About Hot Flashes
Hot flashes are a very common symptom in both perimenopause and menopause. Over eighty percent of women experience hot flashes. The exact cause is unknown. But scientists suspect it has something to do with our changing hormone levels and our internal thermostat, the hypothalamus, which is located in our brains.
Following are the most common signs and symptoms of perimenopause and menopause. It is important to note that we are all individuals and, as such, signs and intensity of the various conditions may vary.
Symptoms of Hot Flashes
If you've had one, there's no mistaking it: the sudden, intense, hot feeling on your face and upper body, perhaps preceded or accompanied by a rapid heartbeat and sweating, nausea, dizziness, anxiety, headache, weakness, or a feeling of suffocation. Some women experience an "aura," an uneasy feeling, just before the hot flash, that lets them know what's coming. The flash is followed by a flush, leaving you reddened and perspiring. You can have a soaker or merely a moist upper lip. A chill can lead off the episode or be the finale.
What causes them
Hot flashes are mostly caused by the hormonal changes of menopause, but can also be affected by lifestyle and medications. A diminished level of estrogen has a direct effect on the hypothalamus, 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 responds to this report by broadcasting an all-out alert to the heart, blood vessels, and nervous system: "Get rid of the heat!" The message is transmitted by the nervous system's chemical messenger, epinephrine, and related compounds: norepinephrine, prostaglandin, serotonin. The message is delivered instantly. 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.
Hot flashes are mostly caused by the hormonal changes of menopause, but can also be affected by lifestyle and medications. A diminished level of estrogen has a direct effect on the hypothalamus, 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."
This heat-releasing mechanism is how your body keeps you from overheating in the summer, but when the process is triggered instead by a drop in estrogen, your brain's confused response can make you very uncomfortable. Some women's skin temperature can rise six degrees Centigrade during a hot flash. Your body cools down when it shouldn't, and you are miserable: soaking wet in the middle of a board meeting or in the middle of a good night's sleep.
Who gets them
Eighty-five percent of the women in the United States and Canada experience hot flashes of some kind as they approach menopause. In addition, the experience usually continues for the one or two years after their periods stop. Unfortunately, 20 and 50% of women continue to have them for many more years. A personal friend had them for 10 years! As time goes on, the intensity decreases.
If you have had breast cancer, your hot flashes can follow the same pattern as for women in general, or they can be more intense and last longer, particularly if menopause was premature, or if you are taking tamoxifen and your body hasn't adjusted to it. Rarely, women may not have hot flashes until they stop taking tamoxifen-an unpleasant surprise. In these women, tamoxifen develops an unusual estrogen-like ability to combat hot flashes.
There is considerable variation in time of onset, duration, frequency, and the nature of hot flashes, whether you've had breast cancer or not. An episode can last a few seconds or a few minutes, occasionally even an hour, but it can take another half hour for you to feel yourself again. The most common time of onset is between six and eight in the morning, and between six to ten at night.
How hot is hot?
Most women have mild to moderate hot flashes, but about 10-15% of women experience such severe hot flashes that they seek medical attention. For women who have had breast cancer, the number who suffer debilitating hot flashes is probably much higher. Randomized studies provide the most objective data: about 50-75% of women taking tamoxifen will report hot flashes, compared to 25-50% taking placebo.
The faster you go through the transition from regular periods to no periods-the perimenopause or climacteric-the more significant your hot flashes will be. Hot flashes are severe after surgical menopause, and they can also be quite difficult after a chemotherapy-induced medical menopause. If you haven't been warned about hot flashes, a sudden severe episode can be frightening; you might even confuse the flash with a heart attack.
The intensity of hot flashes accompanying treatment with tamoxifen eventually improves for many women after the first three to six months. Because of the conversion of androstenedione from the adrenal glands into estrone by fat and muscle cells, heavy or muscular women experience less severe hot flashes than thin women. If you smoke, your blood vessels lose some of their ability to radiate heat, so you may suffer more severe hot flashes.
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