Is it hot in here? WTF are these hot flushes and night sweats about?
Emily was 47 when she had her first hot flush.
“I didn’t know what was happening to me. It was a feeling of overwhelming heat, like a heater being turned on inside me. I got hotter and hotter and then it disappeared. In that moment I didn’t want to be touched or near anyone”.
Paula, 51, describes her night sweats:
“Waking up in the middle of the night completely freezing because your PJs are stuck to you with sweat which has turned cold, and your sheets are soaked through. So you strip and get back into bed on the dry side… shivering as you wrap the less soggy sheets around you in an attempt to get warm enough but not start sweating all over again”.
Why am I so hot?
Feeling like your internal thermostat is on the fritz can be alarming. Sweats and hot flushes are some of the most common perimenopausal symptoms, affecting most women at some stage. Collectively they’re known as vasomotor symptoms and like most things that happen in perimenopause – the time before menopause proper – and menopause, the experiences women have vary a lot. For some women, flushes are an occasional annoyance. For about one in five women, though, they are severe and interfere with quality of life, work, sleep and mental health.
Vasomotor symptoms – also like much about menopause – are not well understood. But they’re thought to be caused by the temperature-controlling part of the brain interacting with the hormones which drive many of our bodily functions. When they go haywire at perimenopause, when hormones fluctuate – sometimes wildly - so does our temperature gage.
Renowned US-based brain researcher Dr Lisa Mosconi explains it like this:
“Your brain is in charge of regulating body temperature. [In perimenopause] the ovaries are telling the body, I’m running out of eggs, and I’m not making the hormones any more. And the brain is like ‘Whoa! Wait a minute, we have a problem here!’ And the lack of hormones and the fluctuations in the hormone levels trigger the brain’s temperature centre [the hypothalamus] at random times.
“One second you have a ton of estrogen, and the next the estrogen is no longer there. And then it’s there, and then it’s not; and then it’s there, and then it’s not. Eventually the hypothalamus goes, ‘I don’t know what’s happening here’, and you get your hot flush.”
What triggers overheating?
Our body temperatures naturally fluctuate through the day. It’s typically lowest in the wee small hours and highest in the early evening. We don’t usually even feel these changes. But at perimenopause, even small changes might cause a flush or a sweat. It might be as simple as having a hot drink, or going from outside to inside. Other triggers women have noted include caffeine; spicy food; alcohol; exercise and hot showers.
How long is this going to last?
Everyone’s different. On average, women experience vasomotor symptoms for about 2 years. Some women, though, have them for much longer, even past menopause. For a small number of women, hot flushes and sweats can persist for up to fifteen years.
What can I do about it?
There’s a range of ways we can deal with hot flushes and night sweats; what you choose to do will likely depend on how much they affect your quality of life. Here’s some solutions starting at the mildest end of the spectrum:
For occasional hot flushes, it might be as simple as dressing in thin layers and going big on cotton and natural fibres.
For mild night sweats, keeping the bedroom cool with a fan or open window might do the trick. Lower temperatures are better for sleep, too.
Losing weight may help. Being overweight is associated with worse menopause symptoms, including flushes.
There are not many natural therapies – no matter the claims – that work for hot flushes. According to the Australasian Menopause Society, ‘no complementary medicine is as effective as estrogen therapy for menopausal symptoms’. The AMS does say there’s some evidence taking vitamin E can decrease hot flushes by one per day. Omega-3, black cohosh, wild yam or evening primrose oil: not so much. Worth noting: there’s a massive 30-50% placebo effect for anything you try for flushes, though - so if what you’re doing seems to be working, and it’s not breaking the bank - carry on.
Some low-dose antidepressants have been shown to help with hot flushes. So have a couple of drugs usually used for epilepsy. These could be worth discussing with your doctor.
For women whose flushes are severe, hormone therapy is the gold standard treatment, according to the experts. More than one woman has described it to me as life-changing.
There’s a deep dive into hot flushes, their causes, treatments and more, in This Changes Everything, chapter 5: So hot: hot flushes and night sweats.