Hot Flashes & Hormones
Hot Flashes & Hormones Next there are hot flashes and night sweats, or “vasomotor” symptoms. These are related to your fluctuating hormones, especially estrogen, and can be very disturbing of your sleep and daily activities. Your thermostat becomes very touchy and does not tolerate over a degree of fluctuation before it responds to cool your core temperature down. Hence the flushing and sweating occurs. The symptoms are usually worse before a period, in times of stress, and at first are worse at night. Caffeine, simple sugar, alcohol, and a sudden burst of activity will bring them on. A diet high in saturated fat will make them worse, as well as even mild dehydration. Remembering to dress in layers, limit sugar and caffeine intake, and drinking 80-100 oz. of water a day will make you less symptomatic. Flannel pajamas are no longer needed. Regular exercise will help you handle the symptoms better. Keep your weight healthy; fat acts like insulation and makes you warmer. “Doing the basics better” applies here big time. Studies show that quiet metered breathing (or meditation) for five minutes, twice a day, leads to fewer symptoms. If the symptoms interfere with your day or your sleep to the point of leaving you distracted, having poor concentration, or increased depressive or anxious feelings, hormone supplementation can be effective in very low doses. There are rules about safe dosing; your health care provider can determine what is best for you. Be very aware your needs will change throughout your roller coaster ride of perimenopause. It is not unusual to frequently change doses; be prepared to be flexible, as should your health care provider. Hot flashes and night sweats are the most common symptoms of perimenopause. It depends on where you are in the process, but they can be quite disturbing. At first they can be very sporadic and easily written off to too many covers or a warm bed partner. The day time flashes can start coming at any time; during a stressful meeting or presentation, with a sudden burst of activity, or as you are ready to go out the door. They can be minor or completely overwhelming. Why do these happen? Because, hormones levels are changing. Estrogen is not the only culprit; levels of less known hormones such as inhibin have been shown to correlate with symptoms. It is a complicated story which we do not completely understand. However, the estrogen related change in our thermoneutral zone as described by Dr. Freedman, of Wayne State School of Medicine, has helped us understand and therefore treat the symptoms. When we are in the middle of nice even cycles, hormones are in balance. Our bodies maintain an even temperature and changes within several degrees do not cause much of a response. We do not sweat or chill at moments notice. However, as the hormone balance changes, our thermostat becomes brittle and there is no more neutral. External factors such as our body weight, flannel pj’s, a warm room, etc. can make us red in the face, very uncomfortable, and for some, visibly wet with sweat. Studies have shown estrogen, progesterone, and clonidine to widen our thermoneutral zone, and lower serotonin levels to narrow the zone. What to do first …. Then there is the issue of using hormones to make us feel better. We know that for most women, low doses of hormones are very helpful. They are clearly shown to help quality of life; they help with sleep, hot flashes, night sweats, and also menstrual migraines and PMS. A philosophy many of us providers follow is of using the birth control pill in perimenopause especially if birth control is needed. If that is not a concern, low dose estrogen and progesterone prescribed in a number of ways can successfully treat symptoms. Bioidentical hormones can be attractive; it just sounds better. These are formulated to be chemically identical to your own natural hormones. The problem is, many do not survive the acid in your stomach and can not be absorbed in pill form. Therefore, they must be put into creams and gels. Some are not tested for effectiveness or FDA-approved for safety. You must know the source. Hormones can be safe and very effective. To know whether they are right for you needs to come from an individualized discussion with your provider. Conditions such as personal or family history of blood clots, known heart disease, migraine with aura, known breast cancer, abnormal bleeding before testing, known heart disease such as heart attack or stroke, liver dysfunction, or pregnancy are general contradiction to using hormones. Contact us at whn@mmpc.com or (616) 726-8520. Be sure to read our "Letters from the Edge." |
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by Diana Bitner, MD
