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Archived Newsletters


2009-06-03
HOT FLUSHES The majority of women


Experience hot flushes during the change of life. Many suffer in silence, thinking there is little that can be done for them, but in fact medical help is available to help them cope with the problem.

Q I am 51 years old and still have my periods regularly every month. I have been having hot flushes for about four months. Is this the change of life?

A The change of life (menopause) is the time when the periods stop. So, to be exact you have not yet reached the menopause. Nevertheless, sometimes the hot flushes associated with it start before the periods begin to alter. If you are worried, consult your doctor.

Q I am 56. My periods stopped three years ago but I have never had any hot flushes. Am I normal or is something wrong?

A There is no need to worry-you are one of the lucky ones! About 20 per cent of women never have hot flushes at the menopause.

Q I have been waking up the last few nights feeling hot and sweaty. Could this be hot flushes? lam52.

A Yes it could. But if it has only been happening for a few nights and you ache all over as well, it could be flu or some other infection. If it continues see your doctor.

Q Can men get hot flushes or are women the only sufferers?

A Yes, men do get hot flushes but it is now generally accepted that although men may slow down in many ways as they get older, they do not undergo a 'change of life' in exactly the same way as a woman does, so their hot flushes usually have some other cause.

Q If women are told they should stop taking the contraceptive pill when they reach 35 why are they given the same hormones when they reach menopause?

A The hormones are not exactly the same though similar and the dosage is smaller. When hormones are given at the menopause they are replacing ones the body is no longer making to lessen the effect of this loss, whereas hormones in the contraceptive pill are used to change the amount of hormones being released from the pituitary gland.

The term 'hot flushes'-also known as 'hot sweats', 'the heats' or, in America, 'hot flashes'-is used to describe the sen­sation of heat that is felt spreading all over the upper part of the body and up the neck to the face.

Hot flushes most commonly affect women at the menopause (change of life). This may occur before the age of 40 or not until the late 50s but in most women it happens between the ages of 45 and 55, the average age being 51.

There may be little to see extemally during a hot flush, although blotchy red patches may appear on the skin. Hot flushes may last from only a few seconds to half an hour, and sometimes the skin becomes moist or drenched in sweat. A cold feeling with shivering may follow and this is sometimes accompanied by dizziness, palpitations and, occasionally, fainting.

Hotfiushes can be acutely embarrassing to the sufferer, especially if the skin becomes moist or drenched in sweat.

A hot flush is quite unlike a blush, which produces a milder, warm feeling that spreads over the face ar.d neck. Menopausal hot flushes rar:ge feCIT: the very mild that pass quickly. tc, :::c~e :::8.: are most distressing a."'1cl OC2ur ~\-eral times throughout the clay and night. Sometimes they can become continuous over many hour~ at a time. sleep may be disturbed and the 5ufferer throw off the bedclothes to try and cool down.

Causes

At the menopause the ovaries cease pro­duction of oestrogen and stop releasing eggs. Menstruation (periods) ceases and the body has to adapt to a new hormone balance.

Until the menopause, oestrogen is secreted by ovarian follicles in response to follicle-stimulating hormone (FSH) released by the pituitary gland at the base of the skull. The follicles gradually run out of oestrogen, and wear out, so that when the menopause IS reached the ovaries no longer contain any of these follicles.

Because there are no follicles to respond to the FSH there is a much higher level ofFSH in the body. This can lead to hot flushes as small blood vessels in the skin become more easily dilated, leading to an increase in skin tem­perature and, at times, a reddening of the skin. Over-stimulation of the sweatglands may also occur.

However, although changes in hor­mone levels are thought to be res­ponsible for hot flushes, it is possible to have them with perfectly normal hor­mone levels several months. or eyen years, before the periods begin to altH.

Other women may haye a hormo:1e deficiency yet have no hot flushes. Yet again, it is possible for hot flushes to persist in spite of the hormone replacement therapy which may be used to correct other symptoms due to the menopause, such as dryness of the vagina which makes sexual intercourse painful and difficult.

Some women notice that some forms of stress bring on hot flushes. They are likely to be more irritable, get upset and cry more easily than usual. Simple day-­to-day tasks that previously caused no problem become difficult and can even lead to a sense of confusion.

Other causes

There are other very different causes of hot flushes which can occur in men as well as women.

There is the feeling of going hot and cold with sweating and shivering, especially during the night, which occurs with many infections that produce a fever.

Eating hot, spicy or curried foods can also produce a hot flush and sweating. Alcohol may also have the same effect. Hot flushes can particularly affect people who have a mild form of diabetes which can be treated with tablets instead of insulin injections. One sort of treat­ment-chlorpropamide-is known to interact with alcohol and about one in three diabetics treated with it will experience hot flushes if they drink even a small amount of alcohol.

Another less common cause of hot flushes is a skin complaint, rosacea, which produces a ruddy discoloration of the forehead, nose, cheeks and chin.

Occasionally a growth called a carcinoid tumour, can occur in the stomach or intestine. This produces excessive amounts of a hormone called serotonin which affects different body organs and causes symptoms such as asthma, loud rumblings in the abdomen and diarrhoea, as well as hot flushes which affect the whole body including the arms and legs.

Treatment

Some women's menopausal symptoms are very mild and transient and require no treatment other than encouragement to accept the natural changes that are taking place and to watch their weight. Reasonable exercise helps to safeguard good health, particularly at the time of the menopause. Walking, swimming, gardening and similar activities are well worthwhile.

However. If the flushes are more severe and frequent, a woman should see her doctor so that proper diagnosis can be

Coping with hot flushes

.,', -;er ',OJ feel a hot flush coming on it s 2es, ~ VOll can stop whatever you are J2r-;j ariO, if possible, sit down quietly. If ,J~- "'0, f,Jshes are very mild and don't as, ::;r;j ,,,ere may not be time to do an\trrg'rore. If, however, you are one o~ ere v: JCKY ones whose hot flushes are severe and last more than a minute or tvvc Jnoo any tight clothing if possible-especially a high collar. If you are in a hot room, or with a lot of people, try and get out into the fresh air.

.If you are driving a car, or working with dangerous machinery, and your hot flushes tend to make you feel faint or dizzy you should stop the car or move away from any moving parts of the machine with which you are working.

• The discreet use of a small fan might be helpful unless this would make you feel more embarrassed. It is worth remembering that unless your hot flushes are severe, it is unlikely that anybody else will notice your discomfiture as the face seldom looks as hot and wet as it feels to you.

.If you are very uncomfortable at night have a warm shower or bath before going to bed and use only the lightest of bed clothes and avoid nylon material altogether.

.If night hot flushes are severe even after hormone replacement treatment tell your doctor as he might be able to prescribe a suitable sedative to take when you go to bed.

• Tell your husband how you are feeling so that he can understand your problem and he may be able to help you to relax.

HOT FLUSHES

made, possibly by testing the hormone levels, and treatment given if necessary. The doctor may refer her to a gynae­cologist for a specialist's opinion if in doubt about the treatment.

Hormone replacement therapy may be considered. Hormones are usually given to replace the body's normal ones if one of the glands responsible for secreting hor­mones stops working. In the case of the menopause, oestrogen is no longer being produced and if this is causing problems, such as severe hot flushes, the patient may be given oestrogen. It may be taken in tablet form, or given by injections or by implanting small amounts under the skin. Sometimes oestrogen is ~pplied to the vagina in the form of a cream or necessary, but this may not be effective in the control of severe hot flushes.

A doctor may advise against hormone replacement therapy if the patient has a history of menstrual disorders, liver disease or a family history of cancer of the womb or breasts.

It is now thought that it is safer for treatment with oestrogen to be combined with treatment with progesterone, but this leads to shedding of the lining of the womb each month, and this may not be acceptable to a woman who has been pleased to stop having periods and now faces the depressing prospect of having them return in exchange for losing the hot flushes.

Also, statistics show that the risk of complications involving thrombosis (clot­ting of blood in arteries or veins) is multiplied about eight times when a woman takes oestrogen, either in the con­traceptive pill or to prevent hot flushes, and also continues to smoke.

Outlook

It is difficult to predict just how long hot flushes will continue, as various factors are involved and it differs from one woman to another. Usually hot flushes diminish in severity and number within two or three years of the menopause­ that is, from the time the periods stop completely.

The treatment time for the use of hormone replacement therapy is initially one year and as long as there is medical supervision with follow-up examinations and tests, there is little risk of serious side-effects and symptoms should diminish quite considerably during this time.

Very occasionally hot flushes persist into the 60s, but more intensive treat­ment can usually bring even these under control, although it may be necessary to continue with hormone replacement treatment for years if it is considered suitable for the patient.

 

Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 27, HOT FLUSHES, Page 746 – 747.

 

(Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out)


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