Hot flushes: 5 burning questions answered

Today's topic

Today on A.Vogel Talks Menopause, I'm going to be telling you about five common questions that I'm always asked about hot flushes and sweats.

So, hot flushes and night sweats are the most common symptom of the menopause. Seventy-five per cent of women will experience them at some point along the way. But there can be different sorts and types of flushes and sweats.

So, I thought I would go through the five main questions I tend to get asked on a regular basis.

Q1. Why are hot flushes worse at night?

This is not so much about night sweats after you've gone to bed, but a lot of women find that after their evening meal, just as they're winding down, the hot flushes or the sweats will kick in with a vengeance. The problem here, in the menopause, is that things can accumulate during the day, and it can be things that you wouldn't normally associate with sweats or flushes.

That accumulation that occurs all the time basically hits a peak in the evening. And this is why symptoms can sometimes be a lot worse. The things that you would be looking for are dehydration, the amount of caffeine that you're drinking, the amount of stress you're under, and what you maybe ate (or didn't eat) along with your evening meal.

So, it's about looking at your whole day - what's going on in your day that might have an adverse effect on your nervous system, on your digestion, or on your general mood. And all of those put together, in turn, can stress the nervous system to the point where your hot flushes or sweats will really, really kick in.

You can do a little diary. I love diaries because, very often, they can pinpoint what's going on and this then makes it easier to sort. One of the main things that certainly can help is looking at your evening meal, your last glass of wine, or your last cup of coffee.

And it's amazing how many women come back and say, "I've given up my after-dinner cup of coffee and that has made such a difference”. So, with your evening meal, just remember, not too many stimulating foods, so that would be things like spicy foods. High salt and sugar foods can also be real culprits for flushes and sweats. And just watch what you're drinking in the evening as well.

If you find that things are happening during the day, you're getting very stressed, if you're skipping meals, if you're not drinking enough water, then these things need to be addressed as well. And you may find, by doing that, that the night time ones will ease off, too, which obviously is a really good thing.

Q2. Can hot flushes stop and start again?

Our second question is, "Can flushes stop and start?" By that, I mean could you get them in the first year of the menopause and then find that they disappear, and then another year or two they come back again? And the answer is yes. From the minute your hormones start to change (so that's in the peri-menopause, until they really start to tail off at the back of the menopause) they don't necessarily fall in a nice, orderly manner.

So, the menopause and peri-menopause are not static states. Your hormones can fluctuate. So, your hormones can rise a bit, they can drop really suddenly, they can spring up very suddenly. And these changes, when they occur, can trigger certain symptoms, and you might find that there are times in the peri-menopause and the menopause where everything tails off nicely.

And you think, "My goodness, that's it!” and then, six months later, everything just starts up again. One of the main reasons for this is just the fact that your hormones are doing a little bit more shifting at that point; that's putting extra stress on your body and that, in turn, is going to trigger your flushes and your sweats.

Q3. Is it normal to feel cold after a hot flush?

It seems a bit strange. One minute, you're boiling, and, the next minute, you're shivering. Hot flushes arise because your body's ability to control its internal temperature basically goes wonky. It's a little bit like your gas thermostat going offline and the boiler ends up firing at all different times of the day when it shouldn't be.

So, when this happens, your body is basically saying, "I am far too hot!" and that process triggers blood to rush to the skin in order to cool you off. So, blood comes from the internal core of the body and ends up going onto the skin. When it hits the skin, the air cools the blood, which then goes back into the body. This is what cools you down.

For some women, that process then induces sweating on the skin, too. And, if you end up sweating on the skin or creating perspiration, that will cool you down even quicker. It's that cooling down process that then makes you feel really, really cold straight afterwards.

This tends to happen more with night sweats rather than day flushes. But, for those of you who are experiencing this, the only real way of coping with it is to wear layers so, when you get really hot, you can take your cardigan or your jumper off. And then, once you feel that the coolness is coming back in, just cover yourself back up again.

Q4. Why do I feel nauseous before a hot flush?

This is such a common one. This is nausea either just before a flush or just after a flush. I’ve done a whole video blog on this so, if you want an in-depth explanation, please do have a look. But this can be caused by a variety of factors.

It can be due to the fact that your blood sugar is too low, it could be because you're dehydrated, it could be because your blood pressure has dropped really quickly, and it could also be due to the fact that you've got a stressed liver.

So, this is another situation for the diary. If you are getting nausea and flushes, especially if they're happening at the same time every day then, very often, there is a trigger beforehand. It may be that you've just not eaten for a long time so your blood sugars are really low; it could be maybe you've had a cup of coffee. It could be even that you're just feeling really, really down and really tired. Or, something like having a heavy meal could have stressed your liver, so you can certainly check that one out a bit more if you're experiencing this regularly.

Q5. Can you still get hot flushes years after menopause?

Yes, you can do. And one of the interesting things that we've found over the years is that more and more women seem to be experiencing an extended menopause, so they're getting symptoms well after their period has stopped.

For some women, it's just really unfortunate if you're one of the minority where the menopause goes on and on for quite a long time. For other women, it can be due to other health issues, and this is where it's really important if, say four or five years after your periods have stopped, you're still getting flushes or night sweats. In this case it's a good idea just to double-check with your doctor.

Again, it could be to do with stress, or it could be to do with low vitamin D, especially if you're getting sweats and flushes that are occurring just above the neckline. So this could be due to some other health issues like poor thyroid function. Low iron can also cause flushes, so just get this one double-checked by your doctor first of all, to rule out anything else that might be going on.

So, I hope this was of interest to you. If any of you out there are thinking, "Wow, I haven't experienced any of those types of flushes, but here's the one that I'm having problems with,” just let me know. You can make a note in the comments section below and I'll be more than happy to answer for you.