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What are hot flashes?
As most menopausal women know, hot flashes are an uncomfortable and sudden sensation of heat accompanied by flushing of the skin. They generally affect the upper chest, neck and face before affecting the entire body. Hot flashes can cause profuse sweating or heart palpitations, they typically last two-4 minutes and they are often followed by a cold chill.
Three out of four menopausal women will experience hot flashes with an average age of onset of 51. The frequency and severity of hot flashes are quite variable and unpredictable, and they can stop and start without rhyme or reason. On average, hot flashes continue for 3-5 years, but 10-15% of menopausal women will suffer from persistent hot flashes for many years. Women who smoke, are overweight, or do not get enough exercise are at increased risk for hot flashes.
What causes hot flashes?
While the cause is not fully understood, it is generally accepted that a “thermoregulatory disorder” at the level of the hypothalamus (the part of the brain that regulates body temperature) occurs in response to falling blood estrogen levels. Estrogen levels decrease during menopause because the ovaries slow down and no longer produce eggs. If the hypothalamus erroneously senses that the body is too warm, it attempts to dissipate the excess heat by dilating (enlarging) the blood vessels in the skin, resulting in a “hot flash.”
Do hot flashes cause other problems?
Yes. Because hot flashes are typically more common at night, they can interfere with sleep, and the resulting sleeplessness can in turn cause daytime fatigue, irritability, difficulty concentrating, mood swings and short-term memory loss.
What can be done for hot flashes?
For mild hot flashes, several lifestyle modifications might be sufficient to help control symptoms; dress in multiple layers (removing outer layers if feeling too warm), avoid hot flash triggers (such as hot or spicy foods, caffeinated or alcoholic beverages), or at the onset of a hot flash take deep, slow, abdominal breaths for several minutes. For moderate to severe hot flashes, hormonal therapies with estrogen, progesterone, or a combination of the two are the most effective treatments. Estrogen should not be taken by women with a history of breast cancer, heart disease, stroke or blood clots. Women who have not had a hysterectomy need to take estrogen combined with progesterone to limit the risk of uterine cancer. Hormonal therapies are available in pills, patches or injections. Some non-hormonal prescriptions medications can be effective for hot flashes; selective serotonin reuptake inhibitors (Prozac®, Paxil®, Zoloft®, etc.), serotonin-norepinephrine reuptake inhibitors (Effexor®), the nerve pain medicine gabapentin (Neurontin®), and the blood pressure medication Clonidine (Catapres®).
Plant-derived estrogens have been marketed as a “natural” or “safer” alternative to hormones for women with menopausal symptoms, but there is little to no evidence that such “phytoestrogens” are effective. Other alternative treatments, including black cohosh, ginseng, dong quai, evening primrose oil, wild yam and progesterone creams have also been studied. There has not been consistent scientific data to support their effectiveness in reducing hot flashes.
What research opportunities are there for hot flashes?
At Baptist Health Center for Clinical Research, we have performed a number of clinical trials on hormonal therapies. A promising new approach to controlling hot flash frequency and severity is to use low dosages of medications that increase levels of serotonin, the SSRIs (selective serotonin re-uptake inhibitors). Newer, alternative medications are also being developed.