While I am a fully licensed physician in Kansas, this communication does not constitute personal medical advice or establish a physician-patient relationship. See your own physician to discuss your particular diagnosis and treatment
When women hit perimenopause and menopause they often complain of hot flashes. These episodes of intense heat can occur at any time. Often, hot flashes occur at night, disrupting sleep. The severity of hot flashes can range from very mild to very severe in different people. Sometimes, women also have palpitations and visible flushing with these episodes. While we don't understand everything in medicine, I have included the proposed mechanism of hot flashes for those women who are inquisitive about this process that is terrorizing them.
The proposed mechanism of hot flashes requires some basic knowledge of the endocrine system and hormones. If you want to jump straight to the treatment options, then skip to the potential treatments section of this post.
Hormones are chemical substances that are usually released in a pulsatile fashion into the bloodstream to send instructions to your organs or glands. The hypothalamus area of the brain is an integral part of the endocrine system and is connected to the pituitary gland at the base of the brain. The hypothalamus functions as a gland that regulates sleep, appetite, autonomic nervous function, blood pressure, heart rate, neurotransmitters, mood, temperature, and sex hormones. Hormones that are produced in the hypothalamus include: antidiuretic hormone, oxytocin, corticotropin releasing hormone, growth hormone releasing hormone, thyrotropin releasing hormone, gonadotropin releasing hormone (GnRH), somatostatin, dopamine, and oxytocin.
For the sake of this discussion, we will first focus on GnRH function in a premenopausal woman. GnRH stimulates the pituitary gland to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). FSH release increases estrogen release from the ovary. Estrogen prepares the uterine lining for implantation of an egg. As the cycle progresses, just prior to when a follicle that contains an egg is released from the ovary, GnRH increases, causing an increased LH. This LH increase causes a follicle to be released. The follicle starts producing its own estrogen. Now, the ovary shifts to producing progesterone in greater amounts to support the uterine lining. If this woman's egg does not get fertilized, both estrogen and progesterone levels drop and the uterine lining sheds resulting in menstrual blood flow.
In the case of a post-menopausal woman, the ovaries are unable to produce adequate levels of estrogen and progesterone even though the pituitary gland is cranking out FSH and LH. There is some conversion of testosterone to estrogen, but eventually, not enough. When sex hormones such as estrogen, progesterone, and even testosterone decline, temperatures can fluctuate in a pulsatile fashion. I have never received a satisfactory explanation of why these low levels of estrogen and progesterone mechanistically cause hot flashes. The hypothalamus does regulate temperature, so maybe some sort of thermal dysregulation at the level of the brain? Instead, are hot flashes due to temporary vasodilation (increasing blood flow) secondary to the effects of lower levels of estrogen and progesterone? Likely, a combination of these two mechanisms are responsible for hot flashes.
Potential treatments for hot flashes
Hormone replacement therapy (HRT) (estrogen, progesterone, and testosterone), black cohosh, vitamin E, B vitamins, vitex agnus (chaste tree berry), SSRIs (Paxil 7.5 mg is approved), clonidine, and gabapentin.
All women should follow a healthy diet and exercise for optimal health.
If you wonder about safety with HRT, I have addressed this in other posts and a YouTube video: youtu.be/KmrAWvl28NU.
I hope this information helps you and your loved ones!
Jason Williams, D.O.