes. Hot flashes can also result from surgically induced menopause, and they can be quite difficult after a chemotherapy-induced medical menopause.

So, what's new hot flash??

Let's review the basics. Estrogens are related to the control of temperature in your body. During perimenopause and menopause, the levels and balance among estrogen, progesterone, and testosterone begin to fluctuate. When your estrogen levels begin to decrease, they can trigger your body's thermostat to send a signal that you are overheated. This causes your body to send out an all hands on deck alert: your heart pumps faster, the blood vessels in your skin dilate to circulate more blood to radiate heat, and your sweat glands release sweat to cool you even more. Your body cools down when it otherwise wouldn't, and you are left feeling miserable: soaking wet in the middle of a board meeting like me or in the middle of a good night's sleep. Here's a breakdown of the possible physical reactions that may occur. Remember that each woman's physiology is unique, and you may not experience all of these:

  • flash of heat spreading over your skin

  • skin flushed red or blotchy

  • racing heartbeat

  • sweating (abnormally like you jumped in a pool)

  • dizziness

  • episodes lasting from 30 seconds to 5 minutes

  • occurring in upper or lower body

  • occurring during the day and/or night (night sweats)

  • infrequent (several per month) to frequent (several per hour)

  • feeling cold and clammy once the hot flash has passed

Sounds like a fun time, doesn't it? Well, the consequences of these symptoms can be:

  • interruption of daily activities

  • difficulty sleeping

  • anxiety

  • feeling out of control or helpless

Strategies

My advice is constant and consistent: educate yourself, find a menopause specialist, and together with your specialist, design a treatment strategy tailored to you so that you can return to living fully. Of course, I now speak from the luxury of perspective, and perspective is nearly impossible when you find yourself on a hot flashed, anxious and tense, emotional roller coaster. "How did I get on this Scream Machine anyway?" you may ask yourself while also trying to remember the names of your children. It's ok. I'm here to help.

Primarily, this is a conversation you should have with your menopause specialist. (Don't have one? Start here.) However, educating yourself and tracking your symptoms is crucial to having the most productive conversation with your doctor when you do finally make that first appointment. There are significant, non-medical lifestyle changes you can try which may help alleviate perimenopause and menopause symptoms:

  • wear layered clothing and avoid wool and synthetics

  • exercise

  • nutrition (reduce or eliminate sugar, caffeine, alcohol, hot drinks)

  • don't smoke

  • relaxation (try yoga)

  • stress management (are you on your own priority list?)

  • reduce stressor hormones (not just to deal with hot flashes but also to reduce your chance of cardiovascular issues)

These sound like a good idea regardless of whether you're having a hot flash every hour or not. I know the thought of giving up your favorite double latte or cocktail is not something to celebrate. I suggest first eliminating one thing at a time. I would start with those desserts that have enrolled you in "the sisterhood of the shrinking pants." If it makes a difference in how you feel - great! If not, try eliminating another item on the list. Sorry :

For some women, this still will not be enough. Here is where your menopause specialist comes in. If you prefer natural remedies or at least like them to be considered in your overall treatment strategy, make sure you choose a doctor who respects homeopathy as well as traditional medicine. This should be one of your questions when you conduct your doctor interview. The following is a list of possible treatments you'll want to research and discuss with your doctor (in order from natural to prescription remedies):

  • homeopathic or herbal remedies - At least one study has found that a combination homeopathic remedy can be useful in the treatment of hot flashes. This study found no adverse side effects from the treatment.

  • phytoestrogens

  • black cohosh

  • Siberian rhubarb

  • acupuncture

  • hormone replacement therapy

  • anti-depressants (SNRIs such as Effexor and Pristiq)

Hormone replacement therapy (HRT) alone is a huge and sometimes confusing topic. Again, you must take the time to educate yourself prior to consulting with your doctor. Start here, and then sign-up to receive my Menopause Mondays newsletter and Menopause News Flash updates. I'll make sure you are aware of the latest news and information available. Depending upon your family medical history, HRT may be a completely viable treatment option. The benefits and risks of HRT change with your specific health profile. You are unique! Only you and your doctor can make the decision about whether HRT is right for you.

You are not alone! There are an estimated two million women entering menopause every year in the U.S. - six thousand women daily giving us a total population of approximately 50 million postmenopausal women. That's a lot of shmirshkies! Eighty five percent of those women experience hot flashes of some kind or another during their menopausal journey. I want you to be empowered to make wise and informed decisions about your health, so you can live fully and enjoy this wonderful life we've been given. Feel free to email me anytime. I am always here for you.

My motto is: Reaching out is IN. Suffering in silence is OUT!

Tell me: When and where did you experience your first hot flash?

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