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Hot Flashes

Symptom: hot flashes.

The terms “hot flushes” and “hot flashes” are often used interchangeably to refer to the sudden, brief episodes of intense heat and sweating that are commonly experienced by women during the climacteric, which is the transitional period leading up to menopause. Both terms are commonly used in the literature and in clinical practice to describe this symptom. “Hot flushes” is a term more commonly used in the United Kingdom and other countries, while “hot flashes” is the term more commonly used in the United States. However, both terms refer to the same phenomenon of sudden sensations of heat, typically accompanied by sweating and flushing of the skin, that are often followed by a feeling of coldness or chills.

The studies reviewed by J.G. Green and Kronenberg suggest that hot flashes and night sweats are the most common vasomotor symptoms associated with estrogen changes during the climacteric and perimenopause. These symptoms are characterized by a sudden sensation of heat in the upper body, often accompanied by sweating that can be cold, and a pounding heart. Hot flashes can vary in frequency and intensity, lasting typically 3-5 minutes. Some women may experience hot flushes for a relatively short period of time, ranging from 6 months up to 2 years, while others may experience them for many years, extending into post-menopause.

Despite the prevalence of hot flashes, there has been limited knowledge about how to reduce their frequency or prevent them. Further research is needed to better understand the underlying mechanisms of hot flashes and develop effective interventions to manage them during the climacteric and menopause transition. For women who cannot or do not want to use hormone replacement therapy, deep breathing and progressive muscle relaxation techniques similar to those used in yoga can be a helpful alternative treatment for reducing hot flashes. In addition to hot flashes, other somatic symptoms such as pressure or tightness in the head or body, muscle and joint pains, numbness or tingling, headaches, dizziness, fainting, breathing difficulties, and loss of feeling in hands or feet may also be observed during the climacteric although they may or may not be directly related to hormonal changes.

Sometimes, doing more physical activity may not stop hot flashes, and women who are very active might even have more hot flashes because they have less estrogen in their bodies. But physical activity is still good for women as it can help reduce symptoms like body discomfort and sweating right after exercising, and make their mood better. Despite this, people wonder if there is a specific kind of exercise that could actually help control hot flashes. Yoga might be the answer because it is different from other exercises in some ways. Yoga can help make different organs and glands in our body better, and it does this in a way that is not the same as regular exercise, according to Mishra (1997). Mishra says that the main difference between regular exercise and yogic exercise seems to be how the body makes energy (rehabilitation) and uses it…the muscles cannot fully recover the energy used in regular exercise and they get tired. But in yogic exercise, the body breaks down and recovers energy in a way that makes the muscles work better without getting too big. Yoga postures focus on aligning the bones to allow energy to flow optimally while stretching the muscles to support this alignment. According to David Frawley, who is the director of the American Institute of Vedic Studies, yoga helps keep the spine flexible to allow energy to flow smoothly through the nerves that connect to the organs and glands. The postures in yoga are not just exercises, but they also help cleanse the body’s tissues and prepare it for breathing practices and meditation, which can awaken vital energy called prana. These breathing practices may be the key to reducing hot flashes.

In a study conducted by Freedman in 1992, it was found that deep breathing and progressive muscle relaxation techniques similar to those used in yoga can be a useful alternative treatment for reducing hot flashes in women who cannot tolerate hormone replacement therapy. In the study, 33 women with frequent menopausal hot flashes were randomly assigned to receive eight sessions of training in paced respiration or muscle relaxation, while electroencephalographic biofeedback was used as a placebo control. The researchers used disposable electrodes filled with potassium chloride paste attached over the sternum to objectively measure hot flashes, even during sleep. The results showed that women who received paced respiration training significantly reduced the frequency of their hot flashes, increased their tidal volume, and slowed their respiration rates, regardless of muscle relaxation. The findings from the study showed that rhythmic deep breathing may help regulate the sympathetic nervous system, which could lead to a significant decrease in menopausal hot flashes by reducing the activation of the nervous system.

Freedman conducted a follow-up study that revealed most menopausal hot flashes are preceded by slight increases in core body temperature. The study replicated exercise-induced sweating thresholds and then cooled the body to determine the shivering threshold in women who experienced hot flashes. The results showed that the thermoneutral zone, which is the range between sweating and shivering thresholds, was reduced in women with hot flash symptoms. This led to the conclusion that small elevations in body temperature could trigger menopausal hot flashes. For yoga teachers, this highlights the importance of assessing the potential stress of an asana practice for perimenopausal women experiencing hot flashes. Women who did not experience hot flashes had a wider threshold for sweating and shivering, indicating a higher tolerance for heat.

Note that hot flashes occur most frequently when the body's core temperature is highest. Therefore, it is important to maintain slow, deep breathing during a strong, flowing asana practice whenever the body's core temperature is raised. It's crucial to recognize that an asana practice may cause stress for perimenopausal women when the room temperature is increased to prevent muscle soreness and aid flexibility. Studies have shown that hot flushes are more frequent and intense in warm temperatures (31 degrees C.) compared to cool temperatures (19 degrees C.) (Lobo, 1997). Therefore, the ambient temperature of an asana room should be controlled to prevent triggering hot flashes in symptomatic women.

If deep breathing can help women manage hot flashes and reduce their frequency, it may also be helpful for managing anxiety and depression, which are common symptoms associated with menopause. Studies have shown that practicing rhythmic breathing, also known as pranayama in yoga, for thirty minutes daily over a three-month period improved clinical depression (Naga Venkatesha Murthy, Janakiramaiah, Gangadhar, & Subbakrishna, 1998). Additionally, mindfulness meditation, which involves breathing and meditation, has been shown to have long-term benefits for anxiety disorders (Miller and Kabat-Zinn, 1995). Both breathing and meditation are parts of a well-rounded yoga practice, which is different from yoga practiced as gymnastics, and they may possibly help with depression related to menopausal symptoms.