My Hot Life

Sweating is sexy isn’t it?

I mean look at all the gorgeous female athletes. They sweat. 

I always wanted to be Gabrielle Reese. I mean she’s tall…I’m tall. She is good at volleyball….I like volleyball. She has a rocking body…. Eh well. I guess that’s where the similarities end. But look, when she works out she sweats and it’s sexy as hell. I sweat when I work out. But I also sweat when I am just waiting in line at the grocery store. And hanging out with friends for a drink of wine on the patio. Did I mention it’s 50 degrees on the patio?  No one should be sweating when they are sitting there sipping wine on a casual Tuesday evening. But here I am. Soaking in my own sweat because, well I don’t exactly know why. 

Looking back I can see that this started in my mid 30s. I remember sitting at dinner with my husband one night with sweat dripping from my face. My makeup melting into my chicken fajitas. I could always feel the heat rising. I’m sitting in a meeting, perfectly calm and it starts deep inside,  I just feel hot all of a sudden. It moves to my face and then it’s all over. I can’t get the jacket I wore that day off fast enough. Now I have just made a ruckus in the middle of the meeting and turned the focus from the presentation to moi… mercy, that’s the last place I want people to be looking. But here it is. Me sweating and everyone politely trying to act like I didn’t just take all my clothes off, turning my jacket arms inside out as I ripped it off my sweaty arms. 

What gives? Why do women experience hot flashes. And better question how can I make them go away?

Let’s dig into this:

Perimenopause is the time when the body prepares to move between reproductive and nonreproductive years. This typically begins in a women’s fourth decade and can last for 4 to 10 years. But as I now know, it can begin as early as the mid to late thirties. Looking back I guess that was me! Yay. 

So here’s what happens. As a woman ages the hormones in the ovaries begin the decline. These are the sex hormones. (Oh la la!) estrogen, progesterone and testosterone begin to drop, causing erratic symptoms at best and annoyingly disturbing when they are at their worst. I’m looking at you night sweats! 

So how does this change in hormone levels cause this all of a sudden surge of heat in the body that feels like hells fire has been dropped into your lap? 

The basis of hot flashes lies in abnormal hypothalamic thermoregulatory control resulting in abnormal vasodilatory response to minor elevations of core body temperature. But seriously, what? 

Hot flashes occur from a decrease in estrogen levels. In response to this, your body release higher amounts of other hormones that affect the brain's thermostat (the hypothalamus), causing your body temperature to fluctuate by allowing your body to release heat (the vasodilatory response thingy).

Because of the lower estrogen our body becomes sensitive to very minor changes in body temperature or situations. Changes like stress (oh check), alcohol (yep), spicy food (always) and increased room temperature, among other triggers. Without going into the intricacies of all the hormones involved, let’s just say that this estrogen drop causes the thermostat to say WOAH, HEY. ITS GETTING HOT IN HERE!  And then the other hormones that affect the sympathetic nervous system, the one that causes the body to be able to fight off a giant saber tooth tiger, or maybe more likely run like hell from said tiger to go into overdrive. Since there is no immediate threat or danger, there is no need to jump up and run out of the board room… although you may want to! But the heater has already been signaled and that heat has to go somewhere if it’s not going to your muscles to fight or flee for your life. So it does its job to release the heat and cool you down. But since it not a gradual cooling process you begin to feel the burning in your face and if you’re like me, you sweat it all out. 

Great! Now we know the why, but how do I prevent it? No clue. Kidding, not really. There are some inconvenient, practical tips. Like dressing in layers, which means that cute sweater you want to wear to dinner may not be the best choice, unless it's a cardigan, or zips down the front so you can peel it off in a hurry. If you are in control of the thermostat (not the internal one that is cooling your insides, the one running the AC) turn that puppy down. Always have an ice cold drink handy, preferably water and chug that baby like you just spent four days in the Sahara. 

Alternatives to prevent hot flashes can also include hormone therapy. Bio-identical hormone therapy can increase your levels of estrogen and progesterone in the body, restoring the balance of the internal thermostat to your days of youth, when the only hot flash you recall is the one that happens when you are embarrassed because Michael, that boy you have a crush on, notices you are staring at him. The treatment may help with hot flashes, as well as other symptoms associated with perimenopause, like night sweats and vaginal dryness. Hormone therapy is an individual choice and one that should be made in conjunction with your medical provider.

Other lifestyle choices that can help alleviate hormonal changes associated with menopause include regular daily activity, sound nutrition, adequate hydration, quality sleep and stress management. We will dive into these topics in more depth in the future.

I have not eliminated hot flashes or night sweats completely, however through the lifestyle modifications mentioned above, and a few others I have been able to reduce the severity and frequency significantly. 

If you are like me and want to know more in-depth sciency read on... I have included references so you can dig into some of the info for yourself. I'm not offended, in fact I encourage you to do your own research and follow-up with those you trust.

What the Science Says

Nearly 55% of women in perimenopause, the years leading up to menopause experience hot flashes. Typically they increase in intensity and frequency as women approach menopause, with 85% of women having regular hot flashes in the year leading up to menopause. More than 25% of women will continue to have hot flashes for five years following Menopause, with some lasting for 10 years or more. Come on! Why???

There are differences with respect to ethnicity, geographic location, and socioeconomic factors, however consistent risk factor seen in published studies include obesity, sedentary lifestyle and smoking. Scientist are researching genetic factors but more work needs to be completed.

I find it fascinating that the exact mechanism is still unknown, however women have been having hot flashes since the dawn of time. It is linked to the decrease in estrogen, but exactly how and why our estrogen signals other hormones to trigger the heat response remains elusive. Some authors have suggested that estrogen triggers the release of serotonin in our body (the hormone linked to happiness, among other things). A decrease in estrogen, leads to a decrease in serotonin. Less serotonin leads to increase in release of norepinephrine, which triggers the hypothalamus to do it's thing. The link to serotonin is the reason many medical providers give an antidepressant to women who have symptoms. Does it work? It has been shown to provide very minimal relief, suggesting that there is a more complex cascade of events triggering the hot flash response.

References:

1. Col NF, Guthrie JR, Politi M, Dennerstein L. Duration of vasomotor symptoms in middle-aged women: A longitudinal study. Menopause. 2009;16:453–7.
2. Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol. 2000;152:463–73.
3. Whiteman MK, Staropoli CA, Langenberg PW, McCarter RJ, Kjerulff KH, Flaws JA. Smoking, body mass, and hot flashes in midlife women. Obstet Gynecol. 2003;101:264–72.
4. Freedman RR. Menopausal hot flashes: Mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014;142:115–20.
5. Sturdee DW, Hunter MS, Maki PM, Gupta P, Sassarini J, Stevenson JC, et al. The menopausal hot flush: A review. Climacteric. 2017;20:296–305
6. Sturdee DW, Hunter MS, Maki PM, Gupta P, Sassarini J, Stevenson JC, et al. The menopausal hot flush: A review. Climacteric. 2017;20:296–305.Loprinzi CL, Sloan J, Stearns V, Slack R, Iyengar M, Diekmann B, et al. Newer antidepressants and gabapentin for hot flashes: An individual patient pooled analysis. J Clin Oncol. 2009;27:2831–7.