When your ovaries are still going strong and you’re dreading the onset of the Big M, you’re likely worrying about what exactly to expect. You’re probably full up on stories about hot flashes during perimenopause, but different women tell different tales — and there are plenty of nuances.
Some brush off hot flashes and chills as no big deal, just a warm feeling then a slight chill — nothing the crack of a window and a cardigan can’t handle. Others respond with an “OMG!” scream that their hot flashes come from the burning depths of hell, followed by an immediate arctic freeze. One minute they’re stripping off clothes, the next they’re pulling on sweaters and a scarf. Some are OK during the day but are constantly kicking off the comforter then piling on blankets as their temperature soars and dips during the night.
Ask a doctor what to expect and his or her noncommittal answer that “it depends” and “every woman is different” doesn’t exactly help. So what are these two most-talked-about symptoms of impending menopause going to really be like — and will there be any relief?
What Is a Hot Flash?
Brutally put, “[peri]menopause is your ovaries giving their last big gasp when estrogen is doing its erratic long goodbye,” says Dr. Pamela Peeke, author of Body for Life for Women and bestseller Fight Fat After Forty, a professor at the University of Maryland School of Medicine, and adjunct senior scientist at the National Institute of Health. “Your ovaries are producing less and less estrogen, and it’s extremely erratic. Some days the heat’s turned up. Some days it’s down. The power surges are all over the flippin’ place, and that’s what drives women crazy.”
Hot flashes are caused by rapid changes in temperature, and cortisol is the culprit. “Stress hormone cortisol is extremely important, working with estrogen to regulate the usual menstrual cycle. However, when its BFF estrogen is going haywire, cortisol is going to get crazy — and trust me, that’s when you have a problem. Because when you have a lot of stress hormone going on, you get pretty heated, and — I’m sorry to say — it feels terrible and awful.”
And it can, literally, be a night and day experience of extremes.
Why Do We Heat Up at Night?
You go to bed cozy in your comforter, then you’re furiously kicking off the sheets, throwing open the windows and turning on the AC, feeling like you’re in the tropics. The next minute, you’re slamming the windows shut, turning up the thermostat, pulling up your comforter, and piling more blankets onto the tundra of your bed. You might wake up chilly or hot and bothered, your sheets soaking, thinking you’ve wet the bed.
Welcome to your new nights.
Normally, throughout the day, cortisol’s journey takes the same course, peaking first thing in the morning. “It’s not your iPhone alarm that wakes you up — it’s the girl mob of cortisol and adrenaline synchronizing to start your day,” Peeke says. This is why most women feel more energetic in the morning. Then, gradually through the day, your cortisol level slowly starts to come down, dipping at around 3 p.m. “That’s ‘OMG! I need another latte’ time!” Peeke explains. Around 5 or 6 p.m., cortisol starts flattening out, going to its lowest level. Your temperature begins to fall, and your metabolism is at its lowest as your body is preparing to sleep.
Remember, that’s “normally.” When you hit perimenopause, cortisol starts to go off the tracks and off course.
“It’s cortisol and its bestie estrogen, again, up to no good,” says Peeke. “They normally cruise at a great low level in the night. But during [peri]menopause, they break curfew and start partying, just like when they play hooky from their day jobs causing hot flashes. When estrogen loses control and gets erratic in the night, that’s when cortisol buddies up with its BFF, heats you up, and makes you sweat.” A brief cold flash or even a big chill can then hit, because your body overcompensates.
Unfortunately, perimenopause symptoms are as unpredictable as a tornado’s twister funnel, and your fluctuating heat index of hot and cold flashes is impossible to forecast. Because, well, “it depends.”