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hot flash

Menopause:
Anatomy of a hot flash

By Carolyn R. Schatz and
Celeste Robb-Nicholson, M.D.
Newsweek International
 


Hot flashes are no joke when they leave you soaked in sweat and feeling dazed. Technically, hot flashes exaggerate how the body normally cools down: blood vessels dilate, letting more blood reach the skin to release heat. They tend to come on rapidly and last from one to five minutes. They range in severity from a fleeting sense of warmth to a feeling of being on fire. Some women have just a few during a week; others get them day and night.
 
 

May 8, 2006

For American women, vasomotor symptoms are common around menopause, but the experience isn't universal: fewer Japanese, Korean and Southeast Asian women report having hot flashes. Scientists say such differences may reflect cultural variations in lifestyle, semantics and attitudes. Genetics could be involved. Smoking and obesity increase the likelihood of hot flashes, for unknown reasons.

Researchers have studied the physiology of hot flashes for more than 30 years but still don't know exactly how or why they occur. Scientist Robert R. Freedman and his colleagues at Detroit's Wayne State University School of Medicine have measured skin temperature, blood flow, heart rate and sweating in menopausal women before, during and after hot flashes. They've found that women who experience hot flashes have a much lower tolerance for small increases in the body's innermost, or core, temperature. Normally, core temperature stays in a thermoneutral zone, above which we sweat and below which we shiver. In some women the thermoneutral zone is exceptionally narrow, and small fluctuations in core body temperature will give them hot flashes.

What narrows the thermoneutral zone? One possibility is elevated levels of the brain chemical norepinephrine, which may act on the hypothalamus, the part of the brain that regulates the body's thermostat. The decline in estrogen during menopause may somehow affect norepinephrine levels. Brain norepinephrine levels may be higher in women who have hot flashes than in those who don't. In animal experiments, increased brain norepinephrine narrows the thermoneutral zone. Conversely, the antihypertensive drug clonidine, which lowers norepinephrine, widens the zone in women with hot flashes. Estrogen and certain antidepressants also widen the zone, though scientists don't understand the exact mechanisms.

Since hot flashes are triggered by increases in core body temperature, try to stay cool — literally. Drink cold drinks, use air conditioners (especially at night), carry a fan and dress in layers that you can shed. The best medical treatment is estrogen, though many women can't or don't want to take it. A good alternative is deep, controlled breathing: inhale and exhale slowly, allowing your abdomen to expand and contract, at a rate of six or seven full breaths per minute. You can often stop a hot flash with a few deep breaths.

Schatz and Robb-Nicholson are the editor and editor in chief of the Harvard Women's Health Watch. For more info on hot flashes, go to health.harvard.edu/NEWSWEEK.

© 2006 Newsweek, Inc.
© 2006 MSNBC.com