From the Guidelines
Night sweats are a common symptom experienced by individuals undergoing a significant decline in estrogen levels, particularly during menopause or following the cessation of estrogen-based therapies.
Causes of Night Sweats
- The abrupt discontinuation of estrogen-containing medications, including combination oral contraceptives, can trigger night sweats in some individuals, often within 2-6 weeks after treatment cessation 1.
- The frequency and severity of night sweats can vary, but they are generally more prevalent in women who experience a rapid decline in estrogen levels, such as those undergoing surgical menopause or discontinuing estrogen therapy after a duration of 6-12 months or longer 1.
Definition and Prevalence
- Vasomotor symptoms, including hot flashes and night sweats, are defined by the North American Menopause Society as recurrent, transient episodes of flushing, perspiration, and a sensation ranging from warmth to intense heat on the upper body and face, sometimes followed by chills 1.
- Night sweats are hot flashes that occur with perspiration during sleep, and are reported to occur in approximately 46% to 73% of breast cancer survivors 1.
Management and Treatment
- Hormone replacement therapy (HRT) may be considered for postmenopausal women with rheumatic and musculoskeletal disease who have severe vasomotor symptoms and no contraindications 1.
- The use of HRT in women with a history of breast cancer or other contraindications should be approached with caution and individualized based on the specific clinical scenario 1.
From the Research
Night Sweats and Estrogen Levels
- Night sweats are a common symptom experienced by women during menopause, which is characterized by a significant decrease in estrogen levels 2.
- The decline in estrogen production during menopause can cause a variety of symptoms, including hot flashes and night sweats, affecting each woman differently 3.
- Vasomotor symptoms, including night sweats, are a form of temperature dysfunction that occurs due to changes in gonadal hormones, such as estrogen 2.
Prevalence of Night Sweats
- The prevalence of night sweats ranges from 10% among older primary care patients to 60% among women on an obstetrics inpatient unit 4.
- Approximately 12.2% of women in a prospective, observational population-based investigation reported clinically important night sweats 5.
Relationship between Night Sweats and Estrogen Levels
- Changing estrogen levels during menopause may impact multiple components involved in maintaining temperature homeostasis, leading to night sweats 2.
- The mechanistic role related to changes in gonadal hormones, such as estrogen, associated with night sweats is not fully understood 2.
- Hormone therapy, which involves the use of estrogen, is the most effective treatment for vasomotor symptoms, including night sweats 2.
Diagnostic Evaluation of Night Sweats
- Night sweats are a nonspecific symptom, and most patients who report persistent night sweats do not have a serious underlying disorder 4, 6.
- Conditions commonly associated with night sweats include menopause, mood disorders, gastroesophageal reflux disease, hyperthyroidism, and obesity 6.
- A systematic and cost-conscious strategy using readily available laboratory and imaging studies is recommended for the diagnostic evaluation of night sweats 6.