Hot flashes are no doubt bothersome, to say the least, but they can be so much more than just a physical nuisance. It’s wise to view each one as a metaphorical red flag to possible health risks worth reviewing with your health care provider.
Everything from painful intercourse to fragile bones and unhealthy weight gain can ride in with the hot flash. “It’s only one of many things that you should be worried about,” says Executive Director of the North American Menopause Society (NAMS) JoAnn Pinkerton, M.D., N.C.M.P. She is also a professor of obstetrics and gynecology at the University of Virginia Health System and directs a large, midlife multidisciplinary health center where she cares for women ages 40 to 70.
Pinkerton reminds us that about 75 percent of menopausal women have hot flashes, while 25 percent of women find them bothersome enough to seek help. “When you ask about hot flashes, it just says to me you are having enough symptoms [to warrant a thorough review of your medical history and risk factors],” Pinkerton says.
“What’s really exciting for me as a practitioner is there’s so much to cover to help women,” she adds. “Am I doing enough to protect my bones? I could lose up to 20 percent of my bones during menopause,” Pinkerton points out as one example.
She says women gain, on average, 12 to 15 pounds in the decade between their 45th and 55th years. In a society where 64 percent of women are sedentary, meaning they spend less than 30 minutes three times per week in physical activity, she says it’s not uncommon for her colleagues to feel it’s a lost cause getting obese women to exercise. “’You can’t change it,’” she hears all the time.
“I try to change it every day,” she counters, pointing out that even light exercise can have an impact, while a significant commitment, such as one hour of walking daily, can cut the risk of obesity by 24 percent. “Not only is it going to decrease your weight, it’s going to decrease your stress,” she adds.
If you skip the discussion about hot flashes with your doctor, you may also miss out on information on emerging science that may be of interest to you. The Cache County Study, for example, has shown that women who received hormone therapy at menopause developed less risk of Alzheimer’s disease than those who did not.
Pinkerton says there is additional evidence that links hot flashes with dementia, as well. One study showed that women who had more hot flashes while asleep had greater “whiter matter burn,” technical speak for damage to the brain associated with dementia.
It is difficult for clinicians to draw any concrete conclusions because much of the evidence is based on observational data, rather than long-term randomized clinical trials of 15 to 20 years which are very expensive to conduct. But the belief is that the declining hormone levels of menopause can accelerate atherosclerosis and dementia.
Discussing the issue with your provider may shed new light on the question of whether or not to consider hormone therapy. And if you do make the decision with your provider to medicate, whether it be hormone therapy or a selective serotonin reuptake inhibitor, or something else, view the pharmacist as a valuable member of your health care team.
Not only is the pharmacist instrumental in working with your clinician to tweak any dosage issues, but she or he is readily available as a resource. “You can just see us,” says Registered Pharmacist Sophia De Monte, RPh, who practices in Long Island, NY. “You don’t have to make an appointment. The pharmacist is just there.”
Is there something about the medication you forgot to ask your health care provider or were too embarrassed to bring up? De Monte says the pharmacist is there to pick up that informational slack.
Finally, be wary of the quality of sources you use to seek out information, particularly on the Internet. “I am a huge believer in education,” Pinkerton says. “I believe we all need to be informed. There are many, many good sites. I think it also gets very confusing because there’s a lot of celebrity hype and a lot of inaccurate information that’s presented as science when in reality, it’s not, and that can make patients vulnerable.”
The MENOPRO app for Apple and Android smartphones from the NAMS website offers a wealth of information on sex, hot flash, bioidentical hormones, and links to other valuable sites.
JoAnn Pinkerton, M.D., via phone conversation January 26, 2016. http://uvahealth.com/findadoctor/profile/JoAnn-V-Pinkerton
Sophia De Monte, RPh, via phone conversation February 1, 2016.
Shao H, Breitner JCS, Whither RA and others: Hormone Therapy and Alzheimer Disease Dementia; New Findings from the CACHE County Study: Neurology 2012, 79:1846-1852. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525314/
Reviewed February 2, 2016
By Philip Sarrel, M.D. and Lorna Sarrel, M.S.