Making Sense of Menopause: Part 2 - Managing Hot Flashes, Night Sweats, and Sleep

What are Hot Flashes? 

• Vasomotor Symptoms VMS, or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. VMS are episodes of profuse heat accompanied by sweating and flushing, experienced predominantly around the head, neck, chest, and upper back. VMS are experienced by most women during the menopausal transition. 

• Vasomotor refers to actions (motor) upon a blood vessel (vaso) which alter its diameter; to either constrict and restrict the flow of blood, or to dilate to increase the flow. 

• During a hot flash, the body experiences vasodilation, or the widening of blood vessels, primarily in the skin, which leads to increased blood flow and heat dissipation, resulting in feelings of warmth and flushing. 

• Hot flashes can be accompanied by sweating and palpitations, causing discomfort and disrupted sleep.

• Night sweats are essentially hot flashes that occur during sleep, often causing women to wake up drenched in sweat. These nocturnal episodes can significantly disrupt sleep patterns, leading to fatigue and irritability during the day. 

What causes Hot Flashes or VSM?

• Hormone levels affect our body temperature control mechanism. With declining levels of Estrogen our internal “thermostat” has a narrower range.

• With small temperature increases in our body or environment, our body tries to cool down by having a hot flash.  

• Changes in estrogen, as well as higher levels of general stress increase the likelihood of hot flashes occurring. 

• In addition to changes in hormone levels, several factors can increase the risk or severity of vasomotor symptoms. 

• Lifestyle factors: smoking, excessive alcohol consumption, low general levels of physical activity, and high stress levels can all exacerbate symptoms.

• Body composition: women with a higher body mass index (BMI) tend to report more frequent and severe hot flashes. Prevalence and severity of hot flashes are associated with weight increases, particularly around the waist

• When estrogen reduces rapidly, such as in women who have had surgical menopause (removal of ovaries), or hysterectomy and in women who have had breast cancer treatments, troublesome hot flashes and night sweats are more likely.

Special Considerations with Cancer Treatment:

• Menopausal hormone therapy, estrogen and progesterone, significantly reduces symptoms of hot flashes, night sweats; and is protective for bone, brain, muscle, and heart. Refer to the book “Estrogen Matters” for a deeper dive into hormone therapy. 

• For patients who are not considered good candidates for hormone therapy, or who choose not to use hormone therapy; there are alternative intervention strategies. 

• Once again, this is a conversation for you to have with your oncologist and medical team. This is a quality-of-life issue, and it is important to get the most pertinent information for your specific situation. 

Non-hormonal strategies for managing Hot Flashes and Night Sweats:

• Restorative Yoga

• Consistent practice of yoga, particularly restorative yoga, can significantly reduce hot flashes and cognitive symptoms and has benefits for sleep and pain. 

• • Paying special attention to the body’s needs, the heat of the menopausal transition can be calmed with cooling foods, calming practices, plenty of rest, and conscious activity that nourishes the body, mind and soul. 

  • Try to include cooling and restorative poses. Any gripping or tension in the body can make hot flashes worse. Using props such as bolsters, folded blankets, and blocks to help support the whole body is a good idea.

  • Placing your head on a bolster or chair during standing forward bends, for example, helps calm the brain and relax the nervous system. 

  • You may need a folded blanket to support the treatment arm (see photo below).

  • Legs up the wall is one of the most calming poses for the nervous system, and good for sleep. 

  • In general, the body needs to be supported for the brain and nervous system to relax.

  • Bonus: restorative yoga reduces circulating cortisol. Increased cortisol (stress hormone) is known to increase abdominal fat. Keeping abdominal fat in check is important for metabolic health, essentially the health of all your cells. 

                                                               

How we think contributes to how we feel 

• Consider the following reactions to hot flashes. Consider how the way our brain / thinking response can lead to very different consequences.

• You are in a public place, you sense heat building up around the chest, and a sudden overall increase in body temperature. 2 options for how your brain might respond:

• Oh no, not again! This is the last thing I need. I can’t cope with this. People will notice. (negative beliefs)

• Vs: This will pass in a minute- every woman goes through it (neutral beliefs)

• Your emotions will follow:

• Panic, anger, frustration, helplessness, embarrassment, self-consciousness.

• Vs: Calm, acceptance

• Your behavioral response:

• Perhaps you try and hide your face, fan yourself frantically, leave the room quickly

• Vs: I breathe slowly through the flash until it passes, focus back on task. I use humor if in the company of others.

• This is from the book, “Managing Hot Flushes and Night Sweats- A cognitive behavioral self-help guide to the menopause” by Myra Hunter and Melanie Smith. 

• The book offers a 4-week self-help guide using cognitive behavioral therapy, provides information and strategies for managing hot flashes, night sweats, stress and sleep.

 

Sleep Strategies:

• • Optimal sleep starts with how we start our day!

  • Taking a morning walk outside. Getting outside in daylight in the morning, helps to re-establish our internal clock, and promote sleep at night.

  • Managing cancer-related fatigue: if you take a nap, try to keep it to 20-30 minutes, and finish by 3:00. 

  • Start hydrating early in the day and taper to just sips in the 1-2 hours before bed to minimize bathroom trips at night. 

  • Adhere to a 1-hour window for bedtime and wake time; aiming for 7-8 hours of sleep per night 

  • Winding down for optimal sleep starts in the 2-3 hours before bedtime.

  • Meal timing: Finish your last meal 2-3 hours before bedtime to allow for proper digestion, and minimal sleep disruption. Avoid late-night snacks. 

  • If you want to block stimulating blue light that could interfere with sleep, avoid screen use as much as possible after dusk — especially within 2-3 hours of bedtime.  Consider good quality blue light blocker glasses if needed.

  • One research article noted that massaging feet before bed can add an hour to your sleep!

  • Keep the bedroom cool and dark. Wear an eye mask if necessary.

• Scandinavian sleep method: We visited our friends in Norway and each of the beds (hotels, homes, ships) all had separate comforters even on a double bed, allowing for individual temperature preferences and reduced sleep disturbances.

• Finally, keep the bedroom for sleep (and sex). Make it cozy and inviting for sleep.

Cooling foods: 

• Sometimes during chemo, nothing tastes great; there may be cravings for sweets or high fat foods.

• Try this recipe for Raspberry and Flaxseed Smoothie Bowl!

  • Raspberries and flaxseed- great for fiber, good for bowel health which is good for estrogen excreting. 

  • It has a nice texture, tastes and looks good too!

  • Beetroot juice is a great tonic for energy boost

  • Natural yoghurt (dairy or plant-based) – great for the microbiome

  • Cacao nibs for texture!

 

• Broccoli Rice and Eggs (broccoli is another cooling food, anti-inflammatory, great for digestion)

• Certain foods and drinks can promote better sleep by providing nutrients essential to sleep.

• Kiwi, cherries, milk (if tolerated), fatty fish, nuts and rice have been found to aide in relaxation and sleep. 

• Kiwis are a good source of serotonin, a neurotransmitter that plays a role in regulating mood and sleep. The body converts serotonin to melatonin, a hormone that helps regulate sleep-wake cycles.

• Tart cherries, either fresh or in juice form, are the best source of melatonin for sleep improvement. 

• Avoid caffeine, alcohol and heavy meals before bedtime for healthier sleep patterns.  Alcohol may make you drowsy, but it disrupts sleep patterns. This is because alcohol suppresses REM (rapid eye movement) sleep, a restorative stage of sleep. 

Resources: 

• Michelle Lyons: Celebrate Muliebrity Celebratemuliebrity.com 

• Books: 

• Good Energy: The Surprising Connection Between Metabolism and Limitless Health by Casey Means, MD

• Managing Hot Flushes and Night Sweats, A Cognitive Behavioral Self-Help Guide to the Menopause by Myra Hunter and Melanie Smith

Next up: Part 3- Bladder and Bowel Health; Nutrition and Lifestyle Strategies