“Hot flashes are so, so common around the time of menopause and a lot of previous work has suggested that they increase certain markers of cardiovascular disease risk such as blood pressure or cholesterol levels,” says study researcher Emily Szmuilowicz, MD, an endocrinologist at Northwestern Memorial Hospital in Chicago. But “there was no increase in risk seen among women who had hot flashes throughout menopause, and women with hot flashes at the beginning of menopause seemed to have a lower risk of cardiovascular disease, stroke, and death.”
During a hot flash or hot flush, blood vessels near the skin’s surface dilate to cool, producing a red, flushed look. Women may also start sweating to cool down their body. Exactly how — or even if — hot flashes may protect against heart disease is not known.
Women in the new study were divided into four groups including those who did not have hot flashes during menopause, those who had hot flashes only when they entered menopause, those who had hot flashes during early and late menopause, and those who developed hot flashes during the later stages of menopause.
Women whose hot flashes persisted throughout menopause were not at any increased risk for heart disease, stroke, or death, the researchers report. Women who had hot flashes only during early menopause were less likely to develop heart disease, stroke, or die. Those women whose hot flashes came on late in the course of menopause were at an increased risk for heart disease and death from any cause, the new study shows.
Hormone Replacement Therapy and Hot Flashes
Some women in the study were taking hormone replacement therapy (HRT) and researchers did attempt to take this into account. Past or current use of hormones may affect hot flashes. What’s more, some forms of HRT have been associated with an increased risk of heart disease. “We are advising women who are appropriate candidates to use hormone replacement therapy early on and in the lowest dose possible for the shortest amount of time to alleviate their symptoms, but not for cardiovascular protection,” Szmuilowicz says.
Older women are at an increased risk for heart disease. “This is the No. 1 killer of women and we are still advising women to do everything they can to reduce their risk through eating a healthy diet, increasing physical activity, and taking steps to control blood pressure and cholesterol levels,” she says.
As far as HRT goes, “If you have an increased risk for heart attack or stroke, stay off of it, but if you at normal risk and are having debilitating symptoms, there is definitely a role for HRT,” says Tara Narula, MD, a cardiologist at Lenox Hill Hospital in New York City.
Jill Maura Rabin, MD, an obstetrician and gynecologist at Long Island Jewish Medical Center in New Hyde Park, N.Y., says that is too early to draw any meaningful conclusions about the connection between hot flashes and heart disease.
“Let’s stay tuned and see what else is elucidated about vasomotor symptoms and cardiovascular disease,” she says.
In the meantime, there are treatments for hot flashes.
“If hot flashes are debilitating and impacting severely on your quality of life, the American College of Obstetricians and Gynecologists and the North American Menopause Society recommend using HRT at low doses for as short of a time as possible,” Rabin says.
Other hot flash treatments may include several herbal products, certain antidepressants, and soy foods. “Talk to your doctor about your risks and symptoms,” she says.