Help for fighting hot-flash hell
A unique program developed at Hamilton’s St. Joseph’s Healthcare Hospital helps menopausal women fight hot flashes through cognitive therapy
When Barbara Coulas heard herself complaining that it was too chilly in the Mississauga real estate office where she works, she had to smile.
That small complaint represented a major victory for Coulas, who at 62 had struggled on and off with hot flashes since her late 30s, when she’d gone into early menopause. On a bad day, Coulas would experience eight to 10 hot flashes, leaving her feeling exhausted and worn out.
At night, extreme night sweats meant she had to get up and change her sheets. She’d tried various treatments, including hormone-replacement therapy (HRT), but negative side effects forced her off it.
Last year, feeling like she was reaching her “breaking point,” regularly missing work and turning down social invitations, she went to Dr. Claudio Soares, director of the Women’s Health Concerns Clinic at St. Joseph’s Healthcare Hospital in Hamilton.
Recalling how her cheeks would redden and perspiration flowed down her forehead, she said, “It was so embarrassing. I thought everyone was thinking I wasn’t as competent or capable.”
Coulas was among the 10 to 15 per cent of women who experience moderate to severe hot flashes, which occur when a woman’s estrogen levels fluctuate. Those fluctuations, which typically start in the late 40s or early 50s, affect the hypothalamus, which acts as a thermoregulator to control and regulate body temperature.
As Soares explains, “Your body is basically eliminating heat to control your temperature.”
Hot flashes can last anywhere from four to seven years and typically become less severe over time as the body becomes more estrogen deficient. While the daily frequency can range from two or three to more than 100, the more important aspect is intensity.
“Some people can’t drive or work because if they’re talking to a client they may sweat so profusely they feel like they’re in the middle of a shower,” said Soares.
Coulas was also having difficulty concentrating, which led to her feeling anxious and depressed.
“It was the classic domino effect. A woman who has significant hot flashes often has broken sleep and the next day she feels exhausted and irritable and even depressed. That can make the symptoms feel worse,” said Soares.
Treatment for hot flashes has been controversial, to say the least. For many years HRT was the most common treatment. That changed in 2002 when the World Health Organization released a controversial study showing there were adverse side effects to taking HRT.
That resulted in a mass exodus of women going off HRT, something Soares said was unnecessary. As long as a woman has no history of breast cancer or blood clots, and if they don’t smoke or aren’t obese, Soares said they are eligible to take HRT.
“The pendulum is swinging back to (HRT) being safe and people are realizing it should be tailored to each patient,” said Soares. Other doctors, however, remain reluctant to prescribe HRT and so the debate will continue.
Among other treatments enumerated by Soares, anti-depressants can help with hot flashes and other symptoms of menopause. Coulas takes a low dosage at night to help her sleep.
Some women have found relief by making simple life changes, for example, sleeping in less clothing, changing the room temperature and reducing caffeine, alcohol and red wine, which is known for triggering hot flashes.
Soares said the evidence is mixed on the effectiveness of natural therapies, such as soy and black cohosh, but they do appear to work for some women.
And fourthly, Soares he was also a driving force behind a program co-developed by Dr. Sheryl Green, a clinical psychologist at St. Joseph’s, which uses cognitive behaviour therapy (CBT) to help women deal with hot flashes.
Coulas completed the program a few months ago and said, “I feel like I have my life back.”
The program, the first of its kind in Canada, uses CBT to reduce the severity of hot flashes, mood swings, sexual problems and sleep disruptions. Green combined her expertise in CBT with chief psychologist Dr. Randi McCabe, an expert in treating anxiety, as well as Soares to develop the program.
Green said the program she designed gives menopausal women the tools to reduce the negative self talk that can make them more vulnerable to depression and anxiety. “They learn how their thoughts can influence how they feel and what they do and how it can influence the intensity of their physical symptoms,” said Green.
“So when they feel a hot flash coming on, rather than saying, ‘Oh my god, here comes another one, I can’t stand it,’ they say, ‘Okay, here it comes again. I’ve been through this many times before. This is temporary and not the end of the world.’”
Green said the program is unique because everything until now has been focused on alleviating a woman’s physical symptoms through such things as HRT or black cohosh.
“Now there’s something to address the psycho-social symptoms,” said Green, who points out that pain also has a mental component that can sometimes be treated through CBT.
The findings have been highly positive with women reporting that both the intensity and amount of distress they experience during a hot flash has been significantly reduced. They also noted the group setting helped normalize their experience.
Coulas went from having eight to 10 hot flashes a day down to two or three and, more important, they are not as severe.
“I recognized that a lot of my discomfort came from the way I was seeing things,” said Coulas.
“Now I realize I can change how I feel by the changing the way I think.”
4 WAYS TO TREAT HOT FLASHES
• Hormone replacement therapy (controversial);
• Natural treatments such as soy and black cohosh
• Lifestyle changes (clothing, diet)
• Cogniture behavioural therapy
After participating in Hamilton hospital cognitive-therapy group sessions, Barbara Coulas went from having eight to 10 hot flashes a day down to two or three and, more important, they are not as severe.
Green, Soares and McCabe have written a book based on the program called The Cognitive Behavioural Workbook for Menopause which is available on Amazon and will be in Chapters in November.
For more information on the CBT program contact Tracy Woodford at the Women's Health Concerns Clinic at St. Joseph's Healthcare at 905-522-1155, ext. 32048.