Latest / What The Peri? - With Kirsten Cooke / Hot Flushes & Night Sweats (Ep 4)

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Hot Flushes & Night Sweats (Ep 4) · What The Peri? - With Kirsten Cooke

0:08
SPEAKER_00: Welcome to What the Perry.
0:09
SPEAKER_00: I'm your host Kirsten Cook, personal trainer, menopause coach, and a woman living it right alongside you.
0:16
SPEAKER_00: This is the podcast for women navigating peri-menopause and menopause.
0:20
SPEAKER_00: The change you didn't ask for, but the conversations you need.
0:24
SPEAKER_00: Let's get into it.
0:33
SPEAKER_00: Let me paint you a picture of my nights.
0:36
SPEAKER_00: I sleep with the aircon on.
0:38
SPEAKER_00: Nearly every single night of the year.
0:40
SPEAKER_00: There might be one four-week stretch, maybe in the very coldest part of winter, where I don't have it on every night.
0:46
SPEAKER_00: But that's the only exception.
0:48
SPEAKER_00: The rest of the year, I cannot sleep without it.
0:51
SPEAKER_00: And I mean that literally.
0:53
SPEAKER_00: It can be freezing in the house.
0:55
SPEAKER_00: I'll be rugged up in a tracksuit and fluffy socks, and I'll still climb into bed with the air con running.
1:01
SPEAKER_00: Because the second I get under the covers, I am hot.
1:04
SPEAKER_00: Not warm, hot.
1:06
SPEAKER_00: So off comes the tracksuit and the socks, and I'm down to a t-shirt and undies before I've even turned the light off.
1:12
SPEAKER_00: And there's no silky, sexy nightwear in my life.
1:15
SPEAKER_00: None.
1:16
SPEAKER_00: This is not about looking sexy or fashionable in bed.
1:20
SPEAKER_00: This is about survival.
1:21
SPEAKER_00: I need comfort and I need fabrics that actually breathe.
1:25
SPEAKER_00: Because sleep is hard enough in perimenopause without the added torture of something that clings or traps the heat or twists itself around you and malfunctions at 2 a.m.
1:35
SPEAKER_00: when you're already overheating.
1:37
SPEAKER_00: And this goes well beyond my own bedroom.
1:39
SPEAKER_00: I can't go away on holiday or stay with family unless I know there's air conditioning and a room that I can get completely dark and completely quiet.
1:48
SPEAKER_00: And that is not me being difficult or precious or high maintenance.
1:52
SPEAKER_00: It's that sleep is so hard to come by in perimenopause, and so precious when I finally do get it, that without the right conditions, a weekend away or a trip turns into a nightmare, and I come home more exhausted than when I left.
2:06
SPEAKER_00: If you have ever quietly dreaded a holiday because you knew you would not sleep, hear me.
2:12
SPEAKER_00: You are not high maintenance.
2:13
SPEAKER_00: You're managing a real problem.
2:16
SPEAKER_00: For years I would fall asleep and then wake up in the small hours drenched.
2:20
SPEAKER_00: Not damp, completely drenched, hair stuck to my neck, heart pounding like I'd been running in my sleep, and my brain already racing.
2:29
SPEAKER_00: I would change my shirt, turn the pillow over to the cold side, and lie there in the dark waiting for my body to settle.
2:35
SPEAKER_00: And a lot of the time, sleep just did not come back.
2:39
SPEAKER_00: I spent years like that, functioning on four or five hours of broken sleep, night after night after night.
2:47
SPEAKER_00: And here's something I only pieced together later.
2:50
SPEAKER_00: The night sweats were a huge part of it, but they weren't the whole story.
2:54
SPEAKER_00: I also had low progesterone.
2:56
SPEAKER_00: Progesterone is your calming, sleep-promoting hormone, and mine had dropped away early on.
3:02
SPEAKER_00: But I didn't know that for many years.
3:04
SPEAKER_00: For the longest time I just assumed I was a light sleeper.
3:07
SPEAKER_00: I told myself that years of getting up multiple times a night to the twins had totally messed with my sleep, and now I was so overtired that of course I couldn't fall asleep, or when I did get to sleep, I couldn't stay asleep.
3:20
SPEAKER_00: So even on the nights a sweat didn't wake me, my sleep was lighter, more broken, harder to fall back into.
3:28
SPEAKER_00: Two separate things were stealing my sleep at once.
3:32
SPEAKER_00: The night sweats waking me and the low progesterone leaving my sleep shallow and hard to hold on to in the first place.
3:39
SPEAKER_00: I'll come back later and explain exactly how that low progesterone piece works.
3:44
SPEAKER_00: But here's what I really want you to hear.
3:46
SPEAKER_00: It wasn't just losing the sleep.
3:48
SPEAKER_00: It was what losing the sleep did to everything else.
3:52
SPEAKER_00: My energy, my mood, my patience as a mum.
3:56
SPEAKER_00: You cannot lose that much sleep for that long and still feel like yourself.
4:00
SPEAKER_00: And I did not.
4:02
SPEAKER_00: Slowly, night by night, I stopped recognizing the woman I had always been.
4:07
SPEAKER_00: I did what most of us do.
4:09
SPEAKER_00: I read the articles, I got the advice, avoid caffeine, keep the room cool, don't do screens before bed.
4:16
SPEAKER_00: And look, some of that is not wrong.
4:18
SPEAKER_00: But when you're waking drenched at 3 a.m.
4:20
SPEAKER_00: and staring down another day of work and kids on no real sleep, being handed a list of things to give up is not a plan.
4:28
SPEAKER_00: And honestly, for a lot of us, cutting out caffeine is its own special kind of torture, especially when this transition has already quietly stripped away so many of life's other little pleasures.
4:39
SPEAKER_00: You deserve more than a list of things to give up.
4:42
SPEAKER_00: So today I'm not gonna hand you that list and call it help.
4:46
SPEAKER_00: We're gonna talk about what a hot flush, or a hot flush as it's called in other parts of the world, but here in Australia we tend to say hot flush, and what a night sweat actually is.
4:57
SPEAKER_00: What is happening to your body when it happens because it's not random and it's not in your head.
5:03
SPEAKER_00: We're gonna talk about what sets them off, and then I'm gonna give you the full range of what actually helps, from the small changes you can make tonight all the way through to the medical options, because you deserve the whole menu, not just the entree.
5:17
SPEAKER_00: So let's get into it.
5:19
SPEAKER_00: Welcome back to What the Perry.
5:20
SPEAKER_00: I'm Kirsten Cook.
5:22
SPEAKER_00: Last week we pulled apart HRT, what it actually is, what the 2002 study really said, and why so many women have been left scared of the one thing that might help them the most.
5:34
SPEAKER_00: If you haven't listened to episode three yet, go back to it because we're going to build on it today.
5:39
SPEAKER_00: And at the end of that episode, I promised you this one.
5:42
SPEAKER_00: Hot flushes and night sweats, the most famous symptom of the whole transition, the one thing that everybody thinks they know about menopause, and at the same time, one of the most underexplained and undertreated.
5:55
SPEAKER_00: Because the joke about a middle-aged woman fanning herself has been around forever, but nobody actually sits you down and tells you what is happening in your body, why it can hijack you in the middle of a meeting, and why it wakes you at 2 a.m.
6:08
SPEAKER_00: soaked through, or that there is real evidence-based help beyond a fan and a good attitude.
6:14
SPEAKER_00: So that's today.
6:16
SPEAKER_00: What it is, why it happens, what triggers it, and the full spectrum of what helps lifestyle, behavioral, and medical.
6:25
SPEAKER_00: Plain English, no jargon, no judgment.
6:28
SPEAKER_00: Let's start with what is actually going on.
6:31
SPEAKER_00: Let me tell you the single most reassuring thing I learned when I finally understood this.
6:36
SPEAKER_00: A hot flush is not a heat problem.
6:39
SPEAKER_00: It's a brain signaling problem.
6:41
SPEAKER_00: Deep in your brain there is a small region called the hypothalamus.
6:45
SPEAKER_00: Among the many jobs it does, one of them is to act as your body's thermostat.
6:49
SPEAKER_00: It has a set temperature it wants you to sit at, and a comfortable range around that setting is where it's happy, where it does not need to do anything to cool you down or warm you up.
7:00
SPEAKER_00: That range has a name.
7:02
SPEAKER_00: It's called the thermoneutral zone.
7:04
SPEAKER_00: When your estrogen is stable, that zone is nice and wide.
7:08
SPEAKER_00: Your core temperature can drift up and down throughout the day, you move, you eat, the weather changes, and your thermostat just lets it ride.
7:16
SPEAKER_00: No drama.
7:17
SPEAKER_00: Here's what estrogen does in perimenopause.
7:20
SPEAKER_00: It does not simply fall, it fluctuates and it falls, and that shifting estrogen makes your thermostat oversensitive.
7:28
SPEAKER_00: The thermonutral zone gets really narrow.
7:32
SPEAKER_00: So a tiny rise in your core temperature, a rise so small you would never normally notice it, now reads to your brain as we're overheating, sound the alarm.
7:42
SPEAKER_00: And your brain responds exactly the way it's designed to respond to overheating.
7:47
SPEAKER_00: It tries to dump heat and fast.
7:49
SPEAKER_00: The blood vessels near the surface of your skin open up.
7:53
SPEAKER_00: That's the flush, the wave of heat, the red chest and neck.
7:57
SPEAKER_00: Your sweat glands switch on, that's the sweat.
8:00
SPEAKER_00: And your heart rate can jump, that's the pounding, the palpitations.
8:05
SPEAKER_00: Your body is doing an emergency cooldown for a fire that was never actually there.
8:10
SPEAKER_00: Then, once you've dumped all the heat, you often overshoot the other way and get the chills, the cold, clammy, shaky afterwards.
8:18
SPEAKER_00: That's the same system swinging back.
8:21
SPEAKER_00: Now the science of why the thermostat goes haywire has moved forward in a way I find fascinating, and it matters for the treatment part later, so stay with me for 30 seconds.
8:31
SPEAKER_00: There's a cluster of nerve cells in the hypothalamus, researchers call them candy neurons, that sit right next to your temperature control center and help regulate it.
8:42
SPEAKER_00: Estrogen normally keeps those cells calm.
8:45
SPEAKER_00: As estrogen drops away, these cells become overactive and enlarged, and they can start effectively shouting at your thermostat.
8:53
SPEAKER_00: That overactivity is now understood to be a major driver of the hot flush itself.
8:58
SPEAKER_00: Hold on to that because there's a brand new class of medication built specifically to quiet those cells down, and we will get to it.
9:06
SPEAKER_00: The thing I most want you to take from this section is simple.
9:10
SPEAKER_00: A hot flush is a real, measurable neurological event.
9:14
SPEAKER_00: It's not a weakness.
9:15
SPEAKER_00: It's not you being dramatic, and it's not you just being a bit warm.
9:19
SPEAKER_00: Your brain's thermostat has truly been recalibrated by your hormones, and it's behaving accordingly.
9:25
SPEAKER_00: That is happening to you.
9:26
SPEAKER_00: It's not being imagined by you.
9:29
SPEAKER_00: Now how long does one last?
9:31
SPEAKER_00: Anywhere from about 30 seconds to several minutes.
9:34
SPEAKER_00: How often?
9:36
SPEAKER_00: For some women, it's a couple a week, for others it's dozens a day and a whole run of them overnight.
9:42
SPEAKER_00: And that word, daytime, is where I want to go next.
9:46
SPEAKER_00: Because we joke about the night sweats, but a hot flush does not politely wait for you to be alone in the dark.
9:51
SPEAKER_00: It comes for you in broad daylight, in the middle of your life, and that's a very particular kind of heart.
9:58
SPEAKER_00: Here's what nobody tells you.
10:00
SPEAKER_00: Hot flushes are not just a nighttime thing.
10:02
SPEAKER_00: They can hit at any hour, anywhere, with no warning and absolutely no sense of timing.
10:08
SPEAKER_00: And when one arrives in the middle of your day in a room full of people, it's not just uncomfortable, it can be genuinely debilitating, and for so many women, deeply embarrassing.
10:19
SPEAKER_00: Let me give you mine.
10:21
SPEAKER_00: I teach reformer Pilates, which means there are days I'm standing at the front of a studio, microphone on, cueing a full class of 20 people who are all watching me, following me, listening to my voice.
10:33
SPEAKER_00: And a hot flush arrives, right there, mid-class, mic'ed up in front of everyone.
10:39
SPEAKER_00: I feel it start, that creep of heat up through my chest and my neck and into my face.
10:45
SPEAKER_00: I can feel my face going red.
10:47
SPEAKER_00: I can feel the sweat coming, and I still have to keep teaching.
10:51
SPEAKER_00: Keep cueing, keep my voice level and my energy up as though absolutely nothing is happening.
10:57
SPEAKER_00: While inside my body has hit the fire alarm and every part of me wants to walk out of the room.
11:02
SPEAKER_00: You cannot walk out of the room.
11:04
SPEAKER_00: So you write it out on the mic in front of 20 people and you keep going.
11:10
SPEAKER_00: Now take that feeling and put it in every other room where women spend their days.
11:15
SPEAKER_00: Picture the woman in a high-level meeting, a serious high-stakes meeting, and a flush hits.
11:20
SPEAKER_00: Picture the woman who has to stand up in front of her peers and deliver a presentation she's prepared for for weeks.
11:27
SPEAKER_00: And 30 seconds in, the heat rolls up her body and the sweat breaks out on her top lip and she can see people noticing.
11:34
SPEAKER_00: Picture her trying to hold her train of thought while her whole nervous system is screaming at her to flee.
11:40
SPEAKER_00: And here's the part that makes it so much crueler.
11:43
SPEAKER_00: Because it is not only the heat.
11:45
SPEAKER_00: During a hot flush, for a lot of women, the brain genuinely goes offline.
11:50
SPEAKER_00: And that's not you being dramatic.
11:52
SPEAKER_00: There's research showing that when women are having measurable hot flushes, their memory performance actually drops.
11:59
SPEAKER_00: You lose your words, you lose your train of thought.
12:01
SPEAKER_00: The sentence you were halfway through just evaporates.
12:05
SPEAKER_00: So there she is, overheating, sweating, heart pounding, and now she cannot find the words she needs in a room full of her colleagues.
12:14
SPEAKER_00: And she has to keep going, keep presenting, keep smiling, keep pretending everything is fine until it passes.
12:22
SPEAKER_00: And so often she was doing all of that in front of men.
12:26
SPEAKER_00: Colleagues, managers, clients, people have no idea what is happening to her, no framework to understand it, and in many cases, no idea that this is even a thing that happens to women at all.
12:38
SPEAKER_00: So on top of the heat and the sweat and the scramble for words, there is this profound aloneness.
12:45
SPEAKER_00: You're having one of the most physically overwhelming experiences of your week, and you are having it completely in secret, in plain sight, surrounded by people who cannot see it and probably wouldn't understand it if they could.
12:59
SPEAKER_00: I want to sit here with you for a second, because I know that feeling.
13:03
SPEAKER_00: I've had a flush takeover mid-class, mic'd up in front of a full studio.
13:08
SPEAKER_00: I know exactly what that particular kind of alone feels like.
13:11
SPEAKER_00: Smiling and cueing on the outside while your body is in full revolt on the inside.
13:17
SPEAKER_00: If that is you, in whatever room you are in, I see you, I really do.
13:22
SPEAKER_00: And here is what that slowly does.
13:25
SPEAKER_00: If no one names it for you, it chips away at your confidence.
13:29
SPEAKER_00: Because you don't just think, I had a hot flush.
13:32
SPEAKER_00: You start to think, what's wrong with me?
13:34
SPEAKER_00: You start to wonder whether you can still do your job.
13:37
SPEAKER_00: And it's not only the flushes feeding that doubt, it's the whole of perimenopause stacked together.
13:43
SPEAKER_00: The brain fog, the words you cannot find, the name that vanishes, the meeting you walked out of, certain you had underperformed.
13:51
SPEAKER_00: Woman after woman I speak to in serious professional roles has quietly started to question whether she's even still capable of the work she's done brilliantly for 20 years.
14:02
SPEAKER_00: So let me say this as clearly as I can.
14:04
SPEAKER_00: You have not lost your competence and you have not stopped being good at your job.
14:09
SPEAKER_00: Your body is having a physiological event, a real, hormonal, temporary event, and it is happening on top of a transition that almost nobody around you understands.
14:19
SPEAKER_00: That is not a you problem.
14:21
SPEAKER_00: That is a knowledge problem and an awareness problem, and it belongs to the whole world, not to you.
14:27
SPEAKER_00: You've earned your place in that room.
14:30
SPEAKER_00: The flush does not take that away, even on days it feels like it does.
14:35
SPEAKER_00: And then there are the nights.
14:37
SPEAKER_00: A night sweat is exactly the same event we just described, your brain misreading a small temperature change as an emergency, except you are asleep when it starts, and you wake up already in the middle of the flood.
14:49
SPEAKER_00: It's a hot flush that happens when you're unconscious.
14:52
SPEAKER_00: And because it yanks you out of sleep, often several times a night, it does something even a daytime flush does not do.
15:00
SPEAKER_00: It fractures your sleep over and over.
15:04
SPEAKER_00: But I promised you at the top of the episode that I would come back to this.
15:08
SPEAKER_00: So let me, because night sweats tend to get all the blame for horrible sleep in this transition, and they are not the only culprit.
15:15
SPEAKER_00: For a lot of us, there is more than one thing happening underneath.
15:18
SPEAKER_00: And a big part of my own picture was low progesterone.
15:22
SPEAKER_00: Progesterone is your calming sleep-promoting hormone.
15:25
SPEAKER_00: We talked about it back in episode two, but here is why it matters so much for your nights.
15:31
SPEAKER_00: Progesterone works on a system in your brain called GABA, the same calming pathway that any anxiety medications and sleeping tablets work on.
15:39
SPEAKER_00: When your progesterone is healthy, it tips your nervous system out of go mode and into rest mode in the evening.
15:46
SPEAKER_00: It quietens the racing mind and it helps you drop down into deep sleep and stay there.
15:52
SPEAKER_00: It is, in effect, one of your body's own built-in sedatives.
15:57
SPEAKER_00: And here's the part that blind signs so many women.
15:59
SPEAKER_00: Progesterone is very often the very first hormone to fall in perimenopause.
16:04
SPEAKER_00: It's made after you ovulate, so as ovulation becomes less regular, which can start happening years before your periods change in any obvious way, your progesterone starts dropping.
16:15
SPEAKER_00: Which means one of the earliest signs of this whole transition, long before anyone is talking about hot flushes, is simply that you don't sleep the way you used to.
16:25
SPEAKER_00: So picture what that does.
16:26
SPEAKER_00: As your progesterone falls, you lose one of your body's own natural sleep aids.
16:31
SPEAKER_00: Even on a night with no hot flush at all, you can still have trouble falling asleep, or you finally fall asleep and then ping wide awake at 2 or 3 a.m., heart going crazy, mind racing, completely wired, and simply not able to get back down.
16:48
SPEAKER_00: Now, I want to be accurate with you here because it's not only progesterone driving that 2 or 3 a.m.
16:53
SPEAKER_00: wake up.
16:54
SPEAKER_00: There is another piece.
16:55
SPEAKER_00: As your estrogen dips overnight, it can drive up cortisol, your stress hormone, the one that is supposed to be at its lowest in the middle of the night.
17:04
SPEAKER_00: And a cortisol surge in the small hours is a big reason you wake up, not just awake, but wired, heart pounding, mind spiraling, wide awake in an instant, as if someone had flicked on a switch.
17:17
SPEAKER_00: So for a lot of us, it's a stack of things happening at once.
17:21
SPEAKER_00: Low progesterone taking away the calm, an estrogen-driven cortisol spike flipping you to high alert, and a night sweat doing the actual waking.
17:31
SPEAKER_00: That was me, over and over.
17:34
SPEAKER_00: Some nights it was just one of those.
17:36
SPEAKER_00: Plenty of nights it was all three, stacked on top of each other.
17:40
SPEAKER_00: It was rarely just one thing.
17:42
SPEAKER_00: And this is the thing I most need you to hear, because I think it will let you off a hook you've been hanging yourself on for years.
17:48
SPEAKER_00: You cannot out sleep hygiene or hormone problem.
17:52
SPEAKER_00: Let me say that again because it matters.
17:55
SPEAKER_00: If the reason you're awake is that your progesterone has dropped away, your estrogen is swinging around, setting off night sweats, and your cortisol is spiking at 3 a.m., then no amount of perfect sleep hygiene is going to fix that on its own.
18:08
SPEAKER_00: You can wear the blue light blocking glasses every night.
18:11
SPEAKER_00: You can banish your phone from the bedroom, black out every window, take the magnesium, do the whole wind-down routine, go to bed at exactly the same time every night.
18:22
SPEAKER_00: And please do, those things are worth doing, and they really do help around the edges.
18:27
SPEAKER_00: But if the thing driving your broken sleep is hormonal, sleep hygiene alone will not carry you.
18:33
SPEAKER_00: And when it doesn't, that is not you failing at it.
18:36
SPEAKER_00: I cannot tell you how many women have sat in front of me, convinced they're doing something wrong, that if they were just a bit more disciplined, a bit better at their evening routine, they would finally fall asleep.
18:47
SPEAKER_00: And they are doing everything right.
18:49
SPEAKER_00: They did the routine perfectly and still lay there wide awake at 3 a.m.
18:53
SPEAKER_00: Because the problem was never the routine, it was their hormones.
18:58
SPEAKER_00: That is not a willpower problem.
19:00
SPEAKER_00: It is a physiology problem, and a physiology problem needs a physiology level answer, not another app or a stricter bedtime.
19:09
SPEAKER_00: I'm not going to lay out the full sleep toolkit today.
19:12
SPEAKER_00: That's next week's episode, and it deserves its own conversation.
19:16
SPEAKER_00: But I wanted you to have this piece now because if your sleep has fallen apart and the night sweats don't fully explain it, you are not imagining the rest.
19:24
SPEAKER_00: There is very likely a hormonal reason for that too, and it has a name.
19:30
SPEAKER_00: So that is what a flush is, day and night and everything it drags along with it.
19:34
SPEAKER_00: Now, how long does this whole thing go for?
19:37
SPEAKER_00: Because that's the part nobody warns you about, so I am going to.
19:41
SPEAKER_00: There is a big, well-respected study I want to point you to, because the number in it stopped me in my tracks, and I think it will do the same for you.
19:48
SPEAKER_00: It's called the Swan Study, the study of women's health across the nation, and it followed thousands of women across the menopause transition for years.
19:56
SPEAKER_00: It's one of the most reliable pictures we have of what this actually looks like over time.
20:01
SPEAKER_00: And here's what they found.
20:03
SPEAKER_00: The median total duration of hot flushes and night sweats was seven and a half years.
20:08
SPEAKER_00: Seven and a half.
20:10
SPEAKER_00: And for a lot of women, it was longer than a decade.
20:13
SPEAKER_00: For women whose flushes started early while they still had regular periods, the average run was more than 11 years.
20:20
SPEAKER_00: I want you to sit with that because of what you have almost certainly been told, which is some version of, it'll pass, push through, it's just a phase.
20:30
SPEAKER_00: Seven and a half years is not a phase.
20:32
SPEAKER_00: That is a chunk of your life.
20:34
SPEAKER_00: That is birthdays and work deadlines and family holidays and every other Tuesday in between, soaked and exhausted and told to wait it out.
20:43
SPEAKER_00: So here's the reframe.
20:44
SPEAKER_00: You don't have to earn the right to treat this by suffering with it for long enough first.
20:49
SPEAKER_00: If hot flushes and night sweats are affecting your sleep and your work, your mood, your relationships, and they affect all of those, then they are worth treating now, not in five years, now.
21:01
SPEAKER_00: That's not being dramatic.
21:03
SPEAKER_00: That is refusing to lose the better part of a decade to something we actually know how to help.
21:09
SPEAKER_00: One more thing from the research that matters.
21:12
SPEAKER_00: We're starting to understand that frequent significant hot flushes may be linked to cardiovascular health, that they might be telling us something about what is happening in your blood vessels, not just how warm you feel.
21:23
SPEAKER_00: I'm not saying this to frighten you, I'm saying it because it is one more reason these symptoms deserve to be taken seriously by you and your doctor, as a real signal from your body, not a punchline.
21:36
SPEAKER_00: Right, let's get practical because there are things pouring petrol on this fire that you can actually do something about.
21:43
SPEAKER_00: Hot flushes have triggers, not causes, the causes the hormonal shift we've talked about, but triggers, things that nudge your core temperature or your nervous system just enough to tip your oversensitive thermostat over the edge.
21:57
SPEAKER_00: The common ones are remarkably consistent from women.
22:00
SPEAKER_00: To woman.
22:01
SPEAKER_00: Alcohol is a big one, and red wine seems to be the worst offender for a lot of women.
22:06
SPEAKER_00: Caffeine.
22:07
SPEAKER_00: Spicy food, big sugar spikes, and the crash that follows them.
22:12
SPEAKER_00: Heat itself, hot showers, hot drinks, a hot stuffy room, a duna that's too heavy.
22:18
SPEAKER_00: Stress and the cortisol surge that comes with it.
22:22
SPEAKER_00: Which is why a flush so often arrives in the exact moment you least want it.
22:26
SPEAKER_00: Mid-meeting, mid-argument, mid-anything that matters.
22:30
SPEAKER_00: And clothing.
22:31
SPEAKER_00: Tight synthetic fabrics that trap heat against your skin.
22:35
SPEAKER_00: Now here's where the coach in me jumps in.
22:38
SPEAKER_00: Your triggers are yours.
22:39
SPEAKER_00: They're not a universal list you have to obey.
22:42
SPEAKER_00: One woman flushes every time she has a coffee, another drinks three a day and it does nothing.
22:48
SPEAKER_00: One can't touch red wine, another is fine with wine and it's sugar that gets her.
22:53
SPEAKER_00: Your body is specific, which means guessing is a waste of your time.
22:57
SPEAKER_00: Finding out is not.
22:59
SPEAKER_00: So here is what I want you to actually do, and it costs you nothing.
23:03
SPEAKER_00: If you're suffering from any kind of hot flush day or night, keep a trigger diary for two to three weeks.
23:09
SPEAKER_00: You're probably already starting a symptom diary from episode one.
23:12
SPEAKER_00: Just add a couple of columns, and when a flush hits, jot down roughly what you ate or drank in the hour or two before.
23:19
SPEAKER_00: What you were doing, how stressed you were, what the room was like.
23:23
SPEAKER_00: That's it.
23:24
SPEAKER_00: You're not doing this forever, you're being a detective for a fortnight.
23:28
SPEAKER_00: Because here's what happens.
23:30
SPEAKER_00: After two or three weeks, patterns often jump off the page.
23:33
SPEAKER_00: You'll see your own triggers in your own handwriting, and that's worth infinitely more than any generic avoid caffeine list.
23:40
SPEAKER_00: Because now you know which levers are actually yours to pull.
23:44
SPEAKER_00: You stop cutting out things that were never the problem, and you start managing the ones that are.
23:49
SPEAKER_00: Now the part you came for, what actually helps.
23:53
SPEAKER_00: And I want to give you the whole menu from the things you can change tonight through to the medical options because you deserve to know all of it, and then choose your level with a practitioner you trust.
24:04
SPEAKER_00: Let's start with cooling and behavior.
24:07
SPEAKER_00: Layer your clothing so you can strip a layer off fast when a hot flush starts, and choose neutral fibers like cotton, linen, or bamboo over synthetic ones that trap heat.
24:18
SPEAKER_00: In the bedroom, this is where you can make the biggest difference to those night sweats, and this is exactly what I was talking about at the top of the episode.
24:25
SPEAKER_00: A cooler room, the air con or a fan you can reach without getting up, light and breathable bedding, and nightwear made of fabrics that breathe rather than cling.
24:35
SPEAKER_00: Comfort over silky every single time.
24:38
SPEAKER_00: Add cooling pillow inserts or a cooling mattress topper.
24:42
SPEAKER_00: This really does help a lot.
24:43
SPEAKER_00: And separate dunas from your partner if you run hot and they run cold.
24:47
SPEAKER_00: None of this is glamorous, but all of it works.
24:51
SPEAKER_00: Then there is paced breathing, and I want you to take this one more seriously than it sounds.
24:56
SPEAKER_00: There is real clinical evidence that slow, deep, diaphragmatic breathing into your belly, long, slow exhales at the very first sign of a flush can take the edge off its severity.
25:08
SPEAKER_00: The moment you feel that wave beginning, drop your shoulders and breathe low and slow.
25:13
SPEAKER_00: About six breaths a minute, which is roughly five seconds in and five seconds out for a few minutes.
25:20
SPEAKER_00: It works because it calms the nervous system that is amplifying the whole event.
25:25
SPEAKER_00: It's free, it's always with you, and it's a tool you can quietly use in a meeting or at the front of a class without anyone knowing that you're doing it.
25:34
SPEAKER_00: Practice it when you're calm so it's automatic when you're not.
25:38
SPEAKER_00: Next, and please don't switch off when I say these words because they're not what you think.
25:43
SPEAKER_00: Mind-body approaches.
25:45
SPEAKER_00: Mindfulness-based stress reduction has been shown to measurably reduce how severe and how bothersome some women rate their flushes.
25:53
SPEAKER_00: And cognitive behavior therapy, CBT, has real solid evidence behind it for reducing the impact of hot flushes.
26:01
SPEAKER_00: I need to be really clear about what that does and does not mean, because I can feel some of you rolling your eyes.
26:07
SPEAKER_00: This is not anyone saying it's all in your head.
26:10
SPEAKER_00: We just spent the first half of this episode establishing that it is emphatically not in your head.
26:15
SPEAKER_00: It is in your hypothalamus.
26:17
SPEAKER_00: So let me tell you what CBD actually is.
26:20
SPEAKER_00: Cognitive behavior therapy is a short, structured, practical kind of talking therapy, not lying on the couch unpacking your childhood, but a hands-on method for noticing the thoughts and reactions that crank a symptom up, and learning to steer them differently.
26:36
SPEAKER_00: For hot flushes, that looks like catching the little spiral of panic, the second one starts.
26:41
SPEAKER_00: The, oh no, here it comes, everyone's gonna see, and learning to meet it calmly instead.
26:48
SPEAKER_00: It does not stop the biology.
26:50
SPEAKER_00: What it changes is your body's stress response to the biology.
26:54
SPEAKER_00: And that can genuinely take the edge off how intense and how distressing a flush feels.
27:00
SPEAKER_00: It's a physiological tool, not a suggestion that you think your way out of a hormonal event.
27:06
SPEAKER_00: There's a big difference.
27:08
SPEAKER_00: Do not let anyone use have you tried CBT as a way to dismiss you.
27:13
SPEAKER_00: But do not dismiss the tool either because it helps.
27:17
SPEAKER_00: Now my area, the fitness angle, and this one's a little counterintuitive.
27:22
SPEAKER_00: Exercise can, in the short term, set off a flush because you're raising your core temperature.
27:27
SPEAKER_00: That's just the physics.
27:29
SPEAKER_00: But, and this is the part that matters, women who exercise regularly tend to have fewer and lesser severe flushes overall.
27:37
SPEAKER_00: Regular movement helps regulate the whole system over time.
27:41
SPEAKER_00: So the answer is not to stop training.
27:43
SPEAKER_00: The answer is to train smart, exercise in a cool environment, stay well hydrated, and give yourself a proper cool down.
27:51
SPEAKER_00: And strength training specifically, which if you've listened to me before, you know I'll bang on until the day I die, has shown benefits for vasomotor symptoms on top of everything else it does for your bones, your muscle, your metabolism, and your mood through this transition.
28:08
SPEAKER_00: Two to three strength sessions a week, non-negotiable.
28:12
SPEAKER_00: For about 10 different reasons, and this is just one more.
28:16
SPEAKER_00: A quick honest word on the natural and herbal options because you're being marketed to relentlessly right now.
28:22
SPEAKER_00: A few of them do have at least some evidence behind them.
28:25
SPEAKER_00: Sage, yes, the herb, has research suggesting it can reduce hot flushes for some women.
28:31
SPEAKER_00: Then there are phytoestrogens.
28:33
SPEAKER_00: That just means plant compounds that act a little like a weak, gentle version of estrogen in the body.
28:40
SPEAKER_00: The best known are soy isoflavons, the ones you get in soy food like tofu, edamame, tempeh, and soy milk, and also in supplement form.
28:50
SPEAKER_00: And vitamin E has a handful of small studies behind it too, for a modest effect.
28:56
SPEAKER_00: Ashwaganda is also worth a mention.
28:58
SPEAKER_00: It's what's called an adaptogen, which means it helps buffer your stress response, and there is some evidence it can support stress, cortisol, and sleep, all of which, as we have seen, are tangled up in this transition.
29:12
SPEAKER_00: Magnesium is worth understanding properly too, because there is not just one.
29:16
SPEAKER_00: The two you will hear most about are magnesium glycinate and magnesium L-theanate, and they're not interchangeable.
29:23
SPEAKER_00: Glycinate is the calming one.
29:25
SPEAKER_00: Most women take it in the evening because it supports relaxation and sleep.
29:30
SPEAKER_00: L-theanate is the form that crosses into the brain, so it's the one linked with focus and cognitive function, and it tends to be taken in the morning.
29:38
SPEAKER_00: So if you are reaching for magnesium, it's worth knowing which job you're actually trying to do.
29:43
SPEAKER_00: Settle your nights or sharpen your days.
29:46
SPEAKER_00: But I want to be straight with you on all of it.
29:49
SPEAKER_00: The evidence is mixed and natural does not automatically mean harmless or right for you.
29:54
SPEAKER_00: Some women respond beautifully, plenty notice nothing.
29:58
SPEAKER_00: If you want to try something, run it past your practitioner or pharmacist first, especially to check if it's safe alongside anything else you take.
30:05
SPEAKER_00: Go in with realistic expectations and do not spend a fortune chasing a guarantee the science does not give.
30:12
SPEAKER_00: And now the medical end of the menu, because for a lot of women, lifestyle changes take the edge off, but do not get them across the line, and you're completely entitled to more than just taking the edge off.
30:24
SPEAKER_00: HRT, menopausal hormone therapy, is the most effective treatment we have for hot flushes and night sweats.
30:32
SPEAKER_00: Full stop.
30:33
SPEAKER_00: It's the gold standard, because it treats the actual driver, the falling estrogen behind the misfiring thermostat.
30:40
SPEAKER_00: We did a whole episode on it last week, so I won't go back over all the fear and the science here.
30:46
SPEAKER_00: Go back to episode three if you missed it.
30:48
SPEAKER_00: I will just say this: if hot flushes are taking over your life, HRT is the conversation to have first with a knowledgeable practitioner.
30:56
SPEAKER_00: And for many women, it is transformative.
30:59
SPEAKER_00: And if HRT is not right for you or not something you want, you're not out of options.
31:05
SPEAKER_00: There are non-hormonal prescription medicines that reduce flushes for a lot of women.
31:10
SPEAKER_00: And there's now a newer one approved here in Australia in 2024, specifically for hot flushes and night sweats, called VIOSA.
31:19
SPEAKER_00: That works directly on the brain pathway we talked about earlier.
31:23
SPEAKER_00: I'm only telling you the name so you know it exists, because for a long time women who couldn't take HRT were told there was nothing for them, and that's simply not true anymore.
31:32
SPEAKER_00: Now, like any medication, it comes with its own risks and possible side effects, and it needs proper monitoring.
31:38
SPEAKER_00: So it's absolutely a conversation to have with a knowledgeable doctor who can look at your history and weigh up the benefits and the safety for you.
31:46
SPEAKER_00: I'm not telling you to take it, I'm just making sure you know the option is there.
31:50
SPEAKER_00: Because the headline of this whole section is simple.
31:55
SPEAKER_00: It runs from a cooling pillow all the way to targeted medication, and you're allowed to be anywhere on it.
32:01
SPEAKER_00: If one thing isn't enough, you move along the menu.
32:04
SPEAKER_00: You don't have to just cope.
32:07
SPEAKER_00: So here's what I want you to actually do with all of this.
32:10
SPEAKER_00: Three things.
32:11
SPEAKER_00: Step one, start your trigger diary.
32:14
SPEAKER_00: This week, two or three columns added to your symptom diary.
32:17
SPEAKER_00: What you had, what you were doing, how you felt every time a flush hits, day or night.
32:23
SPEAKER_00: Give it a fortnight and let your patterns show you your own triggers.
32:27
SPEAKER_00: Step two, change one thing tonight.
32:30
SPEAKER_00: Just one.
32:31
SPEAKER_00: Cool the bedroom down, swap to cotton or bamboo bedding and nightwear, put a fan within arm's reach, or practice your paced breathing so it's ready the next time a flush hits, in bed or in a meeting.
32:43
SPEAKER_00: Don't try and overhaul everything at once.
32:46
SPEAKER_00: Pick the one that fits your life and do it tonight.
32:49
SPEAKER_00: Step three.
32:50
SPEAKER_00: If this is affecting your sleep, your work, your confidence, your mood, and your relationships, and hot flushes and night sweats affect all of these.
32:59
SPEAKER_00: Book the appointment and have the medical conversation.
33:02
SPEAKER_00: Take your diary with you.
33:03
SPEAKER_00: Ask specifically about your options.
33:06
SPEAKER_00: HRT and the non-hormonal options if HRT isn't right for you.
33:11
SPEAKER_00: And if the person in front of you does not have the knowledge to have that conversation properly, find someone who does.
33:17
SPEAKER_00: The Australasian Menopause Society Directory at menopause.org.au is your best starting point.
33:23
SPEAKER_00: It's in the show notes.
33:25
SPEAKER_00: Here's where I want to leave you today.
33:27
SPEAKER_00: Whether your flushes come for you at 3 a.m.
33:30
SPEAKER_00: in a wet sheet or in the middle of a meeting with your heart pounding and your words gone, nothing is wrong with you.
33:36
SPEAKER_00: Your brain's thermostat has been recalibrated by your hormones and it is doing exactly what a recalibrated thermostat does.
33:44
SPEAKER_00: It is real, it is physiological, it is common, and this is the bit nobody tells you, it is treatable.
33:52
SPEAKER_00: You don't have to lose years of sleep the way I did.
33:55
SPEAKER_00: You don't have to keep smiling through a flush in front of a room full of people, quietly wondering if you're still up to your own job.
34:03
SPEAKER_00: You do not have to white knuckle your way through the better part of a decade because someone once told you it's just a phase and it'll pass.
34:10
SPEAKER_00: You have a menu now from a fan and a fortnight of detective work all the way through to medication built for the exact cells causing the trouble.
34:19
SPEAKER_00: Start wherever you can and move along it as you need to.
34:24
SPEAKER_00: Your action for this week?
34:25
SPEAKER_00: Start the trigger diary.
34:27
SPEAKER_00: Change one thing tonight, and if this is stealing your sleep, your days, or your confidence, book the conversation.
34:34
SPEAKER_00: Next week we're going to the place where all of this leads, sleep.
34:38
SPEAKER_00: Why you're waking at 3 a.m., what is actually happening in your body when you do, and a real toolkit for getting your nights back.
34:46
SPEAKER_00: Given how many of you are being woken by exactly what we talked about today, I think you'll find it really helpful.
34:52
SPEAKER_00: It's deeply personal for me, and I can't wait to share it with you.
34:55
SPEAKER_00: If today's episode helped you, please share it.
34:58
SPEAKER_00: Send it to the woman you know who was quietly changing her sheets at 3 a.m., or the one who walked out of a meeting last week convinced she's losing it.
35:06
SPEAKER_00: And please feel free to subscribe and leave a review.
35:09
SPEAKER_00: For a brand new show like What the Perry, it's the single best way to reach the women who need it.
35:14
SPEAKER_00: I'm so glad you're here.
35:16
SPEAKER_00: I'll see you next week.
35:22
SPEAKER_00: Everything I've mentioned today is referenced in the show notes, along with all the links.
35:27
SPEAKER_00: And you can find me at Kirstencookcoaching.com.
35:30
SPEAKER_00: Just a reminder, though, this is education, not medical advice.
35:35
SPEAKER_00: So take these conversations to a practitioner who will actually listen to you.
35:40
SPEAKER_00: Thank you so much for being here and for listening to the What the Perry podcast.
35:44
SPEAKER_00: The change you didn't ask for, the conversations you need to do.