The research published yesterday which shows that hot flushes could linger into our seventies is enough to darken any woman’s day. A sense of impending doom is often a symptom of the menopause anyway, without this news.
The findings come from US research, published in medical journal JAMA, based on 1,449 women aged 42 to 52 over a 12 to 17-year period. To add some perspective to the dramatic newspaper headlines, the average duration of hot flushes and night sweats was seven years. Very few women reported symptoms lasting 14 years.
Of the 881 women in the survey who were post-menopause (i.e. have had their last period), the average length of symptoms was four and a half years. For women whose symptoms did not begin until after their last period, it was just over three years.
The study was also only focused on women who’d had symptoms for six days in the previous two weeks. This may not be reflective of all women who have menopausal symptoms. And it only studied US women, so may not translate to other populations.
NHS Choices has taken an in-depth look at the detail of the story behind the papers’ headlines. Of course, it’s still not good news.
Menopause the number one reason to see our GP
Menopausal symptoms are such a problem that they are now the primary cause of women visiting their doctor.
This follows a dramatic reduction in the number of prescriptions for HRT being requested after negative research results in 2005 about the treatment.
Due to falling and fluctuating levels of oestrogen and progesterone, 80 per cent of Western women pre- and post-menopause suffer sudden surges in body temperature by as much as 9°C, night sweats and blotchy pink skin on their face and neck. For a fifth of women affected, it is severe.
Dr Mark Porter is unconvinced by the huge range of vitamin supplements and herbal products on offer. He says: “A lot of women swear by herbs such as sage and black cohosh, but placebos [dummy pills] provide relief from hot flushes in 30-40 per cent of women, and studies have struggled to demonstrate that herbal products work any better. I have stopped recommending them.”
Is red clover the only herb that works for menopause?
Red clover is perhaps the exception. A review by Monash University in Australia has concluded that taking an extract of red clover is 34 per cent more effective than a placebo for easing hot flushes when taken for three to four months.
However, the research team also found that the effect did not last if red clover was taken for more than a year.
A type of anti-depressant called selective serotonin reuptake inhibitor [SSRI] can be prescribed as an alternative to HRT but is not as effective. SSRIs such as venlafaxine can help reduce the frequency and intensity of hot flushes but they won’t get rid of them.
Ten ways to reduce or prevent hot flushes
So it seems that, crucially, changes to our food and lifestyle are most effective for long-term relief. If you’re having symptoms, these may help to reduce them. If you’re in your late forties implement these now, as symptoms can start two to three years before your periods end (the average for which is 51 in the UK).
1 Avoid heat
Unsurprisingly, heat is a trigger, so keep cool. Dr Jane Woyka of the British Menopause Society, says: “Avoid anything that makes you hot, including spicy foods, hot drinks and hot showers. Keep a fan by your bed and use sheets instead of a heavy duvet. Wear cotton layers in the day rather than a big jumper.” Many women say that cutting out garlic, onions and chilli stopped or reduced their hot flushes.
2 Sleep well (and don’t use sheets with a high thread count). A recent study found that one in four middle-aged women are dissatisfied with the quality of their sleep. Another major piece of research found that menopausal women are nearly four times more likely to suffer insomnia. It helps to stick to camomile or valerian tea or warm milky drinks at bedtime. Keep your bedroom dark, quiet and cool.
The modern obsession with luxury high thread-count sheets could exacerbate night sweats and disturbed sleep. The tight weave on a thread count of more than 120 traps heat, causing the ‘covers-on covers-off’ game that is characteristic of menopausal nights. Opt for low thread-count cotton, or better still, long-lasting linen, which has a thread count of 80-150) and better wicking properties, meaning less fluctuation in temperature and a less interrupted night’s sleep.
3 Don’t be overweight. Being overweight makes menopausal symptoms worse. It’s thought that larger people have a higher body temperature, making flushes and sweats more likely or more painful.
4 Avoid caffeine. Experts at the Mayo Clinic in the US found that 85 per cent of women who suffered hot flushes were consuming high amounts of caffeine in tea, coffee and fizzy drinks. Other studies show that three to four such drinks a day can make flushes worse.
5 Avoid alcohol. Cutting or stopping your alcohol intake can reduce the incidence of menopausal hot flushes. Alcohol is thought to raise oestrogen levels temporarily, making the drop back to a normal level more extreme and sudden once the alcohol has been metabolised.
According to consultant gynaecologist Mike Bowen. “Alcohol is a vasodilator, meaning it causes blood vessels in the skin to dilate. If you are suffering from hot flushes already, due to fluctuating levels of hormones, alcohol is just going to amplify the unpleasant effect.”
However, post-menopausal women are more at risk of osteoporosis if they stop moderate drinking, scientists from Oregon State University have found. And during the peri-menopause (when you’re having symptoms), the medical advice is to abstain or be a light drinker, i.e. a glass of wine once a day or every other day.
6 Smoking. Quit smoking, as it triggers the liver to produce oestrogen-destroying enzymes, making menopausal symptoms worse.
7 Yoga. The University of Washington in Seattle examined a range of non-drug studies, including herbal medicine, Chinese medicine, yoga, exercise and relaxation. Its verdict was: “Yoga, in particular, showed significant treatment effects for hot flushes and cognitive symptoms. In certain groups, yoga also showed benefits for sleep, mood and pain symptoms.” As little as 15-20 minutes practising yoga, body balance or simply lying flat, relaxing muscles and deep breathing, can help.
8 Exercise. Regular aerobic exercise helps. A vigorous daily walk (or equivalent physical activity) seems to ease hot flushes. You don’t have to join a health club, or get involved in anything too rigorous. A few sessions of walking, swimming or cycling every week will boost flexibility, stamina and energy levels, and increase mood-positive serotonin levels.
9 Eat more like the Japanese. Famously, there’s no word for menopause in Japanese and nutritionists have long pondered why only 22 per cent of women there get hot flushes. Western women consume much more meat, and about four times as much fat, as women on the traditional Asian rice-based diet and only a quarter to half the fibre.
For reasons that are not clear, a high-fat, low-fibre diet causes a rise in oestrogen. Women on higher-fat diets have more oestrogen activity than those on low-fat diets. At menopause, when oestrogen production comes to a halt, those women who have been on high-fat diets then have a violent drop in oestrogen levels, which causes the symptoms.
High-protein foods such as nuts, and foods high in nutrients such as zinc, vitamin E and calcium – especially non-diary calcium-rich food such as green leafy vegetables and beans – can also help.
10 Omega-3 fatty acids. Scientists are studying omega-3 fatty acids, a component of fish oil, as a treatment for hot flushes. Women in an eight-week trial at the Centre d’Investigation Clinique de Grenoble in France are taking three capsules a day of omega-3 fatty acids or a placebo. It’s thought that omega-3s act on the brain chemical serotonin, which plays a key role in menopausal symptoms.