Let me explain why perimenopause is hot.
I have a sudden feeling of unease as I watch my colleague start to struggle through a presentation. Normally razor sharp, engaging, and quick witted, she can handle any room and the harshest of critics. She is what my grandmother would call a crackerjack.
Today she struggles to find the words that normally come so easily to her, particularly when a colleague is trying to take her down. And then out of nowhere her face flushes, a crimson tide that started on her chest and neck has suddenly and ruthlessly spread to her entire face; her ears almost look purple. The pace of her breathing has changed to short, shallow intakes.
The smirks that quickly appeared on her detractors faces when they first sensed her uncharacteristic hesitation, have quickly turned to horror and perhaps even a little concern as they all notice that you can see her heart pounding in her chest. Sweat is now dripping from her brow and mercifully someone hands her a box of tissues. She takes a long swig of water, desperate to put out the inferno that has overtaken her body and hopefully regain her composure.
‘Just’ A Hot Flash
Soon she has recovered. The incident seems to have resolved as quickly as it came on. A lesser human may have let this shake their confidence, but not my mentor and hero. The quick witted, razor sharp, engaging style has returned. “Just a hot flash” she says. And then she jokes “perimenopause is hot”. It lands well. Everyone laughs.
After the meeting. My mentor whispers: “They are getting worse and more frequent. I am not sure what to do.” I asked if she has spoken to her doctor. “I don’t have a doctor. Mine retired two years ago. I do need to see someone who can sort this out.”
It took her 11 months to get it sorted.
While her hot flashes and other perimenopausal symptoms had started to take a toll, she is feeling like her old self again; confident, smart, and, if I may say, sexy as hell.
About a year after that hot flash meeting, I am helping a new intern get settled into his summer gig with our company. I introduce him to my hero who is getting a decaf in the lunch room. Always very engaging, she asks him questions that make him feel welcome and push him to think at the same time. “Wow” he exclaims as she leaves the kitchen. “She’s…wow. Is she single?” I respond “Uh yeah, and probably old enough to be your mum.” “I like older women” he says. “The confidence, the sense of style.”
Turns out, perimenopause is hot.
What Are Hot Flashes?
Hot flashes and night sweats are clinically known as vasomotor symptoms. The difference between the two? One occurs at night when you are supposed to be sleeping. Fun.
According to The North American Menopause Society, up to 80% of women will experience hot flash
es and or night sweats at some point during during perimenopause and/or postmenopause. And like with most symptoms related to the menopause experience, why they happen is complex and not fully understood. Sigh.
As estrogen drops, the part of your brain that regulates temperature becomes really sensitive
and makes temperature regulation unstable. In short, your hypothalamus overreacts.
A Sudden Sensation of Intense Heat
Like the experience I described above, hot flashes are a sudden sensation of intense heat in the upper body, particularly the chest, neck and face. The can be quite quick or last about 5 minutes. Hot flash symptoms can include sweating, chills, anxiety, nausea, and heart palpitations. Awesome. Particularly when under pressure, like during a presentation in a room full of mostly men.
Significant sweating and chills are common symptoms with night sweats. If you are over the age of 40, you likely know at least one person who wakes up drenched and freezing in the middle of the night and has to change their pajamas and bed sheets before getting back to sleep.
Why Should Everyone Care About Hot Flashes?
Here are just a few important reasons:
- No one, hero or not, should be expected to ‘just get through it’ and function as if all is well in their daily lives at home and work when they are continually subjected to hot flashes – for some it happens up to 30 times a day. 30. Times. A. Day.
- Women in their 40s and 50s should be enjoying the fruits of their hard work; getting promotions; extending their expertise and wisdom to their communities; thriving in their personal and work relationships; basically spending time being their badass selves, not trolling the internet for purse-sized cooling fans and strategizing about the quickest way to change bed sheets at 2 am.
- Women are leaving work and withdrawing from relationships and their communities because of menopause symptoms.
- We need more women in senior and executive management, on boards, in government, and anywhere decisions about healthcare spending and research are made because we need and deserve better midlife care.
- Read any book or paper on perimenopause, menopause, or postmenopause and count how many times you read phrases like “we need more research”, “we just don’t know”, or “one theory is” – it’s total bullshit that we know so little about a something that will impact anyone with ovaries provided they live long enough.
When do Hot Flashes Start?
There is a menopause myth that hot flashes don’t occur until menopause is achieved. Studies now show that women can experience hot flashes during the menopause transition while their periods are still regular. Don’t let anyone tell you that you are too young for perimenopause, especially if you are experiencing hot flashes and night sweats.
However, for younger patients with hot flashes and night sweats, other causes like diabetes could be at play and should be ruled out by a qualified medical practitioner.
When Do Hot Flashes End?
According to The North American Menopause Society’s 2022 hormone therapy position statement, vasomotor symptoms may begin during perimenopause and may persist on average 7.4 years or longer. We’ve read decades in some cases. Yes. Decades.
How Do You Treat Hot Flashes?
My mentor and hero didn’t have a doctor when she started experiencing hot flashes in her mid to late forties. It took some time to find a doctor who was accepting new patients. Then it took
some time to rule out other causes for the hot flashes, and find a treatment option that was well tolerated. What worked well for her was s nightly does of oral micronized progesterone. It significantly decreased her hot flashes and improved her sleep, which she had also been struggling with for some time. She has a quarterly standing appointment with her doctor to monitor her symptoms and adjust her hormone therapy as required.
As it turns out red wine was a big hot flash trigger for my mentor. She has now switched to tequila, and is thoughtful about when she consumes alcohol. She has weened herself off of caffeine and now only drinks decaffeinated teas and coffees. Superhero, indeed.
Next on her to do list is to try to incorporate a 5-minute meditation practice into her morning routine. And now, we have our mentor meetings while we are walking outside when the weather permits.
The Hero Takeaways for Hot Flashes
- She was kind to herself and also didn’t let her symptoms embarrass her or shy away from the things she loves, like giving a kick-ass presentation.
- She took charge of her situation and prioritized her health.
- She was patient, and perhaps most importantly quickly recognized that there is no ‘one answer’ or silver bullet when it comes to managing hot flashes and other menopausal symptoms.
- She knows that prioritizing her health is not a one-time thing that she did to treat hot flashes. She has committed to continue to make her health a priority.
Treat Hot Flashes or Manage Hot Flashes?
Treating hot flashes implies that you can or should cure hot flashes. For some people their approach to treatment makes the hot flashes go away completely. For others, their treatment success is to significantly reduce their number and duration of their hot flashes. The word treatment can create a lot of room for unrealistic expectation and disappointment. Perspective is always important, and it’s hard to have perspective when you have a poor understanding of a situation and unrealistic expectations.
It’s also important to state that perimenopause is not a disease. It is a natural transition to the next phase of life; like puberty, but in reverse. And this transition can lead to new opportunities, freedom, and a greater sense of self – if you let it.
Lifestyle Changes and Hot Flashes
Leading a healthy lifestyle can lessen severe hot flashes and reduce the number experienced. For example:
- Do you eat a well-balanced and healthy diet? Not sure? Seek professional guidance from a registered dietitian. Their advice may surprise you. And keep in mind that sugar and spice are not so nice when it comes to hot flashes.
- Do you smoke? (Yes, ‘only when I am drinking’ counts.) If you do, it’s time to stop; for the sake of your hot flashes and so many other important health reasons.
- Do you know that alcohol can trigger hot flashes? Have you noticed that your hot flashes are worse when you drink? It may be time to reduce or make a change.
- How much caffeine are you consuming? Too much can negatively impact your sleep and cause anxiety, and is a also hot flash trigger.
- How much exercise are you getting? It’s not about tight abs, it’s about mental and physical health and longevity. You’d be hard pressed to find a study that says it does not help with everything.
Did that list of questions stress you out? Of course it did. That’s why it’s important to set realistic expectations when it comes to lifestyle changes. Choose something easy to start, like maybe one less cup of caffeine a day. Get help if you need and want to stop smoking. Maybe try switching from red wine to tequila.
Most importantly don’t try to do everything at once. The likelihood of sustaining an everything-at-once approach is slim to none.
The Power of Perspective
Cognitive behaviour therapy (CBT) and mindfulness practices can help to reduce your stress. CBT or talk therapy is shown to provide benefits in mood and quality of life with regard to hot flashes. It’s really about challenging negative thoughts so that they don’t make the experience worse.
Like my mentor and hero, try not to frame a hot flash as mortifying. Be kind to yourself, seek help, and move on. And remember, perimenopause is hot; as in sexy as hell.
When it comes to mindfulness there are many options, including meditation, breathing exercises, or just setting a timer throughout the day to pause, close your eyes, and pay attention to how you are feeling. Whether it be 2 minutes a day or an hour a day, the benefits of pursuing the mind-body connection in all aspects of our lives are well-studied and should be on everyone’s to-do list.
Hormone Therapy and Medications For Hot Flashes
According to the North American Menopause Society hormone therapy remains the most effective treatment for vasomotor symptoms. The number of hormone therapy options is overwhelming. Here are a few things to consider for your discussions with your health care provider:
- All medications have risks, be it over-the-counter pain relievers, a prescription for antacids, or a prescription for estrogen, which is the primary hormone used to reduce hot flashes. Be sure your doctor explains the benefits and risks of treatment options in the context of your health and family history.
- What is right for one person may not be right for you.
- Do not assume compounded hormones are safer than pharmaceutical hormones. Both have risks, and there are pharmaceutical options with the same hormones used for compounded products. Have a qualified medical provider and/or your pharmacist explain the differences to you.
- It may take some time to find the best product and dosing that works for you.
Other Medications for Hot Flashes
There are a range of other prescription options for those who can’t take or tolerate hormone therapy including antidepressants, anti-seizure drugs, and blood pressure medication. Be sure your doctor explains the benefits and risks of treatment options in the context of your health and family history.
Supplements and Hot Flashes
From black cohosh to soy, there are no shortage of supplement options used to relieve hot flashes. Do they work? Studies show mixed results. Like medications, supplements also have side effects. For example, in rare circumstances black cohosh can cause liver damage. Supplements can also interact with medications you are taking for other medical conditions.
Be sure you seek the advice and oversight of a qualified medical practitioner if you plan to undertake a supplement regime to address hot flashes.
Be sure your next steps include the advice of a medical professional, are realistic, and move you toward embracing the changes that are currently happening and yet to come.
Do what is right for you. It’s not about being like my mentor. It’s about recognizing that we are all superheroes. Most of us just aren’t aware of our power and the importance of using that power to support ourselves.
- CEMCOR, Progesterone for Hot Flushes: NAMS eConsult.
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society
- The Menopause Manifesto, Dr. Jen Gunter