Hot flashes are a common symptom of menopause, occurring in up to 80% of menopausal women. While hot flashes are most common during the menopausal transition, some women can continue to experience them many years after menopause. There are several reasons why a 70 year old woman may still have hot flashes:
The primary cause of hot flashes is changing hormone levels during menopause. Estrogen levels decline as women go through menopause, while FSH (follicle stimulating hormone) levels rise. This hormone imbalance affects the hypothalamus, the area of the brain that regulates body temperature. When the hypothalamus gets mixed signals from estrogen and FSH, it can cause blood vessels near the skin’s surface to dilate rapidly, leading to a sudden sensation of heat and sweating.
For most women, hormone levels eventually stabilize post-menopause. However, some women continue to have hormonal imbalances years after menopause that can trigger hot flashes. Even small fluctuations in estrogen and FSH can disrupt thermoregulation in the hypothalamus and cause hot flashes in some women.
Some medical conditions are associated with persistent hot flashes in older women:
– Thyroid disorders – Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can trigger hot flashes. The thyroid gland helps regulate body temperature, so thyroid problems can disrupt normal thermoregulation.
– Diabetes – Uncontrolled diabetes with frequent blood sugar fluctuations may worsen hot flashes. Maintaining normal blood sugar appears to minimize hot flashes.
– Panic disorder – Hot flashes can be associated with panic attacks in some women. The anxiety and rapid heart beat during an attack may be misinterpreted as a hot flash. Treating the panic disorder may alleviate hot flash symptoms.
– Obesity – Body fat appears to influence hormone levels and thermoregulation. Obese postmenopausal women tend to have more severe and frequent hot flash symptoms. Weight loss may help reduce symptoms.
Certain medications commonly used by older women can trigger or worsen hot flashes:
– Blood pressure medications like ACE inhibitors and calcium channel blockers
– Antidepressants, particularly SSRIs and SNRIs
– Chemotherapy agents
– Medications that affect estrogen levels, like tamoxifen and raloxifene
– Opioid pain medications
– Drugs that affect serotonin, like triptans used for migraines
If hot flashes develop after starting a new medication, a woman should talk to her doctor about alternatives that may not have hot flashes as a side effect.
Some lifestyle factors are associated with more frequent or severe hot flashes in menopausal women:
– Stress – Managing stress through relaxation techniques may help reduce hot flash symptoms.
– Spicy foods – Spicy foods may trigger hot flashes in some women by boosting body heat.
– Alcohol – Alcohol consumption can worsen hot flashes. Limiting alcohol may help.
– Caffeine – High caffeine intake has been linked to more severe hot flashes. Reducing caffeine consumption may help alleviate symptoms.
– Smoking – Smoking appears to worsen hot flash severity. Quitting smoking could minimize symptoms.
Making lifestyle changes to avoid trigger factors may help reduce hot flashes. Keeping a symptom diary can help identify personal hot flash triggers.
Previous early menopause
Women who went through menopause at an early age (before age 45) tend to have more persistent and severe hot flashes. The earlier estrogen levels decline, the more dramatic the hormone fluctuations. Early menopause predicts longer-lasting hot flash symptoms.
How do hot flashes feel?
Hot flashes can vary in frequency and severity, but commonly have the following characteristics:
– Sudden onset of intense heat spreading through the upper body and face
– Flushing and redness of the skin
– Profuse sweating after the heat sensation passes
– Rapid heart rate
– Anxiety or sense of panic
– Cold chills as the hot flash subsides
Hot flashes often last from 30 seconds up to several minutes. Some women only have occasional, mild hot flashes. For others, hot flashes can occur multiple times a day and be quite severe.
Night sweats – hot flashes occurring at night – can also disrupt sleep by causing intense sweating and waking up. Getting adequate rest is important for managing hot flashes, so night sweats can exacerbate symptoms.
The unpredictability of hot flashes can take a toll. Women may dread the next sudden, uncomfortable heat wave. Learning to identify personal hot flash triggers can provide a sense of control.
Treatments for hot flashes
There are several medical treatments that may help relieve hot flashes:
Estrogen or progesterone therapy can help stabilize hormones and reduce hot flashes. However, hormone therapy is not appropriate for all women due to risks like blood clots, stroke, and cancer. Lower dose vaginal estrogen is an option with less systemic effects.
Certain antidepressants like SSRIs and SNRIs may decrease hot flash frequency by 45-60%. These include drugs like paroxetine (Paxil), fluoxetine (Prozac), and venlafaxine (Effexor).
The anti-seizure drug gabapentin can reduce hot flash severity by regulating temperature regulation in the hypothalamus. Dizziness and drowsiness are potential side effects.
Clonidine is a blood pressure medication that may decrease hot flash frequency by around 20-50% by impacting norepinephrine levels involved in thermoregulation. Side effects may include dry mouth, drowsiness, dizziness and constipation.
Prescription estrogen creams
Vaginal estrogen creams can treat genitourinary symptoms while minimizing systemic effects. This localized estrogen may help reduce hot flashes.
Lifestyle remedies for hot flashes
Along with medical treatments, lifestyle changes and home remedies may help cool down hot flashes:
Layer lightweight, breathable clothing
– Wear loose, airy natural fabrics like linen and cotton
– Use layers you can take off as needed
– Avoid full coverage pajamas that can trap heat at night
Lower room temperature
– Keep home around 65-72 degrees Fahrenheit
– Use fans and open windows
– Take a cool shower or bath when a hot flash strikes
Try breathing exercises
– Slow, deep breathing can help relax muscles and lower heat
– Yoga and meditation techniques may also help
– Avoid spicy foods, caffeine, alcohol and stress
– Stop smoking
– Practice good sleep habits
Use chilling accessories
– Cold packs, cooling scarves/towels, gel pillows
– Place wrists under cold water
– Use a handheld fan for instant relief
Keeping a symptom diary can help identify your personal hot flash triggers. Avoiding triggers combined with targeted lifestyle changes and medical therapies can help manage bothersome hot flash symptoms. Most women do eventually see a reduction in hot flashes over time.
When to see a doctor
Consult a doctor if:
– Hot flashes interrupt sleep or daily life
– Symptoms persist more than 10 years after menopause
– You have other menopause symptoms like vaginal dryness
– You experience heavy sweating or heart palpitations
– You have signs of an underlying condition like thyroid disorder
While hot flashes are common as women go through the menopausal transition and for several years after, persistent symptoms a decade after menopause warrant a medical evaluation.
Blood tests can check hormone levels and screen for conditions that mimic hot flashes, like thyroid problems.
Based on the evaluation, your doctor can recommend medical therapies or lifestyle changes tailored to your hot flashes. Most women can find relief from troublesome hot flash symptoms with a combination approach.
Hot flashes can linger for years after menopause in some women due to hormone fluctuations, underlying medical conditions, certain medications or lifestyle factors. While hot flashes tend to diminish over time, there are many treatment options available to help manage symptoms, including hormone therapy, antidepressants, blood pressure medications and lifestyle changes.
Keeping track of personal hot flash triggers and timing can help guide treatment. Working with your doctor to find the right balance of medical therapies, trigger avoidance and home remedies can help ease the discomfort of hot flashes and let you live your life uninterrupted.