Hot Flashes of Menopause
The following excerpt is from "What Your Doctor May
Not Tell You About Menopause" by John Lee, MD pg 153:
"Around age 45 to 50, sometimes a little earlier or later,
estrogen levels begin to fall. When they fall below the levels
necessary to signal the uterine lining to thicken and gather
blood, the menstrual flow becomes less and/or irregular, eventually
stopping altogether.
Let's zero in and take a closer look at hot flashes, the
hallmark of menopausal symptoms. The prevailing explanation
for hot flashes is follows: Recall that an area (which we'll call
the GnRH, which stimulates the pituitary to make hormones (FSH and
LH), which in turn result in ovarian production of estrogen and
progesterone. The rise in these hormones inhibits further production
of GnRH. At menopause, estrogen levels fall and progesterone
levels are usually already low. The ovaries no longer respond
to the FSH and LH prompt.
When a woman's ovaries don't respond to FSH and LH signals
by ovulating, the hormone signaling system can go awry.
In effect, the hypothalamus begins "shouting", trying to
tell the pituitary to tell the ovaries to ovulate. The inability
of the ovaries to respond is most likely due to a final
depletion of eggs and their surrounding follicle cells. This
over activity of the hypothalamus and pituitary signal begins
affecting adjacent areas of the brain, which we'll call the
vasomotor center (specifically the arcuate nucleus of the
hypothalamus that controls capillary dilation and sweating
mechanisms), and these are the women who get hot flashes
and night sweats. In addition to hot flashes, the heightened
activity of the hypothalamus can cause mood swings, fatigue,
feelings of being cold, and inappropriate responses to
other stressors. Many women will have symptoms of hypothyroidism
despite normal thyroid hormone levels.
In a nutshell:
1. Then GnRH center effectively signals to increase estrogen
and progesterone synthesis.
2. Elevated estrogen and progesterone inhibit GnRH and release.
3. After menopause, the ovaries no longer make estrogen and progesterone.
4. Lack of estrogen and progesterone response results in increased
activity of the GnRH center.
5. Heightened GnRH activity activates te vasomotor center, causing
hot flashes and perspiration.
It is important to recognize that the GnRH center monitors both estrogen and
progesterone. Thus, since the post menopausal woman continues
to make estrogen in respectable levels and makes little or no
progesterone, hot flashes may well respond to progesterone
supplementation alone. Hot flashes will also respond to much smaller
doses of supplemental estrogen when Provera (medroxyprogesterone
acetate) or Megace (megestrol acetate) have been found effective
in treating hot flashes, further indicating that estrogen per se
is not the only factor in hot flashes.
The truth is that estrogen is only one part of the menopausal
picture and is certainly not a cure-all. In fact, these days
I hear more complaints about the side effects of taking estrogen
than I do about menopausal symptoms."
Emotional State
Some how the emotional state of the woman also affects hormones and hot flashes. Back in 1999, when I first started to treat my patients with natural bioidentical progesterone, I would have never believed this. I was ten years out of Medical School and thought that I was very well versed in the use of Natural Progesterone. However, in truth, I didn't know much. Now hopefully, I am smarter, humbler, and wiser in 2009 after listening carefully to some of my 10,000 patients with female problems.
A woman at church, a personal acquaintance, complained that she could not sleep because she was having hot flashes. So I gave her a bottle of Progestelle for free. I instructed her how to use it.
The next time I saw her was a month later at church. I asked her how the insomnia and hot flashes were. She said the hot flashes and insomnia had disappeared. "How did you like the Progestelle?" I asked.
"I never used it," she answered. "My husband and I took a 2 week vacation in Maui, and all the hot flashes and insomnia went away!" she exclaimed.
After talking to other patients, I am beginning to realize that the way you think affects brain chemistry. And brain chemistry affects body chemistry. And body chemistry affects insomnia and hot flashes.