Menopause Mechanics: 3. Hot Flushes: Overheated and Underpowered.

Menopause Mechanics: 3. Hot Flushes: Overheated and Underpowered.


"God, it was hot! Forget about frying an egg on the sidewalk; this kind of heat would fry an egg inside the chicken..
- Rachel Caine

The hot flush - that sudden feeling of warmth that can leave a woman flushed and drenched in sweat - has long been considered the defining symptom of menopause, experienced by around 80% of women.

The typical narrative around hot flushes is that they last for 3-5 years around the last menstrual period, that every woman follows the same pattern, and that they are all about the decline in oestrogen hence replacing oestrogen -whether synthetic, bio-identical or plant based - is key to reducing their frequency.

So let’s bust these myths:

  • Some women - the ‘early onset’ hot flushers - begin to experience hot flushes 5-10 years before the menopause while still having regular periods, and these can stop around the menopause;

  • The ‘late onset’ hot flushers start experiencing them after their last period;

  • The ‘lucky few’ never experience a hot flush, or only have a few near the end of the menopausal transition;

  • The ‘super flushers’ - about 25% of women - begin to have hot flushes early on in peri-menopause and these can continue well past the menopause, possibly lasting for 15 years or more, and into the 70s;

  • For many women, oestrogen replacement makes little or no difference to having hot flashes.

Hot flushes are commonly linked to physiological changes in the body such as:

  • cardiovascular disease;

  • low-grade inflammation;

  • high cholesterol levels;

  • increased heart rate;

  • sleep disruption.

What is less well known is that hot flushes are also significantly associated with reduced brain function:

  • Women who experience more hot flushes, particularly while sleeping, are more likely to have lesions on the brain and are more at risk for stroke and other brain blood flow problems;

  • Hot flushes are often accompanied by clear reductions in brain blood flow;

  • Hot flushes are related to poorer verbal memory function i.e. difficulty remembering words;

  • Hot flushes - especially during sleep - are associated with greater connectivity in the brain when it is at rest, which can lead to depression, pain and insomnia.

Why do hot flushes happen?

In a nutshell, hot flushes compensate for the lack of glucose delivery to the brain (brain starvation):

  • Before the menopausal transition, oestrogen helps to deliver glucose to the brain.

  • As oestrogen levels start decreasing, the amount of glucose that can be delivered also starts decreasing.

  • To increase the amount of glucose in the blood, the brain initiates an adrenaline rush. Adrenaline is also known as the “fight or flight” hormone. It’s released in response to a stressful, exciting, dangerous, or threatening situation. Adrenaline helps your body react more quickly. It makes the heart beat faster, increases blood flow to the brain and muscles, contracts muscle cells below the surface of the skin to stimulate sweat, floods the body with glucose and can make you feel jittery, nervous or anxious.

So the adrenaline rush - in the form of a hot flush - rapidly increases the amount of glucose to the starving brain, but all that sugar can have a detrimental effect on the body, increasing the risk of cardiovascular disease, obesity and inflammation.

Luckily for us, glucose is not the only source of energy that the body can use. The alternative fuel source is fat, and this comes to the forefront in menopause. During the menopausal transition, the energy processing machinery is physically changing to burning fat only. This fat is sourced from breaking down the fat in our bodies and converting it to ketones. When ketones become the primary energy source for the body and the brain, many of the menopausal symptoms - including hot flushes - can be completely resolved.

How can we eliminate hot flushes in the long term?

The key is to allow your body to become an efficient fat-burning, ketone-producing machine, so that the brain is not constantly spiking adrenaline to boost glucose levels.

  • Ketones are made in the liver, which means that the liver has to be in good shape, which is probably why women who drink high amounts of alcohol have worse menopausal symptoms.

  • Fat stores can only be accessed if your carbohydrate intake and insulin are very low (i.e avoiding all bread, pasta, biscuits, grain, rice, beans etc), protein intake is moderate, and fat intake is high. This proportion of fat, carbohydrates and protein in the diet is the basis of the ketogenic diet that you might have heard of. Not all ketogenic diets are created equal, and peri/menopausal women need a particular flavour which I will be writing about soon.

How can we eliminate hot flushes in the short term?

Having hot flushes means that the brain is desperately lacking in energy and is short circuiting (see my previous post). Research shows that an efficient way of delivering ketones to the brain is via coconut oil. Lauric acid is a medium chain fat found in coconut oil which goes straight to the brain where it is converted to ketones and used for energy.

How much coconut oil is needed to make a difference? Each woman will have different requirements, but I would start with 1 tablespoon of coconut oil in the morning and 1 in the evening. Yes, 1-2 tablespoons of coconut oil could be all that is needed in the short term to get rid of hot flushes altogether.

I hope you find this article useful, I will be updating it as new information comes to light.

Keep well,



PS. Don’t forget: this article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment and should never not be relied upon for specific medical advice. Every woman experiences the menopause differently and if you would like specific advice, I recommend that you get in touch and join the Modern Menopause Program which will be personalised to your specific symptoms: a thorough assessment of your health will provide vital insights and allow me to create the perfect health plan for you. 


Menopause Mechanics: 2. It’s Not an Oestrogen Problem. It’s a Brain Problem.

Menopause Mechanics: 2. It’s Not an Oestrogen Problem. It’s a Brain Problem.