Hot flashes are a common symptom experienced by many women during menopause. These sudden intense feelings of warmth can cause sweating, flushing, and sometimes heart palpitations. Hot flashes can be uncomfortable and disruptive to daily life and may even lead to difficulty sleeping which has a multitude of negative health effects. However, with the right management, women can effectively alleviate the symptoms of hot flashes.
So, what causes hot flashes?
The answer lies in the delicate balance of hormones in our bodies, particularly estrogen. Estrogen, a hormone produced by the ovaries, plays a crucial role in regulating our body's thermoregulation, the way our bodies perceive temperature. Estrogen activates and inactivates neurons located in the hypothalamus, a brain region responsible for controlling our body's internal temperature. When estrogen levels drop during menopause, these neurons become more active, causing hot flashes.
While hot flashes are a natural part of menopause, they can be managed with a range of treatments.
The first step is to maintain a healthy lifestyle, which includes regular exercise, a balanced diet, and maintaining a healthy weight. Studies have shown that regular exercise can help to reduce the frequency and severity of hot flashes.
The decision to use HT for the treatment of hot flashes should be based on several factors, including age, severity of symptoms, overall health, and personal preferences. For women who are experiencing moderate to severe hot flashes and who are otherwise healthy, HT is the most effective treatment for vasomotor symptoms and genitorurinary symptoms of menopause.
When considering HT, timing matters. Initiating hormones when younger than 60 years of age or within 10 years of menopasue has few risks (assuming no contraindications) and is effective in treating vasomotor symptoms and preventing bone loss. If initiating HT over 60 or more than 10 years after menopause, the benefit-risk ratio is less favorable becuase of more age related risks of coronary heart disease, stroke, blood clots and dementia.
Not all women are eligible for hormone therapy, and this is where non-hormonal medication comes into play. You may be wondering aboutt the drug that made it on natioanl TV during the superbowl.
Fezolinetant is a new drug that is not yet FDA approved, but it is hoped that it can fill a gap in care for individuals who experience hot flashes and who are ineligible for hormone therapy.
Fezolinetant works by blocking the activity of the neurotransmitter neurokinin B, which is responsible for activating the neurons in the hypothalamus that cause hot flashes. By blocking this activity, fezolinetant aims to reduce the frequency and severity of hot flashes. Although more research is needed to determine the safety and efficacy of fezolinetant, it holds great promise as a new option for treating hot flashes in menopausal women. While, it will treat hot flashes and possibly improve disturbed sleep, it will not impact other symptoms, for instance, bone loss and vaginal dryness.
Hot flashes are a common symptom of menopause, affecting up to 70% of women. The root cause of hot flashes is the decline in estrogen levels, which disrupts the delicate balance of hormones in our bodies and affects our thermoregulation. Hormone therapy is a popular treatment option, but not all women are eligible, which is why new non-hormonal medications like fezolinetant hold great promise for filling the gap in care for menopausal women.