The most common menopause-related discomfort is the hot flash (sometimes called a hot flush). Although their exact cause still isn’t fully understood, hot flashes are thought to be the result of changes in the hypothalamus, the part of the brain that regulates the body’s temperature. If the hypothalamus mistakenly senses that a woman is too warm, it starts a chain of events to cool her down. Blood vessels near the surface of the skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat. This produces a red, flushed look to the face and neck in light-skinned women. It may also make a woman perspire to cool the body down. The heart may beat faster, and women may sense that rapid heartbeat. A cold chill often follows a hot flash. A few women experience only the chill.
Most women experience hot flashes for 6 months to 2 years, although some reports suggest that they last considerably longer—as long as 10 years, depending on when they began. For a small proportion of women, they may never go away. It is not uncommon for women to experience a recurrence of hot flashes more than 10 years after menopause, even into their 70s or beyond. There is no reliable way of predicting when they will start—or stop.
Menopause is a fact of life for every woman around the world. However, the physical and mental impact of this physiologic inevitability varies both within and across all cultures. While there is no universal menopause experience, it can mark the beginning of an exciting new time of life for all women.
Get the checkups you need and maintain a healthy lifestyle. The risks of osteoporosis, heart disease, diabetes, and cancer all rise after menopause. Most women visit their primary care doctor or gynecologist once a year for a “well-woman visit,” which insurance now covers with no co-pay. Even height, weight, and blood pressure checks at your visit reveal a lot about your health risks, and you and your healthcare team can discuss other tests you might need, such as cholesterol measurements, PAP tests, and mammograms. Physical inactivity, obesity, and unhealthy eating, smoking, and excessive alcohol consumption increase the risk of heart disease, stroke, diabetes, and cancer. The evidence continues to grow that getting active, losing excess weight, and healthy habits can reduce these risks.
Although the available treatments for hot flashes do not cure hot flashes, they do offer relief. Hot flashes usually fade away eventually without treatment, and no treatment is necessary unless hot flashes are bothersome. A few women have an occasional hot flash forever. There are a number of low-risk coping strategies and lifestyle changes that may be helpful for managing hot flashes, but if hot flashes remain very disruptive, prescription therapy may be considered. Prescription hormone therapy (HT) approved by the US Food and Drug Administration (FDA) and by Health Canada include systemic estrogen therapy (ET) and estrogen-progestogen therapy (EPT; for women with a uterus)—are the standard treatment. Another FDA-approved hormone product, for women with a uterus, combines estrogen with bazedoxifene instead of a progestogen. Bazedoxifene is an estrogen agonist/antagonist, which means that it works like estrogen in some tissues while inhibiting estrogen activity in others. In this case, it helps to protect the uterus from cancer.
For women who prefer not to take hormones or cannot hormones, nonhormone drugs approved to treat depression, called selective serotonin-reuptake inhibitors (SSRIs), have been found to be effective in treating hot flashes in women who don’t have depression. The only SSRI FDA has approved thus far for treating hot flashes is paroxetine 7.5 mg.
The North American Menopause Society maintains a search feature on this Web site for those women in the United States or Canada who are searching for physicians and other healthcare providers interested in helping them manage their health through menopause and beyond. Those who have passed a competency examination leading to the prestigious credential of NAMS Certified Menopause Practitioner are noted in the displayed results.
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