Flush These Symptoms Away

Helpful general measures for hot flushes and night sweats include regular exercise, wearing light clothing, sleeping in a cool place and avoidance of stress. Hot flushes and night sweats are often unwelcome consequences of menopause.

MENOPAUSE is the permanent cessation of periods as a result of the loss of ovarian activity, and can be said to have occurred only after 12 months without spontaneous menstruation.

The average age of this natural event is 50 years. Women who are at or near the menopause often experience vasomotor symptoms – hot flushes and night sweats.

A hot flush is a feeling of intense heat involving the face and body. Whilst it may be attributed to the hot tropical weather, hot flushes are difficult to ignore.

Women who experience them often switch on the fan and/or air conditioner even when the ambient temperature is low.

The hot flushes may not be apparent to an observer, but are very real to the person experiencing it. Its duration varies from a few seconds to 10 minutes, with an average of about four minutes.

The frequency of the flushes ranges from hourly to a few times a week.

During the flush, the blood vessels open up (dilate), resulting in a slight decrease in the body’s core temperature. After it goes away, there is no other bodily change. Such symptoms are also called vasomotor symptoms.

Night sweats can be troublesome. Some women who experience them complain that it is as if their clothes were drenched by the rain. Sleep disturbances are common when there are night sweats.

Hot flushes and night sweats are often associated with poor concentration and memory. Frequent flushes and sleep disturbances may lead to mood changes, which are common. Depression is not uncommon.

Why it occurs

Why hot flushes and night sweats occur is not well understood. They appear to be related to markedly high levels of hormones called gonadotrophins, which are produced by the brain to stimulate the ovaries when ovarian hormone production fails.

Vasomotor symptoms do not usually occur in men as there is no similar rapid decrease in hormones. The gradual decrease in hormones in older men is not accompanied by high levels of gonadotrophins.

However, men who are treated for prostate cancer with medicines that suppress production of the male hormone, testosterone, can experience hot flushes that are similar to that in menopausal women.

The reported prevalence of vasomotor symptoms varies with different studies. However, certain generalisations can be made.

For one, the frequency and severity of the symptoms are much more at or near the menopause.

The symptoms occur in about half of menopausal women, with some finding it more distressing than others.

They resolve spontaneously in many women within a few months, but persist in others for several years after menopause.

There are studies that report of persistent hot flushes in about three in 10 women aged 60 years.

The prevalence of menopausal symptoms in Malaysian women have been published in medical literature. Dhillon et al reported on the “Prevalence of menopausal symptoms in women in Kelantan” (Maturitas. 2006 Jun 20; 54(3):213-21).

The most common number of menopausal symptoms was eight, with night sweats occurring in 53% and hot flushes in 44.8%. There was tiredness in 79.1%; reduced level of concentration in 77.5%; mood swings in 51%; sleep problems in 45.1%; loneliness in 41.1%; anxiety in 39.8%; and crying spells in 33.4%.

Similar findings were reported by Syed Alwi Syed Abdul Rahman et al in their publication “Assessment of menopausal symptoms using modified Menopause Rating Scale (MRS) among middle age women in Kuching” (Asia Pacific Family Medicine 2010, 9:5).

The common symptoms were physical and mental exhaustion in 67.1%; sleeping problems in 52.2%; hot flushes and sweating in 41.6%; irritability in 37.9%; anxiety in 36.5%; and depressive mood in 32.6%.

Certain factors increase the likelihood of vasomotor symptoms.

They are more severe in women whose body weight is low, who do minimal or no exercise, and those who smoke.

Caucasians and Negroes experience them more often than Asians.

The symptoms are more severe if the menopause is sudden or early, e.g. surgical removal of the ovaries; following chemotherapy or radiotherapy.

Managing vasomotor symptoms

Vasomotor symptoms are not life-threatening, but they affect quality of life, especially when they are frequent and severe.

They usually resolve with the passage of time. However, when they are present, it is vital that the spouse and family members are sympathetic and tolerant. At the same time, the sufferer has to approach it positively.

Helpful general measures include regular exercise; the wearing of light clothing; sleeping in a cool place; and avoidance of stress.

However, some studies report that exercise and diet are of little benefit. Avoidance of factors that precipitate vasomotor symptoms, e.g. tobacco smoke, alcohol or certain foods is helpful.

Vasomotor symptoms are treated specifically with hormones. Both oestrogen (ET) and combined oestrogen-progestogen (EPT) are effective for relief of hot flushes and/or sweats.

ET and EPT are effective in reducing the frequency and severity of hot flushes and/or sweats. Both low and standard dose ET and EPT are effective.

The dose refers to the oestrogen concentration in E and EPT. The standard dose contains either conjugated equine oestrogens 0.625mg or estradiol valerate 2mg. The low dose contains either conjugated equine oestrogens 0.3mg or 0.46mg; or estradiol valerate 1mg.

In short, the quality of life of a menopausal woman with vasomotor symptoms can be improved with a medical consultation.


Dr Milton Lum – is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Disclaimer: Nothing on this blog should be considered or used as a substitute for medical advice, diagnosis or treatment. Blog visitors with personal health or medical questions should consult their health care provider.

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