Low Estrogen is not the only Cause of Hot Flashes

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Dr. Kathy Maupin and Brett Newcomb discuss the causes of hot flashes. Menopause is not the only cause of this symptom, and Dr. Maupin talks about what can be done to treat hot flashes that are caused by other factors.

It is well-known that when women go through menopause one of the symptoms they experience is something called, “hot flashes.” Some people even know that it is correlated with the loss of the hormone, estrogen. When women age, their hormone levels begin to decline. It is assumed that this is a part of becoming old and losing the ability to have children. Most women leave it at that, and either get estrogen replacement to stop the symptoms or learn to live with it.

Because menopause is the most common cause of hot flashes, I evaluate and treat low estradiol levels—the diagnostic key to menopause. If the hot flashes stop with treatment or the natural estradiol and FSH levels are normal, I look for something else.

Other causes of hot flashes include low testosterone, infection, low cortisol, low thyroid, elevated prolactin, head injuries, brain tumors, heart arrhythmias, an elevated ferritin (Hemachromatosis), and hypoglycemia (low blood sugar). I pride myself on approaching a difficult diagnosis like a medical detective.

Diagnosing unusual problems is one of the most satisfying things I do in my medical practice. If a woman does not have a low estradiol or high FSH, but is having hot flashes, I evaluate them through other tests in hopes of seeing what the cause of this symptom is. These symptoms could herald dangerous medical conditions. Men even have what they describe as hot flashes when their testosterone is very low. But, men usually experience anxiety with low-testosterone hot flashes. It is often the dismissal of hot flashes as a minor symptom of menopause that causes patients to suffer severe medical problems that can go undiagnosed for years.

My method includes a series of steps that help me determine what the source of the hot flashes is. After confirming that the estradiol and FSH levels are normal (or adequately replaced) I look for a low testosterone level. Low testosterone can cause hot flashes in the same way that low estrogen can. Most women do not realize that testosterone is necessary for them to be free of hot flashes. They are not even told that they need that hormone. Of course, this is something I discuss in my book, The Secret Female Hormone; the reality that women need testosterone as much as men do.

A second cause of hot flashes is hypothyroidism. If your thyroid is low, then the stimulation hormone TSH surges to try to get your thyroid going. Often, this results in hot flash-like symptoms.

The next hormone we check are the adrenal glands and levels of cortisol. Low cortisol levels cause the pituitary to produce high-stimulatory hormones called ACTH which can cause hot flashes.

Then I look outside the hormonal system for the possibility of arrhythmias. When you have an arrhythmia you start to skip heartbeats  and then you sweat and turn red, which looks and feels like a hot flash (although it may not be one). An elevated iron level in the blood can also cause the symptoms of menopause, and testing ferritin levels are diagnostic for this problem. Lastly, I turn to blood sugar levels and make sure my patient is not suffering from low blood sugar. This also causes the body to sweat until it is fed and can increase the sugar to normal.

So, as a medical detective, I have learned to look at these things when it turns out that the hot flashes are not caused by low estrogen. Watch our podcast and learn what you need to know to determine what is going on with you or those you love. Help your doctor with the checklist of possible causes so that they can find the appropriate intervention to solve your problem.

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