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PMS Hot Flashes—and Perimenopause and Menopause
by Dr. Daniel J. Heller
If you have ever experienced a hot flash, then you know how unpleasant, bewildering, and inconvenient they can be—and sometimes, even debilitating. If you haven’t personally experienced a hot flash, but have been around women in various stages of life who have, you likely witnessed frantic hand waving as a friend or loved one attempted to fan herself to relieve the overwhelming heat and distress.
Hot flashes have been described as sudden feelings of warmth by the Mayo Clinic that produce reddened skin with a blush-like appearance, usually appearing over your face, neck and chest. Rapid heartbeat and profuse sweating frequently accompany hot flashes, and are sometimes followed by chills or feeling chilly.
Hot flashes that occur at night are called night sweats, and are especially bothersome when heavy, drenching sweat, which can soak you, your pajamas, and your bedding, accompanies them. Of course, they’re also likely to wake you up, even out of a sound sleep. Some women have to get up and change their clothing, and even their bedding, after a night sweat. This can prove disruptive not only to you and your sleep cycle, but also to anyone sharing your bed.
Medical science still doesn't fully understand the causes of hot flashes, but the research so far suggests a causative role for both brain chemistry and hormones. Brain chemistry and hormonal fluctuations seem to contribute to changes in the way your hypothalamus functions. The hypothalamus is part of the brain but also directs much of the activity of the brain, and of your endocrine, or hormonal, system. The hypothalamus has a large role in regulating body temperature, which may be why hot flashes occur with the hormonal changes associated with PMS, PMDD, perimenopause, and menopause. The sudden withdrawal of estrogen, more characteristic of perimenopause and menopause than PMS and PMDD, may be a chief culprit in hot flashes.
There is more than one way to try to treat hot flashes, but three main categories of approaches. The first are the practical and DIY tips; the second is the medical, or drug, approach; the third, which we we’ll discuss in another article, is natural treatment of hot flashes.
These practical, DIY solutions are more likely to work if your symptoms are more of an annoyance, rather than truly disrupting your life:
Now let’s define the different types of hot flashes that impact women: premenstrual hot flashes (yes, premenstrual hot flashes), perimenopausal hot flashes, and menopausal hot flashes.
Hot flashes are normally associated with middle-aged women who are approaching menopause or whose monthly cycle has ceased. However, sometimes much younger women can experience the discomfort of hot flashes, especially with premenstrual syndrome (PMS) or its more severe form, premenstrual dysphoric disorder (PMDD).
This comes as a surprise to many people who hadn’t realized that hot flashes can happen to younger women, or that this hot flashes can be part of PMS rather than menopause. If you also experience premenstrual bloating, cramping, fatigue, and/or irritability in addition to hot flashes, then your hot flashes are probably part of PMS. Of course, hot flashes can be part of the spectrum of PMDD symptoms, since PMDD is really just very emotionally severe PMS.
Perimenopause is the transition phase your body goes through as it approaches the cessation of your monthly cycle and thus, menopause. During this time, as your ovaries begin to exhaust the supply of eggs, or ova, in which you were born, the levels of the hormones estrogen and progesterone, that are released along with those eggs, drops dramatically. We have more basic information on a woman’s hormonal and menstrual cycle.
Perimenopause can begin anywhere from age 35 to 50, though for the majority of women it doesn’t truly begin until their mid- to late-40s. The symptoms of perimenopause range from mild to severe menopausal symptoms such as hot flashes, vaginal dryness, problems with sleep and memory, mood swings, decreased sex drive, as well as irregular periods. But, as you may have noticed, there is a lot of overlap with PMS symptoms: mood, memory and brain fog, sleep, and hot flashes can all be part of both syndromes. Because menopause tends to receive more attention than PMS and PMDD, perimenopause is often assumed to have more in common with menopause, but in fact it varies from woman to woman. Perimenopausal symptoms can last from months to years, and can range from an inconvenience to a downright problem.
The best known symptom of menopause is hot flashes, even though there are plenty of other potential physical, mental, and emotional menopausal symptoms. There are also potential medical problems like heart disease and osteoporosis that occur more in older women, after menopause. But when you feel like someone’s dunked you in hot water ten times a day from the inside out, it gets your attention pretty quickly!
The medical definition of menopause states that it begins after you have gone an entire year without a period or menstrual cycle. However, since symptoms often begin in perimenopause, the symptoms of menopause may begin well before you actually enter menopause.
Drugs for hot flashes are usually reserved for the most severe cases, though they are usually the most effective symptomatic treatment. Of course, your doctor would have to help you decide if this is the right course for you.
Hot flashes—whether they are premenstrual, perimenopausal, or menopausal—can be normal, and not a sign of disease or of anything seriously wrong. They are really just symptoms of a passing, temporary disruption of your brain chemistry and hormones. They can be incredibly uncomfortable, inconvenient, and frustrating, for sure. But we’d suggest that they don’t necessarily have to be considered a medical, and medicalized, syndrome.
A hot flushing sensation that affects the face and upper body is, in fact, something nearly everyone of every age experiences, whether from stress, anger, embarrassment, panic, and other strong emotions. Unfortunately, women’s hormonal hot flashes often come on for no apparent reason, making them that much more uncomfortable and disconcerting.
There has been a movement now for some time for women to call their hot flashes power surges, as a way of saying that perimenopause and menopause is a rewarding time of life, and that age and experience are strengths to be embraced. Power surge sounds more empowering than hot flashes, and is meant to indicate a feeling of control and strength, rather than a medical symptom. Perimenopause and menopause are just as natural a process as is getting your period. However, whether you call them hot flashes or power surges, they can make life miserable, and treating them can feel like an absolute necessity.