Managing Hot Flushes and Night Sweats

A Cognitive Behavioural Self-help Guide to the Menopause

Myra Hunter, Melanie Smith

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000076509
• Edition: 2
• Topic: Medicine
• Subtopic: General Health

This revised edition of Managing Hot Flushes and Night Sweats offers up-to-date and evidence-based information about the menopause and about hot flushes and night sweats, which are the main reason that women seek medical help.

The four-week self-help guide uses cognitive behavioral therapy, providing information and strategies for managing hot flushes and night sweats, as well as stress and sleep. The guide is interactive with exercises and homework tailored to women's individual circumstances and lifestyles. It challenges myths about menopause and aging and provides better understanding of flushes which in turn reduces stress and improves post-menopausal well-being. The various chapters discuss processes of identification and modification of triggers of hot flushes and offers tips to women on dealing with hot flushes in social and work situations.

The guidecan beas effective as eight hours of group CBT and will help women who want to try a non-medical treatment that is brief andeffective without side effects, or just want to be better informed.

1
The menopause

A bio-psycho-social transition

What is the menopause?

The menopause occurs on average between the ages of 50 and 51 in most Western cultures, and literally refers to a woman’s last menstrual period. The term originally comes from the Greek words ‘menos’ and ‘pausos’, which mean ‘month’ and an ‘ending’. In this case, the ‘ending’ refers to the cessation of ovulation – the production of fertile eggs or ovum – and therefore fertility, and it also marks a change in life stage for many women. Most women will go through the menopause, although for some the timing of the menopause is influenced by surgery or disease. Hot flushes and night sweats (the medical term for these is ‘vasomotor symptoms’) are the other main physical signs of menopause.

The last menstrual period takes place within a gradual process of biological change, occurring at the same time as other age-related changes and within varied social and cultural contexts. Consequently, the menopause happens at several levels – the biological, psychological, social and cultural (Hunter and Rendall 2007). Perhaps because it typically occurs at the age of 50, during midlife, when most women are working, and life demands and stresses typically accumulate, the menopause has been associated with role and social changes for women. However, this is not necessarily the case for everyone. As we will see in the following sections, what is happening in a woman’s life is very varied and can influence how she feels about approaching the menopause. Increasingly, the role of personal and lifestyle factors is being acknowledged and understood when considering how women experience the menopause. There is a gradual shift away from a primarily biomedical approach to the consideration of the influence of the psycho-social and cultural factors in women’s lives that can shape the menopause transition (Judd et al. 2012) (see Figure 1.1).

Figure 1.1A bio-psycho-social model of factors influencing experience of the menopause

For example, for one woman the menopause meant that she no longer had to deal with having heavy periods, and this was a relief to her; for her friend, however, whose night sweats had woken her every night and disturbed her sleep for several months, the menopause felt like an ordeal. Similarly, for a woman who is planning to have children in her 40s, an early menopause is likely to have a major impact, whereas for a woman who has already had her family, the issue of fertility may be less relevant. However, for many women, uncertainty and some anxiety about what is happening or is likely to happen to them is a real concern, and the impact of accumulation of stresses during midlife should not be underestimated.

Some definitions

Menopause is defined by doctors and researchers as the permanent ending of menstruation and is said to have occurred when a woman has not had a menstrual period for one year. While the hormonal changes that accompany menopause happen over a number of years, the stages of the menopause transition are generally based on patterns of menstrual periods:

• Premenopause is defined by regular menstruation.
• Perimenopause includes the phase immediately before the menopause and the first year after menopause and is defined by changes in the regularity of menstruation during the previous 12 months.
• Postmenopausal women are those who have not menstruated during the previous 12 months.

It can be difficult to fit all women easily into this classification; for example, if you have had a hysterectomy (removal of the womb), had surgery to remove your ovaries or are taking hormone therapy, you will not be having natural menstrual periods. Women in these categories tend to be classified separately because, for them, menstruation would not be a reliable indicator of menopause.

In 2012, the Stages of Reproductive Aging Workshop (STRAW) created a better system to describe stages of reproductive ageing across the whole life cycle (Harlow et al. 2012). It is based on evidence and reflects the parallel changes in menstruation, hormonal changes and experience of hot flushes and night sweats across women’s lifespans.

The term ‘perimenopause’ is commonly used to refer to the menopause transition and early postmenopause, since this is the stage during which most physical changes occur. The STRAW definitions have also increased our understanding of when menopause occurs and how long it typically lasts (see Box 1.1).

Box 1.1 Stages of Reproductive Aging (STRAW) definitions

• Reproductive stage: includes menarche (onset of menstrual periods) with variable menstruation initially; it can take several years for regular menstrual cycles to develop, and these are usually every 21 to 35 days. Across this phase – typically from adolescence to late 40s – fairly regular menstruation continues, but there can be some changes in flow (sometimes becoming heavy) and in the length of the cycle.
• Menopause transition: includes early transition (regular menstruation but changes in menstrual cycle length) as well as late menopause transition (two or more missed menstrual periods and at least one interval of 60 days or more between menstrual periods), which happens one to three years before the final menstrual period. During this stage follicle-stimulating hormone (FSH) levels tend to rise (this hormone is working hard to try to produce ovulation) and oestrogen levels start to reduce. Hot flushes are likely to occur during the late menopause transition.
• Menopause: the last menstrual period (LMP).
• Postmenopause: this stage is divided into early (up to six years after the LMP) and late (the subsequent years). Early postmenopause is characterized by hormonal changes and hot flushes, which tend to stabilize during the late postmenopause.

Additional terms – such as ‘climacteric syndrome’ and ‘menopause syndrome’ – have been used, mainly by doctors, to refer to a range of physical and emotional experiences that may or may not be related to hormone or menstrual changes. These include hot flushes, vaginal dryness, loss of libido, depression, anxiety, irritability, poor memory, loss of concentration, mood swings, insomnia, tiredness, aching limbs, loss of energy and dry skin. These will be discussed in later sections but – apart from hot flushes, night sweats and vaginal dryness – the other symptoms are not necessarily a result of menopause and, if they occur, may well have other causes as well, such as stress, ageing and lifestyle.

‘The change’ or ‘change of life’ is a commonly used term in Western cultures, reflecting the view that the meaning of the menopause is closely associated with general psychological and social adaptations women experience at midlife. ‘Midlife crisis’ also suggests that this stage might coincide with dramatic changes in personal and social relationships and with life events such as illness, caring for (and the death of) parents, dealing with adolescents and children leaving home, as well as reaching the age of 50. We tend to view menopause as a period of transition with pros and cons, just like other life transitions for women, such as adolescence and childbirth, when women report a broad spectrum of experiences. Thinking about other reproductive stages, such as adolescence or pregnancy, while these are defined primarily by the physical changes that are taking place, it is hard to separate out the other significant psycho-social changes that take place at the time. We would think about menopause in a similar way.

Women can often review their lives at this age and may have existential thoughts about the past and the future, which are of course quite normal. Whether these changes are experienced as a result of the menopause, or are linked to it, will vary between women and will in part be a function of what is happening in their lives, as well as the social and cultural meanings of ageing and menopause.

When does it happen and how long does it last?

Remember that the menopause can occur quite normally during a wide age range – at any time between 40 and 60 years, in fact. Studies have found that in some parts of the world, however, women experience the menopause slightly earlier. For example, in India and Pakistan, menopause age ranges from 44 to 48 years (average 47 years), compared with 50 to 51 in Europe and North America. Earlier menopause can be associated with poverty, poor nutrition and smoking (Freeman and Sherif 2007; Andrikoula and Prevelic 2009). Menopause is considered early, or premature, when it occurs in women aged 40 or younger, and this is estimated to affect approximately 1 per cent of women (Panay and Fenton 2008). The causes of early menopause are often unknown, but early menopause can be caused by certain genetic conditions, as well as some autoimmune disorders. Menopause also happens earlier due to surgery (surgical removal of the ovaries, or oophorectomy); medical treatments, such as chemotherapy and radiotherapy; or some hormone treatments, which interfere with natural hormone production. Medically induced menopause, if not caused by surgery, can be permanent or temporary. This can be the case for women who have had chemotherapy to treat breast cancer. So, if this has happened to you and you are uncertain about your menopausal status or fertility, do discuss this with your doctor.

If you have had a hysterectomy, you will not be having menstrual periods, and so it can be difficult to know when you have reached the menopause. If you still have ovaries, you will go through the menopause at roughly the same age as other women. However, you may have a slightly earlier menopause on average than those who have gone through this stage naturally. If you are having a hysterectomy, it is important to be clear about the difference between this operation (surgical removal of the womb) and surgical removal of the ovaries (oophorectomy) as the consequences are very different. Oophorectomy does cause menopause and rapid hormone changes, which can lead to more severe hot flushes if not treated. Women who have had surgical menopause and those who have early menopause are advised to use HRT until the natural age of menopause, i.e. 50 years, to maintain good health.

How long the menopause lasts is really very variable. Typically, it was thought to last between two and five years, but recent studies suggest that the duration of the menopause can be longer. In a 13-year Australian study (Col et al. 2009) following women through the menopause, the average duration (from the onset of menstrual changes to the stopping of hot flushes) was five to six years. But some women still have hot flushes and night sweats in their late 50s and early 60s (Hunter et al. 2012; Avis et al. 2015). This may be partly due to some women stopping HRT and having hot flushes later as their bodies adjust to the lowering of oestrogen levels.

Is there a male menopause?

The term ‘male menopause’ is often used in the media to explain a range of ‘symptoms’ experienced by middle-aged and older men, such as low libido, impotence, tiredness or depression. As for women, the term has negative connotations and is often used as a jokey insult. ‘Male menopause’ also suggests that the symptoms noted earlier occur as a result of a sudden drop in the hormone testosterone during middle age. This is not the case, however: testosterone levels reduce very gradually as men age, in fact, and the decline is steady at about 1 to 2 pe...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgements
• Introduction
• 1 The menopause: A bio-psycho-social transition
• 2 Menopausal symptoms: Hot flushes and night sweats
• 3 A cognitive behavioural approach
• Managing menopausal hot flushes and night sweats: A four-week self-help guide
• 4 Week 1: Being informed and reducing stress
• 5 Week 2: Managing hot flushes
• 6 Week 3: Managing sleep and night sweats
• 7 Week 4: Reviewing and maintaining changes
• Hot flush rating scale
• Resources
• References
• Index