Paging Dr. Frischer - Hot flashes

Hot flashes: the most common symptom of menopause. The experience may include a warm feeling spreading through the upper body and face, rapid heartbeats, sweating, a flushed appearance, and a chilled feeling as it concludes. They occur in nearly 70% of North American women around menopause, and happen when the blood vessels near the skin’s surface dilate to cool. The frequency of hot flashes varies from woman to woman, and may range from one a day to one per hour. They are more common at night, and typically last between one and five years. The two general types include the hot flash that comes on rapidly, reaches a maximum intensity in a minute, and fades in a few minutes. A slower, more prolonged type appears as quickly but is less intense and may last for a half-hour.

Hot flashes may not be dangerous, but they can be quite troublesome. Nighttime hot flashes can interfere with sleep, and too little sleep can add to memory problems, anxiety, and depression. Besides that, they are uncomfortable, embarrassing, and problematic for daily life.

Why do they happen? We’re not exactly sure! Of course, they are clearly related to changes in reproductive hormones, especially reduced levels of estrogen. Interestingly, not all women have hot flashes. Some lifestyle factors do increase the likelihood, including smoking, obesity, and physical inactivity. Ethnicity matters: African-American women are more prone to hot flashes, while those of Japanese and Chinese descent are least likely.

Diagnosing the cause of hot flashes is usually straightforward. If a woman is of menopausal age and has experienced recent changes in her period, a simple blood test will confirm whether she is in or approaching menopause.

Since the precise mechanism of hot flashes is not completely clear, most research focuses on treatment options rather than on prevention.

•The most straightforward treatment is estrogen and progesterone replacement therapy. Replacing declining hormone levels has been the standard of care for years. This thinking has now shifted, as these hormones have been linked to an increased risk of stroke, heart attacks, and many cancers. When hormone replacement therapy is chosen, it is used for the short term, and never for longer than five years. Even in the short term, risks include blood clots, headaches, and gallbladder disease.

•Prescription medications include antidepressants, neurontin (an anti-seizure medication), and clonidine (typically used for high blood pressure). These medications have their own possible side effects, but may be used as an alternative to hormone therapy.

•There are a multitude of herbal remedies that may bring relief for some. These include plant estrogens, black cohosh, ginseng, dong quai, caffeine, phytoestrogens (like ginseng), flaxseed, soy products, and kava. Remember that just as with prescription medications, these herbal supplements may also have side effects.

•Lifestyle changes certainly can make a difference. Keep cool – open windows, use fans or air conditioners. Dress in layers. Sip cool drinks. Some foods may trigger hot flashes, including hot and spicy foods, caffeinated beverages, and alcohol. There is a growing body of evidence supporting the use of meditation, yoga, tai chi and qi gong to reduce the severity of hot flashes. Acupuncture and hypnosis have shown benefits. On the other hand, both smoking and excess weight have been linked to more severe hot flashes.

Hot flashes experienced by anyone but a menopausal or pre-menopausal woman become more worrisome. Other causes could be diseases of the pituitary gland or thyroid gland, medication side effects, undiagnosed infections, or cancer. For men, hot flashes may be a result of low testosterone levels, be related to prostate or testicular cancer, or even be a side effect from hormone therapy. Be sure to see your doctor if you are experiencing hot flashes and the diagnosis or treatment is unclear.


Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.



Published: Oct. 9, 2014 - Volume 13 - Issue 26