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What are hot flushes

Hot flushes, or hot flashes as they are called in the USA, describe a sensation of heat that occurs over the face, neck and chest. They can be accompanied by palpitations (a sensation that the heart is beating too fast), anxiety, insomnia (poor sleep) and irritability.

Hot flushes can last over a period of months to years. Some women experience them daily while others unfortunately suffer several times a day. On average, they last anywhere from a few seconds to a few minutes.

The flushes can occur at any time of the day or night and can be unexpected. The degree of severity of the hot flush varies, causing minimal disruption in some women’s lives and profound social embarrassment in others.

What causes hot flushes?

Although other medical conditions can cause hot flushes (see below), they are most often associated with the menopause, which is the cessation of periods/menstruation.

Menopausal hot flushes are caused by the fall in circulating oestrogen concentrations, which occurs when the ovaries stop producing eggs. Most women go through the menopause at around age 50 but some women can experience premature menopause (before age 35) as a result such of surgery to remove of the ovaries, chemotherapy or radiation therapy.

LHRH analogues, which are used in the treatment of endometriosis, can also cause menopausal symptoms and hot flushes.
Other causes of hot flushes include drugs such as calcium channel blockers, which are used to lower blood pressure; certain antibiotics; raloxifene and tamoxifen; hormonal excess e.g. carcinoid syndrome, phaeochromocytoma, or hyperthyroidism (overactive thyroid).

Smokers have an increased risk of hot flushes and they are also more common in those who take little or no exercise.
Men undergoing androgen deprivation treatment for prostate cancer can also experience hot flushes.

Is there any treatment for hot flushes?

Simple measures such as dressing in loose clothing and using a water spray or fan can help reduce the discomfort of hot flushes. However, if your menopausal hot flushes are causing you distress or are severe, you should consult your GP, who may prescribe HRT treatment or other medication.

HRT. As the oestrogen levels are low, oestrogen replacement therapy (also known as hormone replacement therapy or HRT) may be prescribed. In those women with an intact uterus, oestrogen is combined with progesterone to reduce the risk of uterine cancer. The side effects of HRT include clots in the leg and lung and an increased risk of breast cancer.

HRT should only be used in the short term (up to five years). Women on HRT should have regular health checks with their doctor and report any unusual symptoms. The benefits of HRT should be balanced with the risks. HRT is available in topical (as patches and gels) and tablet forms.
Steroids.

Tibolone is a synthetic steroid with oestrogen-like effects that can be used to treat hot flushes. Side effects of this treatment may include headache, gastrointestinal upset, fluid retention and thrombophlebitis (inflammation of veins).

Clonidine is a drug designed to lower blood pressure but it has also been shown to reduce hot flushes. Its side effects may include constipation, dry mouth, low blood pressure and drowsiness.

Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine (used in the treatment of depression) may also be useful in the treatment of hot flushes. It seems that serotonin, a neurotransmitter (brain chemical), may be one of the causes of hot flushes. Side effects of SSRIs include nausea, constipation, insomnia and tremor if the medication is stopped suddenly.

Alternative treatments

Vitamin E is reputed to be beneficial but this has not been scientifically proven.

Soybeans and soya contain an isoflavone, which is a naturally occurring plant oestrogen that helps to reduce hot flushes. It should be avoided in women with breast cancer. Its side effects include nausea and diarrhoea.

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