Night sweats are wrecking my sleep

I AM 71 and started the menopause aged 47 but, ten years ago, I developed night sweats that cause me to wake each hour with sweat dripping off my nose and joints. I’m getting depressed about this.

IFEEL f or you and, sadly, you are not alone in experiencing such trouble some and enduring post-menopausal symptoms. While many believe these will decline over the years, studies show that 9 per cent of women aged 72 continue to have them.

The average age a woman goes through the menopause (i.e. no longer has periods due to a lack of oestrogen) is 52, so this means that, in some cases, the symptoms are persisting for decades. Hot flushes are the most common symptom, affecting 80 per cent of women.

Our body temperature is controlled by an area of the brain known as the hypothalamus. When oestrogen levels fall, this causes abnormalities in the cells of this area, which disrupt the usual mechanisms that come into play to dissipate heat when body temperature rises by 0.4c.

In menopausal women, these mechanisms kick in at a much lower temperature — the feeling of heat is due to an increase in blood flow in the skin, followed by perspiration to cause rapid heat loss.

The sudden sensation starts around the face and upper chest, and lasts for several minutes, rapidly becoming generalised.

Hormone replacement therapy (HRT), which you say in your longer letter you’ve tried on and off, can be effective.

If it is not considered suitable — possibly, at the age of 71, you fall into this category, as women over 65 on HRT may have an increased risk, albeit very small, of developing a blood clot or cancer — there are a number of non-hormonal medical options.

The best studied are selective serotonin reuptake inhibitors (SSRIs), a class of drugs usually prescribed as antidepressants.

The antidepressant venlafaxine is commonly used to ease symptoms such as yours, and achieves a positive response within days.

Side-effects can include nausea, loss of appetite and drowsiness, but these generally wear off after a fortnight. However, patients must come off this drug slowly — otherwise they may experience side-effects such as dizziness.

Anti- epileptic drugs such as gabapentin and pregabalin are also used to treat hot flushes — the downside of these is that they can cause sleepiness, nausea and dry mouth, but all are minimal if started at a low dose.

There are a number of alternative therapies, but none has yet thoroughly been proven to work.

You mention that your doctor has suggested Botox: injected into the area, this will stop sweating in the armpits for many months, but it is not practical for the generalised symptoms that you describe.

I suggest you discuss other options with your doctor — and hope that you can find something that works for you.