One of the first signs that a woman is going through the menopause is the appearance of hot flushes. These are not quite like feeling flushed, or even hot; a hot flush is a weird sensation that strikes without warning. The skin feels hot, but prickly, as if it is suddenly burning and this prickling can make you think that you have gone bright red and look very sweaty. This is rarely the case though – most women having a hot flush look perfectly normal to everyone else.
What Causes Hot Flushes
Menopause begins when the ovaries start to wind down and no longer release an egg each month. Levels of progesterone and oestrogen, the two major female sex hormones start to fall and this leads to a period often called ‘the change of life’. The menopause can take several years before the periods stop completely, and the annoying symptoms caused by hormonal fluctuations stop happening.
Hot flushes happen because the changing hormonal levels cause confusion in the autonomic nervous system of the body. This is the part of the nervous system that controls all of our automatic functions – such as heart beat, breathing and keeping our body temperature at a steady level. When we get hot, the autonomic nervous system pushes more blood into the blood vessels near the skin and opens the sweat glands so that we can lose heat more rapidly and cool off. During the menopause, the strange hormonal levels cause this to happen even when a woman’s body temperature is normal and she doesn’t need to lose extra heat.
Suddenly, autonomic nerves become stimulated and cause a sudden rush of blood to the skin all over the body, simultaneously opening sweat glands and stimulating sweat production. The result is that you suddenly feel very hot, and start sweating. Each hot flush can last up to about 5 minutes and may only strike once a day, or you can have several in an hour.
Other Menopausal Symptoms
Hot flushes can also cause problems at night and night sweats can lead to disturbed sleep and tiredness during the day. Hormonal changes during the menopause can also lead to mood swings, thinning of the skin, loss of interest in sex, an increase in needing to pass urine, and an increased risk of osteoporosis. Some women also experience some depression around the time of the menopause as this signals a definite end to their childbearing years.
Treatment for Menopausal Hot Flushes
Hot flushes and some of the other more troublesome symptoms of the menopause can become very difficult to deal with when they are happening on a daily basis and could last for several years. Some women find it useful to have hormone replacement therapy, which comprises a pill taken each day that contains a small amount of oestrogen. This is just enough to keep the levels of sex hormones in the blood more stable, so avoiding the erratic mood swings and effects on the autonomic nervous system. Treatment does, however, mean that periods, which may have stopped, return on a monthly basis, particularly if small amounts of progesterone are introduced into the last 14 days of the cycle. Some women prefer this to an occasional very heavy period but if you like the idea of avoiding menstruation, some HRT formulations are designed to allow a period only once every three months.
Risks of Hormone Replacement Therapy
Although HRT solves some problems, it is not without risk. Minor symptoms such as fluid retention, the tendency to put on weight, feeling sick and having tender breasts can occur, particularly in the first few months. It does not prevent mood swings completely and it may be necessary to take HRT constantly for about a year before it has any impact on hot flushes. Although HRT may decrease the risk of heart disease and bowel cancer, although the evidence for this is still debated, it definitely can increase the risk of breast cancer and endometrial cancer by a small amount. In the end, the decision whether to have hormone replacement therapy comes down to personal choice.
