June 8, 2012



flashes and night sweats, after menstrual irregularity, are the most common
symptoms of menopause, and can be the most disruptive and disabling. I call
these vasomotor symptoms the symptom of
because despite all our efforts, we simply do not know their
precise cause.

course, not knowing the exact cause means that we cannot design the best
treatment. But we do have much to offer.


The brain
is a sponge for hormones that in turn exert a multiplicity of effects. When
present in normal amounts the sex steroids can trigger specific brain actions –
when absent this ability is reduced or lost.

many of these processes and conditions interact with each other, I will
consider specific conditions one by one:

Body Temperature Control: Sudden
short-lived wide fluctuations in body temperature are the hallmark of
menopause. Whether called hot flushes,
hot flashes, night sweats
, or their technical name vasomotor symptoms (VMS), they and their impact are the same. An
episode of flushing, sometimes preceded by an early warning flash, is
associated with a sensation varying from warmth to intense heat on the upper
body and face. Perspiration follows as the body attempts to counteract by
cooling, and as the perspiration evaporates, so there can actually be chilling
and shivering. When these events occur during the night, they can disrupt sleep
and are called night sweats. They can last up to 5 or 6 minutes or more, and
are associated with remarkable temperature increases, as well as the heart
beating rapidly (palpitations). They
can be infrequent (weekly or monthly) or frequent (hourly). Reaction to them
can vary from being a minor nuisance, all the way to a total disruptive
influence on regular activities and living. 

second most common symptom of menopause after irregular periods, 75% of women
are affected by VMS. This is a true “rule of quarters.” One quarter of women
are not affected at all. Mild, moderate, or severe VMS, each account for a
quarter of women. VMS can start several years before menopause and usually begin
to decline in frequency and severity 2-3 years after menopause. Unfortunately,
they do persist in some women for many years.

We do not
know the cause of VMS , the “symptom of
.” They occur more frequently in African-American women, followed by
Hispanic, Caucasian, Chinese, and Japanese women. Of greater influence than
race is body mass index (BMI). The greater the BMI, the higher the prevalence
of VMS.

women who have early onset of menopause as a result of surgical removal of the
ovaries, chemotherapy, or radiotherapy, are more likely to have the most severe
form of VMS.

Never to
be forgotten is that
there are
other causes
for VMS. These include an overactive thyroid
gland, epilepsy, hypertension, leukemia, and hormone-producing tumors such as
of the adrenal gland and appendix. Certain drugs may also be the cause.

HEADACHE: Headache is a very common
midlife complaint. Of the three kinds of headache, tension, cluster, and
migraine, it is the latter that mostly drives people to the doctor’s office.
Fortunately most headaches are not serious, which is not to minimize the
negative impact they can have on quality of life, but some may indicate a more
major underlying problem. A trigger mechanism can be identified in many cases,
including various foods, stress, and environmental factors like noise or
changes in the barometric pressure.

hormones, however, affect one type of migraine. While there is no sex-related
difference in incidence of headaches before puberty or after menopause, women
between 25 and 55 have triple the number of headaches (18% vs. 6%). These
headaches occur largely around periods, hence their being named menstrual migraine. These headaches may
increase in severity during perimenopause, but usually wane after menopause.



brings us right into the middle of the debate on hormone therapy after
menopause, and I will dive right into this in great detail in future blogs. I
will also discuss alternate therapies.


Have a
great week!

Wulf Utian MD PhD DSc

Author; CHANGE YOUR MENOPAUSE – Why one size
does not fit all


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