Monday, 18 June 2018 09:29

Hot Flushes Featured

Hot Flushes

Probably the most disturbing menopausal symptom is the hot flushes that usually start early on.  They often settle after a year or two although for some women they can persist for much longer. If they are troubling you then it is worth seeing your doctor as they can have other causes other than the menopause and there is treatment available to relieve your distress.

The hot flushes are caused by the fall in oestrogen levels around the time of the menopause. This seems to change the body’s thermostat in the hypothalamus of the brain so that there is a more narrow body temperature range that it is willing to tolerate. Anything that slightly raises the bony temperature such as stress, alcohol, spicy foods, caffeine or a warm room can provoke a rapid and vigorous response of dilation of skin blood vessels which causes the flushing, sweating and a feeling of overheating.

Without a doubt the only way to completely remove the flushes is through hormone replacement therapy (HRT), which is very safe therapy. Our earlier post deals with this safety issue.

Lifestyle changes such as avoiding triggers like spicy foods and alcohol can help reduce flushes. Dressing in light layers that can be easily removed helps manage the flushing distress. Avoiding weight gain around the menopause can also reduce the risk of troublesome symptoms.

Some women should not take HRT such as those with a history of breast cancer or some women do not feel comfortable using HRT. There are other medications available such as low dose antidepressants, clonidine and gabapentin that have been shown to reduce flushing when used at relatively low doses. However they are not as effective as HRT and they are more likely to have side effects.

Non-drug therapies such as acupuncture, hypnosis and mindfulness techniques can be useful for some women.

Many women consider complementary or herbal therapies for hot flushes, as they are easily accessible and promoted by non-medical practitioners as effective and safer than HRT. Unfortunately this is not the case when they are subject to close research scrutiny. Most have been shown to be no better than placebo (which can improve symptoms in 50% of women for the first 3 months anyway) or have not been subjected to research sufficient to justify the claims of their advocates. These include therapies such as black cohosh, soy based oestrogens, wild yam cream, evening primrose oil and progesterone cream. Most have not been researched sufficiently to assess their safety in the long term.

Compounded bio-identical hormones are also promoted as an effective and more natural alternative to HRT. However there is no evidence of their superiority to HRT for symptom relief. They also lack safety data and consistency in the purity and potency of their preparations.

Vitamin E can help very mild menopausal symptoms but only by reducing the number of hot flushes by about 1 each day.

For further reading the Australian Menopausal Society provides excellent information.:

So if you are troubled by hot flushes then consulting your doctor is a good first step. A full assessment of the cause can be undertaken and options for management that are safe and evidence based can be discussed. That way therapy can be tailored to your needs and give you the best chance for relief.