Why do menopausal women get hot flushes?

320px-Thermometer_0.svgIt’s still not completely clear why women suffer from hot flushes with the menopausal transition and afterwards. However, researchers are gaining a better understanding of why these symptoms occur.

It seems we all have an internal “thermostat”. Our bodies like to stay within a certain core body temperature. When our core body temperature rises or falls above or below this range (0.4C in women who aren’t having hot flushes) our bodies activate mechanisms to correct this. If our core body temperatures rise too much, for example, the tiny capillaries in our face, chest and arms will suddenly dilate, causing a rush of blood to the surface and, consequently, heat dissipation. This is part of the reason we get a red face and sweat during aerobic exercise – we’re trying to cool down.

Researchers think that something about the menopausal transition causes a resetting of this internal thermostat. It seems to be related to the drop in oestrogen, a key female hormone, and subsequently, a drop in serotonin and rise in noradrenaline. Serotonin is a “happy hormone” – a neurotransmitter, or chemical messenger, that makes us feel happy and also plays a part in pain transmission. Noradrenaline is a hormone that is released when we feel anxious or under stress – it raises our blood pressure and causes the “fight or flight” syndrome. Researchers now know that these two chemical messengers are involved in the resetting of our internal thermostat after a drop in oestrogen with the menopause. The threshold for sweating decreases, so that a tiny rise in core body temperature causes the sweating and flushing mechanism in an attempt to “cool down”. Why this doesn’t happen in all women is still a bit of a mystery, but much work is being done in understanding risk factors for experiencing hot flushes.

Half of the time, hot flushes are triggered by something external such as drinking a hot beverage, having caffeine or alcohol, exercise, feeling stressed, a hot day etc. The other half of the time, hot flushes appear spontaneously, for no apparent reason.

So the next time you start fanning yourself during a meeting and wiping the sweat off, just explain to your colleagues that your “thermostat is busted” and hopefully will be fixed in due course!

Photo: By Kilom691 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Hypnosis for hot flushes

I read a fascinating article today about a clinical trial on hypnosis for hot flushes. After five sessions, hot flushes decreased by almost 70% in the group that received clinical hypnosis. This is amazing! Wouldn’t you love a 70% decrease in your flushes?

The control group received “structured attention control” during which they had an opportunity to talk about their symptoms and receive empathetic communication from a trained health professional, but were not taken through a hypnosis sequence with suggestions about reducing hot flushes and finding coolness. Hot flushes in this group increased by 7%.

Researchers don’t know why hypnosis and other mind-body therapies (like cognitive-behavioural therapy) might work for hot flushes, but think that these therapies decrease the sympathetic tone in the body (the “fight or flight” hormones).

This is a strong study, with a reasonable sample size of 187 women and commendable attempts to control for the placebo effect by introducing “structured attention control” for the “placebo” group. The researchers also measured hot flushes objectively by using a device that measures the number of episodes of sweating.

Some limitations have to be mentioned, including that the women who volunteered for the study were likely to have been more open to exploring mind-body therapies for their symptoms. Clinical hypnosis also involves having the time and financial resources to attend for regular sessions. However, it is encouraging that only five sessions were needed for such a good response, and that the improvement was sustained at the three month follow-up mark. The hypnosis group also rated their satisfaction with the treatment as “very high”, and no side effects of hypnosis were reported.

Reducing sympathetic tone in the body, or the levels of circulating adrenaline (a “stress” hormone) has many benefits and is certainly worth trying. If you can’t get to a trained hypnotherapist, you could try meditation, yoga, deep breathing, and regular aerobic exercise. While these methods are yet to be proven as effective for hot flushes, they are safe and likely to improve your sense of wellbeing and reduce stress.


What’s this perimenopause about anyway?

Beautiful_mature_womanYou’re feeling extra premenstrual, your cycle is all over the place and you’re starting to get those hot flushes your girlfriends have been talking about. Is it the perimenopause and what does this mean?

The term perimenopause is often used to describe the years leading up to the last menstrual period during which menstrual cycles change and hormone levels fluctuate and, later, drop. Researchers have now changed the terminology to the “menopausal transition”.

The menopausal transition lasts 1-3 years on average, with age of menopause (the last menstrual period) happening at 51 years of age in most European women. This age may vary due to weight, smoking status, physical activity, or genetics.

What happens during the menopausal transition? Cycles start to change – they may initially be shorter, and then (yay!) get longer. Skipping a period is seen as a hallmark sign of the menopausal transition.

The number of “eggs” in the ovaries has declined to a critical level (usually less than 100 an ovary) and as a result hormone levels fluctuate a great deal, and eventually fall.

A number of symptoms are blamed on the menopausal transition, including hot flushes, joint pains, sleep disturbances and depression. It is unclear if any of these symptoms, apart from hot flushes, are due to the menopause itself or due to other factors such as stress or physical ageing.

It’s not all bad news. Many women feel liberated when they stop having periods – FINALLY! – and are no longer “trapped” by their cycles or reproductive capacity. In India, women speak of this liberation as “attaining heaven” and “finally becoming like a man”. (This is especially important when you consider the low status of women in India).

If you’re less than 45 years of age and are experiencing changes in your menstrual cycle, see your GP to assess if any other reasons apart from the menopausal transition are causing this. If you’re over 45, it’s still a great idea to see your GP to discuss lifestyle and preventive issues. Kind of like a mid-life overhaul. You’re likely to live another few decades so this investment is worth it!

Photo credit: By Jmettlen (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons


If you’re having hot flushes, you’re not alone

Feeling hot? Can’t sleep at night from tossing the blankets on and off? Sweating during meetings? Cardigan going on and off all day?

You’re not alone – a whopping three-quarters of women experience hot flushes during the menopausal transition (the years leading up to the last menstrual period, during which your menstrual cycle starts to change) and in the years after those periods finally end.

Research from large population studies on women in midlife consistently show that the majority of women will experience hot flushes or night sweats during and after the menopause. You may have heard that non-Caucasian women suffer from fewer hot flushes, in general. This is true, however these women tend to complain more of other physical symptoms such as joint pain and insomnia. Whether or not there is a true genetic difference or a cultural difference with symptom perception and reporting is still unclear.

So if you’re carrying a personal fan around with you, don’t despair. Chances are your friends and colleagues are too, as are millions of women around the world. Most hot flushes resolve on their own after a period of time, so have hope. For most women, they do not last forever (although the average persistence is five years… sorry to be the bearer of bad news!) In the meantime, evidence is emerging about the effectiveness of mind-body approaches such as mindfulness, cognitive behavioural therapies and even yoga. Stay cool!

Could High Intensity Interval Training be the answer for menopausal weight gain?

I have many patients complain to me about an increase in weight during and after the menopause. I still don’t know if this is due to the menopause itself, or due to a gradual lowering of the metabolic rate over the years (mostly due to an increase in sedentary behaviour). I’m looking into it as it’s a common and important issue. I came across this short YouTube video made by an exercise scientist talking about her research on whether High Intensity Interval training can help with menopausal weight gain.

High Intensity Interval Training is hot at the moment, with research flooding in on how effective it is at burning fat and increasing fitness. Both of which are desirable after the menopause, with the spectre of an increased risk of cardiovascular disease (that’s heart attacks and strokes) in the post-menopausal years. Additionally, improving aerobic fitness may decrease the risk of heart attacks and strokes, independent of weight loss.

HIIT is an efficient, fun and safe way to lose weight and improve fitness. Studies have shown that it is better than low-intensity continuous exercise in these regards (low-intensity exercise being walking, jogging at a moderate pace etc). In my opinion, HIIT is also sustainable as it is a low-volume exercise – that means you spend less time doing it for the same, if not more, gain as low intensity exercise. Now I know for a fact that the vast majority of midlife women are extremely busy. Most of you work and have family responsibilities on several levels – kids, partner, ageing parents. You’re time-poor and need an efficient solution. Why not try HIIT?

A great way to start is to use a timer like Seven (30 second intervals and 10 seconds rest) or various Tabata timers (20 second intervals and 10 seconds rest). Download these for your smartphone. You can then perform various high-intensity exercises at home such as pushups, planks, sprinting on the spot, tricep dips and squat jumps etc using the timer. The Seven app takes you through the exercises, or you could go to the FitMum website for sample workouts. You’ll learn a whole heap of new ways to work out including the Burpee, Mountain Climbers, Squat Thrusts and more… Twenty minutes may be all you need – but make sure you’re working at about 80-90% of maximum intensity. (You will be, trust me! It will make you sweat – and smile!)

Mountain climbers: Start in plank position, then alternate jumping your feet in as though you're climbing a mountain. What a great workout for arms, abs and legs (And heart!) Photo: http://apptob.org/benjamin-all/3-short-exercises-you-can-do-at-home-to-keep-fit/
Mountain climbers: Start in plank position, then alternate jumping your feet in as though you’re climbing a mountain. What a great workout for arms, abs and legs (And heart!) Photo: http://apptob.org/benjamin-all/3-short-exercises-you-can-do-at-home-to-keep-fit/

Give it a go, keep it up (aim for 20-30 minutes five times a week) and I think you’ll be pleasantly surprised. I’d love to hear how you all went, so feel free to comment below or on the Facebook page 🙂

Some good news for post-menopausal women – drink wine for healthy bones

Preventing hip fractures one glass at a time. Photo credit: By Photos Public Domain [Public domain], via Wikimedia Commons
Preventing hip fractures one glass at a time.
Photo credit: By Photos Public Domain [Public domain], via Wikimedia Commons
It’s not always that post-menopausal women get a break. I lie, they are prone to breaks. Broken bones, that is, from osteoporosis, or thin bones.

However, a recent review has produced some fabulous conclusions. Drinking wine reduces the risk of hip fracture. Yes, that means women who drink wine are less likely to break their hips than women who don’t drink wine, women who drink infrequently, and women who drink beer or spirits. I’ll toast to that!

For more information on preventing osteoporosis beyond enjoying your Chardonnay, see the Osteoporosis Foundation website. Don’t forget, drink in moderation only (1 glass of wine a day at the most), and keep in mind that alcohol increases the risk of cancers such as breast cancer.

Beat those hot flushes with this pearl of an idea

You gotta love something that is endorsed by Oprah, no? Imagine cooling yourself down in the heat of a hot flush, with a set of classy pearls. That’s right, pearls! Or something that looks a lot like pearls anyway – these babies contain cooling gel. Pop them in the freezer, and they are good to go for when you start feeling that face fry! Recently one of our participants was describing how she was sitting with a bag of frozen peas on her chest while talking to me on the phone, and I immediately thought of these Hot Girls Pearls. Infinitely more attractive than frozen peas, and you can even purchase a chic little insulated purse that will keep your pearls cool while you’re out and about. I love it!

Alternatives to HRT for treatment of menopausal hot flushes

I speak to many women who do not wish to start HRT (Hormone Replacement Therapy) for various reasons – some have a family history of breast cancer, or risk factors for stroke/heart disease, or simply want something non-pharmacological. Unfortunately there are few good alternatives, although the following are worth discussing with your doctor:

  • certain antidepressants may reduce hot flushes by 50% – side effects may limit this form of treatment though. The most popular one at the moment appears to be Efexor.
  • Clonidine and Gabapentin, two non-hormonal conventional medications, are also effective – but again, often cause side effects such as dry mouth and dizziness.

It never ceases to amaze me when new over-the-counter products appear on the shelves with very cute names (I won’t name any for fear of libel!) but currently there is little evidence to support the use of these products (and I’ve never met anyone who swore by a particular product either). That isn’t to say that the active ingredients are not effective – it more reflects the lack of research. However, a recent re-appraisal of all the studies on black cohosh (also known as Remifemen) concluded that it is no better than a placebo. Pfft! There goes that! The only supplement with any reasonable evidence so far is soy isoflavone, which may reduce hot flushes by 25%. Recently I’ve come across single studies that suggest Chinese herbal medicine (a formula called “Dang Gui Bu Xue Tang”), pine bark extract and licorice may help but I don’t think it’s wise to draw conclusions from one study – just look at black cohosh.

There’s interest in the mind-body connection with hot flushes, with talk about the link with serotonin and adrenaline, and Prof Myra Hunter in the UK has published studies that suggest psychological strategies, such as cognitive behavioural therapy, can reduce hot flushes. A small study found yoga could be helpful, as well as studies on paced breathing and exercise. Certainly the area of the brain that tells us that we are feeling hot also seems to have a role in emotional control, so this could be another reason why these therapies might help.

I would encourage all women who are flushing to consult their doctors if they are not coping, to discuss their options. Don’t suffer alone! More useful information can be found on the Jean Hailes website and the Australasian Menopause Society website.


Smoking leads to earlier menopause (along with the other problems)

It’s been long recognised that smokers go through the menopause earlier than non-smokers, and a recent large study confirms this. The lead author is quoted as saying “‘General consensus is that earlier menopause is likely to be associated with the larger number and higher risk of postmenopausal health problems, such as osteoporosis, cardiovascular diseases, diabetes mellitus, obesity, Alzheimer’s disease, and others.”

Of course, smoking causes other problems such as cancer of the lung, mouth, nose, throat, oesophagus, pancreas, kidney, liver, bladder, bowel, ovary, cervix, bone marrow and stomach; and lung diseases such as chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema; and poor blood circulation in feet and hands, which can lead to pain and, in severe cases, gangrene and amputation. Ouch.

Never too late to quit: according to the Quit website, “After fifteen years your risk of heart attack and stroke is close to that of a person who has never smoked.”

Some great sites on menopause

Not all websites are created equal… but here are some reliable ones by independent (read: non-commercial) organisations.

www.managingmenopause.org.au – maintained by Jean Hailes for Women’s Health, a national not-for-profit women’s health foundation (and a close collaborator on our acupuncture for hot flushes study – we love them!)

www.menopause.org.au – website of the Australasian Menopause Society. Find a doctor that specialises in menopause, read factsheets and latest research, and find studies on menopause currently recruiting for volunteers (including ours!)

http://www.thewomens.org.au/GynaecologyAndWomensHealthFactSheets – fact sheets on women’s health from the Royal Women’s Hospital in Melbourne

Don’t forget to check out our official study website if you live in Melbourne and are interested in taking part in a study on acupuncture for hot flushes

Treatments for hot flushes include HRT and electric fans