Understanding Your Personal Summer!
I was so excited to see a super bowl ad that talked about menopause!
It was the talk of us menopause warriors internet posts. If you happened to see it, the topic was Vasomotor Symptoms (VMS) or more commonly known as Hot Flashes/Flushes.
Hot flashes are the most common bothersome symptom of menopause. Your hot flashes may occur during the day or at night (also known as night sweats). Your hot flashes may be mild and tolerable, moderate and troublesome, or severe and debilitating. Hot flashes get better with time. Although most women have hot flashes for a few years, some women have them for decades. It is not known why some women have severe hot flashes for many years while others have no hot flashes or mild ones that resolve quickly. If your hot flashes are mild or moderate, you may find relief by changing your lifestyle. If you have severe hot flashes, you may still benefit from lifestyle changes, but also may choose to take a nonprescription remedy or a prescription medication, including hormones to help you manage your symptoms.
What do hot flashes feel like?
The severity with which you experience a hot flush varies from woman to woman but they are commonly described as a feeling of intense heat that can creep throughout your whole body but is often concentrated through your head, neck and chest. Many women say they feel like an internal fire has started inside them. Others liken it to the kind of intense heat you feel when lying on a sunbed or going into a sauna. This can, unsurprisingly, lead to profuse sweating and may be accompanied by heart palpitations and/or feelings of anxiety.
How long do hot flashes last?
The whole flash episode can last a matter of minutes (the average is four) but it often feels like longer. They can occur every few hours to a couple of times a week. They may also potentially last for years after your periods have stopped.
Hot flashes are categorized by severity:
Mild
You’re hot, but at least you’re not sweating.
Moderate
You’re hot and starting to sweat, but you can keep going.
Severe
When you’re so hot and sweaty, you literally have to stop what you’re doing.
Here's what's causing Your Hot Flashes
VMS originates in a part of your brain called the hypothalamus, which regulates your body's temperature.
It's here that specific neurons called KNDY (pronounced can*dee) neurons play an important role in temperature control.
To keep your internal thermostat in check, your body relies on having a balance between estrogen and a brain chemical called NKB.
During menopause, levels of estrogen and NKB become unbalanced. This causes the KNDy neurons in your hypothalamus to tell your body you’re hot when you’re not.
To cool down, your hypothalamus triggers hot flashes and night sweats.
To keep your internal thermostat in check, your body relies on having a balance between estrogen and a brain chemical called NKB.
Nonprescription remedies
Nonprescription remedies you may consider for hot flash relief include
Soy: Eat one or two servings of soy foods daily (containing isoflavones), such as low-fat varieties of tofu, tempeh, soymilk, or roasted soy nuts. Supplements containing soy isoflavones, such as Promensil, reduce hot flashes in some studies.
Herbs: Supplements containing certain herbs like black cohosh, such as Remifemin, . decrease hot flashes in some studies.
My gynecologists suggested Relizen when I first told him about my hot flashes. I took the supplement for the recommended 3 months feeling lesser and lesser hot flashes throughout and but he third month, I had none.I continued taking them for about a year and decided to stop to see if my hot flashes would return and I have yet to have another one. Now that was my experience and your's may be different.
Prescription therapies
The most effective way to treat symptoms of the perimenopause and menopause is to replace the hormones that your body is no longer producing. Taking HRT also has health benefits - as women who take it have a lower future risk of developing conditions including heart disease, osteoporosis, diabetes, depression and dementia in the future.
HRT is a hormone treatment that includes the hormones estrogen, often progestogen and in some cases testosterone.
Estrogen - This replacement estrogen can be given to your body in various ways - either as a skin patch, as a gel or a spray, or as a tablet that you swallow.
Progestogen - If you still have a uterus (womb), then you will need to take a progestogen alongside the estrogen - this is known as combined HRT. Taking estrogen on its own can thicken the lining of the womb and increase the risk of uterine cancer; taking a progestogen keeps the lining thin and reverses this risk.
Testosterone - For women who still experience symptoms such as fatigue, brain fog and lack of libido after taking estrogen for a few months, testosterone can be beneficial (in addition to the estrogen) to bring about further improvements of these particular symptoms.
What are the benefits of HRT?
Your symptoms will improve – most women feel a return of their ‘old self’ within 3-6 months of starting HRT. Your risk of developing osteoporosis will reduce – your bones will be protected from weakening due to lack of estrogen.
Your risk of cardiovascular disease will reduce – you will be less likely to develop heart problems, stroke or vascular dementia.
Your risk of other diseases will reduce - women who take HRT also have a lower future risk of type 2 diabetes, osteoarthritis, bowel cancer, and depression.
*I do not personally have experience with HRT. What I know is through research. Schedule time with your gynecologist to discuss what works for you.
What are the risks?
For the majority of women who start taking HRT under 60, the benefits outweigh the risks.
There are two small risks for some women who take HRT - the risk of breast cancer and the risk of a blood clot.
Taking combined HRT (estrogen and progestogen), may be associated with a small risk of developing breast cancer however some studies show this risk is reduced if progesterone is used. The risk of breast cancer with any type of HRT is low; for comparison, the risk of breast cancer is greater in a woman who is obese or who drinks a moderate amount of alcohol.
If a woman has a history of blood clots, liver disease or migraine, there is a small risk of a clotting if taking the tablet form of estrogen, but taking it through the skin as a patch, gel or spray does not have these risks so is safe for these women.
What are the side effects of HRT?
Side effects with HRT are uncommon but might include breast tenderness or bleeding. If they do occur, they usually happen within the first few months of taking HRT and then settle with time as your body adjusts to taking the hormones.
When is the best time to start taking HRT?
HRT is most effective to start when you are perimenopausal – this is before your official ‘menopause’ – which is 12 months after your last period. This means you don’t have to wait for your periods to stop before starting HRT. Your first step should be talking to a health professional about the options available to you. Don’t wait until symptoms become unmanageable before you seek advice. The most health benefits from taking HRT are in women who start taking HRT within 10 years of their menopause but usually women of any age can start taking HRT.
Variety of factors that increase or decrease the risk of vasomotor symptoms:
Ethnicity: African American women report the longest duration of hot flashes-an average eleven years or more. Japanese American and Chinese American women five to six years, and White and Hispanic women are in between.
Social Determinants of Health: Poverty, lower level of education, and adverse childhood experiences are all linked with an increased risk. Adverse childhood experiences can cause permanent structural changes to the brain that could make the brain more vulnerable to the process that triggers hot flashes.
Smoking: Current or former smokers have a longer duration of hot flashes.
Mental Health: Stress, depression, and anxiety increase the risk.
Alcohol: Light drinking may reduce hot flashes, but heavier drinking has the opposite effect.
Caffeine: Coffee, tea, and other drinks or food containing caffeine can trigger hot flashes for some women.
Anxiety: Women with high levels of anxiety are more likely to experience hot flashes. Anxiety can also mimic hot flashes. Many of the symptoms are identical, for example, palpitations and sweating, and to make things more complex women can feel anxious during hot flashes.
Lifestyle changes
Staying cool and reducing stress are the principal lifestyle changes to treat your hot flashes. Some women can find relief with these options:
Avoid warm rooms, hot drinks, hot foods, alcohol, caffeine, excess stress, and cigarette smoking. Wear layers of clothing made from light, breathable fabrics, removing a layer or two when you’re hot and replacing them when you’re cooler. Cooling products, including sprays, and gels,may be helpful.
To reduce stress and promote more restful sleep, exercise regularly, but not too close to bedtime. Meditation, yoga, qigong, tai chi, biofeedback, acupuncture, or massage also will lower your stress levels.
When a hot flash is starting, try “paced respiration”—slow, deep, abdominal breathing, in through your nose and out through your mouth. Breathe only 5 to 7 times per minute, much more slowly than usual.
Try different strategies to stay cool while sleeping. Dress in light, breathable nightclothes. Use layered bedding that can be easily removed during the night. Cool down with a bedside fan. Keep a frozen cold pack or bag of frozen peas under your pillow, and turn the pillow often so that your head is always resting on a cool surface. If you wake at night, sip cool water. Try different techniques for getting back to sleep, such as meditation, paced respiration, or getting out of bed and reading until you become sleepy.
Women who are overweight have more hot flashes, so maintain a healthy weight and exercise regularly to decrease bothersome hot flashes and improve your overall health.
Although hot flashes are the most commonly reported symptom of menopause, it is not the only symptom. There are 33 more symptoms that can happen during menopause. Click here to get a symptom chart to help you identify and daily chart the symptoms you may be experiencing.
Resources: The menopause manifesto~Dr. Jen Gunter, whatsvms.com, menopause.org