Hot Flashes and Night Sweats in Perimenopause and Menopause
Hot flashes and night sweats are common symptoms that occur during a woman’s menopausal transition. These can occur well before a woman has gone through menopause, a transitional time referred to as Perimenopause, and can last for years after a woman’s period has ceased. Up to 80% of women going through menopause experience hot flashes. For some women, these vasomotor symptoms are infrequent and manageable, only lasting a couple of years. For others they can be often, dramatically affecting quality of life, and persistent lasting far beyond the menopause.
Hot flashes, for those of you who have not yet experienced one, is a sudden sensation of heat in the chest, and head, often followed by flushing and sometimes sweating and chills. When a hot flash happens at night, it can come with drenching sweat that we call night sweats. Women who experience hot flashes at night or night sweats often have issues with insomnia since each time they are woken by a sweat the adrenaline surge that comes along with it can make it difficult to go back to sleep.
Studies have shown that women who start with hot flashes and night sweats in perimenopause (before cessation of menstruation) have them for an average of 10 years. Whereas women who start having hot flashes after their last period generally have them for an average of 3 years. Though this is most common, it is not a rule. It is recommended that, no matter when they started or how long you have been dealing with them, you seek out treatment if they are affecting your quality of life.
What causes vasomotor symptoms?
The theory of hot flashes is that they are caused by declining estrogen along with rising norepinephrine. Norepinephrine is a stress hormone, related to “fight or flight” response. As estrogen levels drop, norepinephrine rises and as it makes our heart beat rise and changes our core temperature. In a sense, it breaks our thermostat! This causes inappropriate temperature changes and sweating (when the body is hot or cold). Other stress hormones play a role in these temperature fluctuations as well, which is why stress will often increase the number and intensity of hot flashes.
What can be done?
Whether you are in perimenopause or menopause lifestyle changes can significantly reduce number and severity of hot flashes.
Cut down on alcohol
Adopt a healthy diet, rich in fruits, vegetables, and essential fats.
Non-hormonal treatment options:
A number of trials have shown that acupuncture can be highly effective for improving hot flashes, improving hot flashes by 50% in just 8 weeks.
When the right herbs are chosen for the right woman they can be very effective in reducing number and severity of hot flashes. Two of the most common herbs used are Vitex and Black Cohosh.
Hormonal Treatments- Bioidentical Hormone Therapy (BHRT)
Some women have hot flashes that require more than treatments listed above. When a woman is dealing with vasomotor symptoms that cannot be treated with diet, lifestyle and alternative measures, BHRT is a safe and effective treatment option. This type of treatment is reserved for women who have low blood levels of hormones, or those whose quality of life is being seriously impacted (this applies especially to those who are losing sleep).
When considering hormone therapy for women with hot flashes and night sweats, it is important to start with testing your hormone levels in order to determine the best possible treatment for your symptoms. Some women do need estrogen, but for other women bioidentical progesterone alone has been shown to be effective for the treatment of hot flashes and loss of sleep in menopause.
What is the Risk?
In the past hormone replacement therapy consisted of equine estrogen and medroxyprogesterone acetate (also referred to as MPA, progestin or progestogen). When these hormones were studied using the large, famously cited, Nurses’ Health Study, that followed thousands of women, there was a 1% increased risk of Breast Cancer (when using both estrogen and MPA together), there was no increased risk in those who were given estrogen alone. This studies discouraged patients and practitioners from using hormones, for years, to many women’s detriment. As this study has been re-examined, there have been MANY flaws especially in the group being studied who consisted of women older than the average age of menopause with poor health status prior to initiation of the study.
BHRT or Bio-Identical Hormone Therapy referred to hormones that are identical to your natural hormones. Studies that have been conducted on this type of hormone therapy, in contrast to equine estrogens and MPA, have been shown to cause less increase in cancer-causing estrogens, and low to no risk of blood clots. Studies using bioidentical progesterone have even shown some protection against breast cancer.
Every woman is different. Based on your symptoms and blood work, your Naturopathic Doctor can advise you of a plan that is best for you.
Dr. Lisa Maddalena, ND