Q. I stopped menstruating three years ago. Despite taking hormone replacement, I still suffer from terrible hot flashes and night sweats. My gynecologist says I am taking the right dose of estrogen. Now what?
A. Without question, it is a given that most hot flashes are a result of a change in estrogen level. No one knows what exactly causes menopausal hot flashes, but most theories attribute these unpredictable, often debilitating shifts in body temperature to thermoregulatory dysfunction in the brain initiated by estrogen withdrawal. Having said that, some women suffer from hot flashes that are either not due to menopause or persist despite huge doses of estrogen.
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Hot flashes typically begin as a sudden sensation of warmth on the face and upper chest lasting two to four minutes. Body temperatures are normal at the beginning of a flash, but then drop below normal, causing sweating, chills and shivering. This can happen once a day -- or once an hour.
If estrogen doesn't eliminate the flashes, the first step is to make sure that you are not taking one of the many medications that are known to decrease the absorption of, or speed up the metabolism of estrogen. Antibiotics and tranquilizers are common culprits. The result is that flashes will continue despite taking the dose of estrogen that usually eliminates flashes. Changing from an estrogen pill to a transdermal method such as a lotion or patch will often help since estrogen won't need to be metabolized by the liver.
It's also possible that what you are experiencing is not hot flashes, but night sweats. The distinction between perimenopausal hot flashes and night sweats is not always obvious, but is important since night sweats are often an indication of a medical or drug related problem, not lack of estrogen.
While "night sweats" typically occur only at night (hence the name), some women also experience increased sweating throughout the day. There are dozens of medications (both prescription and over the counter) that are known to cause excessive sweating, including anti- migraine drugs, anti-depressants, and blood pressure medications. Anti-depressants such as Prozac or Effexor reduce menopausal hot flashes but can then cause night sweats!
Other non-menopausal causes of night sweats and hot flashes include hyperthyroidism, cancer, and various chronic infections (such as tuberculosis). Many endocrinologic and neurologic problems are also on the list. Alcohol and certain food additives can also increase a tendency for night sweats.
Your gynecologist should still be the first stop if you are ripping your clothes off, but if menopause isn't the problem, your internist is the next place to look for relief.
Dr. Lauren Streicher practices at Northwestern Memorial Hospital.
drstreicher@suntimes.com
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