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People who experience more hot flashes and night sweats during menopause may have higher risks for dementia and stroke. Westend61/Getty Images
  • Hot flashes and night sweats during menopause may be an indication of an increased risk for issues like stroke and dementia, according to a new study.
  • The new research suggests that people who experience more hot flashes and night sweats during menopause have more white matter hyperintensities, a brain biomarker that can put people at higher risks for dementia and stroke.
  • Healthcare experts caution people not to panic but to use this information to discuss ways to improve health outcomes with their providers.

Hot flashes and night sweats are hallmark symptoms of menopause. But could they signal something else?

New research suggests they might. A new study published in the online issue of Neurology suggests that women who have more hot flashes and night sweats during menopause may have more white matter hyperintensities.

Some research indicates that these tiny lesions on the brain are linked to higher risks of stroke, Alzheimer’s disease, and cognitive decline.

The idea that menopause marks a transitionary period for women and their health is not new.

Recent studies have suggested that women’s risk of cardiovascular disease increases post-menopause, and they are disproportionately affected by Alzheimer’s.

Alzheimer’s Association points to data that indicates that two-thirds of patients with the disease are women.

But this study shows the potential for a link between common symptoms, white matter hyperintensities in the brain, and a potential for increased probability of strokes, dementia, and overall cognitive decline.

The results may seem alarming, and some terms may be challenging for a non-medical professional to understand. Experts not associated with the research unpacked the findings and what people can do to improve health outcomes after menopause.

The study involved monitoring 226 women for three days. The participants’ average age was 59, and they experienced about five hot flashes or night sweats during a period of one day.

On day one, participants wore a monitor that could detect hot flashes and night sweats by the skin’s temperature. Over the course of three days, the women also wore a wrist device that tracked sleep. They were asked to self-report hot flashes, night sweats, and sleep.

At the end of the study, they underwent bloodwork and brain scans that measured white matter hyperintensities in six brain regions.

The researchers adjusted for age and risks like high blood pressure and diabetes.

They found that every additional night sweat increased the white matter hyperintensities in the brain by about 6%. Hot flashes and night sweats were mostly associated with white matter hyperintensities in the frontal lobe, which is the part of the brain linked to voluntary movement, expressive language, and organization abilities.

“We previously thought the symptoms of menopause were just a benign rite of passage in a woman’s life — this may disprove that,” says Dr. Shae Datta, co-director of NYU Langone’s Concussion Center and director of cognitive neurology at NYU Langone Hospital—Long Island. “Previous research showed us that menopause causes worsening of cardiovascular health during menopause. Since cardiovascular health is closely tied to brain health, this study may give us more clues into brain health after menopause.”

Datta hopes the new study may help inform patient and provider conversations about preventing, screening for, and treating cardiovascular and brain health postmenopause. But the study had limitations, and it should not be construed as a one-size-fits-all approach to postmenopausal health.

“The study did not show generalizable results for all races as it mainly had white participants,” Datta points out. “It was also done over a three-day period. A longer timeline may be needed to see a more robust correlation.”

What’s more, James Giordano, PhD, reminds people to remember that the authors were not looking for a cause of cerebrovascular events like stroke and dementia.

“The authors were not attempting to define whether the underlying mechanisms of hot flashes or the hot flashes themselves may be contributory to changes in brain function and structure that could lead to neurological disease,” says Giordano, a professor and the chief of the Neuroethics Studies Program at the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center.

Instead, they found a correlation between hot flashes, night sweats, and white matter hyperintensities, which does not equal causation.

Also, Giordano says the self-reporting nature of the study design leaves room for subjectivity.

“It is important to note that night sweats and hot flashes are subjective symptoms, and objective signs reflect hormonal changes that affect the vascular system, metabolism, and overall physiology, including brain function,” Giordano says.

In other words, no, women going through menopause and experiencing hot flashes and night sweats should not be immediately concerned, based on this study. But they aren’t something to discount, either.

“Hot flashes may be a ‘caution sign’ telling the individual, ‘Hey, there’s something going on up here,’” says Dr. Nita Landry, a board certified OB/GYN. “Be mindful of your brain health.”

Giordano says you can always speak with your doctor about concerns, regardless of whether you have hot flashes or night sweats.

Laurence Miller, PhD, a clinical and forensic psychologist and adjunct professor at Florida Atlantic University, notes that genetics is the luck of the draw. But there are ways for women to lower their risk for strokes, dementia, and cognitive decline after menopause. The tips are similar to the ones he’d give any person, regardless of age or gender:

  • be mindful of genetics
  • exercise
  • eat a nutritious diet
  • attend medical check-ups as needed
  • perform mentally-engaging activities, like work or puzzles
  • socialize

The National Institutes of Health says Alzheimer’s can run in families, but genetics is not the only factor.

The CDC has issued similar comments about heart disease and genetics and says shared environmental factors can also contribute to multiple members of the same family having cardiovascular issues.

A small 2020 study of 35 postmenopausal women suggested that aerobic exercise is associated with preserved white matter microstructures, especially in areas of the brain that play a role in memory and sensorimotor control.

A larger 2020 study of more than 59,000 women with an average age of 52 suggested that sustained dietary modifications could lower the 26-year risk of total stroke by about 23%. These modifications included eating more fish and completely nixing processed red meats.

Research from 2015 suggested that adhering to the MIND Diet, a combination of the Mediterranean and DASH diets, could lower the risk of Alzheimer’s disease, though not all participants were women.

The DASH diet is promoted by the National Heart, Lung, and Blood Institute for the prevention and control of hypertension.

The MIND diet prioritizes eating produce, lean proteins, and healthy fats like olive oil and fish and limiting the consumption of processed foods.

“Remember that things that are good for your heart are also good for your brain,” Landry says. “Therefore, just like you need good blood flow to your heart, you need good blood flow to your brain.”

A small 2018 study of 100 cognitively healthy adults suggested doing jigsaw puzzles could help prevent long-term cognitive decline.

A 2018 literature review indicated that isolation could increase Alzheimer’s risk.