Hot flashes, they are hard to describe and women experience them differently, and it's been a really long, hot summer. But what if that summer lasted 15 years?
All women who live long enough and it really isn't all that long, just to about 51, will have their ovaries stop working. When that happens, estrogen levels fall. And about 85 percent of women who make that transition from ovaries on to ovaries off will experience hot flashes.
The baby boomers, formerly the largest generation in the U.S., now replaced by the millennials, are aging and 6,000 women in the U.S. enter menopause each day. By the year 2020, coming right up, about 50 million women in the U.S. will be post-menopausal, one-third of all women in the U.S.
Symptoms Associated with Hot Flashes
The two signature symptoms of estrogen withdrawl are hot flashes and vaginal dryness, and both are treated pretty well by estrogen. Many women are not distressed by these symptoms and good for them.
But AARP, formerly the American Association of Retired Persons—but as not all members are retired, they are just AARP—anyway, AARP did a menopause survey of their female members between 60 and 69, and 72 percent said that menopausal symptoms interfered with their lives and eight percent said it interfered a great deal.
Now, these women were actually about 10 years from their menopause. And when their ovaries stopped working 10 years ago and they're still having symptoms, 20 percent said that they had vaginal dryness, 24 percent had hot flashes, and 23 percent night sweats. Of course, some had all three symptoms and some had none.
Women with severe hot flashes typically experience them for seven to 15 years, and 15 percent of women with severe hot flashes experience them for more than 15 years. Now, what in the brain makes this hot flash happen? Do only women get them?
Studying the Neuroscience of Hot Flashes
Recently, some very cool research on hot flashes was done in mice, and they found that the KISS1 neurons, kiss isn't that cool, KISS1 neurons that are part of the brain that make up the ovaries and testes work, so these KISS1 neurons make the ovaries and testes work, actually have their feet on the ground in the part of the brain that controls temperature.
These KISS1 neurons in mice work the same way that those neurons work in humans. Activating KISS1 neurons initiated a fast rise in the mouse's skin temperature followed by a drop in core body temperature. The same symptoms occurred in male and female mice. Removing the female mouse's ovaries made this temperature swing worse. We know that men that had their testes removed or who take medication for prostate cancer that makes the testes stop working can have hot flashes.
Now, we don't know if the mice who experienced these changes in their body temperature experienced distress, but some other studies suggest that they seek out cooler places in their cages. We don't know if they have spikes in anxiety or irritability, or if they're having hot flashes and they're getting angry, but that would be an interesting experiment to do.
Hot flashes at menopause may have more complex neuron functions than just KISS1, and about 15 percent of normal women never have hot flashes with menopause. So it's complicated. But understanding some of the brain's mechanisms might help us to think about new therapies.
Coping with Hot Flashes and When to Seek Help
Now, back to that survey from AARP, 46% of the women surveyed said that they had never discussed menopause with a health care provider, and only 1 in 12 had been referred to a menopause specialist. So what's the takeaway from all these numbers?
One, most women who experience menopause will have hot flashes.
Two, most women who experience hot flashes will tolerate them.
Three, most women with hot flashes will find that their flashes decrease in a couple of years. That sounds like a long time to me in a long, hot summer with hot nights.
Four, about one in eight women will have significant distress from their hot flashes and they'll go on for a long time. For 50 million women who will be post-menopausal in 2020, one in eight of 50 million is a lot of women.
Five, women who bring to their experience of menopause all the physical, social, cultural, environmental, emotional, financial, and spiritual experiences. In other words, hot flashes can be wrapped up in all of the seven domains of women's health.
Six, there are quite a few options other than estrogen, which works best, for managing hot flashes, and most clinicians don't know about all of the options.
Seven, if you are suffering from hot flashes that seem to go on and on and on, the longest summer ever, talk to your clinician. Ask them what is their training in menopause and ask what they know about different options. If you try some of the options they offer and you're not getting better, or if you don't like the side effects of the options, you should seek out a menopause specialist.
Eight and last, many specialists called reproductive endocrinologists have training in menopause. And some physicians, primary care providers and OB/GYN's have a special interest in understanding menopause and caring for women who are having difficulties. Some clinicians have made it their special interest in their practice. It could be a search, but your doctor probably knows where you can get help.
At University of Utah Health, you can use our app for finding a doctor who has an interest in treating menopause symptoms. That will get you started. The most important thing is that we're learning more and developing and understanding new options. So no big sweat, and thanks for joining us on The Scope.
updated: November 12, 2020
originally published: September 6, 2018
