Hot Flashes and Heart Health: What Does the Research Really Say?
You wake up at 2 a.m., sweaty and wide awake. Again.
You came here hoping to learn how to get a decent night’s sleep. Now I’m bringing up your heart?
I know. That sounds like an unwelcome plot twist. But the connection between hot flashes and heart health is worth understanding—and it calls for curiosity, not alarm.
A new study in JAMA Internal Medicine gives us one more piece of that conversation. It raises interesting questions about menopausal hormone therapy and cardiovascular health. It does not give us all the answers.
“Vasomotor symptoms” means…what, exactly?
If you have ever felt a wave of heat arrive out of nowhere, or woken up damp when the room was perfectly comfortable, you may already know what vasomotor symptoms are. They’re hot flashes and night sweats.
They can be mildly annoying. They can also disrupt sleep, concentration, work, and whatever patience you had left by 3 p.m. You do not have to prove they are “bad enough” before asking for help.
What do hot flashes have to do with heart health?
Researchers looked at information from 2,737 women who had reported hot flashes or night sweats. Some started menopausal hormone therapy; others did not. Women who started therapy had an estimated 22% lower relative risk of a cardiovascular event in the researchers’ analysis. The association was stronger among women who started treatment within 10 years of menopause.
That sounds promising. It is also where we need to slow down.
The women were not randomly assigned to take hormone therapy. Researchers studied decisions that women and their clinicians had already made. They took careful steps to account for differences between the groups, but they cannot rule out every other reason the outcomes differed. The study cannot prove that hormone therapy protected these women’s hearts. The authors specifically say their findings should not be used as a reason to prescribe it to prevent cardiovascular disease.
In other words: this study makes me curious. It does not make me ready to prescribe hormone therapy for heart protection. We need more research to understand whether hormone therapy changes cardiovascular risk, and whether the answer differs depending on when treatment starts and which treatment is used.
Wait—are my night sweats telling me something about my heart?
Not necessarily. A hot flash does not mean you have heart disease, and this research does not show that hot flashes cause it.
What researchers have observed is a connection between vasomotor symptoms and future cardiovascular risk. They are still working out why that connection exists and what it means for an individual woman. That may feel less satisfying than a neat yes-or-no answer, but it is the honest one.
Here is what we can do with that information: use a conversation about your symptoms as a chance to look at the bigger picture. How is your blood pressure? What do we know about your cholesterol and blood sugar? How are you sleeping? What about your family history?
The age at which you reached menopause also matters. A separate study highlighted by The Menopause Society found that women who experienced menopause before age 40 had a higher risk of developing high blood pressure. That is another reason to make sure your clinician knows your menopause history, especially if it happened early.
So where does hormone therapy fit?
For bothersome hot flashes and night sweats, menopausal hormone therapy is our most effective treatment. That is a solid reason to discuss it. Whether it is right for you depends on your symptoms, your health history, when menopause occurred, your preferences, and the treatment you are considering.
I would never want you to leave this article thinking you need hormone therapy to keep your heart healthy. I would want you to know that you can ask for help with your symptoms and give your cardiovascular health some attention. Those conversations belong together.
Perhaps you came in wanting to sleep through the night. That is reason enough to talk. We can start there, look at your health as a whole, and decide together what makes sense for you.
At Focused Health & Wellness, I offer individualized menopause and hormone care in Jefferson City and through telemedicine for women elsewhere in Missouri. If you are tired of trying to piece together answers on your own, I would be glad to talk with you.
Dr. Lenora Epple is an Internal Medicine physician and Women’s Hormone Therapy Specialist at Focused Health & Wellness, Inc.
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