Could your hot flashes put you at risk for heart disease?
Hot flashes may be more than just uncomfortable and embarrassing for women. They may put them at risk for heart disease.
Researchers who followed more than 3,000 women for 20 years found that participants who experienced frequent hot flashes earlier in menopause were twice as likely to develop cardiovascular disease events. In addition, those who reported more persistent hot flashes over the course of the menopausal transition were associated with an 80 percent increased risk for cardiovascular disease events.
Rebecca Thurston, lead investigator on the study, called the magnitude of the increased risks “substantial,” but doesn't want the results to scare women.
"What we do know, likely at a minimum, is that the [hot flashes] are telling us something about the health of women's cardiovascular systems, and that they need to be engaging in positive health behaviors,” said Thurston, a professor of psychiatry, psychology and epidemiology at the University of Pittsburgh.
What should women who are having hot flashes do in response to this information? Elizabeth Speed, MD, an obstetrician/gynecologist at Falmouth Women's Health, explained that although there is no data on whether treating hot flashes will decrease the risk to heart health, it is still important to talk to your provider if you are experiencing hot flashes, as this can open the door to discussions about changing other behaviors that may further increase your risk of heart disease.
“For instance, you may know that smoking, obesity and inactivity increase your risk of cardiovascular disease, but have not been able to make those changes. Perhaps knowing that if you also experience frequent hot flashes, your risk is further increased, it may motivate you to finally make those lifestyle changes that will improve your overall health and reduce your risk of cardiovascular disease,” she said.
Risk factors for hot flashes include smoking, obesity and inactivity, so by kicking the smoking habit and staying fit, women can reduce the frequency of uncomfortable hot flashes while also reducing their risk of heart disease, Dr. Speed said.
A new study in the American Journal of Obstetrics and Gynecology concluded that women who maintain a normal weight before menopause and who quit smoking before age 40 may reduce their risk of having hot flashes. According to the study, “high body mass index and cigarette smoking substantially increased women’s risk for experiencing frequent or severe vasomotor symptoms (hot flashes), and smoking intensified the effect of obesity.”
Women need not just accept the fact they will experience hot flashes during menopause, Dr. Speed added. Hot flashes can have a significant negative impact on your quality of life, both in the workplace and at home, she noted. They can be extremely uncomfortable, and the associated flushing may be embarrassing or occur at inopportune times.
“Don’t dismiss them as something you have to live with. Women ignore symptoms more often than men do, so I encourage everyone to quit delaying health issues. Talk with your provider. Make your health a priority,” she said.
“In addition, I encourage women and men to do everything they can to reduce their risk of cardiovascular disease. Don’t smoke, keep your weight, blood pressure, cholesterol and blood sugar under control, and exercise.”
Managing Hot Flashes
According to the North American Menopause Society, hot flashes are “the most common menopause-related discomfort."
Scientists think that hot flashes are the result of changes in the brain's hypothalamus — the area that helps control the body's temperature. When the hypothalamus misfires, it sends signals to the blood vessels on the surface of the skin to dilate and disperse body heat because it mistakenly thinks the body is too warm.
Because of this effect on blood vessels, medical professionals often refer to hot flashes and night sweats as vasomotor symptoms.
“People who have hot flashes once in a blue moon may not have a need for treatment, but there are several treatment options for people whose hot flashes are affecting their daily lives,” Dr. Speed said.
Hormone replacement is one option and is very effective, but many women have concerns about the increased risk of cardiovascular events as well as other health complications associated with taking combined (progesterone and estrogen) hormone replacement. What many women don’t know is that this risk is much lower when used in early menopause, at low doses and for shorter periods of time, according to Dr. Speed.
Additionally, if a woman has undergone a hysterectomy, she may be a candidate for estrogen-only therapy which has much less risk of adverse events compared with combined therapy.
“These are things you can discuss with your provider,” she said.
For women who are not candidates for hormone replacement therapy (those with endometrial or breast cancer or history of blood clots in the lungs or legs), there are alternative medications.
“Paroxetine and venlafaxine, which are traditionally used as antidepressants, have been found to significantly decrease hot flashes without the risk associated with hormone replacement,” Dr. Speed said.
Many women find mindfulness meditation, yoga and exercise very helpful for managing menopausal symptoms, she added.