The infamous ‘hot flushes’

What are they?

Who gets them?

And what can I do to make them stop….?

Hot flushes and night sweats are so synonymous with the menopause, that some women think that if they don’t experience them, they aren’t menopausal! But that definitely isn’t the case. Some women either won’t experience hot flushes at all during the menopause, or find that they are mild in relation to their other symptoms. 

Often women will know they may be susceptible to hot flushes or sweats because they have experienced these in other times of hormone fluctuation – for example postnatally or when breastfeeding. During early perimenopause, women may also find them occurring in the few days before their period, but disappearing when their next cycle starts.

Why do they happen?

We have an area in our brain called the hypothalamus, which acts as a thermostat, and it is very sensitive to female hormones – particularly to fluctuating hormones. Most women, approximately 4 out of 5, will experience some issues with temperature regulation during the perimenopause and menopause – but these can vary in severity.

For some women they may be mild, but for some they can be so severe that they impact every aspect of their day to day lives; making it difficult to do their jobs, enjoy social occasions, get a proper night’s sleep - or putting stress on their relationships as a result.

What treatments are there?

Treatments for hot flushes fall into three main categories:

1.     Hormonal medication (HRT)

2.     Non-hormonal medication

3.     Alternative therapies and supplements

(There are also some great hints & tips that can help women to cope with this category of symptoms, read on for those…)

1.     Hormonal medication (HRT)

 The good news for many women is that HRT is proven to be incredibly effective for the treatment of hot flushes and night sweats. The effect (once the dose & absorption levels are right) is often absolute (can remove them altogether), and the response to treatment very quick. Most women will experience an improvement in their symptoms in a few weeks, or even in a few days!

 HRT works by replenishing oestrogen levels, that naturally drop as we approach menopause, and by stabilising the hormone fluctuations that occur. As well as hot flushes, HRT can also treat most of the many other, various symptoms of the menopause from anxiety to sleeplessness, headaches to joint aches.

 Of course some women may be unable to take HRT, or choose not to – and thankfully there are still other options out there.

 2.     Non-hormonal medication

 There are a number of medications, most used for treating other conditions, that reduced hot flushes as a side effect. These include:

-       Clonidine: a blood pressure medication, is effective at reducing hot flushes by around 50% but side effects particularly sleep disturbance often mean it isn’t tolerated.

-       SSRIs (eg paroxetine, fluoxetine, sertraline, citalopram and escitalopram) and SNRIs (eg Venlafaxine) - a group of drugs that are licensed to be used as antidepressants, but which can be around 50-60% effective in reducing hot flushes. (Please note that fluoxetine and paroxetine may inhibit tamoxifen so should not be used together)

-       Pain medication such as Pregabalin & Gabapentin, can moderate vasomotor symptoms by about 50-60% but may come with unwanted side effects such as brain fog and sedation

-       Oxybutynin, a medication used for an overactive bladder can reduce hot flushes by upto 70% and is normally well tolerated but can give a headaches, dry mouth and dry eyes. It isn’t a good choice for older women as it can cause episodes of confusion in this group.

Don’t feel that your doctor is fobbing you off by suggesting these other medications! There is plenty of evidence that they work.

 There are some, newer medications that work by blocking the neurokinin receptors in the brain that cause hot flushes. These are fezolinetant (brand name Veozah) and elinzanetant (brand name Lynkuet). Both show a significant reduction, of up to 70%, in moderate to severe vasomotor symptoms, and they are well tolerated with a good safety profile. Elinzanetant has been specifically tested in women with breast cancer (OASIS 4)

 Both are licensed (Elinzanetant only very recently as we write), but haven’t yet been approved by NICE for use in the NHS, so unfortunately are currently only available privately.

3.    Alternative Therapies & Supplements

Alternative therapies that have a good evidence base for efficacy are:
-       CBT (Cognitive Behavourial Therapy)
-       Cold water therapy
-       Breathwork
-       Acupuncture

 It may also be worth trying supplements. The ones we recommend are:

-       Isoflavones, a concentrated form of soya, contain a natural oestrogen. They are nowhere near as powerful as HRT, but for some women they will be enough.
-       Black Cohosh, a plant root, has some evidence
-       Red Clover also has some evidence

 Be aware that, although these substances are natural, they can still be potent, and have their own side effects. So use with caution and consult your healthcare professional for advice if you are taking other medication. Natural oestrogen supplements  are NOT recommend if you have had a hormone sensitive cancer, consuming moderate amounts of food that contains natural oestrogens is not a problem.

 Also be aware that there are a huge number of ‘menopause supplements’ out there, some of which may contain a good level of active ingredients, but many of which are incredibly expensive thanks to expensive marketing and premium labelling! Good quality supplements needn’t cost the earth..

Women’s Health Concern has a great factsheet that outlines the evidence for complementary treatments for menopause symptoms, which is a great source of information. You can read it here.

What else can I do?

 Although most (80%) women’s hot flush symptoms will ease once hormones become low and stable post-menopause, this could take some time – and for some they may still suffer even with low but stable hormones in the years after their periods stop. So it is worthwhile investing in some good quality, natural bedding, fans or anything that will help to ease symptoms (even alongside medication).

Here are some of our favourite hints and tips…..

-       Wear cotton clothes (which are much more breathable than synthetic fibres)
-       Wear layers – which can be added or removed as your temperature changes
-       Don’t wear clothing that is difficult to get on and off!
-       Try a fan – and put some cold water or ice in front of it to try and cool the air that you are moving around
-       Even a portable or paper fan, when out and about, can really help for a quick cool down…
-       Try taking an ice pack to bed (perhaps wrapped in a towel), that can help to cool you quickly when needed
-       Invest in some new bed linen that is made of natural fibres
-       Pop your sheet in the freezer before bed!
-       If you use body moisturiser, put it in the fridge and apply before going to sleep
-       Have a cool shower before bed, and don’t dry off to thoroughly (as the evaporation helps with cooling)
-       Try to keep your room cool, ideally around 18 degrees (which is better for everyone)

When is a hot flush, not a hot flush?

 If you are experiencing hot flushes outside of the menopause transition or is they are not responding to HRT, they should to be investigated further, conditions such as hyperthyroidism; this can mimic menopause (palpitations, hot flushes & feeling anxious) and hot flushes can be caused by other things such as; endocrine conditions, infections and cancer. Speak to your healthcare professional, who can discuss further investigation with you.