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Warming Up to Midlife Changes

Excerpted from

Your Perfectly Pampered Menopause: Health, Beauty, and Lifestyle Advice for the Best Years of Your Life


Hot Flashes, Night Sweats, and Other Fun Ways to Know You're Over Forty!

I will never forget the time my friend Sheila had her first hot Hash. We were window-shopping on Madison Avenue and had just stepped inside this tiny shoe boutique to look around. While I was trying on this great pair of red patent leather stilettos, I glanced across the small store to notice Sheila grabbing the counter and nearly toppling an artful display of sandals. I immediately hobbled over to her (the stilettos were killing me!).

"Oh my God," she whispered in that hushed tone that is a prerequisite for shopping on Madison. am so dizzy-and I think my hair is on fire," she said, clutching the back of her head with a kind of reckless panic that told me she was convinced it really was. I watched as her face turned from a light, just-back-from-the-Bahamas tan to a bright pink and then a crimson stayed-out-in-the-sun-way-too-long red.

"I think I'm having one of those medical Twilight Zone episodes where people spontaneously combust from a rapid rise in body temperature, Sheila said, trying to keep her equilibrium as her dizziness seemed to get worse. "We've got to get out of here," she almost bellowed, more than an edge of panic now in her voice. I quickly kicked off my red heels and jumped into my clogs, and as Sheila clung to my arm for dear life, we headed out the door. Once outside I propped her against a parked car as I went out into the street to hail a cab.

"It's a stroke-I know it's a stroke-get me to NYU Medical," she told the cabbie in a loud, defiant voice as we piled into the backseat. While I was pretty sure that someone having a stroke couldn't yell instructions at a New York City cabdriver, I didn't want to argue with my friend. So I motioned to the driver to go, and we headed downtown to NYU.

Well, I probably don't have to tell you that by the time we actually got to the hospital, Sheila was feeling fine-and a little silly, I might add. Ultimately, we just told the cabbie to turn around and head for my friends Upper East Side apartment. The next day she did visit her gynecologist, and his diagnosis was something I had guessed back there in the shop on Madison. Although she was only forty-three, Sheila was having her first hot Hash-and perimenopause had officially begun.

While it's true that the path that cuts through the middle of our life is literally strewn with crazy symptoms (and you'll learn more about all of them throughout this book), perhaps none marks the bend in the road more than the veritable "hot flash." As we slowly morph our way from Reproductive Goddess to, well, simply Goddess, that undeniable rush of body heat can't help but be a familiar companion. And while the National Institute on Aging estimates that 60 percent of all women approaching menopause have hot flashes, judging by the women in my world, I'm figuring the "real" number has got to be closer to something like 99 percent. Quite honestly, I don't know a single gal who hasn't reached age fifty without having at least one uncontrollable urge to run naked into a blinding snowstorm seeking hot flash relief.

Yes, It's Hot in Here!

As irritating and exasperating an experience as a hot flash can be, traditionally doctors didn't pay a whole lot of attention to this mostly female phenomenon. In fact, it wasn't so very long ago that medical science barely acknowledged the existence of hot flashes, let alone made any efforts toward understanding why they occur. In fact, I was stunned to discover that the first medical paper exploring the physiology of what happens during a hot flash wasn't even published until 1975. That's when a little-known publication called the Journal of Applied Physiology first documented what actually happens to a woman's body during one of these events-besides the desire to tear off your clothes, that is. Of course, if a man's pants were on fire the same way our face and neck burn during a flash, I can't imagine that medical science wouldn't have put a move on finding out why, but I try not to be bitter. At least we finally had some information as to what was going on and why.

What the Journal documented back in 1975 was that during a hot flash your skin temperature goes up, then down; you begin sweating, and your heart rate increases by about 13 percent at the start of each flash. According to NYU professor Dr. Steve Goldstein, it's not uncommon for your pulse to reach 150 beats per minute when a flash is coming on.

What all this amounts to is something called "vasomotor instability"-or blood vessels that contract and expand without any real rhyme or reason. The cause of all this commotion is, as far as anyone can tell, the result of a snafu in our body thermostat-a system that is nestled securely in an area of the brain called the hypothalamus.

Normally, when we are overheated-from exercise, for example, or, heaven help us, great sex-it is the thermostat in our brain that sends the "cool down" message to our body. This, in turn, dilates or widens the blood vessels in the skin, which then allows hear from the blood coursing through our inner core to escape. The end result is that we cool down. When our body once again reaches the ideal temperature, the thermostat directs the blood vessels to constrict or tighten to keep heat in. In this way, we maintain a pretty even body temperature 24/7. Except, of course, during perimenopause. This is when our thermostat goes completely wacky, jumping up and falling down with absolutely no regard for what we are doing-or wearing, as the case may be-at the time.

Tags: Health