Hot Flashes



 

The term 'Hot Flashes' also known as ' hot sweats', 'the heats' or 'hot flushes' is used to describe the sensation of heat that is felt spreading all over the upper part of the body and up the neck to the face.


Hot flushes most commonly affect women at the menopause. This may occur the age of 40 or not until the late 50s but in most women it happens between the ages of 45 and 55 the average age being 51.


A hot flush, is quite unlike a blush, which produces a milder, warm feeling that spreads over the face and neck. Menopausal hot flushes range from the very mild that pass quickly, to those that are most distressing and occur several times throughout the day and night. Sometimes they can become continuous over many hours at a time, sleep may be disturbed and the sufferer may throw off the bedclothes to try and cool down.


Causes

Primary:
At the menopause the ovaries cease production of estrogen and stop releasing eggs. Menstruation (periods) ceases and the body has to adapt to a new hormone balance.

Until the menopause, oestrogen is secreted by ovarian follicles in response to follicle - stimulating hormone (FSH) released by the pituitary gland at the base of the skull. The follicles gradually run out of estrogen, and wear out, so that when the menopause is reached the ovaries no longer contain any of these follicles Because there are no follicles to respond to the FSH there is a much higher level of FSH in the body. This can lead to hot flushes as small blood vessels in the skin become more easily dilated, leading to an increase in skin temperature and, at times, a reddening of the skin. Over - stimulation of the sweat glands may also occur.

 

However, although changes in hormone levels are thought to be responsible for hot flushes it is possible to have them with perfectly normal hormone levels several months, or even years, before the periods begin to alter.

 

Other women may have a hormone deficiency yet have no hot flushes.Yet again, it is possible for hot flushes to persist in spite of the Hormone Replacement Therapy which may be used to correct other symptoms due to the menopause, such as dryness of the vagina which makes sexual intercourse painful and difficult.


Some women notice that some forms of stress bring on hot flushes. They are likely to be more irritable, get upset and cry more easily than usual. Simple day - to day takes that previously caused no problem become difficult and can even lead to a sense of confusion

 

Other causes:
There are other very different causes of hot flushes, which can occur in men as well as women.

  • There is the feeling of going hot and cold with sweating and shivering, especially during the night, which occurs with many infections that produce a fever.

  • Eating hot, spicy or curried foods can also produce a hot flush and sweating. Alcohol may also have the same effect. Hot flushes can particularly affect people who have a mild form of diabetes which can be treated with tablets instead of insulin injections. One sort of treatment -- chlorpropamide -- is known to interact with alcohol and about one in three diabetics treated with it will experience hot flushes if they drink even a small amount of alcohol.

  • Another less common cause of hot flushes is a skin complaint, rosacea, which produces a ruddy discoloration of the forehead, nose, cheeks and chin.

  • Occasionally a growth called a carcinoid tumour, can occur in the stomach or intestine. This produces excessive amounts of a hormone called serotonin which affects different body organs and causes symptoms such as asthma, loud rumblings in the abdomen and diarrhoea, as well as hot flushes which affect the whole body including the arms and legs.

Triggers for hot flashes include spicy food, hot drinks, alcoholic drinks, white sugar (sugar can also cause palpitations), stress, hot weather, hot tubs and saunas, tobacco and marijuana and anger, especially when unexpressed.


Symptoms

  • Commonly reported symptoms following a hot flash may lead some women to perspire, or really sweat! The upper body, from the chest to the scalp, may begin to sweat profusely. You may also "flush," that is, become red as you flash. Heart rate and skin blood flow increase, although internal body temperature may drop by as much as three or four degrees as the body struggles to correct the imbalance. After the flash, the body quickly becomes chilled as it struggles to regain its normal temperature. Most flashes last about three to six minutes, although it's possible to have one that goes on as long as an hour.

  • Depending on the intensity of the hot flash, some women may get headaches, feel weak, dizzy, tired or lose sleep.


  • Some may experience palpitations, skipped or erratic heartbeats and
    occasionally, fainting.

  • Night sweats and hot flashes can be tough to handle and can cause insomnia, panic attacks, anxiety, depression can lead to extreme fatigue and anxiety.

Remember to be sure to check with your health care practitioner before attributing any of the above symptoms to menopause. Hot flashes can be the sign of illness or medical disorders.


How Long Does a Hot Flash Last ?

Hot flashes can be categorized as mild, moderate or severe.Hot flashes may last two to three minutes or up to 30 minutes. They may occur several times a day, or feel like they're occurring all day! They can occur once a week, maybe never. Hot flashes may happen once or twice, or continue for up to ten years. No wonder women think they are going crazy!


Management

First, try to remember that hot flashes are a natural phenomenon, and are harmless in and of themselves. Some women like to call them �power surges.� Below are some simple solutions :

  • Wear clothes made of natural fibers (cotton, wool, silk) which can disperse heat away from the body. It is more practical to dress in layers so that clothing can be removed and added as needed.

  • Keep a fan at your desk and use it when you feel hot while your office mates are not.

  • Splash your face and hands with cold water. Stay well hydrated, and drink ice-cold water when a flash comes on.

  • Get regular exercise. Reasonable exercise helps to safeguard good health, particularly at the time of the menopause. Exercise helps to decrease hot flashes by lowering the amount of circulating FSH and LH and by raising endorphine levels (which drop during a hot flash). Walking, swimming and similar activities are well worthwhile. Menopause is associated with a shift of body fat from the hips to the middle, a fat redistribution linked with increased cardiac disease risk. Weight training (Strn Trai conten) can help prevent this change by contributing to maintenance & increase in body's muscle mass.

    The benefits of exercise are multiple�it maintains and even increases bone mass as we age. It lowers cholesterol. Those who are active and have lower calorie intake (especially fat calories), live longer and maintain vigor much longer into old age than those who are sedentary. Exercise can be thought of as prevention for breast cancer, given that obesity is one of its risk factors. The endorphin release associated with regular exercise can also help battle the mood swings and depression some women experience during this time of life.

    It�s important that your exercise regimen be frequent (at least five days per week) and long enough (at least 30 minutes). Strength training is critical to maintaining muscle mass and preventing bone loss. Strength training is best done with weights rather than machines, so a set of hand weights will do the trick. (You will need your doctor�s approval before embarking on an exercise program, and may need to limit your exercise if you have any particular orthopedic problems.)

  • Keep regular sleeping hours.

  • Find out if certain foods trigger a hot flash for you, and avoid them. The usual suspects are alcohol (red wine is notorious), spicy foods, and caffeine.


  • Practicing relaxation for just 20 minutes a day can greatly reduce the severity and frequency of hot flushes. Relaxation techniques to be used can be visualizing a beach scene and listening to a soothing voice on a tape.

  • Diet : Hot flashes deplete our bodies of the vitamins B, vitamin C, magnesium and potassium so it is helpful to increase our consumption of these nutrients, don't forget Calcium. Hot flashes are much less common in non-western cultures, where there is a high soy bean consumption which stimulates estrogen production.Studies in Japan, Hong Kong, Pakistan and Mexico suggest that 10 percent or less of menopausal women experience hot flashes. This is the reason to why many women have turned to natural plant estrogens, aka soy phytoestrogen, such as found in products like Revival Soy Protein, which is very high in soy isoflavones -- the magic inside the soybean that acts similarly to estrogen replacement therapy.

However, if the flushes are more severe and frequent, a women should see her doctor so that proper diagnosis can be made, possibly by testing the hormone levels,and treatment given if necessary. The doctor may refer her to a gynaecologist for a specialist's opinion if in doubt about the treatment.


Treatment Options Available

 

Hormone replacement therapy:
Hormones are usually given to replace the body's normal ones if one of the glands responsible for secreting hormones stops working. In the case of the menopause, estrogen is no longer being produced and if this is causing problems, such as severe hot flushes, the patient may be given estrogen. It may be taken in table form, or given by injections or by implanting small amounts under the skin. Sometimes estrogen is applied to the vagina in the form of a cream or pessary, but this may not be effective in the control of severe hot flushes.

 

A doctor may advise against Hormone Replacement Therapy if you have history of menstrual disorders, liver disease or a family history of cancer of the womb or breasts. However, it is now thought that it is safer for the two hormones, estrogen and progesterone to be combined in one treatment, but this leads to shedding of the lining of the womb each month, and so may not be acceptable to a women who has stopped having periods and now faces the depressing prospect of having them once more in exchange for losing the hot flushes. Also, statistic show that the risk of complications involving thrombosis ( clotting of blood in arteries or veins ) is multiplied about eight times when a women takes estrogen, either in the contraceptive pill or to prevent hot flushes, and also continue to smoke.

 

Vitamin E:
Vitamin E has been a popular estrogen alternative for treatment of hot flashes for many years. Unfortunately, there is no evidence to suggest that it is effective. There has been only one thorough study to date, which examined the use of vitamin E for control of hot flashes in breast cancer survivors. The frequency of hot flashes decreased by 25 percent, similar to the effect of placebo (22 percent). Only one dose was tested and further research is needed.

However, don�t let this keep you from getting enough vitamin E in your diet. Vitamin E is one of the important groups of antioxidant vitamins, which also includes vitamin C, selenium, and carotene. These vitamins appear to be important in prevention of cancers and heart disease. The U.S. RDA for vitamin E is five micrograms. Rather than taking expensive supplements, get your antioxidants in their natural form�fruits and vegetables. USDA Food Guide Pyramid recommends two to three servings of fruit and three to five servings of vegetables per day.

 

Isoflavones and hot flashes:
In general, isoflavones appear to reduce hot flashes, although they are not as effective as estrogen. One study found that daily intake of 60 grams of soy protein over 12 weeks reduced hot flashes by 45 percent, compared to 30 percent with a placebo. Based on this data, I recommend 60 grams of soy protein to my patients. This amount can be difficult to obtain in soy foods alone and most patients resort to shakes or supplements. Be careful, because soy has calories. Be sure to read labels�not all soy products and foods are equivalent

 

Herbs:
Herbs commonly used to alleviate hot flashes include ginseng, black cohosh, vitex agnus castii, blue cohosh, dong quai, "wild yam root" [natural progesterone, licorice root, false unicorn and sarsaparilla]. Experiment with using one herb or several in combination.

 

Evening Primrose Oil (Oenothera biennis L. family: onagraceae; aka: King�s Cure-all)
The small seeds of the evening primrose, a plant native to North America, contain essential fatty acids, most notably gamma linoleic acid (GLA). GLA is found in high concentrations in breast milk, but is limited in most adult diets. GLA is converted to prostaglandin E1, which is thought to inhibit inflammation, decrease platelet aggregation and blood clot formation, relax blood vessels, and lower cholesterol.


Evening primrose appears to be useful in treating breast pain, a common symptom in perimenopause. In one study, gamma linoleic acid was 97 percent effective over the course of six months in the relief of breast pain in Asian women. Other studies have reported efficacies ranging from 27 to 45 percent. One study found fatty acid profiles in women with mastalgia (breast pain) to be abnormal. Treatment with evening primrose oil did not necessarily reduce symptoms, while it did improve the fatty acid profiles toward normal. I prescribe evening primrose in my practice for treatment of breast pain that does not respond to other treatments or measures.

Although evening primrose is a commonly-used remedy for premenstrual syndrome (PMS), all studies to date are unanimous in showing that GLA is no more effective than the placebo in the treatment of this disorder.

The recommended amount of evening primrose oil is 500 to 1,000 milligrams two or three times daily, or about 150 to 250 milligrams of GLA daily. Side effects from the use of evening primrose oil are limited to occasional mild nausea, which can be avoided if it is taken with food, and occasional skin rashes.

 

Natural Progesterone creams:
Many women get relief from OTC (over the counter) topical natural progesterone creams. It is a transdermal cream and is absorbed through the skin and carried directly to where it is needed. It is non-toxic and without the same sorts of side effects as synthetic progestins. Be advised that some women have problems even with natural progesterone -- irritability, anxiety and other issues while others benefit greatly from it. Stronger doses of natural progesterone creams are available only through consultation with the gynaecologist.

 

Relaxation Therapies:
Various relaxation techniques have been advocated for managing the effects of menopause. These include yoga, deep breathing, visualization, massage, and biofeedback. Little objective data exists to substantiate their effects on menopausal symptoms, and the placebo effect is likely to be important in success with their use. Nevertheless, all of these techniques are safe and may have other important physical and mental health benefits. Be forewarned�not all those who offer massage or relaxation therapy are well-trained or appropriately licensed, so do your homework.

 

Acupuncture:
The use of acupuncture is becoming increasingly popular in the United States, with considerable success in certain disorders. Research in the Western literature on the use of acupuncture for the treatment of menopause is limited. Only three studies were found in my review, and only one of these was placebo-controlled. A Swedish controlled study of 24 women found that acupuncture decreased hot flashes by more than 50 percent. The only-placebo controlled study to date was conducted in Germany, where 10 post-menopausal women with hypertension underwent either placebo or verum acupuncture. Verum acupuncture, but not placebo acupuncture, significantly reduced menopausal complaints, and the effect lasted two months. Clearly more research is needed on this mode of treatment.


Coping with Hot Flushes

  • When you feel a hot flushes coming on it is best if you can stop whatever you are doing and, if possible, sit down quietly. If your hot flushes are very mild and don't last long there may not be time to do anything more. If, however, you are one of the unlucky ones whose hot flushes are severe and last more than a minute or two undo any tight clothing if possible -- especially a high collar. If you are in a hot room, or with a lot of people, try and get out into the fresh air.

  • If you are driving a car, or working with dangerous machinery, and your hot flushes tend to make you feel faint or dizzy you should stop the car or more away from any moving parts of the machine with which you are working.

  • The discreet use of a small fan might be helpful unless this would make you feel more embarrassed. It is worth remembering that unless your hot flushes are severe, it is unlikely that else will notice your discomfiture as the face seldom looks as wet as it feels to you.

  • If you very uncomfortable at night have a warm shower or bath before going to bed and use only the lightest of bed clothes and avoid nylon material altogether.

  • If night hot flushes are severe even after hormone replacement treatment tell your doctor as he might be able to prescribe a suitable to take when you go to bed.

  • Share your feeling with your partner, so that he can understand your problem and he may be able to help you to relax.


Conclusion:

Use of alternative treatments for menopause are promising but unfortunately limited by a lack of well-controlled long-term studies. For all my menopausal patients however, exercise (particularly weight training), calcium and vitamin D supplementation, and a positive approach is important to life. Slow abdominal breathing, six to eight breaths per minute, can bring about a 40 percent decrease in frequency of hot flashes, according to two research psychologists from Wayne State University. Women used this technique for 15 minutes twice a day and when they felt a hot flash coming on. ("A Friend Indeed", April, 1993).