- “Is it hot in here or is it just me?”
- Covers off, covers on, covers off, covers on… repeat.
- “I’m having these weird episodes of feeling warm and prickly, could this be a hot flash???”
- Sitting in a work meeting and suddenly feeling your face flush and fanning yourself while your clothes get damp with sweat… and all the men are just staring at you thinking how unprofessional you look. (grr!)
- “I’ve tended to run cold all my life but now I keep getting suddenly hot and sweaty for no apparent reason.”
- Needing to dress in layers… including a tank top underneath… because you never know when it’s going to hit you.
- Suddenly feeling uneasy, nervous, anxious, or doom and gloom… then feeling quickly relieved once you realize that “Oh, it’s just a hot flash!”
If you’ve experienced any of the above and are in the 35-55 age range, welcome to perimenopause! There may be other causes (see below) but approximately 75% of women experience hot flashes as they go through menopausal hormone changes.
What exactly is a hot flash?
Good question! While we still have a lot to learn about them, a hot flash is a sudden feeling of heat, usually only in the torso and head, that can include a prickly feeling and flushing of the skin (may appear red in light-skinned women) and sweating that can range from minimal to hugely disruptive. It usually lasts about 1-5 minutes and if it happens in your sleep it is called a night sweat.
The experience can vary greatly from one person to another, and the length of time that you may have to deal with them is very unpredictable. Most commonly they start in the late 40s and can go on for anywhere from 6 months up to 10 years, or in some cases may continue for the rest of a person’s life.
What causes hot flashes and night sweats?
We don’t really know, but they are thought to be triggered by signals from a region of the brain called the hypothalamus, which is responsible for regulating body temperature as the body attempts to cool itself. These signals result in dilating blood vessels to shunt blood towards the surface of the skin and activating sweat glands to induce evaporative cooling from the skin. Some women feel anxiety or heart palpitations either before or during, and most women feel chills afterwards once that internal heat has dissipated.
The hormonal shifts that can trigger hot flashes and night sweats are not very well understood. It is largely recognized that the low levels of estrogen that happen post menopause are related. But we also know that the night time sweats are especially common in perimenopause, while women are still having menstrual cycles but producing low levels of progesterone.
We also see increases in hot flashes when hormone levels are CHANGING, not just due to hormones being low. This can happen frequently as you move through perimenopause or as you are adjusting doses of hormone therapy. It’s important to know that it can take up to a few weeks for the body to settle into a new dose.
Are there other reasons why I might be hot?
Yes, your temperature can change for a variety of reasons.
- Cortisol: In the normal 24hr circadian rhythm, your body temp lowers over the night (this is why we tend to sleep under blankets) and then cortisol raises body temperature as you near the time for waking in the morning. This cortisol effect can also compound with hormonal shifts in perimenopause, making night sweats worse near waking time.
- Ovulation/Progesterone: In a monthly cycle, progesterone is produced after ovulation and raises basal body temperature by approximately 0.5 degrees Fahrenheit in the luteal phase (from ovulation to the next menses). You may be familiar with this if you have ever tracked your cycle for fertility awareness.
- Thyroid: Imbalances of your thyroid hormones T3 and T4, especially high levels as seen in hyperthyroidism, can contribute to increased body temperature.
- Medications: There are some medications that can raise temperature so read about side effects carefully.
- Fever/Infections: Your temperature can also rise when you are fighting an infection, so it is important to consider your other symptoms if you are having a sudden onset of hot flashes.
- (rarely) Cancer or other medical conditions: There are some health conditions that can have unexplained fevers, hot flashes or sweating as a symptom. Check with your healthcare provider if you have a concern that your temperature changes are not just related to your menopausal transition.
What can I do to keep my cool?
The good news is that there is a lot you can do to reduce the frequency and severity of your hot flashes and night sweats. Here are some of our favorite tips:
Stress reduction – Yes, stress has a huge influence on your hormones!
- Daily exercise (stick to exercise that feels energizing and strengthening rather than exercise that exhausts you)
- Daily meditation
- Breathing practices
- Setting boundaries
- Avoid hot or spicy foods and drinks
- Avoid alcohol, sugar and cigarettes
- Drink cold drinks (pro tip: get an insulated water bottle and add ice)
- Eat for balanced blood sugar by including protein, healthy fats and fiber/veggies at every meal
Adjust your sleep environment/clothing
- Bedding – consider a more cooling mattress, pillow and sheets
- Use fans, open windows and increase air flow
- Clothing – cool, loose and light (pro tip: athletic “wicking” material can decrease the dampness and chill after a night sweats)
- If you feel the start of a heat wave coming on, remove your layers right away and you can prevent it from getting as intense or lasting as long
- Think of your hot flash as a “power surge” and embrace your inner flame
- Reframe any thoughts that “it’s all downhill from here” and know that this is a normal part of the process of moving into a new stage of life where you can absolutely still be vital
Supplements and Herbs
- Many herbs and supplements have been used and studied for hot flashes. Though results are mixed, some women find them to be very helpful.
- Some considerations include: Soy, Black Cohosh, Red Clover, Maca, Siberian Rhubarb extract, Hops, Chaste Tree Berry
Bioidentical Hormone Therapy
- Estrogen, Progesterone or both (holistic hormone balancing should also always consider the thyroid hormones, adrenal cortisol and DHEA, as well as testosterone)
- Supplementing with bioidentical hormones can increase levels if low, or can stabilize levels if fluctuating
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