Videos of Dr Nicola Davies

An expert's guide to hot flushes - Online interview

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Dr Nicola Davies, leading GP and menopause doctor, discusses hot flushes. Schedule an appointment with Dr Davies via her Top Doctors profile: https://www.topdoctors.co.uk/doctor/nicola-davies ✔ Follow us on Instagram: https://bit.ly/3fSrqXb ✔ Follow us on Facebook: https://bit.ly/3t5kGsW ✔ Follow us on Twitter: https://bit.ly/39TidKh 00:00 Hot flushes, some figures. Hot flushes and night sweats are the most commonly recognised symptom of the menopause. Approximately 55% women with experiences hot flushes up to 2 years before their menopause. The prevalence is thought to be highest in the first year after the final menstrual period when they occur in 60-80% women but possibly in up to 93% of women. We know that they vary in frequency and intensity but in studies they are reported as severe in 29% women. Hot flushes are usually present for less than 5 years but median duration is 7 years. 50% women are still experiencing hot flushes 4 years after their last period and 10% women are still experiencing hot flushes 12 years after their last period. 00:55 So what is a hot flush, also known as ‘flashes’? Hot flushes are defined as transient periods of intense heat in the upper body, arms and face, which are often followed by flushing of the skin and profuse sweating. They can involve any part of the body. It typically lasts 1 to 5 minutes. It may, or may not, be associated with profuse sweating and redness or flushing; many are followed by chills. Whilst the skin temperature rises by several degrees Celsius, the core body temperature appears to fall. Women having hot flushes may also experience palpitations and a sense of anxiety. For some women these can occur every hour, but for other women they happen much less frequently, such as once a week or once a fortnight. 01:46 Why do hot flushes occur? The pathophysiology is not fully understood, but it is thought to be very likely that the thermoregulation zone in the brain changes in response to low oestrogen levels. The hypothalamus becomes narrowed so that vasodilatation and sweating are triggered at a lower temperature. Whilst low oestrogen is key, not all women with low oestrogen develop hot flushes and there is a huge variation in severity and duration. We also know that whilst oestrogen levels stay low during the menopause, most women will stop having hot flushes after 5 years so that cannot be the full explanation. There are likely to be many neurochemicals involved in the mechanism causing hot flushes. We also know that flushes can be aggravated by stress and anxiety, diet, lifestyle and medications. 02:58 What’s the fuss all about? Hot flushes in themselves are not dangerous but they can have a significant detrimental effect they can have on quality of life. They can cause considerable distress, particularly if frequent. Daytime episodes can be socially embarrassing and professionally challenging. Heavy sweating and hot flushes have been shown to significantly affect sleep quality and increase the risk of frequent waking at night. Sleep disturbance contributes to fatigue and irritability. Anxiety and depression scores correlate with sleep quality, so the poorer the quality of sleep the more this is likely to impact on emotional wellbeing. A correlation has also been found between the severity of hot flushes and the risk of cardiovascular disease. Women experiencing more severe hot flushes seem to be at higher risk of heart disease. This could be useful in helping to identify women at higher risk of heart disease to make sure they get preventative care and monitoring. 04:05 How can hot flushes be managed? Lifestyle is very important. For many, weight loss can be beneficial. Reducing alcohol and caffeine can make a significant difference to the frequency and severity of hot flushes, as can changes in diet such as the exclusion of spicy and sugary foods. Regular exercise can also be extremely beneficial. Cognitive Behavioural Therapy shows good evidence of reducing hot flushes. If hot flushes are still problematic after these lifestyle changes, hormone replacement therapy can be used as a very effective treatment. Oestrogen replacement works extremely well to treat hot flushes. For those who cannot take oestrogen, or do not want to, there are other options such as selective serotonin reuptake inhibitors, which are well known antidepressants also known as SSRIs. There are other medications including Clonidine, Oxybutnin, Gabapentin and Pregabalin. There is a new non hormonal medication Fezolinetant; this is the first non-hormonal drug to be licensed for menopausal hot flushes. This will be another good option for those looking for an alternative to Oestrogen replacement. Hot flushes are a very common and often debilitating symptom affecting quality of life during the perimenopause and menopause. Thankfully there are effective treatment options and we would be very happy to discuss these this with you at Medical Prime.