Disrupted sleep, irritability, sweats, rapid heart rate — 67-year-old Nora Barler has battled extreme hot flashes for three decades, ever since having a total hysterectomy in her late 30s that removed her uterus and ovaries.
When her hot flashes began, she was working in human resources as a labor and employee relations manager and felt self-conscious when one would strike during meetings. “I was in meetings with high-level executives, at times the only woman, and I would start sweating up a storm. Beads of sweat would be dripping into my contact lenses, burning my eyes and [running] down my face. My makeup would be smearing. I could feel my heart going boom, boom, boom,” she recalls.
The hot flashes also regularly struck at night, despite Barler enlisting central air conditioning, a window unit in the bedroom and two fans. “When they were really bad at night, I used cold packs I kept in the freezer. It sounds over the top, but that’s how it often was. My husband was freezing, and I kept him awake. And because I didn’t sleep, I was exhausted when I went to work. I was irritable and antsy.”
Hot flashes during menopause are a fact of life for most women. They come on rapidly and then spontaneously resolve after a few minutes, explains Barbara Soltes, MD, an endocrinologist at Rush University Medical Center.
“[Women] feel a sensation of heat or a flush over the upper part of their bodies, which subsides in minutes and is followed by perspiration down their face,” she says. “It is associated with an increase in heart rate and skin temperature, which also subsides in minutes.”
I would start sweating up a storm. Beads of sweat would be dripping into my contact lenses, burning my eyes and [running] down my face. My makeup would be smearing. I could feel my heart going boom, boom, boom.”
Hot flashes during the day can interrupt work or other activities. At night, they can disrupt sleep, which can kick off a cascade of complications: lower energy levels, lower cognition levels, fatigue and irritability. Hot flash symptoms can persist for seven to 11 years or more, according to the long-term Study of Women’s Health Across the Nation (SWAN).
Treatment options include:
Estrogen replacement is very effective at easing hot flashes, but women should discuss hormone replacement therapy with their physician because of the risks. Research has found that women who used hormone treatments had a higher risk of cancer, heart disease, stroke and blood clots.
Estrogen can be valuable as a short-term treatment for women experiencing hot flashes and night sweats, according to the National Institute on Aging. Estrogen replacement therapy, which is approved by the Food and Drug Administration (FDA), comes as a pill, patch, gel, topical spray or vaginal ring. The pellet form is not FDA-approved.
“Provided there are no significant risk factors such as active heart disease, estrogen-dependent cancer or a history of blood clots, we will start at a low dose of bio-identical hormone replacement,” Soltes says. After six to eight weeks, the dose may be adjusted.
Certain antidepressants — in particular, selective serotonin reuptake inhibitors (SSRIs) — prescribed in a low dose can help reduce hot flashes. They act by altering the brain neurotransmitters involved in temperature regulation. Low-dose paroxetine (Brisdelle) is the only FDA-approved SSRI for treatment of hot flashes.
Clonidine, a blood pressure medication, and gabapentin, prescribed for seizures and pain, are also used to relieve hot flashes, although they are used off-label.
If hot flashes are not severe, some women take the herb black cohosh or bee pollen, though research studies have been small and have had mixed results. “There has been quite a bit of research on herbal therapies, most of which do not provide more symptomatic relief than a placebo,” Soltes says. “Black cohosh has been the only herb that seems to have estrogen-like qualities, which may be effective in providing relief for at least six months.”
Weekly acupuncture treatments may also be effective, she says. Acupuncture has been shown to reduce the frequency of hot flashes, although it does not work for all women, according to a 2016 study from Wake Forest Baptist Medical Center published in the journal Menopause.
Lifestyle measures include avoiding caffeine, alcohol and spicy foods, adopting stress-reduction techniques and dressing in layers of cotton clothing, Soltes says.
New numbing research
David Walega, MD, associate professor of anesthesiology and pain management at Northwestern University’s Feinberg School of Medicine, has been researching new treatment options.
His 2013 study of a numbing medicine, injected in the neck, showed promising results on a small sample of women. Half of the women received an injection of bupivacaine hydrochloride — a local anesthetic that blocks nerves and can alleviate pain — into the stellate ganglion, a nerve bundle in the neck. The other half received a placebo injection.
Women who received the real injection had a 52% decrease in their moderate to severe hot flashes at the six-month follow-up — a statistically strong effect, Walega says. “Secondarily, we saw trends of improved depression and anxiety scores and also observed improved verbal learning on cognition testing in the treatment group but no improvement in the placebo group,” he says. The study showed that benefits of the injection lasted at least six months. In some cases, Walega has seen benefits last as long as 18 months.
Walega and his team are working on a similar study of the numbing injection with a larger group of women. He hopes that the results, expected in about three years, will give women a safe option to effectively treat their debilitating hot flashes.
Turning down the heat
Barler participated in Walega’s study. She had tried hormone pills and hormone patches. The pills didn’t work for her, and the patches were expensive, not covered by her insurance and had some cancer risks.
When nothing seemed to help, Walega’s numbing injection did. It was a “life-changer,” Barler says. Although the pilot study has ended, she continues to get the injections and has gone as long as two years between injections.
Barler has changed from constantly being hot to being comfortable. “I used to wear shorts and tank tops at home, even in winter,” she says. “Now I wear long-sleeve sweatshirts, yoga pants and warm socks around the house.”
While hot flashes can still be debilitating to many women, the hope is that new research will take the heat off of menopause.
By Nancy Maes