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Dr. Andrew Rynne

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What causes hot flashes during perimenopause?

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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1681 Questions

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Posted on Wed, 8 Mar 2017 in Women's Health
Question: Hello,
I am 48 years old and perimenopausal. I wake up two to three times a night sweaty with hot hands and high heart rate 100-140. As soon as I wake up in the morning before I get out if bed, my heart rate is over 100 and I instantly an hot. My hands and chest especially. The feeling subsides withint about 5-10 minutes. I currently take losartan 25 for HBP and synthroid 50 for hypothyroid. My thyroid was just tested and levels are within normal range. When I check my BP when why heart rate is high and I am hot, it is relatively in normal range.
Any thoughts as to why this is occurring?
Thanks
doctor
Answered by Dr. Timothy Raichle 26 minutes later
Brief Answer:
Could be heart problems or hot flashes

Detailed Answer:
Thank you for the question. When I first read the story, the most common explanation that would come to mind in a 48 year old with what sound like hot flashes is simply that - hotflashes associated with the peri-menopausal transition. As you approach menopause (the cessation of your periods), you experience 'temperature instability'. This means that your body misfires with regard to the ability to keep your body temperature within a tight range. Many women experience these hotflashes just as you are describing and they certainly could be associated with an elevated heart rate (as your body tries to quickly shunt blood to the skin to dissipate heat).

When I think more deeply about your question, there is one important problem that must be considered. In women with heart disease, the first symptoms of a problem might very well be an elevated heart rate and feeling sweaty or clammy. Given that you are treated for high blood pressure, this must be considered. It does not matter whether your blood pressure is normal during these episodes.

As far as hotflashes, there are a number of ways to treat these either using hormones or other non-hormonal remedies (but that is a whole other question). You need to:

1. Get in touch with your doctor to discuss the symptoms
2. Ask if they would like your heart further evaluated
3. Ask about treatments for hotflashes.

Dr. Tim
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Timothy Raichle 2 hours later
I scheduled an appointment with a cardiologist since my doctor does not seem concerned. I also have Factor V Leiden heterozygous. I am not any medication, but I know I can not take hormone replacement therapy.
I have oth symptoms that are probably not related, like horrible varicose veins because I stand all day. I'm a teacher. I have weird heat sensations on the bottom of one foot and sometimes in my arm. I occasionally get tingling in my forehead. I wonder if any of those are related to menopause approaching or if they are just signs of age. I am not overweight. I do not smoke and never have. I eat fairly healthy, no red meat. My cholesterol is good. Thoughts on any of those oddities?
doctor
Answered by Dr. Timothy Raichle 8 hours later
Brief Answer:
I am not sure if these can be connected in any way...

Detailed Answer:
First, I am glad that you scheduled the appointment with your Cardiologist. That seems like an important thing to work out. Be specific about the symptoms of an elevated heart rate and sweating / feeling hot.

Factor V Leiden heterozygosity is actually quite common (3-8% of Caucasians). Yes, there might be an increased risk of blood clots and I would agree that you should ideally not be on hormones. The other symptoms:

1. Varicose veins - likely related to childbirth, time and genetic predisposition
2. Wierd sensations on foot and in arm - probably nothing but worth mentioning to your docs. No, they are not signs of menopause
3. Tingling in forehead - probably just muscle twitching, worth mentioning but it is likely nothing.

I would try to keep things simple and focus on the main things that you mentioned in your original question. I hope that this helps.

Dr. Tim
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Timothy Raichle 7 hours later
This morning it was very unpleasant. I am thinking it is not a hot flash causing the high heart rate. I think it is the heart rate causing me to feel hot. With a pulse ox monitor, I watched my heart rate go up to 128 and then jump all over to finally go back down to 82. This was all while I still was lying in bed. The heat I felt seemed to only happen when my heart rate went up. I felt the pounding first. That is what woke me up.
Is this a common complaint of perimenopausal women? I really thought I was technically almost in menopause because I went 9 months without a period. This weird hot flash/ heart rate issue happened over a year ago briefly and then stopped. Now it happens every day for the past few weeks. My endocrinologist actually told me I was in menopause based on blood work, but at that time I was still getting my period every few months. My OB/GYN said blood work alone does does not determine menopause. How do you determine menopause? Both bloodwork and no period for a year?
Thank you for your replies. I appreciate it.
doctor
Answered by Dr. Timothy Raichle 13 hours later
Brief Answer:
Your heart evaluation is really important as soon as possible!

Detailed Answer:
I think that your thought process is more correct. Whatever is causing the elevated heart rate makes you feel ill including hot and sweaty, just like a hotflash might feel. All the more reason to get in to see your Cardiologist. It is NOT normal to have a resting heart rate of 128 under ANY circumstance and I do not think that this would be typical with menopausal symptoms or hot flashes.

1. No, the elevated heart rate and pounding in the chest is NOT a common complaint of peri-menopausal women
2. The definition of menopause is 'no period for 12 months'. It is not defined by labs which can become abnormal, suggesting menopause, 5-10 years before you actually meet this definition
3. Your endocrinologist is wrong. Menopause is not defined by abnormal labs. The labs (FSH in particular) starts to become more abnormal beginning in your late 30's. Your OB/GYN is correct.

This all being said, in addition to the Cardiology visit which must happen, it may be worth readdressing the fact that you went almost 9 months with no period and now still continue to bleed every few months. It would not be wrong to consider a workup which would include an ultrasound and a sample from the inside of the uterus to rule out pre-cancerous changes. This is a separate issue and a separate question but you might just consider asking your OB/GYN about whether this deserves more attention as well.

Dr. Tim
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Timothy Raichle 23 hours later
The longest I have gone is 9 months without a period. I had my period last March 2016 and did not have it again until December 2016. Before that, it was every other month, then every 2-3 months, then every 4-5. That is just the longest time. It never reverted back. I had my tubes removed last year due to a paratubal cyst. I still have my ovaries. I had vaginal ultrasounds every few months leading up to the surgery. First, they were just watching the cyst, but it got bigger so it was removed. Do you still think there is a concern for an ultrasound and tissue sample? Maybe you misunderstood the pattern of my periods.
My endocrinologist did the blood work as part of the check for my thyroid over a year ago and told me I was in menopause despite my period never ceasing for a year. I told my OB GYN and he said it was not true just because of the lab work. My endocrinologist really scared me because she said I shouldn't be getting a period. You seem to concur with my OBGYN.
As for my elevated heart rate, it only lasts for a few minutes. It is frightening though. My appointment is in March. It's weird because this happened over a year ago for a short time and then stopped. I have an extremely stressful job. I am a teacher in a rough, inner city school. Everyday is extremely tiring and stressful. I also have three young children. I am wondering if somehow stress is related. Maybe I am just grasping.
Do you have any knowledge as to what would cause this mainly only occurring right when I wake up? I do get hot a few times during the day, it seems when I am stressed it is worse.
Thank you again for your detailed response. I appreciate it.
doctor
Answered by Dr. Timothy Raichle 17 hours later
Brief Answer:
Yes, I concur with your OB/GYN

Detailed Answer:
I agree that there is low concern regarding your pattern of bleeding. I just suggested that you have someone reconsider whether there is any need for imaging based on the labs suggesting menopause AND bleeding ALMOST one year from the prior period. It is certainly not urgent.

You should NOT have to wait until March. They could set you up with a 'Halter monitor'. This records your heart rate and is typically set up for 24 or 48 hours. This would be incredibly useful. You should not have to wait so long given the progression of your symptoms - please call and tell them you are having 'uncomfortable chest related symptoms' when this occurs and they will see you sooner.

Dr. Tim
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Timothy Raichle 6 hours later
I will call and see if they can set up the monitor. I don't think they will though because my regular family doctor referred me to the cardiologist at my request and did not say that it was urgent based on the same symptoms I explained to you.
I have been reading and am worried that it could be an adrenal tumor, specifically phenocytotoma, or sinus tachycardia. Are you familiar with either?
I had these symptoms more than a year ago for a short time and then they resolved. When I went for the long 9 month stretch with no period, I rarely had hot flashes and I did not have the high heart rate upon waking. When I got my period after that 9 month stretch, the hot flashes returned and then the rapid heart rate in the morning. I don't know if that has any correlation. Thank you for all your responses. I appreciate it.
doctor
Answered by Dr. Timothy Raichle 18 hours later
Brief Answer:
Either of those are possible

Detailed Answer:
In twenty years I have seen two patients with Pheochromocytomas - they are rare and would present in this manner. And yes, heart rhythm abnormalities are actually relatively common.

Your Primary doctor has not really helped to address your concerns. If the appointment is made, then you can leave them out of the loop. Call the Cardiology office directly and state:

1. I have an upcoming appointment to evaluate my heart
2. I am having a racing heart rate and chest discomfort
3. Is there any way that I can get in sooner

They should have someone on call for the Cardiology group. If the receptionist gives you a hard time, then ask to speak to whoever is on call.

Does this help?
Dr. Tim
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Timothy Raichle 6 hours later
I did send a message to my primary doctor restating the problems and mentioned cardio can not see me until March 17. She finally ordered a Holter monitor. I am waiting to see if they can get me in on Friday to put it on. I am going to call cardio tomorrow and request an earlier appointment.
Now you have me worried about a phenochromocytoma. Would there be other symptoms? Wouldn't I have sustained uncontrollable high blood pressure? What treatment did your two patients receive? In general, I am worried and now am having high anxiety on and off throughout the day. I don't even want to go to sleep at night for fear of what could happen and how I feel when I wake up.
Thank you so much.
doctor
Answered by Dr. Timothy Raichle 2 hours later
Brief Answer:
The symptoms fit pheochromocytoma but it is rare...

Detailed Answer:
The classic triad of symptoms in patients with a pheochromocytoma consists of episodic headache, sweating, and tachycardia (elevated heart rate). Yes, this certainly fit but it is quite rare. It occurs in 0.2% of patients who present with hypertension. But hypertension is not necessarily part of the diagnosis - you might just have hypertension regardless of the cause of your symptoms.

Treatment is medications (to slow your heart rate) and/or surgery. I do not remember the specifics, but I think that they had surgery.

I am glad that you are getting the Halter monitor - this will be very useful in defining what is going on. You are on the path to getting this figured out!

Dr. Tim
Above answer was peer-reviewed by : Dr. Kampana
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