Hot flushes and night sweats belong in a category of symptoms that doctors call ‘vasomotor symptoms’, that is they are concerned with the blood vessels dilating and constricting, and with the flow of blood through these vessels. The symptoms are harmless, but most women greatly dislike having them, and find them uncomfortable, embarrassing and unpleasant. They may also affect a woman’s ability to cope at work and at home, and she may even avoid social contact for fear of feeling ashamed.

The typical hot flush starts as an unpleasant sensation of heat in the face, neck or body. If it starts in the face or neck, it will probably spread down to the main part of the body; if it starts there it will spread up to the face. Often the face becomes red, and sweat appears; but many women find, to their surprise, that, despite the feelings of great heat in their face, there are no outward signs at all, and nobody has noticed.

Flushes may occur at intervals from several each hour, to just a few times each month, usually in the days leading up to the start of a period. There will be times when flushes occur frequently, and times when they do not occur at all. Each flush may last for a few seconds, or for up to half an hour, or more, but most last for about three minutes. After a flush, you may feel sweaty, then cold, and you may seem to be endlessly taking clothes off and putting them on again to get comfortable. Flushes can occur at any time of the day or night, and may be accompanied by heart palpitations, dizziness and feelings of faintness. In America, they are called ‘hot flashes’, but this is a less appropriate name, as it suggests something that comes and goes very rapidly. The British term ‘hot flush’ describes more accurately the feeling of heat that builds up and dies down slowly.

When flushes occur at night, they are called ‘night sweats’. Typically, a woman will wake from sleep to find she is drenched in sweat and has to get up to change her night-clothes, and perhaps even the bedding. Night sweats cause greatly disturbed nights and lack of sleep, for the woman suffering them and perhaps also for her partner who may find himself woken several times in the night as she gets up to wash and change into something dry. Repeated broken nights cause fatigue, loss of concentration, irritability, and a general sense of lethargy.

The underlying cause of a hot flush is a falling level of oestrogen. This is not the same as a low level: girls before puberty and men have low levels of oestrogen, but they don’t suffer hot flushes; women get them when the level of oestrogen in their body has been high and then starts to fall. Women who lose their oestrogen suddenly, as when they have both ovaries removed, tend to get flushes that are particularly troublesome. If the decrease in oestrogen is gradual, the symptoms will be less severe. In most cases, once the body has adjusted to its final low level, the flushes will end.

It is thought that the falling level of oestrogen throws the body’s heat-controlling mechanism into confusion, and the ‘thermostat’ becomes set too low. The result is that the body thinks it is suddenly too hot, so it dilates the blood vessels and sweats to cool itself down. The dilated blood vessels produce redness and a sensation of heat in the skin, but although the skin itself may become several degrees warmer than normal, the body’s underlying temperature remains unchanged. Even if the skin hardly becomes warm at all, the woman will still feel hot – usually uncomfortably and embarrassingly so.

Flushes can be triggered by several things – or by nothing. Common causes of a flush are: anxiety, hot weather, moving from a cold room to a hot one, drinking tea, coffee, alcohol or hot drinks, or eating spicy food. However, most flushes don’t seem to be triggered by anything. As smoking reduces oestrogen, smokers tend to find flushes more troublesome than non-smokers do.

If you get hot flushes, you may feel freakish, and wonder if everyone is staring at you. In reality, the chances are that no one will notice, and, far from being a freak, 75 per cent of women going through the menopause get hot flushes, just like you. Of that number, 80 per cent still have them a year after they first appeared, 25 per cent still have them five years later, and for an unfortunate 5 per cent, they continue indefinitely.


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