But something weird began happening when I hit my late 40s that nearly broke my funny bone. As soon as I made with the witticisms, my face, neck, and chest would turn beet red. I’d perspire so intensely it was like I’d taken a shower. In public. Instead of laughs, now I was getting totally mortifying sympathy stares. I had no explanation for this super-uncomfortable phenomenon, but the dots quickly connected once I noticed other weird sensations. Unusual periods. Restless sleep. Roller-coaster moods. I hadn’t recognized the infamous midlife transition: menopause. Turns out, these sweaty, red-faced, in-public episodes were my body’s way of manifesting hot flashes.
The Season of Menopause
Officially, menopause occurs when menstruation stops and the ovaries stop producing eggs—but it doesn’t happen overnight (unless you’ve lost your ovaries and uterus to surgery or disease). Although we’ve historically thought of menopause as a women’s issue, anyone who has ovaries—including transgender men and nonbinary people—can experience menopause. As the ovaries slowly stop responding to the hormones estrogen and progesterone, physical changes and challenges set in over the course of months or even years. That’s when symptoms like irregular periods, hot flashes, night sweats, and sleeping problems may develop—all of which can precede, by several years, the actual end of menstruation. And for 40% or so of women around age 45-65, hot flashes and night sweats have a negative impact on their work, leisure life, mood, concentration, sleep, and even sex life, according to a 2011 study. Many, like me, also experience social embarrassment and anxiety. Though menopause isn’t a medical condition requiring treatment, symptoms of “the change” can be difficult to navigate without some sort of intervention. When hormone therapy (HT) came on the scene in the 1940s, it was embraced by doctors and their patients for its ability to ameliorate menopause’s most annoying symptoms like hot flashes, vaginal dryness, overactive bladder, and bone loss. But in 2002, a major women’s health study suggested that taking HT could raise the risk for breast cancer, heart disease, strokes, and blood clots. This left women who chose not to use HT, or whose doctors advised against it, without a viable drug to control the symptoms. Enter mindfulness as a side-effect-free option.
The Science of Hot Flashes
If it seems odd that my hot flashes were only triggered by joking around in public, it turns out that “clinical experience and research show that every woman’s menopausal experience is unique,” says Richa Sood, MD, associate professor of medicine at the Mayo Clinic in Rochester, MN. Her research suggests that, with the benefit of a mindfulness practice, maybe my amateur stand-ups wouldn’t have been so discombobulating. Sood and her team at the Mayo Clinic’s Menopause and Women’s Sexual Health Clinic studied mindfulness and the role it could play in easing menopausal symptoms. They focused on the fact that chronic stress can intensify the symptoms you’re already experiencing. Unchecked stress, Sood explains, triggers a flood of neurochemicals, including norepinephrine, which is a part of the fight-or-flight response in our body. In turn, this can influence the hypothalamus, a tiny cone-shaped region of our brain that is involved in the regulation of our body temperature. Norepinephrine is thought to narrow the thermo-neutral zone, or safe-temperature zone, in the hypothalamus. With higher stress chemicals leading to a narrower safety zone, says Sood, your body perceives overheat at a lower threshold, and in response, your blood vessels expand to radiate the “excess” heat out. Hello, hot flash.
Stress, Mindfulness, and Menopause
Menopause intertwines biological elements—such as these dramatic changes in neurochemicals—and psychological elements like sadness, irritability, or, as I found, out-of-the-blue bashfulness. Stress and anxiety not only intensify the symptoms of menopause, Sood notes in her study—they can also mess with your performance at work, your relationships, and even lead you to feel less happy than you used to be. “Studies using strategies like Cognitive Behavior Therapy and hypnosis (which both target the emotional response to menopause symptoms) show some benefit for managing the symptoms,” Sood told me. So, her theory was that mindfulness, which also helps us regulate our emotional responses, could ease menopausal symptoms and overall stress. Sood and her team enrolled over 1,700 women between the ages of 40 and 65 who had never been trained in mindfulness and had them fill out detailed questionnaires. The questionnaires assessed the participants’ level of menopause symptoms and their stress levels. Using a symptom scoring scale, a lower number (0-2) was assigned to milder menopausal symptoms, and a higher number (3-5) to more severe ones. The researchers also used a questionnaire called the Mindful Attention Awareness Scale to assess how mindfully receptive and aware participants tended to be in their day-to-day lives. The study revealed that participants who had higher levels of mindfulness had lower stress levels and milder hot flashes, night sweats, and other symptoms. “Mindfulness appears to be a promising tool for alleviating menopausal symptoms and stress,” Sood summarizes, noting that higher mindfulness scores were also associated with lower symptom scores for irritability, depression, and anxiety. The study also indicated that the higher a woman’s stress levels, the greater the potential benefit of mindfulness for easing her menopausal symptoms. “Mindfulness has the effect of engaging the parasympathetic nervous system, which is opposite to the sympathetic ‘fight-or-flight’ system,” explains Sood. “This shift can help decrease the severity of hot flashes by widening the thermo-neutral zone.”
Turning Toward Your Symptoms
Mindfulness has these biological effects that can ease menopause, Dr. Sood told me. But it also works on psychological aspects of menopause by reducing anxiety and worry in the moment. A 2011 paper by James F. Carmody, PhD, professor of medicine at the University of Massachusetts Medical School, investigated how this works. Among Carmody’s areas of expertise is how mindfulness reshapes our habitual ways of attending to the world that result in everyday anxiety and unease: “Those unrecognized patterns run so much of our lives, keeping us anxious and limiting connection with those around us,” he says. For the 2011 study, his team decided to study mindfulness as potential relief for hot flashes, night sweats, and other menopausal symptoms. Carmody and his UMass team enrolled 110 women in various stages of menopause who were experiencing more than five moderate-to-severe hot flashes (including night sweats) in a day. The women were randomly assigned to two groups. One group took a weekly two-and-a-half hour Mindfulness-Based Stress Reduction (MBSR) course for eight weeks, and the other group didn’t attend classes or learn about mindfulness. Following the course, the women reported that they felt less stressed and more able to navigate their hot flashes and night sweats with ease. And three months after the MBSR course ended, they still reported feeling only “slightly” to “moderately” impacted by their symptoms. What’s more, they reported an outstanding improvement in their sleep, says Carmody. Carmody’s research pinpointed the role our attention plays in mitigating menopausal symptoms: “One of the things mindfulness does is help you redirect your thoughts and focus on something neutral, like your breathing.” As a result, he says, your perceived level of stress goes down—and, with any luck, so will your hot flashes. While there isn’t yet a precise recommendation for how much you should practice mindfulness to see results during menopause, Sood says that what’s important is to integrate moments of mindful awareness wherever you can in your day, so that it becomes as much a part of your reality as any symptoms you’re living with. “Ultimately,” says Dr. Sood, “with the practices of training attention and reducing negative judgments, neuroplasticity starts happening, leading to adaptive and healthy ways of thinking and interpreting events.”
