Understanding Hot Flashes
Hot flashes and night sweats are two symptoms women in perimenopause talk about the most. Even women who haven’t reached perimenopause know about these symptoms. We hear about them and may dread them. Perhaps if we understood them a little better we may not dread them, and we may it easier to find how to manage them or even reduce them.
What is the difference between hot flashes and night sweats?
Hot flashes/flushes and night sweats are related to vasomotor symptoms, and they are in some way the hallmark symptoms that can indicate a woman is nearing menopause.
Hot flashes are moments where you may feel an intense heat coming on, this can occur suddenly or slowly. There may be sensations of tingling, your face may become red “flushed”, sweating, and burning skin sensation. Some may experience dizziness, nausea, or a faster heartbeat (heart palpitations). Night sweats are basically a hot flash/flush that occurs at night.
Not all women will experience hot flashes, and for those who do, the intensity, length of time they occur, and how often they happen, will vary from woman to woman.
How long do hot flashes last?
Hot flashes can last for a few seconds or minutes, their frequency can vary as well. In general, they are not considered harmful. However, there is some evidence that is pointing towards women who have a lot of hot flashes during the day may be linked to an increased risk of dementia and heart disease after menopause.
What causes Hot flashes and night sweats?
The actual cause is still unknown. There is speculation (lots of hypotheses out there) as to what is really happening and why. Most research points to the relationship between the brain and the ovaries—hormones. In the (hypothalamus) brain, there is a thermoneutral zone within the thermoregulatory mechanism, the hypothalamus has a range that is considered a normal range. It is thought, that during perimenopause this zone becomes narrowed, meaning the range of temperature becomes narrow.
Think of this as the hypothalamus managing the thermostat in your house. It starts out saying, okay, a shift in ambient temperate in the house by 0.5 degrees is normal. No need to turn on the heat or the AC. However during perimenopause, the hypothalamus gets a bit touchy with the thermostat, and when there is a slight change in ambient temperature, it cranks up the heat and then blasts the AC to try and get the temp back to “normal”. In the body, this means hot flashes, maybe some sweating, and then followed by some cold shivers.
What does estrogen have to do with hot flashes?
First off, estrogen and the body's temperature control have been connected since puberty, when menstruation became part of your life. During your menstrual cycle, your body temperature will increase midway between ovulation and menstruation. During the luteal phase (that time between ovulation and bleeding) is where estrogen levels are high, but progesterone is now on board and is significantly higher (or it should be) during this phase of the menstrual cycle. The neurons (nerve cells) that are involved in the menstrual cycle are also involved in regulating body temperature as well. Another way to think of this, the nerve cells are the universal remote and both the thermoregulation system and reproduction system use this remote to regulate body temperature thermostat.
Perimenopause and hot flashes –Thermoregulation
During perimenopause, that time when sex hormones are fluctuating, this causes highs and lows of estrogen. The sudden drops of estrogen, which the brain senses, trigger a vasomotor thermoregulation response.
Estrogen suppresses messages from a group of neurons that communicate about the heat (those nerve cells). Low to no estrogen equates to the thermoregulation system becoming overly sensitive to small changes in temperature. When there is a sudden drop in estrogen, that suppression is no longer there to help manage the thermostat effectively. This equates to the body sensing high heat (even when there isn’t any). The body will think there is a fire that needs to be put out. The response to this is dilated blood vessels and moving blood to the skin to get the heat out of the body. This is when the skin flushing happens, and sweating–a hot flash/flush. The flush of heat or wave of heat can be felt in the face, neck, arms, and chest. In addition to the heat rising and blood vessels dilating, blood flow to the brain decreases. This can contribute to anxiety during and after a hot flash.
When will hot flashes start? When will they end?
As I mentioned, not all women will experience hot flashes. Those who do get hot flashes can begin during the early or last stages of perimenopause. Usually, they will start to show up in the mid to late 40s for most women. The end of hot flashes takes some time, some women will experience hot flashes after 1 year to several years after menopause (post-menopause).
When to talk to your doctor about your hot flashes
If you are experiencing several/multiple hot flashes within an hour, and they are impacting your ability to function in your daily life, it would be a good idea to speak to a health professional that can help you address what could be triggering them, and/or determine if there is a health situation that needs to be addressed.
Natural options for managing your hot flashes?
There is no single way to manage hot flashes. What works for one person may not work for another. Aside from hormone therapy treatment, there are natural ways you can manage your hot flashes. This includes making adjustments to your diet, addressing and managing stress, avoiding alcohol and smoking, and reducing or cutting out caffeine.
