What Are Menopause Cold Flashes?
The first time Cynthia Halow, 53, of Denver, started having cold flashes, she thought she was coming down with the flu. But when Halow took her temperature, she saw she didn’t have a fever.
The chills began a few months after she had her very last menstrual period, marking her official departure from perimenopause, during which she’d had regular hot flashes. It never occurred to her the opposite — sudden chills — could be related.
“It was odd,” says Halow, the founder of PersonalityMax, a website that specializes in personality tests. Only after experiencing these chills several more times did Halow decide to do her own research — and learned that “cold flashes” can be another symptom of menopause.
Like hot flashes — that ubiquitous symptom that the North American Menopause Society (NAMS) says as many as 3 in 4 menopausal women — it’s thought that cold flashes are linked to the drop in estrogen levels that occur during menopause. When this happens, the hypothalamus gland, which regulates body temperature, may become more sensitive to small changes in body temperature, causing it to “overreact” by having a cold (or hot) flash.
It’s worth pointing out, though, that experts aren’t entirely sure what causes either cold flashes or hot flashes — this is just the leading theory. What’s more, cold flashes are even less understood than hot flashes.
While some women, like Halow, experience these chills at random times, research suggests that other people have them after having a hot flash.
As a consequence of having a hot flash, the blood vessels near the surface of the skin dilate to try to get rid of perceived heat in your body, explains Wen Shen, MD, MPH, co-director of the Women's Wellness and Healthy Aging Program and associate professor of gynecology and obstetrics at Johns Hopkins Medicine in Baltimore. “Once that passes and the body feels that the temperature has gone back down again ... you get cold.”
These symptoms can be very disorienting, says Dr. Shen. “You can wake up in the middle of the night with a drenching hot flash and kick all the covers off, then the next thing you know, you’re getting bone-rattling chills and you’re diving under covers again,” she says.
For some women, these chills can be debilitating. “I have patients who tell me that they have one every single hour, and if they're at work, they have to stop what they're doing,” Shen says. “It also happens while they're trying to sleep, leading to sleep deprivation.” This can have a serious effect on quality of life.
While there’s no way to prevent cold flashes completely, there are ways to cope with them and mitigate the symptoms.
Currently, the only nonhormonal drug approved by the U.S. Food and Drug Administration to treat hot flashes is paroxetine, a selective serotonin reuptake inhibitor (SSRI) that’s most often used to treat depression. It has been shown to significantly decrease hot flashes and can also decrease cold flashes. (Other SSRIs are sometimes used off-label to treat hot flashes.)
Other nonhormonal drugs that are used off-label to help reduce cold flashes are gabapentin, an anti-seizure medication; clonidine, which treats hypertension; and oxybutynin, which is commonly prescribed for overactive bladder syndrome. These medications all act on the neurotransmitters that are involved in the hypothalamus, Shen explains, the same region of the brain involved in triggering a hot flash.
Your doctor may also prescribe hormone therapy (low doses of estrogen and progesterone) to ease hot or cold flashes. These are the primary ovarian hormones that decline in menopausal women.
Shen says there is a lack of resources available to women who are going through menopause compared with women in other phases of life, such as puberty or pregnancy.
Know, however, that you deserve support and treatment. Shen sees many people who’ve gone too long without finding the help they need. “By the time they come to me, many of my patients have been told, ‘Every woman goes through it — suck it up,’ or ‘It's all in your head,’” Shen says. Find a doctor who will listen to you and help you find relief. The NAMS has a tool that can help you find a provider near you.
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