Hot Flushes and the Menopause

Hot flushes and night sweats are the most common symptoms of the menopause; with around 75 percent of menopausal women affected. Hot flushes are characterised by sudden feelings of heat, which spread upwards through the body to the neck and face. They are caused by fluctuating hormone levels which affect the body’s temperature control mechanism. 

Some women only experience an occasional mildly warming sensation lasting a few seconds, whereas other women have intense hot flushes throughout the day and night, lasting several minutes or longer and accompanied by sweating, dizziness, light-headedness and sometimes heart palpitations.

In addition, women who have severe hot flushes may experience more ‘brain fog’ possibly due to several factors – the temporary disruption of blood flow to the brain that happens with a hot flush, sleep deprivation caused by night sweats and the low mood that can result from these physical symptoms.

A menopause study¹ found that women could experience hot flushes for up to 10 years and the earlier hot flushes began, the longer they were likely to last. Not only do they interfere with quality of life, they also represent a risk to physical health. Severe hot flushes and sweats during the menopausal period are associated with an increased risk of  cardiovascular (heart) disease.² Therefore they should not be ignored or dismissed as ‘just part of the change’.

Cardiovascular disease and women

Before the menopause, women are protected from cardiovascular disease by oestrogen, a hormone produced in the ovaries.  But after the menopause women are as likely as men to be affected by heart disease, due to declining oestrogen levels. A little discussed fact is that  cardiovascular disease is the leading cause of death in women, but is often under-recognised and under-treated.³

Hormone Replacement Therapy (HRT)

The good news is that oestrogen based HRT significantly reduces the risk of heart disease in women. Ideally HRT should be started when menopausal symptoms like hot flushes first appear; and before the age of 60. For most women, HRT is a safe option.⁴ Besides its impact on heart health, HRT helps prevent osteoporosis, Alzheimer’s disease and several other long-term health conditions, including type 2 diabetes.

Oestrogen also helps preserve muscle health in older women and several studies of HRT have shown that menopause-related obesity and loss of lean and skeletal muscle mass can be reversed.⁵ But while HRT has a significant role in preventing many health conditions, there are other lifestyle measures which can have a huge impact on health and wellbeing during the menopause.

Diet

Making changes to what you eat can help reduce menopausal symptoms like hot flushes and night sweats; as well as improve your cardiovascular health.

A large scale trial found that women eating a Mediterranean style diet rich in vegetables, fruits, nuts, legumes, and healthy oils such as olive oil and oily fish reduced their risk of vasomotor symptoms like hot flushes and night sweats. Whereas menopausal women eating a high-fat and high-sugar diet increased their risk of these symptoms.⁶

Whilst a Mediterranean diet does not suit or is not accessible to everyone, cutting back or avoiding highly processed foods and eating a diverse diet of minimally processed, high-fibre, plant-based foods will help control many menopausal symptoms. A plant-based diet doesn’t mean that you can’t eat meat, fish or dairy products, just that these shouldn’t be the main constituents of your diet.

Exercise

Exercise is good for your physical and mental health at all stages of life, but is particularly important during the menopausal period. As oestrogen levels fall, muscle mass decreases, the distribution of body fat changes, so more fat is deposited around the abdomen, and bone strength decreases. Muscle mass is linked to heart health, and low muscular strength is a risk factor for developing cardiovascular disease.⁷ Studies have consistently shown that obesity is a risk factor for menopausal hot flushes.⁸

Women should aim to do some form of strength training at least twice a week and eat enough protein at every meal to give their body the fuel it needs to make and maintain vital muscle mass. Resistance bands or using weights are a great way to build muscle mass. Pilates and certain types of yoga can also improve strength.

Aerobic exercise which makes you feel out of breath (but still able to speak) for 15 minutes, three times a week  will help improve cardiovascular health. This may be fast walking, running, swimming or cycling.

During the menopause, it’s essential to find an exercise plan that suits your lifestyle and which you enjoy (this way you’re more likely to stick to it!). You’ll have a healthier heart, a leaner body, less hot flushes and night sweats.

Lifestyle advice

There are other steps you can take to help reduce the impact of hot flushes including:

• Avoid triggers.  Many women find that caffeine, hot drinks, alcohol and spicy foods trigger hot flushes.
• Stop smoking.  Smokers tend to experience more severe hot flushes and carry an increased risk of heart disease or stroke.
• Try to wear natural fibres or those that wick away moisture like cotton, linen, silk, wool and bamboo.
• Try Mindfulness or meditation.  Having a hot flush can increase anxiety which further exacerbates the hot flush. Try to concentrate on your breath and remember, each flush is only going to last a short time and will pass.
• Cognitive Behavioural Therapy (CBT) is a talking therapy that has been shown to benefit some women experiencing hot flushes.

Conclusions

Enough is known about the menopause that there are treatments and interventions which can help ease many of the symptoms and even reverse changes associated with a drop in oestrogen levels. Approached with a positive attitude, this can be a positive stage of life for many women.

Nneka Nwokolo, is Co-Founder New Woman Health,  has 20 years’ experience as an NHS Consultant Sexual Health Physician, and is an expert in women’s sexual and reproductive health, contraception and the menopause

References

1. Freeman E, How long do hot flushes go on? British Menopause Society https://thebms.org.uk/2011/05/how-long-do-flushes-go-on/ accessed 161023

2. Zhu D, Chung HF, Dobson AJ, et al. Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. Am J Obstet Gynecol. 2020;223(6):898.e1-898.e16. doi:10.1016/j.ajog.2020.06.039

3. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010;18(12):598-602. doi:10.1007/s12471-010-0841-y

4. Hodis HN, Mack WJ. Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It Is About Time and Timing. Cancer J. 2022;28(3):208-223. doi:10.1097/PPO.0000000000000591

5. Geraci A, Calvani R, Ferri E, Marzetti E, Arosio B, Cesari M. Sarcopenia and Menopause: The Role of Estradiol. Front Endocrinol (Lausanne). 2021;12:682012. Published 2021 May 19. doi:10.3389/fendo.2021.682012

6. Herber-Gast GC, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr. 2013 May;97(5):1092-9. doi: 10.3945/ajcn.112.049965. Epub 2013 Apr 3. PMID: 23553160.

7. Lopez-Jaramillo P, Lopez-Lopez JP, Tole MC, Cohen DD. Muscular Strength in Risk Factors for Cardiovascular Disease and Mortality: A Narrative Review. Anatol J Cardiol. 2022;26(8):598-607. doi:10.5152/AnatolJCardiol.2022.1586

8. Gallicchio L, Miller SR, Kiefer J, Greene T, Zacur HA, Flaws JA. Change in body mass index, weight, and hot flashes: a longitudinal analysis from the midlife women’s health study. J Womens Health (Larchmt). 2014;23(3):231-237. doi:10.1089/jwh.2013.4526