Hot flushes and night sweats are also medically described as vasomotor symptoms (VMS).
Caution! Unlike night sweats caused by hormonal changes in menopausal or perimenopausal women, which occur sporadically, those linked to cancer tend to be persistent. Drenching night sweats that require changing clothes are more concerning than mild night sweats.
What is the mechanism of a hot flush?
Most research suggests that hot flushes occur when decreased estrogen levels cause your body's thermostat (hypothalamus) to become more sensitive to slight changes in body temperature. When the hypothalamus thinks your body is too warm, it starts a chain of events involving short episodes of reversible narrowing or widening of blood vessels — a hot flush — to cool you down.
How common are hot flushes?
3/4 of women get hot flushes, however, 1/4 never get hot flushes!
Hot flushes may begin from ages 45 onwards but for some unfortunate women, they may start in their mid to late 30s. For 3/4 of women who get hot flushes, the onset of hot flushes signals the onset of perimenopause. Perimenopause may be present for 4 months to 10 years before menopause. For some, hot flashes can continue well beyond the age of 80.
What is perimenopause?
Perimenopause is the period of time leading up to menopause. Perimenopause is the whole duration of time from when you first start having menopausal symptoms and your periods usually start to change, right up to the ‘menopause’ point in time. This period of transition may last from 4 months to 10 years.
One of the soft markers of perimenopause is periods changing. Periods may become heavier, lighter, longer or shorter. In short, any change in your periods may signal the start of perimenopause. There are other perimenopause symptoms, for example, hot flushes, anxiety, poor sleep, depression, weight gain, headaches, joint pain, racing heart, tinnitus, recurrent tendinitis, bursitis, backache, brain fog, worsening premenstrual mood swings, recurrent UTIs and thrush etc. Because perimenopause is not a widely recognised stage in a woman's life, most women miss it altogether and may get medicated or over-investigated for some of the symptoms. There is a place for investigation in every one of the perimenopause and menopause symptoms, please discuss your options with your GP.
Diagnosis of Perimenopause
Usually, you do not need a blood test to diagnose perimenopause. In Australia, AMS symptoms score is usually sufficient. Dependent on your symptoms, your doctor may order a basic panel of haematology and biochemical tests to rule out other causes of your symptoms. For example low iron, overactive or underactive thyroid. In addition, ensure your cervical Cytology Test (smear test is up-to-date). You may also need an ultrasound scan to rule out other causes of irregular bleeding.
What if I've had a hysterectomy?
Cumulative evidence shows that women who've had a hysterectomy but still have their ovaries intact are likely to experience menopause symptoms approximately 6 months to one year after the hysterectomy. Women who have had a hysterectomy and their ovaries removed have a very harsh 'surgical menopause' and are pretty much plunged into menopause straight away. This is, by far the harshest type of menopause. In addition, young women who have had a hysterectomy are at an increased risk of osteoporosis, wedge fractures of the spine, diabetes, hypertension, chronic anxiety and depression and suicidality, alopecia and even autoimmune conditions like underactive thyroid and dementia later in life. Early treatment with oestrogen for these women is important; at least until the natural age of menopause which is 51. They would be naturally producing oestrogen, so in most cases, there's no increased risk in taking oestrogen, especially transdermal oestrogen.
Menopause
Menopause is the period of time when a woman's ovaries stop producing eggs and consequently stop making oestrogen. This is the period of life before post-menopause. Menopause is when a woman is within less than 12 months of her last period.
Post-Menopause
Post-menopause means that a woman has not had a period for 12 months and one day. Any vaginal bleeding in post-menopause is abnormal and should be thoroughly investigated. This is medically termed post-menopausal bleeding.
The hot flash experience!
A hot flush is described as a sudden feeling of heated warmth often accompanied by a short episode of profuse sweating. Some women may experience light-headedness, feel faint, and have a racing heart and a red, flushed face. Other symptoms accompanying hot flushes are anxiety, nausea, a racing mind and poor sleep and night sweats. These episodes can last for a few seconds to 30 minutes and the skin often feels hot to the touch The earlier in life you experience hot flushes, the longer the hot flushes are likely to persist.
How long for?
Women who experience hot flushes for the first time in post-menopause may have an average of 3-4 years of hot flushes. Conversely, for women who experience hot flushes in perimenopause, the hot flushes may last up to 10 years or more.
Hot flushes cardiovascular disease link
A 2020 study carried out by the university of Queenland (UQ), combined the data from multiple studies and identified an overall trend to suggest that women who have post-menopausal vasomotor symptoms (VMS) – hot flushes and night sweats – are 70% more likely to have heart attacks, angina and strokes than those without symptoms. Further, the UQ study shows that women of any age experiencing hot flushes and night sweats are more likely to experience non-fatal heart attacks or strokes.
Until now, it has been unclear if VMS (for example hot flushes) are associated with heart disease or stroke, but now we know it to be true.
In addition, VMS before menopause increases a woman’s chance of cardiovascular events (heart attacks or strokes) by 40%
In conclusion. Hot flushes are not innocent, we need to manage our lifestyle to lower the risk of diabetes, heart attacks, high blood pressure and stroke. This means stopping smoking, losing weight, exercising an average of 30 minutes a day and eating healthy. There are various treatments for hot flushes. But nothing works as well as HRT, in addition, HRT has clear benefits for your future health.
If you are getting hot flushes, take time to get informed on management options and the types of treatments available to you. Be sure to speak to a doctor who has knowledge of all available types of treatment and their benefits vs risks.
If you are not happy with the advice given, you can always seek a second opinion.
It's your body, your life, and your health. Don't accept your symptoms as 'just what it is'.
If you are symptomatic. Seek the right help for you!
If you want to discuss your symptoms further
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