Hot Flushes – All In Your Head?

Women are occasionally still told that menopause symptoms are ‘all in their head’ but a study provides the first new insights into how they may indeed arise in the brain. You can’t think them away, but bioidentical hormones can help.


Hot flushes are the bane of many womens lives, and not just at menopause as they can also be experienced post menopause and at the other end of the hormonal cycle also during pregnancy.  We certainly know the symptoms well enough: the sudden but temporary episodes of body warmth, flushing and sweating that can soon seem to take over  your life but just what causes them has never been clear.

Because they can strike at any time and with usually little warning, there is a known link to stress or certain medications but a new research paper, unattractively entitled ‘Temporal Sequencing of Brain Activations During Naturally Occurring Thermoregulatory Events,” that’s hot flushes and sweats to you and me, may open up a new area of possibility.

This paper appeared in Cerebral Cortex, a journal of Oxford University Press and was produced by Professor Robert Freedman,  a professor of psychiatry and behavioral neurosciences in Detroit   and his collaborator Vaibhav Diwadkar, Ph.D., associateProfessor of psychiatry and behavioral neurosciences.  Professor Freedman may be an academic but he does have a good handle on hot flushes as he finds that because they are internally generated, they are unique and presented quite a challenge to study.

They came up with the idea of understanding the brain responses to such episodes by having their participants lie in the MRI scanner while being heated between two body-size heating pads for up to two hours while we waited for the onset of a hot flash. I am happy to say he recognises the discomfort this could cause and says of his subjects

“They were heroic and the study could not have been conducted without their incredible level of cooperation.”

“Menopause and hot flashes are a significant women’s health issue of widespread general interest,” his colleague Diwadkar also commented while acknowledging that  understanding of the neural origins of hot flashes has remained poor. To remedy this they during the course of a single year followed 20 postmenopausal women ages 47 to 58 who reported six or more hot flashes a day.

They monitored skin conductance levels as this is an electrical measure of sweating.  The researchers focused on regions like the brain stem because its sub regions are implicated in temperature regulation, while forebrain regions have been implicated in the personal perception of how someone feels. They showed that activity in some brain areas, such as the brain stem, begins to rise before the actual onset of the hot flash.

This is serious evidence of where the hot flush is originating, and gives even more credence to those who see stress as a trigger for flushes and the researchers also are exploring possibilities for integrating MRI imaging with treatment to examine whether specific pharmacotherapies for menopause might alter regional brain responses. That means supplements or drugs in lay language and there are already many anecdotal studies on such methods.

Great, but what can I do now?!

There are many ways to help deal with hot flushes, and it does seem to be variable as to what works in individual women. Certainly HRT can be effective as it swamps the body with hormones to even out the fluctuations in levels that can give rise to flushes.

However, many women find the side effects and potential health risks unacceptable or are simply unable to take it because of strong contraindications for oestrogen due to a history with breast cancer.

Bioidentical natural progesterone has been shown to be effective in both menopause and post menopause in controlling flushes, and some women who need oestrogen find that a natural form of HRT which combines the two hormones is also good at dealing with more severe meneopause symptoms.

Phytoestrogens are helpful for some women, the best known are soy, red clover and seeds such as flax, sunflower and sesame.  Herbal combinations containing black cohosh, and dong quai are popular as is acupuncture to help with severe symptoms,

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