Hot flushes (aka as flashes in the US) are one of the most recognisable and common symptoms of menopause affecting 3 out of 4 women during menopause. (1) The medical term is vasomotor symptoms or VMS.  

1 in 5 will find that they interfere with their quality of life and affect their sleep, work and mental health, (2) Whilst they are sometimes referred to as a ‘private summer’ there is nothing pleasant about them. 73% of women reported they experienced them in the workplace with 90% of women feeling embarrassed and  unsupported in their workplace). (3)  A survey conducted in 2021 showed that 66.5% women wanted to know more about hot flushes (3). Just to be clear some women experience intense cold flushes but these are fairly rare. . 

A hot flush is an intense feeling of heat that comes on suddenly and spreads upwards in the body and up into the chest and face. It can last seconds, minutes and even up to an hour.  On average they are thought to last about 4 minutes. Some women experience them frequently – several times a day and some experience several times a month.  They usually only continue a few years but unfortunately some women can experience them for decades even way past menopause.  (1) 

 

You may experience:

• Coldness beforehand 
• Sweating
• Flushing/Redness of your face
• Dizziness
• Heart Palpitations
• Tingling in your hands and fingers
• Nausea

 

What causes them?

The sad thing is that we actually have no idea what actually causes them although there are several theories. What we do know is that oestrogen is playing a role. Oestrogen has many receptors in the brain so when oestrogen declines, this has an impact on the brain and therefore functions in the body including temperature regulation. The hypothalamus is a part of the brain that is in charge of body temperature regulation and appears to be affected by declining or fluctuating oestrogen. Currently the exact mechanism is unknown. (1)

One theory is that as oestrogen drops it impacts another hormone called norepinephrine (a.k.a. noradrenaline) which is one of our stress hormones and helps to regulate our body temperature. When norepinephrine is low it can cause our temperature to rise resulting in the hot flush. (1)

 

Triggers

Certain things have been shown to increase the risk of hot flushes including spicy food, hot food, hot drinks, caffeine and alcohol, being in a hot room, wearing tight clothing, being overweight or obese, smoking, stress, anxiety, depression and insomnia. (1) Considering insomnia, weight and mood disorders can be symptoms of menopause we have a vicious circle right there!

 

Long term Risk

Whilst hot flushes themselves are not a cause for concern, research has shown a link between hot flushes and heart disease. The more severe the flush the higher the risk. This link was noted during a huge study on menopausal women that started in 1994 and has been following 3,302 American women to assess the physiological and psychosocial changes that occur during the menopausal transition and to observe their effects on subsequent health and risk factors for age-related diseases. (4) 

A more recent University of Queensland study confirmed that women who had severe flushes and night sweats were 70% more likely to experience heart disease and strokes. (5) Frequency doesn’t seem to have the same effect. 

 

Tips on how to manage them

1. Breathing techniques have been shown to be particularly effective in reducing the frequency of hot flushes as far back as 1992. (6)  Box breathing can be helpful (breathe in for 4 seconds, hold for 4, breathe out for 4 seconds and repeat) or breathe in for 4 seconds, hold for 7 seconds and breathe out for 8 seconds may also help. For every inhalation, doubling the exhalation can make us feel more relaxed. 
2. Listening to relaxing music – a really interesting 2015 study that compared the effects of slow breathing (10 breaths per minute) for 15 minutes per day to listening to relaxing music showed that the breath practice alone reduced the frequency of hot flushes by 19%, the listening to relaxing music reduced by a whopping 44%. (7) The message here is that relaxing and not panicking seems to be the key. Accept the hot flush, go with it rather than fight against it. 
3. Acupuncture has also been shown to reduce severity and frequency. (8,9)
4. Vitamin E – a recent 2023 literature review showed that vitamin E was effective at reducing hot flushes. The authors concluded vitamin E influenced symptoms like hot flushes, vaginal changes, lipid levels in the blood and blood vessel health. Whilst oestrogen administered as hormone therapy led to better clinical effects vitamin E is a viable option either alongside hormone therapy or as alternative for those who cannot use oestrogen therapy (e.g. those with a personal history of oestrogen sensitive cancers). (10)
5. Herbs such as black cohosh have been found to be an effective treatment for some women. (11, 12)  Sage is another herb that has been traditionally used for hot flushes. There are very few scientific studies to show efficacy but one study in 2011 showed a 64% reduction in hot flushes over 8 weeks. (13) 
6. Evening Primrose Oil may help with reducing hot flushes but does not appear to be as effective as black cohosh. (11) 
7. Whilst exercise doesn’t reduce hot flashes itself, regular exercise helps to reduce the triggers by improving mood and sleep, helping to cope with stress and reduce or maintain a healthy weight. It is important to note that intense exercise for some women might exacerbate hot flushes. 
8. Antidepressants have been shown to reduce hot flushes in some women (in fact have been shown to be more beneficial in reducing hot flushes than reducing depression in menopausal women). 

• Clothing – dress in layers so you can adjust as temperature changes. Wearing cotton clothing or wicking fabric to help manage sweating. 
• Sipping ice water at the start of a hot flash
• Keeping a cold pack on your bedside table for night sweats or in the fridge at work.
• Asking your workplace to provide fans or to change seating so you are near an open window or fan. 
• Keep a symptom journal – by writing down what you’re doing, thinking, feeling, eating, drinking or even wearing, where you were and what time of day it was or even when in your cycle – when you have each flash. After a few weeks you may start to see a pattern of specific triggers.
• Get support from a GP who has a special interest in menopause or book a call with me for a chat. 

 

References

1. Dr. Louise Newson. (2019). Menopause: All You Need to Know in One Concise Manual: Signs and Symptoms – Time to Rethink HRT – Holistic Treatments – Coping at Work – Advice for All the Family. Haynes Publishing Ltd.
2. Niki Bezzant. (2022). This Changes Everything. The Honest Guide to Menopause and Perimenopause. Penguin Books Ltd. 
3. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01582-0#study 
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185240/
5. https://www.ajog.org/article/S0002-9378(20)30664-5/fulltext
6. https://www.ajog.org/article/S0002-9378(11)91425
7. https://pubmed.ncbi.nlm.nih.gov/25932840/
8. https://journals.sagepub.com/doi/10.1136/aim.2010.003285
9. https://ascopubs.org/doi/full/10.1200/JCO.2015.63.2893
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9824658
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868221/
12. https://www.researchgate.net/publication/260116278_Efficacy_of_black_cohosh_Cimicifuga_racemosa_L_in_treating_early_symptoms_of_menopause_A_randomized_clinical_trial
13. https://pubmed.ncbi.nlm.nih.gov/21630133/

 

Email me at admin@sarah-brenchley.com or book a free discovery call to discuss how I can help you. I offer a 1:1 sessions and various programmes on gut health, empowered eating (non-diet approach to food and weight) and menopause. Go to https://sarah-brenchley.com/links for information and free resources and join the best Facebook Group ever  – Women’s WellBeing Circle. 

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