By Jasminee Sahoye

Stroke and other brain blood flow problems have been found to be prevalent among women who experience more hot flashes, especially while sleeping and during menopause transition, according to a pilot study led by researchers at the University of Pittsburgh School of Medicine published online in Menopause.

More than 70% of women have hot flashes; a sudden feeling of intense warmth and sweatiness; while transitioning into menopause, said principal investigator Rebecca Thurston, Ph.D., associate professor of psychiatry, Pitt School of Medicine.

Research has shown that hot flashes can be linked to signs of sub-clinical heart disease such as changes in the blood vessels as well as high blood pressure and elevated cholesterol levels. But Thurston and colleagues examined the possible connection between hot flashes and brain health.

The team recruited 20 women in midlife who were not taking hormone therapy and, using a device that measures skin conductance, biologically monitored their hot flashes for 24 hours. They also conducted MRI brain imaging on participants to detect white matter hyperintensities, which are bright spots on the scan that are thought to develop due to disease of the brain’s small blood vessels. Participants also kept electronic hot flash diaries.

The women reported an average of three hot flashes per day but the monitoring showed greater frequency, at an average of eight per day as some were likely not self-reported because they occurred during sleep, Thurston said. Women with more monitor-detected hot flashes, particularly during sleep, also had a greater number of white matter hyperintensities on their brain scans.

Thurston said, “Other factors like age and cardiovascular risk factors did not explain this effect, so these findings suggest there is a relationship between menopausal hot flashes and blood vessel changes in the brain.”

She added that further work is needed to understand whether one causes the other, “or if hot flashers are a signal of some other vascular process that impacts brain health.”

Another related pilot study with 40 overweight or obese white and African American women with hot flashes, shows that behavioral weight loss can help manage menopausal hot flashes.

More than 70% of women report hot flashes during the menopausal transition, with many of these women reporting frequent or severe hot flashes.

Newer data indicate that hot flashes are typically persistent, lasting an average of nine years or more.

For purposes of the pilot clinical trial, hot flashes were assessed before and after intervention via physiologic monitoring, diary and questionnaire. The study confirmed a significant correlation between weight loss and hot flashes. Furthermore, the degree of weight loss correlated with the degree of reduction in hot flashes.

Although newer data has suggested a positive relationship between hot flashes and the percentage of fat in a woman’s body, no studies, to date, had been specifically designed to test whether weight loss reduces hot flashes.

“This is encouraging news for women looking for relief for this bothersome midlife symptom,” says NAMS executive director Margery Gass, MD. “Not only might behavior weight loss provide a safe, effective remedy for many women but it also encourages a health-promoting behavior.

“Since many of the women in this pilot study indicated their primary motivator for losing weight was hot flash reduction, we know that this could be a strong incentive for women to engage in a healthier lifestyle which provides numerous other health benefits beyond hot flash management.”