Hot Flashes

Hot flashes are one of the hallmarks of perimenopause. They involve temporary but recurring episodes of flushing with a sensation of warmth or heat on the upper body and face. Hot flashes are reported by as many as 75% of perimenopausal women in the United States. Some hot flashes are easily tolerated, others are annoying or embarrassing, and others can be debilitating.

Menopause-related hot flashes typically follow a consistent pattern unique to each woman. Their frequency usually increases during perimenopause, peaks during the first 2 years of postmenopause, and then declines over time. Most women experience hot flashes for 6 months to 2 years, although some studies suggest that the average period is as long as 3 to 5 years. In some women, hot flashes linger for 10 years or more, and older women are known to have occasional hot flashes.

Women who experience abrupt menopause when their ovaries are surgically removed often suffer severe hot flashes that start right after surgery and typically last longer than those in women who undergo natural menopause.

Hot flashes often occur during sleep, producing intense perspiration known as night sweats.

What’s the connection to sex? Studies have shown that severe hot flashes can be negatively associated with sexual activity. Hot flashes can contribute to sexual problems in any number of ways:

• Simple sweatiness. The sensation of heat brought on by hot flashes can be so intense and unpleasant that the idea of intimacy or being sexual may be inconceivable around the time that flashes occur. Being red and sweaty just doesn’t feel sexy.
• Sleep disturbances and reduced energy. Although studies have not shown a clear cause-and-effect relationship between hot flashes and sleep disturbance, nighttime hot flashes and night sweats certainly do not make for restful sleep. The result can be fatigue and less energy for sex.
• Less closeness in bed. Women who used to enjoy sleeping close to their partner may find that their partner’s body heat triggers hot flashes. For some couples, differences over what’s a comfortable bedroom temperature can lead to sleeping in separate rooms.
• General negative effect on quality of life. Severe hot flashes have been found to take a toll on women’s social function, energy level, concentration, and overall quality of life. They also can intensify underlying symptoms of depression. Under these circumstances, women may not feel motivated to have sex.

Hope for hot flashes. Although available treatments may not eliminate all hot flashes, they can offer enough symptom relief to make a big difference in many women’s quality of life and interest in sex. These treatments include lifestyle changes, nonprescription remedies, hormone therapy (with estrogen plus progestogen, or estrogen alone  for women without a uterus), and nonhormonal prescription drugs. However, only hormone therapy and Brisdelle, an antidepressant, have received government approval in North America for treating hot flashes. Because of risks of hormone therapy, its use should be limited to the shortest duration consistent with an individual woman’s treatment goals and benefits.  For more on weighing the benefits and risks of hormone therapy, see “Hormone Therapy: The Benefits & Risks” on The North American Menopause Society website.

If you are having difficulty finding a healthcare provider who is especially interested in managing hot flashes and other menopause-related symptoms, look for the initials “NCMP” after the provider’s name and degree. The NCMP credential means a provider has earned the NAMS Certified Menopause Practitioner certification, which demonstrates that he or she has passed a rigorous exam in menopause-specific practice. The NAMS website includes a geographic directory of all NCMP-certified providers in North America.