Let's Talk About Menopause: Hot Flashes
What is a hot flash, and why am I getting them?
Menopause is achieved after 12 months without a menstrual cycle.
I started having hot flashes intensely last year. It took a few weeks for me to realize what they were, because I thought I was experiencing temperature changes just like everyone else, until it became obvious that I was the only one sweating! Up untiI 4 years ago, I had been the cold one in my family, always asking someone to turn up the heat. I was so cold in my final year at UVM, that I moved to Phoenix, AZ and stayed for 7 years! That has surely changed!
I am now the proud owner of at least 10 tank tops. I wear these tank tops under almost every outfit I wear, even on the coldest winter days, so I can get down to that base layer if needed. I bought new sheets for my bed that are cooler and lighter, and I use them year round. I have a pile of turtlenecks and sweaters that I haven’t worn in at least 4 years, as my internal temperature heats me from the inside out.
What is up with this? Hot flashes, also known as vasomotor symptoms, and can begin many years before the onset of menopause (menopause is defined retrospectively at 12 months after the cessation of menstruation). As estrogen levels begin to drop off in your mid-30’s, you may begin to notice vague symptoms that continue to increase until you get to the stage called perimenopause. This is the most symptomatic stage of menopause, it usually starts in your mid-40’s and typically lasts 6 years. Yes, my lack of warm clothing is pretty much right on target.
If you have been experiencing hot flashes, you are absolutely not alone. These vasomotor symptoms are the most common symptom of perimenopause (remember, it starts in your mid-40’s), with up to 85% of women experiencing them to some degree. The exact cause of hot flashes is unknown, but it is linked to the drop in estrogen that occurs after age 35. As we move out of our 30’s and into our 40’s, estrogen continues to fall until we finally reach menopause at about age 52 (this varies widely). Our bodies take a long time to adjust to this drop in estrogen, which happens as our ovaries stop working, our follicles are depleted, and all of our hormones start establishing a new homeostatic level. Our hormones pretty much run everything in our body, and when they are out of balance, we can have a plethora of symptoms.
Here are some of the most common hot flash triggers. Identifying yours so that you can avoid them is key.
Common hot flash triggers:
Hot drinks - the heat may trigger a hot flash
Warm environments - have you noticed a hot flash while taking a shower or bath? Or sitting next to a warm fire? Using your hairdryer?
Stress / Anxiety - your increased heart rate may trigger this response
Alcohol (red wine perhaps even more) - alcohol is a vasodilator, which may trigger your hot flash
Caffeine - although it is a vasoconstrictor, it also increases your heart rate, which may be a trigger
Smoking - your heart rate may increase, triggering your hot flashes
Tight clothing or too much clothing - again, increases your temperature
Intense exercise - although good for you, and the benefits far outweigh the drawbacks, a hot sweaty workout may trigger a hot flash, have a cold water nearby, or even a cold pack
A diet with too much sugar, gluten or processed foods
And others that may be individual to you.
Can you identify any of the triggers above that you have experienced? I know being in tight clothing in a too warm environment has become an almost unbearable trigger for me (shopping, ugh! I leave my coat in the car).
You have the power to change your behavior in a way that lessens the chance of triggering a hot flash. Try taking a few notes for a week or so to see when you are getting hot flashes and if you can identify specific triggers. Can you avoid any of the triggers?
For me, alcohol, too much bread and warm clothing have been big triggers that I have had to modify. As much as I like a glass of wine in the evening, along with gluten-filled food, (bagels, pasta, crackers), without them, I sleep better and have fewer hot flashes. Estrogen has an effect on insulin regulation, and changes in my food sensitivity have made my eating more challenging (more on this in another post).
Take on new challenges, over 50 can be the most rewarding time of your life!
Severe hot flashes occur in 10-15% of women, and for these, a visit to your physician may be helpful. Hormone replacement therapy can be beneficial, for a short duration of time, to reduce the severity of them (again, more on this in another post). Other medications may also be considered. Blood work that looks at vitamin deficiency can also be ordered. Specifically look at Vitamin E levels, as well as Vitamin B and D.
Every single one of us is different (and that is a good thing). Take some time to take care of yourself, and reduce your stress levels by doing something you enjoy. This is an exciting transition time, as you move into a new phase of life where women often hit their stride. Taking on the menopause transition as something to celebrate and not to avoid, we can move this experience from something negative and make it a positive milestone. We need to support each other by talking about the changes and learning from each other. Lift each other up!
References
Gupte, A. A., Pownall, H. J., & Hamilton, D. J. (2015). Estrogen: an emerging regulator of insulin action and mitochondrial function. Journal of diabetes research, 2015, 916585. https://doi.org/10.1155/2015/916585
(Pre) Menopause Matters: Early Planning for a Healthier Future. Presenters Karen Litos PT, DPT, WCS and Karen Snowden PT, DPT, WCS. July, 2020. https://www.snowdenlitos.com/.
The North American Menopause Society. Hot Flash FAQs: Triggers, Symptoms & Treatments. https://www.menopause.org/home.