Hot Flashes in the Absence Menopause: Other Explanations
Frederick R. Jelovsek MD
"I am a 32 year old female. Throughout the last year, I've developed "night sweats". I have them sporadically about once a month. I know this is a common occurrence with menopause, but I'm only 32! I also know that I could be starting menopause early. However, are there other conditions that would cause night sweats? Is there a way to prevent them? Thanks a bunch. ". J.S.
The quick answer to this is that at a frequency of once a month, night sweats are not very likely due to a disease process or menopause or even perimenopause. Also at that frequency, I would not suggest going to extreme means to try to stop them other than some of the simple suggestions below.
In the mind of many women, hot flashes are only associated with low estrogens but that is not true. It may surprise you that men have hot flashes too. They can get them if undergoing treatment for prostrate cancer using anti-testosterone therapy, using thermal blankets and from alcohol, hot liquids and other substances. Both estrogen and testosterone seem to protect against frequent hot flashes. If either of those hormones are withdrawn after one's body is used to them, a rapid increase in skin temperature due to dilatation of the skin blood vessels can occur very frequently. While these hormones protect from frequent hot flashes, many other events and ingested substances can also cause the skin vessels to rapidly dilate and release heat.
What exactly is a hot flash?
Characteristically, a hot flash (also called hot flush) is a sudden feeling of warmth and often a breakout of sweating usually confined to the upper half of the body (chest and up), neck, face and head. There is an intense feeling of heat and the face head and neck can turn red. When they occur at night, they are called "night sweats". It can be difficult to distinguish them from a low grade fever such as that seen with the flu, a cold, a urinary tract infection or a more serious cause of fever such as tuberculosis or cancer. Fevers usually cause the sweating to last longer than the typical few seconds or few minutes that hot flashes last. Non fever caused hot flashes can occur rarely or every few minutes.
No one knows exactly what the physiologic cause is for hot flashes but the beginning trigger is probably increased heat (or blood flow) in the heat regulatory area of the brain. The brain, sensing an increased body temperature, releases chemicals that cause the skin blood vessels to dilate so the heat can be released. Apparently estrogens and testosterone allow the body to have a higher tolerance for changes in core body temperature. In other words, normally a body might tolerate a change in 1.5 degrees C. before dilating the blood vessels whereas in the absence of the sex hormones, the blood vessels are triggered to dilate at a change of only 0.8 degrees C. This means that anything increasing core body heat or even just the heat of increased blood flow at the brain's heat regulatory center will cause a hot flash. The hot flash will last or keep repeating as long as needed to dissipate the increased heat. Even women who are menopausal can reduce by almost 50% the number of night sweats by dropping the evening bedroom temperature a few degrees cooler.
Can foods or drinks cause a hot flash?
Definitely yes. Almost everyone should be familiar with how a meal containing hot pepper (capsaicin) can cause a rapid out break of a hot sweat. In this case, the capsaicin directly stimulates nerve endings that affect and dilate the brain blood vessels. Alcohol, other food additives and just eating a large meal itself can cause hot flashes. The truth is that we do not know all the different foods and additives and other ingested substances that can trigger this reaction.
Many prescription drugs such as anti-hypertensives and mood altering drugs such as anti-depressants or anti-anxiety medications can also cause hot flashes. Each prescription drug you are taking should be checked to see if hot flashes or night sweats are a known side effect. Over-the-counter medications and supplements should also be examined for their side effect profile.
What other conditions or circumstances can cause hot flashes that are not "menopausal"?
Many systemic conditions can also produce flushing such as carcinoid syndrome, systemic mast cell disease, pheochromocytoma, medullary carcinoma of the thyroid, pancreatic islet-cell tumors, renal cell carcinoma, hyperthyroidism, neurological flushing, emotional flushing, and spinal cord injury. These conditions are thought to secrete chemicals into the blood stream that can stimulate the nerves or blood vessels of the brain.
By far, the most common cause of hot flashes is a stress reaction that causes epinephrine and norepinephrine release into the blood stream. This in turn causes increased blood flow and thus increased heat. A hot flash may ensue to get rid of the heat. The trigger can even occur during deep REM sleep (presumably from dreaming). The next most common cause of a hot flash is just simply that the body is too warm. This can happen at night with thermal blankets or by just sitting with a portable computer on your lap for awhile. We have radiant heat panels at our house that overshoot the thermostat and often cause our family to have night sweats when they come on.
How can I know if the hot flashes mean I am menopausal?
We know that women have hot flashes in the decade before menopause. They certainly are not as frequent as during the menopause but we cannot predict them and cannot know for sure if they are due to low estrogen at the moment. When we measure estrogens or measure FSH, the brain hormone that becomes elevated when the ovaries finally fail, they are usually in normal ranges. If you are still having normal, regular menses, then asking the doctor to request blood studies for menopause is not likely to yield results. The doctor should check the TSH level for hyperthyroidism however. Alternatively, if your menses are irregular, you should ask you doctor to check for possible menopause or low estrogen state. Remember that smoking can lower blood estrogens; thus women who smoke will have more hot flashes in the perimenopausal period.
What can be done to lessen or stop hot flashes or night sweats that are not due to low estrogens?
First of all, I would say that if hot flashes or night sweats are less than once a week, you might just ignore them. They are not harmful and at that frequency, they do not usually represent a disease process. If they are more frequent, you might try the following:
- Avoid any foods, alcohol or caffeine within 3 hours of going to bed
- Avoid exercise, hot liquids or smoking within 3 hours of going to bed
- Drop the evening thermostat by about two or three degrees without adding more covers
- Wear light bed clothing
- If you feel stressed out from daily work or family events, take at least an hour before bedtime for some relaxation activity ( if you cannot "afford" an hour before bedtime to do this, there's your answer)
For night sweats:
- Examine and try to avoid individual triggers (i.e., strong emotions, caffeine, alcohol, cayenne, occlusive clothing, heat).
- Use fans during the day.
- Wear clothing made of natural (i.e., cotton) materials.
- Practice deep, slow abdominal breathing, taking six to eight breaths per minute: Practice 15 minutes in the morning and evening, and use this technique in conjunction with "premonitions" of hot flashes. This can produce a 50% decrease in hot flash frequency.
- Exercise or walk, swim, dance or bicycle every day for 30+ minutes but not within 3 hours of bedtime
For daytime hot flashes:
If the above measures are not successful to stop night sweats and hot flashes almost entirely, then you should see your doctor to be evaluated for menopause or thyroid disease as well as other possible conditions.
|Other Related Articles|
Natural versus Surgically-Induced Menopause
Designer Estrogens - Are They for Me?
What is Natural About Natural Hormone Therapy?
Will Testosterone Help Menopausal Symptoms?
Will Androgens Help Menopausal Mood Symptoms?