What is Menopause?
Known as the "change of life," menopause is the last stage of a gradual biological process in which the ovaries reduce their production of female sex hormones. This process begins about 3 to 5 years before the final menstrual period. This transitional phase is referred to as the perimenopausal phase. Menopause is considered complete when a woman has been without periods for 1 year. It marks both the end of menstruation and the end of a woman's ability to naturally conceive a child.
In the United States, the average age of menopause is 51, with most women usually reaching natural menopause somewhere between 40 and 58 years of age. For some women natural menopause has occurred as early as in their 30s and some have been in their 60s, though this is quite rare. Typically, a good indicator of when a woman will reach menopause is to look at when a woman's mother and sisters experienced menopause. If a woman smokes or is a former smoker, menopause may occur up to 2 years earlier than expected.
How does Menopause occur?
The ovaries contain structures called follicles that hold the egg cells. You are born with about 2 million egg cells and by puberty there are about 300,000 left. Approximately 400 to 500 egg cells mature fully and are capable of release during the menstrual cycle. The remaining eggs degenerate over the years. During the reproductive years, the pituitary gland in the brain generates hormones that cause a new egg to be released from its follicle each month. The follicle also increases production of the sex hormones estrogen and progesterone, which thicken the lining of the uterus. This enriched lining is prepared to receive and nourish a fertilized egg following conception. If fertilization does not occur, estrogen and progesterone levels drop, the lining of the uterus breaks down, and menstruation occurs.
For unknown reasons, the ovaries begin to decline in hormone production during the mid-thirties. In the late forties, the process accelerates and hormones fluctuate more, causing irregular menstrual cycles and unpredictable episodes of heavy bleeding. By the early to mid-fifties, periods finally end altogether; however, estrogen production does not completely stop. The ovaries decrease their output significantly, but still may produce a small amount. Also, with help from the adrenal glands, another form of estrogen is produced in fat tissue. Although this form of estrogen is weaker than that produced by the ovaries, it increases with age and with the amount of fat tissue.
Progesterone, the other female hormone, works during the second half of the menstrual cycle to create a lining in the uterus as a viable home for an egg, and to shed the lining if the egg is not fertilized. If you skip a period, your body may not be making enough progesterone to break down the uterine lining. However, your estrogen levels may remain high even though you are not menstruating.
At menopause, hormone levels don't always decline uniformly. They alternately rise and then fall again. Changing ovarian hormone levels affect other glands in the body, which together make up the endocrine system. The endocrine system controls growth, metabolism and reproduction. This system must constantly readjust itself to work effectively. Ovarian hormones also affect all other tissues, including the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary tract, and skin.
Hot Flash Facts
An estimated 5 million women in the United States are markedly affected by hot flashes. Hot flashes are considered to be the hallmark of hormone fluctuation and menopausal transition. They are the most common perimenopausal symptom reported by women in the United States and the primary reason that women seek medical care during the menopausal transition. Almost 75% of menopausal women in the United States experience hot flashes.
Hot flashes can begin as early as two to three years before the last menstrual period, and persist for six months to as long as several years after the final period. Hot flashes are highest during the period immediately following menopause, and then gradually lessen with increasing years. The frequency of hot flashes varies; some have only a few episodes per year, while others have as many as 20 episodes per day. Hot flashes occur in women who experience natural menopause, as well as in women who undergo menopause due to surgical removal of the ovaries.
When hot flashes occur before the end of menstrual periods, this signifies that the estrogen level produced by the ovaries is reduced, but not enough to stop menstruation. During this time before menopause, a woman may experience irregular menstrual bleeding as well as the hot flashes. When the ovaries are surgically removed the estrogen level will drop abruptly and women usually will experience more severe hot flashes, and for a longer period of time.
What are the Symptoms of Hot Flashes?
A hot flash begins as a sensation of intense warmth in the upper body, followed by skin flushing (redness), drenching perspiration, and finally a cold, clammy feeling. Typically, these symptoms begin at the head and spread downward toward the neck and chest. They last from 30 seconds to five minutes. The average is four minutes. Hot flashes generally begin suddenly, although most women say they can feel a hot flash coming on several minutes before it occurs.
Hot flashes can be accompanied by other uncomfortable sensations, such as heart palpitations, a pressure feeling in the head, or feelings of dizziness, faintness or weakness.
What Impact do Hot Flashes have on Daily Life?
For some, hot flashes are but a mild sensation. For others, they are severely disabling and physically draining. They often negatively impact the quality of life for women by causing sleep disturbances. Sleep disturbances can result in fatigue, irritability, forgetfulness, physical discomfort, and negative effects on work productivity. Other associated symptoms that commonly go along with hot flashes include incontinence, sudden bouts of waistline bloat, heart palpitations, crying for no reason, temper outbursts, migraines, itchy, crawly skin, and memory lapses.
What causes Hot Flashes?
Researchers do not know exactly what causes hot flashes. In general, the studies examining the etiology of hot flashes suggest that changes in core body temperature or changes in endogenous hormone levels (hormones produced by the body), or both are associated with the onset of hot flashes. The change in hormone levels affects the hypothalamus, an area of the brain that regulates body temperature. In a hot flash, the hypothalamus apparently senses that your body is too hot even when it is not, and tells the body to release the excess heat. One way the body does this is to dilate (widen) blood vessels, particularly those near the skin of the head, face, neck and chest. Once the blood vessels return to normal size, you feel cool again.
Studies examining factors that may predispose women to hot flashes suggest that endogenous hormone levels, body mass index or BMI, (a number, derived by using height and weight measurements, that gives a general indication of whether or not weight falls within a healthy range), smoking, some reproductive variables (tubal ligation and surgical menopause), and race/ethnicity are associated with risk of hot flashes.
Other conditions like hyperthyroidism (an over-active thyroid gland), diabetes, tuberculosis, rare tumors of the adrenal glands, and other chronic infections can cause hot flashes.
Can Hot Flashes be Prevented or Controlled?
Hot flashes related to menopause cannot be prevented; however, certain lifestyle behaviors may decrease the severity and frequency.
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Drink 6 – 8 glasses of water per day. Also try sipping cold water at the onset of a hot flash; this may help lessen the severity.
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Exercise regularly
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Eat a healthy diet high in vitamins and minerals.
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Avoid drinking beverages that contain caffeine or alcohol, since these can make hot flashes more uncomfortable.
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Cut down on your consumption of red wine, chocolate and aged cheeses. They contain a chemical that can trigger hot flashes by affecting the brain's temperature-control center.
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Avoid spicy foods.
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Try to keep your stress level to a minimum.
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Don't smoke. Smoking can make hot flashes worse.
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Wear loose, comfortable clothing made of cotton to help absorb perspiration.
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Dress in layers, so that you can remove some clothing if you suddenly feel hot.
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At home, lower your thermostat to keep your house cool; while at work, keep a small fan handy.
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At night, use lightweight blankets that can be removed if hot flashes wake you up.
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Try keeping a diary to find associations between hot flashes and possible triggers. Then try to eliminate the triggers.
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Avoid going from a hot to a cold environment.
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Increasing your intake of soy-based foods or supplements may help decrease the incidence of hot flashes
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Supplements and Hot Flashes
Researchers have linked societies with high dietary intake of soy and soy isoflavone concentrate to a lower incidence of hot flashes during menopause. The amount of soy in the diet of the average American is negligible, while in Japan it is the major source of protein. In the United States, 70-80% of menopausal women experience hot flashes, in China and Singapore the numbers are 18% and 14% respectively.
Soy isoflavones that are plant compounds with weak hormone-like effects. Considerable research has focused on the effects of soy isoflavone containing foods. Several randomized trials have shown that increased dietary intake of isoflavone rich foods and/or supplements providing between 40 and 160 mg per day, resulted in a decreased incidence of hot flashes as well as an overall improved quality of life. In addition to improving hot flash symptoms, there is considerable evidence that supports a role for soy in reducing the risk of cardiovascular disease and osteoporosis.
 Advocates of the herb Black Cohosh say it has a natural effect similar to the female hormone, estrogen. Declining estrogen levels are responsible for the hot flashes and other symptoms that often accompany menopause. Estrogen replacement therapy relieves these symptoms, but poses an increased risk of breast cancer in susceptible women. Black Cohosh is said to offer a non-hormonal alternative.
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