Struggling with hot flushes? Don’t know what you can do about them?
As part of our Lunch & Learn webinar series, we were joined by Dr Tonye Wokoma of The Menopause Centre.
Henpicked: Let’s start with the basics. What are hot flushes?
Dr Tonye Wokoma: There isn’t a single answer to that, everybody describes them differently. Some say it’s a feeling of sudden unpredictable heat inside, for some it rises up and they feel a warmth. Some even get cold flushes. So it’s very different for different women.
The body is a finely tuned thermostat. When our hormones start changing then our temperature control mechanism changes as well. Any slight change in temperature sees our body adjust, for example with changes in circulation. The body then says ‘hang on, I’m too hot’ and wants to cool down.
Henpicked: They can cause a lot of concern, many people feel embarrassed about hot flushes don’t they?
Dr Tonye Wokoma: Yes, they can have a huge impact. For some people there are certain triggers that they’re aware of. But for others it’s unpredictable. Imagine you’re sitting in an important meeting and a hot flush that comes over you. This can have an impact. You start getting flustered, you don’t know what to do next, so you start getting anxious and sweating. It’s not a pleasant experience.
Sometimes it can lead to downward spiral and chips away at your confidence. It gets so bad in some women they don’t leave their houses for fear of what may happen.
Henpicked: Are there any common triggers?
Dr Tonye Wokoma: Hot flushes can be triggered by activity or stressful events, or the anticipation of stressful events. There are other things like caffeine, spicy food and alcohol which women report as being triggers. It’s a good idea to keep a diary of hot flushes. When do they happen, how often, for how long, what might bring them on? This can help you to identify your triggers. The great thing with a diary is you can see when things start to improve, as well.
Henpicked: Are some of us more prone to hot flushes? Can I predict if I’ll get them or not?
Dr Tonye Wokoma: They affect women all over the world. In fact, hot flushes and night sweats are the most commonly reported menopause symptom. We can’t exactly say who will and won’t get them but we do know that things like obesity and smoking can make it worse.
Henpicked: At what stage could somebody experience hot flushes?
Dr Tonye Wokoma: They can begin in perimenopause, the time leading up to your menopause. They can go on for years – four to eight years but some people have flushes forever and some lucky people don’t get any at all! For those struggling, taking the steps I’ve outlined can help.
Henpicked: Does body temperature actually rise or is it perception?
Dr Tonye Wokoma: A lot of people are worrying about this at the moment due to Covid, if they’re having their temperature taken. But your temperature doesn’t rise more than a tiny bit, it’s just that your adjustment mechanism has changed. The range at which your body will kick in and do something is much smaller.
Henpicked: Are hot flushes and night sweats the same thing – is the treatment the same?
Dr Tonye Wokoma: They are collectively known as vasomotor symptoms, all due to our temperature control mechanism and the treatment is same thing. If you’re struggling at night there are things like cooling pillows and breathable nightwear which could help.
Henpicked: For those struggling, what can they do to reduce or get rid of them altogether?
Dr Tonye Wokoma: Let’s start off with what you can do yourself. Lifestyle change is a huge one. Altering your diet, getting active and losing a little bit of weight can have a huge impact on the number and severity of hot flushes. Quitting smoking is always a good idea. Staying hydrated is also important.
Things like Cognitive Behavioural Therapy (CBT) are very helpful. This can teach you how to reframe things. Instead of thinking ‘this is a disaster’, you tell yourself it’s not a big deal, it will pass. And this is a proven technique for hot flushes.
Mindfulness can also be very helpful and focus your mind. It’s just a hot flush at the end of the day, it will settle and it’s not the end of the world. But it can feel like that when you’re in it.
Try to wear cool clothing that lets your skin breathe. And pace your activity. Ask yourself in advance, what am I doing, how long will it take, is there anything I can do up front? This can all help.
Henpicked: Are there any medications for hot flushes?
Dr Tonye Wokoma: Hormone replacement therapy (HRT) is very effective at treating hot flushes as it replaces the oestrogen your body is wanting. But some women don’t want HRT, or they can’t take it. Antidepressants are quite good for treating hot flushes and can help with mood. High-dose progestogen is sometimes prescribed, or a medication called oxybutynin, which helps your temperature mechanism.
Henpicked: Some women worry about HRT due to the risks. Do you have any advice?
Dr Tonye Wokoma: Please speak to somebody who is knowledgeable, like your doctor or a menopause specialist. There are small risks of HRT for some, so it’s important it is given to the right women and any risks are explained – there are so many different types of HRT. Some suit some women better than others and they can be tailored. But there are also huge benefits for a range of menopause symptoms. There’s a big myth you can only be on HRT for five years but this isn’t true. So you don’t need to feel desperate before you start.
Henpicked: What about herbal remedies?
Dr Tonye Wokoma: These can also be useful, but they aren’t studied as extensively as HRT. If you use herbal remedies make sure they’re from a reputable place. There is some evidence that black cohosh and red clover can help. But these could interact with other medicines you’re taking, so it’s always best to speak to a qualified medical herbalist. You can find one in your area here.
Henpicked: Is there a time we should worry?
Dr Tonye Wokoma: Some women can experience palpitations alongside flushing and sweating and that feeling of anxiety, of dread. But it’s important if you’re worried to go and see someone, don’t just shrug it off as menopause.
Henpicked’s Deborah Garlick was joined by Dr Tonye Wokoma, menopause expert from My Menopause Centre.
Tonye is an experienced Consultant in Sexual and Reproductive Health and Community Gynaecology and a BMS-recognised menopause specialist. She was admitted as a Fellow of the Royal College of Obstetricians and Gynaecologists in September 2016.
Tonye holds the Faculty of Sexual Reproductive Health (FSRH) Advanced Menopause Certificate and is also the FSRH Menopause Guardian involved in the curriculum, logbook and training in menopause care basic and advanced certificate.