For any woman enduring the double trouble of hot flushes and night sweats, GP Dawn Harper offers realistic self-help suggestions and weighs the merits of hormone replacement.
A few years ago I could hardly hold a single GP surgery without seeing a menopausal woman wanting to discuss her symptoms and ask me about HRT (hormone replacement therapy).
Then came headline after headline based on the results of The Million Women Study and the Women’s Health Initiative, which threw the safety of HRT into doubt — and quite frankly, scared women witless.
Overnight menopausal women stopped coming to see me. The good news is the pendulum is finally beginning to swing back, but in the meantime thousands of women have suffered in silence.
The average age for menopause in Australia is around 51 years — and a lucky 25 per cent of women sail through with nothing more than the absence of periods to show for it. But that leaves more than seven out of 10 women experiencing a variety of symptoms, with probably the most common being night sweats, hot flushes, and sleep and mood disturbances.
Why do hot flushes happen?
Falling oestrogen levels around the time of menopause trigger a chain of events that alters the chemicals in the brain that regulate body temperature. As a result, the body reacts to tiny variations in temperature which are happening naturally all the time, in a sort of turbo-boosted way, causing the typical hot flushes and night sweats associated with menopause.
You won’t necessarily experience both these symptoms — some women will have just one or the other — and they vary in intensity and duration. They usually affect the upper body, face and hands. I’m always being asked how many weeks, months or years symptoms will last, but I’m afraid that’s crystal ball territory. It’s usually between six months and two years, but some women can have symptoms for years.
What can ease the symptoms?
It very much depends on their severity and their impact on quality of life. Lots of women tell me they can cope with flushes during the day, but the night sweats cause such disruption to their sleep they struggle through the next day. I’ve heard of women whose sweats are so frequent and severe they have to change the bed sheets several times a night.
If the symptoms aren’t too bad, I’m a great believer in trying to tackle them with lifestyle changes in the first instance. This includes easy switches, such as wearing several light layers of clothing during the day so that you can add or remove them depending on how you feel. Natural fibres are more breathable than synthetic. The same goes for bed linen — wherever possible, opt for 100 per cent cotton. If, like many women, you’re constantly throwing off the duvet, try a lighter one, or use two thin ones, so you can continue the layering theme.
Can your diet help?
Dietary changes are worth trying too. Both caffeine and alcohol cause blood vessels to expand, so cutting back on these may help. Avoiding spicy foods is a good idea, as these can make anyone hot!
Interestingly, there’s no direct translation for the term ‘hot flush’ in the Japanese language. It’s thought Japanese women suffer much less than their Western counterparts because of their high soy intake (soy is a natural plant oestrogen that may mimic the action of human oestrogen in some women). Good sources of plant oestrogens include tofu, lentils, chickpeas and beans, whole grains (oats, barley and brown rice), and a range of leafy green vegetables.
What about exercise?
Women who exercise regularly also seem to have fewer flushes than those who don’t, so that’s another good reason for staying fit. Be aware, though, that if you take up exercising as you hit menopause, the flushes may temporarily worsen.
As with most conditions, being overweight and smoking are likely to make hot flushes worse, so menopause is a good time to think positively and aim for healthier habits.
What’s the deal with HRT?
HRT isn’t a huge problem, contrary to what you might have heard. In fact, for some women it’s a ‘lifesaver’, not least for the improvement it can make to disruptive mood swings. I have one patient who tells me she’s convinced that without HRT she’d be jobless, friendless and divorced!
As falling levels of oestrogen are responsible for menopause symptoms, it stands to reason that replacing the lost hormone will help resolve the problem. However, oestrogen alone causes the womb lining to thicken and can increase the risk of womb cancer. This thickening is prevented by adding progestogen to the medication, so women who still have their womb may take a combination of the hormones.
HRT comes in different forms — you may use patches, tablets or creams. Choosing the right formulation is a bit like choosing a little black dress. What suits one woman just doesn’t work for another. One thing’s for sure: HRT is an extremely effective way of treating hot flushes and night sweats. Many women say it can start working within days (although it can take up to three months to achieve the maximum benefit). I usually see women a month after they start on HRT, and many are looking and feeling better already.
So why the scary headlines?
Negative press around HRT did have a basis — that is, prolonged use of HRT increases the risk of blood clots, and breast and ovarian cancers. If you have other risk factors for these conditions, HRT may not be right for you — but don’t let that put you off at least having the discussion with your GP.
Are there natural alternatives?
Plant oestrogens (also known as phytoestrogens) found in legumes, soy products, whole grains and seeds may help reduce flushes. Interestingly, the amount of active ingredient absorbed from these foods varies hugely from woman to woman. This is partly down to the variation in gut flora, so I usually advise women to take a daily probiotic to improve the health of their gut microbiome, and as a result increase their absorption of phytoestrogen.
Supplements such as black cohosh, which is derived from the root of the buttercup family, may help reduce flushes and sweats for some women. The evidence is mixed, with some studies showing their benefit and others not. Anecdotally, many of my patients have had great results with this, and with red clover. If you’re considering a herbal supplement, always talk it through with your doctor, however, as it may affect other medications you’re taking.
I’ve also had good results using an old-fashioned blood pressure treatment called clonidine. It doesn’t work for everyone, but if you are struggling and don’t want to take hormones, it may be worth asking your GP about it.
Seize the day!
In any case, don’t suffer in silence. If flushes and sweats are ruining your sleep and your life, make an appointment to see your GP and at least have the conversation. A short course of low-dose HRT may be all it takes to get your life back on track, and if HRT isn’t for you, your doctor will be able to talk you through all the options.
51 years is the average age of menopause in Australia.