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Hot Flashes & Night Sweats

Menopause Oasis
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Here is some information that I’ve gathered over time about this wonderful menopausal event! I do hope it will give you a better understanding of what is happening and what you can do to both prevent and ease the symptoms. Please know that while some women experience only a mild warmth and/or redness of skin others will actually become extremely hot and sweaty. I’ve been known to say that hot flashes come in as many varieties as shoes!

It has been said that only about 50% of all women experience hot flashes and night sweats at some point during the peri- through post-menopausal years. As one progresses through the peri-menopausal years the percentages rise. For the women who do experience them it has been discovered that they often continue to need to deal with them for three years following menopause, if they are not treated.

Interested mostly in "Night Sweats"? Click here!

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What are the symptoms of a hot flash?

Warmth and/or redness on the skin of your face, neck, shoulders, and upper chest
May be accompanied or followed by...
• pounding heartbeat
• nausea
• dizziness
• anxiety
• headache
• weakness or a feeling of suffocation
• sweating
A chill can lead off the episode or be the finalé

For most women, hot flashes are mild and infrequent, but some women have them many times a day or night. Sometimes hot flashes disturb sleep or cause heavy sweating.

How long will a hot flash last?

A hot flash generally lasts from a few seconds to 5 minutes, but it may last up to a half hour.

Hot flashes may begin before you have stopped having your menstrual periods. They may stop after a few months or continue for 5 years or longer.

How often do hot flashes occur?

They can occur as infrequently as once a month or come as frequently as every few minutes (feeling almost as if they are constant).  For most women it will probably happen from every few hours to several times a week. This varies from person to person and day to day for the same person.

How hot is a hot flash?

For some women it is a matter of feeling a bit warmer than normal, for others it feels as if they have just stepped into a blast furnace!  Some women develop a wee bit of sweat on their upper lip and/or forehead.  Other women find themselves drenced in sweat and in serious need of a shower following a hot flash.  Some women find that experiencing a hot flash will leave them feeling totally 'wiped out' or exhausted for a while after it goes away.

What can be done to help prevent hot flashes?

•  Wear clothing made of cotton or other natural fibers and dress in loose layers.
•  Keep your house cool.
•  Use lightweight (natural fiber) sheets and blankets an your bed at night.
•  Keep a supply of ice water nearby - even at night beside your bed.
•  Limit your intake of red wine, chocolate, and aged cheeses, which contain a chemical that can affect your body's thermostat and trigger a hot flash. 
•  Pay attention, learn your trigger foods and avoid them!
•  Avoid spicy foods (especially late in the day).
•  Avoid smoking, caffeine, and excessive alcohol intake. These can make you irritable, which can make hot flashes worse.
•  Use meditation and breathing exercises as a good stress reducer. Deep breathing during hot flashes sometimes helps women feel better and quiets the heat.
•  Exercise regularly. Walking is a great way to help here and to reduce stress as well.
•  Take hormone replacement therapy, if prescribed by your health care provider.

Other hot flash triggers:
•  diet pills
•  hot food
•  hot tubs
•  saunas 
•  hot showers
•  hot beds 
•  hot rooms
•  hot weather
•  stress

What causes hot flashes?

Hot flashes are mostly commonly caused by the hormonal changes of peri-menopause, but they can also be affected by lifestyle and medications. Many women who take a supplement that contains Niacin experience what is commonly called a "Niacin Rush", during which their face turns flush and their skin starts to itch. 

A diminished level of estrogen directly effects the hypothalamus, which is the part of the brain responsible for controlling your appetite, sleep cycles, sex hormones, and body temperature. Somehow (we don't know how), the drop in estrogen confuses the hypothalamus – which is sometimes referred to as the body's "thermostat" – and makes it read "too hot."

The brain then responds to this by sending an alert to the heart, blood vessels, and nervous system to: "Get rid of the heat!" The message is transmitted by the nervous system's chemical messenger, epinephrine, and related compounds: norepinephrine, prostaglandin, serotonin. In response, your heart pumps faster, the blood vessels in your skin dilate to circulate more blood to radiate off the heat, and your sweat glands release sweat to cool you off even more.

This is the same heat-releasing mechanism that your body uses to keep you from overheating in the summer. But when the process is triggered by a drop in estrogen, your brain's confused response creates the hot flash that can make you very uncomfortable. Some women's skin temperature can rise six degrees Centigrade during a hot flash.

What can I use to help with them?

If the symptoms are truly disabling, it may be best for you to consider using an effective hormone treatment, in spite of the low risk of serious side effects. However, other drugs, such as Clonidine or one of the SSRIs, may provide relief, with only annoying, but not serious, side effects also.

HRT....

The most studies have been done with estrogen, with results showing that hot flashes are reduced two to five times more often than with a placebo.

Progestin is also effective in reducing hot flashes when give as a skin cream, oral tablets, or a vaginal gel. Side effects include vaginal bleeding in about 30% of women, weight gain, and blood clots in leg veins. The male hormone, androgen, given alone, or in combination with estrogen, has been shown to be effective, but it carries the risk of weight gain, bloating, growth of hair on the face and body, and acne.

Other Drug Approaches....

Bellergal-S    This is a drug that is not often used, but many doctors who have women who cannot use estrogen therapy have begun to use it again. Its generic name is ergotamine and it narrows blood vessels and thus sometimes relieves hot flashes. 

Clonidine is an older drug that's about twice as effective as placebo in treating hot flashes. Side effects include a dry mouth, constipation, and low blood pressure on standing, which may lead to dizziness or fainting.

Serotonin drugs (selective serotonin-reuptake inhibitors, or SSRIs) are also about twice as effective as placebo in reducing hot flashes. However, they can cause a range of side effects: feeling generally unwell, sedation, agitation, headache, nausea, and loss of appetite. Sexual problems occur in as many as 15% of patients.

Studies have shown that often a placebo is as effective as some of the remedies offered. Here is an interesting table (that I borrowed from HealthAndAge.com) that shows the results of such a study:

Agent

Hot Flash Reduction by: Drug

Hot Flash Reduction by: Placebo

Estrogen

50% - 100%

...

Progestin

71% - 90%

21% - 26%

Soy

35% - 45%

25% - 38%

Black Cohosh

27% - 28%

30% - 32%

Vitamin E

25%

22%

Clonidine

37% - 41%

20% - 27%

Serotonin drugs*

34% - 65%

27% - 38%

* 'selective serotonin reuptake inhibitors', such as fluoxetine (Prozac®) and sertraline (Zoloft®)

Alternative Medicine....

As shown in the table above, vitamin E, soy, and black cohosh do not seem superior to placebo in well-controlled clinical studies. Ginseng, red clover, and Chinese herbal remedies have also proved disappointing when studied carefully.

Those alternative treatments that seem to be more effective than placebo are the ones that mimic estrogen's beneficial effects. However, longer-term studies are needed to see if these alternatives are, in fact, any safer than estrogens.

The aternatives that we (at our board) have had some good reports on the board about are:
• Vitamin E (400 IUs) morning and evening along with Citrus Bioflavonoids (1200 mg).
• Vitamins B5 and B6 are both good for hot flashes and other symptoms. A B-complex vitamin should also be taken to prevent the other B vitamins from becoming imbalanced.
• Borage Oil, Evening Primrose Oil, and Flaxseed Oil are sources of essential fatty acids that help with many of the symptoms of menopause
• Black cohosh (MAY be a phytoestrogen)
• Chasteberry (a phytoestrogen)

 

If you are in search of even more information about hot flashes BreastCancer.org is an excellent site to visit!

This is a subject we often address right along with Hot Flashes, since for peri-menopausal women they are basically the same thing!  However there are some differences that require separate discussion. So here goes....

Most doctors generally refer to true night sweats as "severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment". 
 
Nightime sweating, in general, is a fairly common problem that many people experience from time to time.  Although uncomfortable, nighttime sweating typically isn't a sign of a serious underlying medical condition. It may be triggered by something as simple as too warm a room or too many blankets on the bed.
 
But there are some medical problems (inlcuding perimenopause!) that can be the underlying cause for night sweats and following is some information about those medical problems and some hints for dealing with the "night sweats" that accompany perimenopause.

What Are the Symptoms of Night Sweats?
For fear of stating the obvious, sweating is the primary symptom of night sweats. Night sweats differ from other sweating in that they:

  • occur without exercise
  • they occur primarily while sleeping
  • they can be very profuse; soaking bedclothes, sheets and blankets

What Can Be Done About Night Sweats?

The worst thing about night sweats is they are so uncomfortable. Sleep becomes difficult when your bedclothes are soaked with sweat. If you have sweats here's what you should do. While there is no way to eliminate night sweats entirely, certain interventions can make the condition less annoying.

The following tips can help you reduce the intensity and frequency of night sweats:

  1. Diet that contains protein, fiber, fruits, vegetables and grains.
  2. Sleep in a cool room.
  3. If weather permits, leave your window open and use a fan.
  4. Take a cold shower before going to bed.
  5. Lower the thermostat where possible.
  6. Drink 2 quarts of water each day.
  7. Keep cold water at hand.
  8. Support your body with natural remedies.
  9. Avoid alcohol, caffeine, sugar, spicy foods and hot soups.
  10. Stop smoking.
  11. Get regular moderate exercise to reduce stress.
  12. Sleep in layered natural fabric nightwear.
  13. Purchase and use a Chillow pillow.

If you suffer from night sweats or you find that your night sweats are more severe or more frequent than they used to be, contact your doctor so he or she can investigate the cause.

There are now a few products on the market that can help us with our night sweats.   Here is a list of the ones with which I am familiar, including links to Web sites where they may be purchased.  Please be aware that some of these products can be purchased for less at other sites, so do shop around!!!
 
Chillow  (this is a pillow, but the company has other products as well!)
Cooljamaz  (Cooling sleepwear and bedding)
NiteSweatz   (sleep and day wear)
Cool-jams  (moisture wicking sleepwear)
 
If any of you are aware of another product that you would like to see listed here, please let me know.  You can post to me on the Menopause and Peri-menopause Board.

Potential medical causes of night sweats include:

Andropause - some men suffer from night sweats during the male menopause.

Anxiety

Cancers – Night sweats are an early symptom of some cancers. The most common type of cancer associated with night sweats is lymphoma.

Consumption of alcohol or spicy foods

Diabetes

Drug or alcohol abuse

Gastrointestinal reflux disease (GERD)

Hypoglycemia (an abnormally low level of sugar in the blood)

Idiopathic hyperhidrosis (a condition in which the body chronically produces too much sweat without any identifiable medical cause)

Infections:  TB is the infection most commonly associated with night sweats. Bacterial infections, such as endocarditis (inflammation of the heart valves), osteomyelitis (inflammation within the bones), and abscesses all may result in night sweats. Night sweats are also a symptom of AIDS virus (HIV) infection.

Medications such as:

  • high blood pressure drugs
  • over-the-counter fever reducers
  • antidepressants and antipsychotics
  • cortisone medications such as prednisone and prednisolone

Many drugs can cause flushing, which, may be confused with night sweats. Some of the many drugs that can cause flushing include:

  • niacin (taken in the higher doses used for lipid disorders)
  • tamoxifen
  • hydralazine
  • nitroglycerine
  • sildenafil (Viagra)

Menopause - The hot flashes that accompany the menopausal transition can occur at night and cause sweating. This is a very common cause of night sweats in peri-menopausal women.

Sleep apnea - If you also suffer from severe snoring and excessive daytime sleepiness, it might be time for a study.

Anatomy of a Hot Flash - an article on this topic provided by iVillage.