When a woman enters menopause, one of the main complaints is related to the appearance of vasomotor symptoms – the famous hot flashes, popularly called “hot flashes”, which cause intense discomfort. It is believed that at least 90% of them will experience these symptoms mildly (a feeling of heat without sweating, which is not a complete nuisance).
However, a new study shows that a third of Brazilian women will suffer from moderate to severe intensity, which negatively impacts their quality of life and has a direct influence on the quality of sleep.
Hot flashes during menopause are linked to a decrease in estrogen, the main female hormone. Typically, they appear suddenly, especially at night, while the woman is sleeping, causing intense heat in the chest area and a feeling of oppression. The discomfort can be so intense that some women report feeling their face “burning” and sweat dripping.
The research evaluated data from 12,268 women aged between 40 and 65 years in Brazil, Canada, Mexico, as well as four Nordic countries: Denmark, Finland, Norway and Sweden. To obtain the results, the authors administered an online questionnaire with specific questions about quality of life during menopause, productivity at work, impairment of activities and assessment of possible sleep disorders. Participants also provided information about the attitudes adopted in relation to symptoms and available treatments.
Results show data from Brazilian women above average
The results indicate an overall prevalence of moderate to severe symptoms of 15.6% among all women assessed. However, this prevalence was significantly higher among Brazilian women (36.2%, equivalent to one third) compared to Nordic women (11.6%). The researchers also found that hot flashes impaired work performance in up to 30% of cases, with the greatest severity of symptoms being observed in relation to sleep.
Still according to the study, many women sought medical advice, but the majority (56.9%) were not undergoing treatment for vasomotor symptoms. The article was published in the journal Menopause, a journal of the American Menopause Society.
According to Rogério Bonassi Machado, one of the authors, president of the Brazilian Climate Society (Sobrac) and professor at the Faculty of Medicine of Jundiaí, the fact that Brazilian women report more intense symptoms than Nordic women caught attention — and one of the possible explanations is the temperature difference between countries.
“We are a much hotter country, so most likely Brazilian women also suffer because of the influence of the climate,” he said.
Another fact that caught the researchers’ attention is that Mexican women also reported fewer hot flashes – only 16% of them said they felt moderate to severe vasomotor symptoms – and they live in climate conditions similar to those in Brazil.
“This is data that we need to understand better. But talking to the researcher from Mexico, one of the possible explanations involves the cultural issue. Mexican women would have a tendency not to report cases as much as Brazilian women: that is, they complain less about their doctors”, suggested Machado.
Why do hot flashes happen?
Hot flashes appear because of the decrease in the action of estrogen in the hypothalamus, which has a region that is responsible for regulating temperature in the body and works as if it were a thermostat: “in the hypothalamus there is a thermoregulatory center that acts within normal ranges to exchange heat or not. If the outside temperature is very hot, our body will want to exchange heat in an attempt to reduce the temperature. The same thing when it is cold, mechanisms also occur in the hypothalamus for retaining heat. When the estrogen level is reduced, any variation in temperature activates the thermoregulatory center and makes it want to lose heat. It’s as if this thermostat is out of regulation”, explained Machado.
Most of the time, the sensation causes the woman to wake up from sleep – she is woken up by the heat wave and has difficulty going back to sleep, causing a significant impact on the quality of her sleep. The heat usually lasts from 30 seconds to a minute, and may be longer in some cases.
According to Machado, what defined the symptoms as mild, moderate or severe is the impact on the woman’s daily activities. In the study, mild symptoms were defined as a feeling of heat with sweating, but maintaining the ability to continue an activity.
Moderate and severe symptoms were defined as those with a feeling of heat with excessive sweating, causing the woman’s routine to be interrupted. Furthermore, the specialist emphasizes that the number of episodes reported by the patient is also an important factor.
“There are women who report 50 episodes of hot flashes per day. It’s very bad because it interferes with their quality of life, their daily activities and, above all, their quality of sleep,” said the researcher.
Is there a way to avoid it?
Hot flashes are a component of menopause, and symptoms typically last three to four years. They tend to resolve spontaneously, but there are cases in which they become persistent and last for more than ten years.
The gold standard treatment is hormone replacement therapy (estrogen replacement) – this is the most traditional, safe and recommended line because it usually brings a lot of relief to vasomotor symptoms. It can be used in gel form, in patches and orally.
“Hormone replacement is the most effective treatment for hot flashes and, in general, it is precisely the hot flashes that motivate patients to seek treatment, especially in cases where the flashes are more intense”, said the gynecologist and obstetrician Sérgio Podgaec, from Hospital Israelita Albert Einstein.
The problem is that not all women can take hormone replacement therapy – there are contraindications specifically for those who have had breast cancer. Therefore, a medical evaluation is necessary to analyze the risks and correctly indicate treatment.
“Many women are afraid to take hormone replacement therapy because the use of estrogen and progesterone for those who still have a uterus can increase the risk of breast cancer. It is a very small risk, but it exists. Women who do not have a uterus should replace with estrogen alone and, in these cases, the risk of cancer is not increased,” said Podgaec.
Einstein’s gynecologist and obstetrician emphasizes that the contraindication of hormone replacement is only for women who have had breast, endometrial or ovarian cancer. For these cases, there are alternative pharmacological treatments, such as the use of antidepressants in lower doses that can alleviate hot flashes a little, but they do not always resolve them. There are also behavioral therapies, such as yoga, acupuncture and physical exercises.
“This study is very important because it helps us to understand the epidemiology and population data of the disease in Brazil. This helps us to better understand the profile of women and understand from a practical point of view what should be studied and followed for treatments”, concluded Podgaec.