Exactly what’s happening in your body you have a hot flush (and how to find the best treatment)

by | Menopause Symptoms

A menopausal woman having a hot flush

Professor Susan Davis

Clinician Researcher

What’s happening in your body during a hot flush?

Researchers believe changes in sex hormones before and after the menopause are the trigger for hot flushes (aka hot flashes) and night sweats. “As much as we can understand – because we can’t get inside people’s brains, so a lot of it’s from animal studies – the centre in the brain that gets switched on at puberty that’s important for reproductive function and the menstrual cycle, also project nerves onto the temperature control centre of the brain,” explains Monash University’s Professor Susan Davis AO, a global authority on menopause treatment. “The reproductive centre responds to a drop in oestrogen, and that triggers communication with the temperature regulation centre of the brain, which then starts to behave inappropriately.”

Is a hot flush a marker of my skin health?

When you’re in the throes of a flush, you’d be forgiven for thinking it’s very much a skin-related situation. But on the contrary, a hot flush is actually a neurological response taking place in your body. Of course, anyone who has ever tracked Basal Body Temperature for fertility will be familiar with the connection between our temperature and our hormones. “During the menstrual cycle, our body’s temperatures change; when women ovulate their actual blood core temperature goes up, and women who are pregnant have slightly higher body temperature,” explains Professor Davis. A hot flush is a continuation of this relationship between hormones and our body’s temperature regulatory system.

What does a hot flush feel like?

A hot flush or night sweat feels exactly as it sounds – you’ll experience a sudden wave of extreme heat causing you to break into a sweat and/or flush. There’s no telling when or where you’ll have one, which adds to their potential for causing anxiety and distress when they can overwhelm you at an inopportune moment. The heat is most commonly felt around the neck, chest, upper back and head. “If you’re in the tropics and it’s stinking hot, your blood vessels dilate and you sweat to cool down,” explains Professor Davis. “Your body is having the same reaction during a hot flush.”

How common are hot flushes?

Hot flushes and night sweats known as “vasomotor symptoms” (VMS) and are one of the most common indications reported during perimenopause and menopause. A study of more than 2000 Australian women found that 75% under 55 experienced hot flushes and/or night sweats, and 42% of women between 60 and 65 still experiencing these symptoms, in their post-menopausal years[1].

The severity of hot flushes and night sweats can range from mild, but manageable, to totally debilitating, with women who experience extreme VMS three times more likely to experience moderate to severe depression than those who don’t[2].

Why do some women experience hot flushes more than others?

One things experts agree on is that everyone’s experience of menopausal symptoms is unique. “The symptoms do vary considerably by some factors,” says Professor Davis. Research shows lifestyle factors have a significant influence over whether you will experience hot flushes. “Women who are overweight or have obesity tend to have more severe symptoms,” explains Professor Davis. “Smokers are more likely to have flushes and sweats.

When will I stop experiencing hot flushes?

While some women will never have a hot flush, some women who are still flushing decades later. “As we age, the number of women with severe symptoms progressively falls. So, by the time women’s over 60, only 6% of them have severe men, hot flushes and sweats. So progressively with increasing age, the symptoms diminish.”

What treatment is available to manage hot flushes?

There are many treatments available for hot flushes. Unfortunately, misinformation about menopausal hormonal therapy (MHT) – one of the most effective treatments – means that many women suffer in silence with VMS. “There’s a really clear evidence base, that oestrogen is effective for alleviating symptoms of the menopause,” says Professor Davis. “Oestrogen, or oestrogen plus progestogen[SD1]  for women with a uterus is very effective. There is also evidence a particular group of antidepressants called SSRIs could treat hot flushes too.”

A brand-new drug called fezolinetant has also recently been approved by the TGA to treat VMS. “Cognitive behavioural therapy (CBT) and hypnosis have also been shown to help women manage symptoms and deal with their symptoms,” says Professor Davis. “The important thing to know is that CBT and hypnosis  do not necessarily get rid of symptoms, but alleviate[SD2]  the negative impact of symptoms.” While yoga, exercise and relaxation methods have not been proven to assist directly with symptom management, they may assist with sleep which is often directly impacted by VMS.

Is MHT dangerous?

If you’ve dipped a toe into researching anything about Menopausal Hormonal Therapy (MHT) once known as HRT (hormone replacement therapy) you likely encounter its link to increased risks. “A study back in 2002 showed a small, but statistically significant increased risk of breast cancer when oestrogen was given with a synthetic progestogen to women with a uterus. The biggest issue is that, that study recruited women at age 50 and older,” explains Professor Davis. “It doesn’t tell us about the risk for somebody who’s 45 or 40. So there’s still so much to learn, plus now we tend to recommend lower doses of MHT.”

In a parallel study, oestrogen was given without a synthetic progestogen to women who had a hysterectomy. “In that study, oestrogen given alone was not associated with an increased risk of breast cancer. Also, in the 18 years follow up, there was no difference in any, all-cause mortality or cancer mortality or heart disease mortality between MHT users and non-use irrespective of progestogen use. So, in fact, really the study’s shown us that if anything, MHT is probably pretty safe compared to most things people do,” says Professor Davis.

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Do different therapies carry different risks?

In short, yes. Oestrogen tablets (taken orally) have some increased risk of blood clots – although that risk is low in women under 60. That risk is reduced when the same therapy is given via a patch (worn on the skin) or as a skin gel making this delivery system the preferred approach for people at higher risk of clots (e.g. overweight and  people with obesity[SD4] , smokers, etc.). For women who have had a hysterectomy, oestrogen-only therapy may be prescribed, unless you have a moderate to severe history of endometriosis.

The takeaway? There is no once size fits all approach to VSM symptoms, but a discussion with your GP can help you weigh up the advantages with the risks and decide on a. Treatment plan appropriate for your health history. “Medication can be life changing for some women, but not fix problems for other women,” says Professor Davis. “The problem is that menopause occurs at an age where life is complicated. It’s busy, and there are a lot of challenges for women both physically and mentally. Just going on a tablet or throwing on a patch is not going to fix anything.”

Where treatment can really help, is in supporting you with symptoms that make other issues in your life more challenging. “If you’re waking up three times a night with flushes, sweats and anxiety, and I give you something that makes you sleep well and wake up in the morning feeling refreshed, then yes, that’s life changing,” says Professor Davis.

  1. https://research.monash.edu/en/publications/prevalence-of-menopausal-symptoms-in-australian-women-at-midlife-
  2. https://www.menopause.org.au/hp/gp-hp-resources/menopause-matters
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