FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[HOT FLASH IS OFTEN EARLY SIGN OF MENOPAUSE]

Question: My blushing bride, after 29 years of marriage, has begun having episodes of flushing. I think these are hot flashes, but she doesn't believe so because she is still having periods. Do hot flashes occur before menopause? Are there conditions other than menopause that cause them?

Answer: Hot flashes are a sense of feeling hot, sweating and flushed, primarily in the head, neck, chest and back areas. A headache or symptom of pressure in the head may precede the flushed feeling as well as occasional symptoms of nausea, fatigue and dizziness. The entire episode may last for a few fleeting moments or for as long as 10 minutes.

Several different conditions can cause hot flashes, including heart disease, medication side effects, endocrine disorders and cancer. But, by far the most frequent cause of hot flashes in women is, as you suggest, menopause. A physical examination and the history of the symptoms are usually enough to distinguish menopause-induced hot flashes from those resulting from these other causes.

Most women experience menopause between the age 40 and 55, with 51 being the most common. I suspect that your blushing bride is within this age range, and from this fact alone, is likely to be having symptoms of early menopause.

Hot flashes are a common part of menopause. They occur in 75 to 80 percent of women and often start a year or two before the cessation of menstrual periods. Of women with hot flashes, 75 percent have them for one year while up to 50 percent may have them for five years. For many women they are a minor annoyance while for others they can be a serious problem.

A hot flash occurs principally because of fluctuations in the levels of pituitary hormones, not as a result of changes in the levels of the female hormones that are produced by the ovaries. In a fashion that is not yet clearly understood, pituitary hormone fluctuation causes a dilation of the blood vessels in the skin that consequently causes the skin to appear flushed and skin temperature to go up. As a result, there is sweating. At the same time there is a slight drop in the core body temperature. Other symptoms such as headache or dizziness may also be a product of these complex events.

Fortunately, women don't need to endure these uncomfortable episodes. Despite the fact that estrogen levels are usually still at normal levels when hot flashes begin, taking supplemental estrogen dramatically reduces the symptoms. In fact, in many women, this therapy totally eliminates hot flashes. It needs to be taken for one to five years. After this period, the fluctuations in pituitary hormones stabilize at the lower post-menopausal levels, and therefore, no longer causes hot flashes. Many women choose to continue hormone replacement therapy for a longer period, however, to reduce the risk of heart attack, osteoporosis and dementia.

Ask your blushing bride to talk with her doctor about her hot flashes. Your responsibility is to be supportive and loving as she goes through this normal life transition.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.