Why am I so hot? Hot flashes - causes and symptoms

Your doctor may not know this about your body! Discover how a thyroid imbalance may indicate deeper issues and why your hormones could be disrupting your sleep.  A Naturopathic Doctor's recommendations to help perimenopausal and menopausal women FEEL BETTER.

Dr. Danielle Marchildon ND received her Bachelor of Science in Biology from the University of Waterloo and her Naturopathic Doctor degree from the Canadian College of Naturopathic Medicine. At the Collective Health Clinic in Orangeville, Ontario she treats all aspects of women’s health, mental health, fertility, digestive concerns, skin conditions, and chronic pain to name a few. She also offers food sensitivity testing, hormone testing, and can run all standard bloodwork. 

Connect with Dr. Danielle Marchildon ND at:
Collective Health Clinic
drdanielle@collectivehc.ca
519 941 3100

RESOURCES:
New Menopausal Years, The Wise Woman Way - by Susun Weed

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Transcript

[00:04] Debra Jones: Welcome to OWN THE GREY, a podcast to dispel the notion that aging is undesirable and setting new positive attitudes. I'm Debra Jones, and I believe you can be vibrant and healthy throughout the best years of your life. Today on OWN THE GREY, we have Dr. Danielle Marchildon, a licensed naturopathic doctor from the Collective Health Clinic in Orangeville, Ontario, Canada. You may remember her from episode 19 when we were talking about menopause, and I invited her back to share her wisdom on other issues that we women suffer from. So, thank you for joining us again, Dr. Danielle.

[00:52] Dr. Danielle: Yes, thanks for having me. I'm thrilled to be back.

[00:55] Debra Jones: It's great to have you because I know you have such a passion for women's health and women's wellness, and you also have a lot of wisdom based on some of the research that you're always doing. You're always learning new things that are coming up. Isn't that right?

[01:12] Dr. Danielle: Absolutely. And I think particularly with this subject around women's health and menopause. The research in this field of medicine is really evolving. Particularly since 2001. When there was a big study done called the Women's Health Initiative that has largely been refuted since. But has really taught the medical professional to sort of go with the narrative that we should fear estrogen. When in fact. I find we now know better. And the opposite is true, that we need to learn to love estrogen.

[01:46] Debra Jones: I love that. So tell us, what kinds of complaints do women come to you with, that are related to what we're talking about?

[01:56] Dr. Danielle: Sure. I think probably the most common two symptoms, I would say, that I hear from menopausal women are both hot flashes and sleep disruption, and they can coexist. I can see one over the other. Hot flashes, of course, causing sleep disruption. But I also have just as many women who are waking frequently without hot flashes. But those are the two main ones. The other one that I think surprised me is the amount of genital urinary symptoms that I'm seeing in this demographic. So vaginal, dryness, chronic bladder infections or bladder discomfort, prolapses, that kind of thing, that are really affecting menopausal. Women. I think we're just we have some voices now compared to 50 to 60 years ago. Women were suffering and weren't saying anything. So it is a massively evolving field, and I am so honored to take part in helping these women feel better.

[02:58] Debra Jones: Yeah, I'm glad we've got you on our side. It's great to have somebody who can actually really understand what's going on, because I know in my mother's day, when she would go to the doctor and nine times out of ten, or maybe ten out of ten at that time would be a male doctor. And, you know, they have their knowledge, but they don't have any experience, and they also have a different perspective. Do you think men are equipped to help women with menopause?

[03:33] Dr. Danielle: No, I don't. I'm not questioning competency here. I'm questioning the ability to therapeutically connect and understand where the patient's coming from or even properly put that female into context so that when she is saying my quality of life is largely disrupted because I'm having hot flashes 30 times a day. To have a male doctor look back at her and say, you know what, women have been doing this for years, so just push through it, I think that's dismissive. I think we know better. I think it is a huge injustice to these female patients. I will say though, I do become a little shocked. I have heard through patients that some female practitioners still I mean, when I hear a negative response or that fearing estrogen narrative come from a female gynecologist, for example, I will check on her age. Right? I'll ask the patient ballpark her age for me because there's a pretty good chance she's pre menopausal. It is hard to gauge the effect of menopause until you're really going through it, but until you're, until you're in the midst of it because it's similar to being in labor, right. You always hear how bad it is, but you don't really know until you can, right. I definitely find I'm up against resistance with more male doctors, for sure. In terms of me, I like to be fully transparent with my patient's healthcare team. So if I have a patient who's starting a prescription, I want them to fully inform their family practitioner or their gynecologist or whoever what they're doing. And I think I definitely see more resistance from the male side. I know some family doctors who are male. The second you bring up hot flashes or anything that has to do with female reproductive, it's an automatic referral for them. And I really respect that right. That they can recognize that they maybe don't have the capacity to fully care for this patient because they can't, they can't empathize with how this must be for them. And I see that and I really respect that. Right. Like, okay, I'm going to send you to a female gynecologist who can further like, I think that's phenomenal, but otherwise I'll fight the fight for them. I'll send the studies and you know what I mean, I'll do my due diligence to show that male doctor. And I've seen, like I said, I've come across resistance even within, mostly within the area to which I practice. And I send the studies, I send the communication to prove that this is a good therapeutic choice for the patient. And I'm slowly seeing leaves turnover. So it's working one doctor at a time.

[06:30] Debra Jones: That's as great as the progress in that department. But the one thing that came to mind as you were talking is it isn't black and white. This women's health and even the idea of menopause. There's no one size fits all. There's no textbook version, is there? And so there's so many different layers, emotional, mental, physical, and spiritual. All four of them are involved in this, and it takes somebody with some compassion and understanding of that. Everybody's journey is different, and I think that's what you do as a naturopathic doctor, to really ask some questions and go much deeper than the surface. How important do you think that is?

[07:20] Dr. Danielle: Very. I mean, I think it's something that's really it's foundational to a naturopathic doctor's process, to individualize every single treatment plan. So I don't treat a diagnosis. I don't treat a disease. I'm treating a person. I can speak for Ontario, whereby we spend a lot of time with our patients. So ten minutes with a patient, I can learn about the symptom, but I can't put that into context, right. Half an hour, an hour, sometimes more, with patients. So now I've got a really good idea of what this symptom looks like in the life and world of this patient. And menopause here is no exception. Right. If I have a female coming to me saying, I'm anxious, I'm having more feelings of sadness, yes, I have hot flashes. And I don't ask, what does stress look like, what does your diet look like? What about lifestyle? What's your support network look like? If I don't have all of those pieces, I won't get full resolution. I'll be limited in terms of how effective I can be.

[08:29] Debra Jones: That's really important. Yeah, for sure. So then let's talk a little bit about hot flashes. What are they, and what can you share with us about that?

[08:42] Dr. Danielle: So, hot flashes are very dynamic in the sense that there's sort of two separate things going on. So initially, when the ovaries start to decline in their output of hormones, and also ovulation, there is a brain hormone called luteinizing hormone. I'll short form that to LH. For people listening, if they've ever been through fertility treatment, LH will surge around day 14, which increases our body temperature, and that usually equates in an ovulation in perimenopause. When the ovaries start to slow down, LH surges at day 14, and there's no ovulation. So LH will surge again, and there's still no ovulation. LH will continue to surge. And as we know, LH increases our basal body temperature or our core body temperature. So every time we get that LH surge, we can go into a hot flush. As things start to progress into full blown menopause, whereby you no longer have a period, what's happening is the drop in estrogen really increases our sympathetic nervous system activation or our capacity for managing that. So certain things will start to bring hot flashes on. Anything that increases sympathetic nervous system will do so. So stress and, you know, even I have lots of patients who will talk to me about how horrible their hot flashes are. And as they're talking about how horrible their hot flashes are, it brings on a hot flash.

[10:10] Debra Jones: Yeah.

[10:14] Dr. Danielle: Right. But even just the stress of telling me how horrible they are we'll bring them on. And then of course, there are things, anything that vasodilates that we put in our body. So one of the results of that sympathetic activation is a huge vasodilation. Our blood vessels increase in diameter, which allows for that flush and that quick surgeon in blood flow. So other things that will do this coffee, chocolate, alcohol, particularly red wine. Red wine is a huge vasodilator. I've got patients who drink a lot of coffee and drink quite a bit of red wine, particularly coming out of COVID. And even when we just drop those out, we can see such an improvement in hot flashes alone.

[11:00] Debra Jones: Wow, that's pretty incredible. So what my mind is going to is feeling hot at night time in bed. Is that a hot flash or is that something else?

[11:12] Dr. Danielle: It's a dysregulation of your core body temperature, right? So your own thermostat has gone awry. There is a connection to circadian rhythm. This is why some women only feel hot or only have hot flashes at night because there is a connection between time of day, things like melatonin secretion. So we do know that nighttime certainly puts us at high risk for a dysregulation and body temperature and therefore a higher vulnerability to go towards a hot flash. Hot flashes are defined by that surge of temperature. Feeling hot throughout the night isn't diagnostically a hot flash, but still tightly connected to the menopause.

[11:58] Debra Jones: And so that leads us into the conversation that we had when we decided we would do a podcast on it. And that is the link with the thyroid. Can you share with us if there is a link and if so, what is it?

[12:13] Dr. Danielle: There are links. The term being used right now in studies is it's an indirect link, meaning that estrogen as a result of higher or lower levels? The other thing I'll mention is that the thyroid and the ovaries are constantly talking to each other. Okay? So we know if I have a 30 year old female who hasn't had a period in three months and had check her thyroid, I would never assume that that's perimenopause because of her age. But I'm going to check her thyroid because the ovaries in the thyroid are constantly communicating. Now, there's a couple of situations here that we have to talk about because the thyroid is really sensitive to both high levels of estrogen and low. So when levels go high, which they will in perimenopause, right. We actually can see an overcompensation by the ovaries where we end up having periods of really high estrogen. This will increase something called thyroxin binding globulin. Thyroxin binding globulin will attach to active thyroid hormone and decrease the presence of thyroid hormone in our cells. So it can create like a hypo or a low thyroid picture. The other thing we have to think about is that the whole idea of epigenetic change. So we're all born with a set number of genetics. Some are expressed or turned on, and some are not expressed or turned off. And certain things as we go through life will turn genes on and off. Menopause, being women, certainly are at a higher risk of epigenetic change because we have monthly cycles, we are the ones giving birth. We also have a higher emotional capacity. So stressful events typically affect us physically more than a male, but menopause being one of those key opportunities for epigenetic change. So you can have no issues with thyroid your entire life, hit menopause, and all of a sudden, now you've got a thyroid problem. Right. So this is a particular patient population that I am watching that thyroid like a hawk. Right. The other thing is both hypothyroid symptoms and hyperthyroid symptoms can mimic those of menopause. So it's also something if I have a patient coming to me saying, I'm really hot and I'm starting to have palpitations, which are both symptoms of menopause and hyperthyroidism, I'm going to check, I'm going to make sure that it's not just menopause doing this. I want to make sure that thyroid isn't playing a role. And the same can be said for hypothyroidism, where we have brain fog and low energy and weight gain. I want to check in on the thyroid there as well, to make sure that it's not just lack of estrogen doing the job here.

[14:58] Debra Jones: Yeah, that's great. That brings up the question, do medical doctors and naturopathic doctors have different ways of testing for these things?

[15:10] Dr. Danielle: Yes. I know a lot of patients are frustrated around their primary care physicians or their family doctors and the lack of thyroid testing, where a lot of medical doctors will just run something called a TSH or a thyroid stimulating hormone. We should be more angry at the system than we are at our medical doctors. At least here in Ontario, this is an OHIP strategy, not so much a clinical one by the doctor. So OHIP allows TSH testing annually and will allow further testing if the TSH is abnormal. Right. There's the obstacle. The downside for me as a naturopath is that kind of to back it up that your TSH is based on your T four levels. Okay, so what happens here? Your thyroid gland, which sits in your neck, it secretes both T four and T three. T four peripherally will be converted to T three, which is what we want. We want to make sure there's good conversion because T three is the more metabolically active hormone. The brain is constantly screening the body for how much T four is in the system. So the brain only cares about T four, not T three. OK, so if the brain sees that T four is good, your TSH will be good. But here's the problem. If your T four is good because you're not converting it to T three peripherally, your TSH looks normal, but you don't have enough active T three, which will present like a textbook hypothyroid case in the presence of a normal TSH. So this is why it's really important to check TSH, T Four and T Three to get a better idea of what's really happening in the body.

[17:03] Debra Jones: Wow. So my question is, if you furnish your doctor with that request, can they fulfill that request for you?

[17:14] Dr. Danielle: They usually say no, but they don't think it's necessary. Even in the treatment of thyroid, from a pharmaceutical standpoint, the number one first line therapy here is a drug called Synthroid, and it's just T Four. So they don't even see value in checking T Three. So even if you do have a hypothyroid diagnosis and they give you medication, they're still just checking TSH and T four. And again, once I give a body T Four, your TSH, your T Four numbers are going to look great. But what's your conversion doing? Do you have enough active t three. Right, so I got a lot and I see it all the time. I have patients who come to me saying, my doctor found hypothyroid, I'm being medicated, but I feel no different.

[18:03] Debra Jones: Right.

[18:04] Dr. Danielle: So then I run the T Three and I see that they're not converting well. Things that will block conversion here of T Four to T three, stress is a big one. Looking at iron and vitamin D levels in the body as well, can block and also melatonin. We want to check that sleep wake cycle, because we can see low melatonin could be high, cortisol that's the relationship which would block conversion. So when we optimize conversion, then the patient start finally starts to feel better.

[18:36] Debra Jones: Wow. So you've unpacked a lot there and I've got some questions.

[18:40] Dr. Danielle: Yes.

[18:41] Debra Jones: So did I just hear that or did I just think that high vitamin D levels can block that conversion?

[18:52] Dr. Danielle: No, the opposite. So deficient in vitamin D. OK.

[18:55] Debra Jones: So then looking at our diet, looking at the supplements that we take, that's something that somebody that would go to you as a naturopathic doctor, you would be asking those kinds of questions to know what it is they're taking.

[19:10] Dr. Danielle: Well, absolutely. I mean, every patient, I look at everything they're currently taking and then particularly my thyroid patients, even when they're already medicated, even when they present to me a TSH level that is perfectly normal, that was done last week, I will still say it's not enough. It's not enough. I need to see that, because their chief concern is fatigue. But my thyroid is fine. Well, we actually don't know that yet. The other thing I'll bring into the conversation here is that I'm finding majority of my female hypothyroid patients also have Hashimoto's, or their hypothyroidism is due to Hashimoto thyroiditis also, not something typically ruled out or in by a primary care physician. So Hashimoto's is the autoimmune disease that affects the thyroid. Being autoimmune, there is usually a systemic effect here, but we can catch it looking at a full thyroid panel. This is an inflammatory condition. My approach to treating Hashimoto's is different than if there isn't Hashimoto's, there. Medical doctors, the way they see Hashimoto's is it's only worth treating if it's actually affecting thyroid hormones, which they would use Synthroid anyway, so they don't see the clinical value in ruling Hashimoto's in or out. I certainly do, particularly in women's health, more specifically around fertility.

[20:42] Debra Jones: So that also then leads to correct a thyroid imbalance. So you talked about Synthroid, which is the common one that a doctor would prescribe. Are there different kinds of medications?

[20:57] Dr. Danielle: Yeah, they also have a pharmaceutical, just a straight T three, which you don't see them use often. I'm not sure. I think it's just really algorithmically and it's hard to find for them anyhow. I think, to find that right. Ratio of T four to T three, I don't know. Is it lack of understanding, lack of sufficient evidence to support using both of them and what that would look like? So there is a T three, but I don't see it used. Justin it's usually Synthroid, which is T four from my end. I do have my prescription license, so I do have access to a desiccated thyroid medication. Both this is a combination T four and T three medication, which is helpful because it means that if I have a patient who's having a hard time converting their T four to T three, I can use the desiccated thyroid to increase their T three so that they feel that metabolic improvement. Alternatively, we always check on things like vitamin D and iron to make sure that those levels are optimal. Otherwise we're hitting our heads against a wall with thyroid if they aren't. If you have Hashimoto, selenium being as an antioxidant, having the highest affinity for the thyroid. So taking selenium really kind of protects that thyroid from the autoimmune process. And then, of course, we can use herbs. Plantbased medicine comes in really well here in terms of managing symptoms of hyper or hypothyroidism and improving looking at stress management to improve conversion. It really is a comprehensive approach to thyroid versus just a Synthroid. Right. Which is the only thing that's really discussed when a medical doctor determines your thyroid is low.

[22:46] Debra Jones: Yeah. So all of the things that you're mentioning, you're not suggesting we take them, you're saying those are the things that you often will go to when someone has come to you and you've done a full check on who they are and what they're taking and what's going on with them. Is that right?

[23:04] Dr. Danielle: Absolutely. I'm very particular in prescribing and knowing the whole person allergies, but they're currently taking any other concurrent diagnoses that may be playing a role. Always seek professional assistance or guidance when starting to take anything.

[23:22] Debra Jones: Yeah, that's very important. So, from your perspective, what do you want us to know about this realm of hot flashes, menopause and thyroid? What are the main takeaways that you would like us to take.

[23:40] Dr. Danielle: I think, first of all, I think a proper assessment as you move into perimenopause and further into menopause, make sure you're prompting your medical doctor, your naturopath, for proper assessment, because we know all of the things that can go awry here. So let's see which parts of these are affecting you. This is part of women's anatomy and biology. It is a natural process that we go through. But we know so much more now that to sit back and suffer because our grandmothers did it is no longer necessary. There are treatments that are effective and safe. I will underline and bold and endorse that statement with everything I can to help you get through this part of your life with the added benefit of preventative health. So reducing your risk of these things like cardiovascular disease, dementia, colon cancer, type two diabetes, joint pain, like mental health, there's so much benefit. And in terms of the thyroid that comes in there with that proper assessment, right. Make sure that your thyroid is being monitored as you go through this perimenopause and into menopause. I have now been in practice long enough where I've tracked many women from the time their period started to skip to the time when their period stopped completely, where their thyroid was fine the whole way. And then a year after their last period, that's when their thyroid flipped. So if we stopped checking because we were like, well, the past three years has been fine, if we stopped checking, that female would be running around with an undiagnosed type of thyroid and not feeling good.

[25:31] Debra Jones: It's very important for us to take control of our own health and to pay attention to how we're feeling. And sometimes these symptoms and these discomforts and things can roll in, and then we just kind of adjust to them thinking that they're normal. And it's really important if you pay attention to your body and the way you're feeling and thinking and experiencing life, and then you will notice if there are any subtle changes. And of course, you'll definitely notice any of the big changes. But by paying attention and then knowing your own body, you'll more likely be able to determine when something is out of whack, something's not quite right, and then coming to somebody like yourself, any naturopathic doctor, but Dr. Danielle is really good at this stuff. But going to somebody who can look at all of those aspects that you were talking about and even some of the things, even the questions that you ask can trigger, oh, yeah, that is different. You might not have even realized it until somebody actually asks you the question. So there's such validity to knowing your own body and to speaking with somebody that understands the subtleties of health.

[26:56] Dr. Danielle: Yeah, I think I hear all too often when I'm asking through every system of the body and I'm asking questions, I get the answer a lot of, oh, you know, normal, but always and this applies to how often do you have a bowel movement? Average or normal? Do you get pain with your periods? Normal. How much alcohol do you drink a week? Normal. Define normal. Because my answer usually once they tell me, I am usually saying, I'm going to tell you something that what's common is not normal. I must say this 30 times a day. So, for example, period pain, the medical term for this, Dysmenorrhea, is not normal. It is common, but it is not normal. And the number of women who just accept it as normal because them and her and her and her and her all have period pain, we should just suck this up and take a ridiculous amount of Advil, right? But we can do something about that. It's not normal. You have more inflammation around your uterus at the time of your menzies than there should be, right? So we can do stuff to help you with that.

[28:10] Debra Jones: That reminds me of a story when I was a teenager and I went to the doctor with period pain. And you know what he said to me? He said it's normal. He said, Once you have a baby, it will go away.

[28:26] Dr. Danielle: Oh, that's hopeful. It didn't, of course it didn't. I have three girls. I have two boys and three girls. And my oldest girl, she'd be embarrassed if I shared that she's recently started her period. And I say to her, like, listen, don't fall into this culture of having difficult periods. It doesn't have to be this way. Now, gratefully she's managing fine, but I will be having the same conversation with all three of my girls. Like, here's a normal period. If it goes Awry, talk to me, because we can do something. There is a fine line, because the flip side of this is we're becoming with the access to information through Google, I am starting to see, and I know medical doctors will really relate to this we're starting to see a trend where we are pathologizing everything. So if I have a patient who comes to me saying, well, my period is on day 26 one month and on day 23 the next, my hormones are out of balance, I would disagree with that, right? That there is a normal, even though that's not consistent, that's not a pathology, because hormones fluctuate in a female on a 20, like every day, there is a hormone shift happening that it's actually normal to see an irregular cycle within a certain range. So I say that because in having the conversation with my daughter, I had to walk a very fine line between I didn't want to create a mindset for her where she would start pathologizing everything about her cycle. But we talked about the importance of tracking it just so we could be predictable with when it was coming. God forbid she's ever, you know, in public and then also looking at how heavy it is and how painful it is, because that's where the pathology within the period lies, right?

[30:29] Debra Jones: So if you could leave our listeners with one bit of advice about the idea of a woman's body and menopause, what would you say to them?

[30:45] Dr. Danielle: How much time do we have? I think it's around the love and acceptance for estrogen and progesterone. Right. We learn to hate it. It's giving us breast tenderness and mood changes in this darn period every month. And then when we lose it, then we have hot flashes and sleep. Like, what's this thing with estrogen? We need to flip the script and learn to love it and not fear it. And as you had said earlier, our health care system, at a time when we need them to be more present, it feels like they've stepped back, which then puts the advocacy in your hands. So start asking the questions. Find the provider that is going to listen to you. It could be your family doctor, it could be your gynecologist, it could be your naturopath, it could be your chiropractor who doesn't have the same access to treatments but can help you navigate the system so that you get the help, right? But you've got to find that person you connect with and you feel that really listens. So go find her. Particularly her.

[32:04] Debra Jones: Thanks for listening. And did you know that positive reviews from listeners like you help me get these messages out into the world? Leave a rating for OWN THE GREY on your podcast app or at ownthegrey.ca