Menopausal hot flashes last longer than once thought
Q: I just experienced my first, full-blown menopausal hot flash. It was awful. How long can I expect hot flashes to continue?
A: Your question reminds me of a patient I saw when I had recently finished my training. (Believe it or not, I was even younger then than I am now.) She said she had come to see me because of hot flashes. Then she said: "I had heard about hot flashes since I was a girl, and I thought I knew what to expect. But you can't really imagine it until you've experienced it."
I told her I had treatments that could help reduce her symptoms until they went away on their own. She asked me how long that would take, and I repeated what I had been taught - and what was in the textbooks: "A few years."
Twenty years later, she was still having hot flashes. When she informed me of this, she added: "In my dictionary, doctor, 20 is more than 'a few' years!"
By that time, I knew this patient was not unique; I had seen plenty others like her. So I asked myself: Who are you going to believe, your textbook or your patients? It seemed to me the patients must be right. But I also knew that doctors wouldn't believe it until there was a scientific study of the question. The problem was that none of my colleagues seemed interested in doing the study, because "everyone knows that hot flashes just last a few years."
That's how important discoveries don't get made, and people suffer as a result.
Well, thankfully someone finally did the study, and the textbooks are in for a change. The data were collected from a long-term (13 years thus far) women's health study. The study focused on 1,449 women who were asked every year about having hot flashes and night sweats.
Half of the women reported symptoms for more than seven years. The younger they were when symptoms started, the longer they tended to last. More than half of women who began having hot flashes when they were still having periods had symptoms for nearly 12 years or longer. If symptoms started only after menopause had begun, they lasted about three years.
To be included in this study, women had to have had frequent symptoms. So it's possible that women with less frequent symptoms would have reported having them for fewer years. In other words, it may not be that half of all women entering menopause continue to have hot flashes seven years later. But the study shows that plenty do.
For some women, hot flashes are a minor annoyance. For others, they severely disrupt quality of life.
Just as that first patient I saw said that she didn't really understand what hot flashes were until she had experienced them, I'm sure we male physicians (and premenopausal female physicians) don't really understand them either.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.