What Causes Hot Flashes, Anyway?

THURSDAY, April 12 (HealthDay News) — Millions of middle-aged
women experience it: that sudden onset of intense heat, sweating and
flushing known as a hot flash.

Though it’s long been believed that the drop in hormone levels that
accompanies menopause contributes to hot flashes, experts say relatively
little is known about what actually causes them, or what’s occurring when
women have one.

“About 70 percent of women experience hot flashes, but their underlying
physiology isn’t well understood,” said Rebecca Thurston, an assistant
professor of psychiatry, psychology and epidemiology at University of
Pittsburgh.

A new study by Thurston and her colleagues attempts to get at the
underlying physiology. Researchers had 21 perimenopausal and
postmenopausal women aged 40 to 60 who reported having daily hot flashes
wear a heart monitor over a 24-hour period. Perimenopause is the time
leading up to menopause when the ovaries produce less estrogen but a woman
still gets her period.

The heart monitor showed that during a hot flash, heart-rate
variability — a measure of beat-to-beat changes in heart rate —
decreased significantly, a sign that the parasympathetic nervous system
isn’t working as well as it normally does.

The parasympathetic nervous system is one aspect of the autonomic
nervous system, which regulates unconscious bodily functions such as heart
and respiration rates. While the sympathetic nervous system governs the
fight-or-flight response, the parasympathetic nervous system is involved
with “rest and restore,” or regulating the body at rest, Thurston
explained.

Other research has found an association between cardiovascular disease
and decreased parasympathetic nervous system control of the heart. While
researchers say it’s too soon to conclude that hot flashes have a
connection to heart disease, it’s worth continuing to study them, Thurston
said.

“There were transient decreases during the hot flash, but the good news
is it does come back up,” Thurston said.

The research is in the April issue of Menopause.

For something that’s so common, experts say it’s surprising how little
is understood about hot flashes. What’s known is that they can vary in
severity, frequency and duration. Some women may get just a few hot
flashes; others suffer from multiple hot flashes a day for years.

Hot flashes are also one of the most common complaints sending women to
see their doctors, experts said. Hot flashes can impair quality of life,
sleep and lead to feelings of depression, according to background
information in the study. Still other studies have hinted that hot flashes
are associated with ill health effects, including low bone density and
heart disease.

Specifically, studies have found that women who experience hot flashes
are more likely to have signs of early atherosclerosis (sometimes called
hardening of the arteries), such as calcified plaques in the aorta of the
heart, Thurston said.

But women don’t have to simply suffer with them, said Dr. Margery Gass,
executive director of the North American Menopause Society.

The most effective treatment for hot flashes is hormone therapy,
typically estrogen and progestin, Gass said. However, because hormone
therapy carries some risks — including boosting the risk of certain
cancers, including endometrial cancer — women should only turn to
hormones if they’re really bothered by hot flashes, and then they should
stay on hormones only as long as they need to, Gass said.

Another treatment option: selective serotonin reuptake inhibitors, or
SSRIs — a class of drugs commonly used to treat depression or anxiety.
But the medications don’t work as well as the hormones for most women,
Thurston said.

Lifestyle changes can also help, Gass said. As people age, their
“thermoneutral zone” — the temperature at which they feel not too hot and
not too cold — shrinks.

A very minor increase in core body temperature can trigger hot flashes
in some women. So, avoid becoming overheated, Gass said. Bring a fan to
work and switch it on if you feel you’re getting warm. Wear layered
clothing so that you can peel off layers as needed. At night, sleep with a
loosely woven blanket and sleep with one leg uncovered, and avoid down
comforters.

Over time, hot flashes diminish, and usually totally disappear, Gass
said.

“The natural course of hot flashes is they get milder and less frequent
over time, and for the majority of women, they disappear altogether,” Gass
said. “A few women may have occasional ones forever, but usually they’re
manageable.”

More information

WomensHealth.gov has more on menopause.

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