Q&A: Hot Flashes

What is a hot flash?

That is a sudden wave of heat that goes up from the waist. You get red and sweat, and when it goes down, you get cold and shivering. A hot flash can occur at any time, during the day or at night. It lasts from half a minute to half an hour and can occur several times in one day, but also only once a week. At night it can wake you up and in the worst case it can make you sweat so much that you have to change the sheets. Insomnia can result.

What causes hot flashes?

In all women, the production of the sex hormone estrogen declines in the period prior to the last menstrual period, which for most women falls between the ages of 45 and 55. Due to the disturbance in the balance between sex hormones – in which the drop in estrogen levels plays a role – and the nervous system, some blood vessels dilate when this is not necessary. About three quarters of women experience hot flashes during the menopause. Testosterone levels are low in 20 to 30 percent of men between the ages of 60 and 80. Only a few of them get hot flashes.

What can I do myself?

You can try to reduce the effects of the hot flash, for example by sleeping in a cold bedroom or by putting on several layers of clothing so that something can come out during a hot flash. Drinking something cold at the beginning of a hot flash can provide relief. Some people experience fewer hot flashes if they avoid stress, caffeine, alcohol, and spicy foods.

How long do hot flashes last?

Some women only have symptoms for a few months, but in most women the symptoms disappear within two years after the last menstrual period. A small proportion of women continue to have hot flashes for up to ten years after their last menstrual period.

What medicines are there?

Estrogen helps to reduce hot flashes in 70 to 90 percent of women. But those who take estrogen for more than a year around the menopause have an increased risk of breast cancer. Because estrogen makes the endometrium grow and therefore the risk of uterine cancer increases, it is recommended to also use the hormone progestogen every month. As a result, blood loss occurs once a month. To have less frequent bleeding, some women use progestin once every three months. This is not recommended: there are indications that this also increases the risk of uterine cancer. There are also tablets that contain both estrogen and progestin. Most women who start taking the tablets after they have not menstruated for several years do not have monthly bleeding. The risk of uterine cancer is the same as with the separate estrogen and progestogen tablets. There are patches for women who prefer not to take tablets, but they offer no other benefits. For men with a testosterone deficiency, it is being investigated whether testosterone helps against menopausal symptoms.

Are you only postponing hot flashes by using hormones?

New. It is a myth that you will still get your share if you stop. For most women, hot flashes are over within two years of the last menstrual period – whether you’re on hormones or not. It is recommended to stop half a year to a year after the start of treatment. If the hot flashes don’t return within two months, you’re ‘through the menopause’. Otherwise you can take it again for a while and then stop again.

Are There Alternatives to Estrogen?

Isoflavones are mentioned as an alternative (see phytoestrogens on p. 69). They have about the same effect as estrogen, but they are much weaker. In studies, women who receive 30 to 100 mg of isoflavones per day have fewer and less severe hot flashes. However, the differences with a fake pill are minor. Isoflavones are found in soybeans and products such as soy milk, tofu (tofu) and tempeh. They are also offered in tablet form.

Want to know more about menopause & hot flashes?

Read more about menopause in our menopause special