Though less difficult than rolling panic attacks and sleepless nights, night sweats and hot flashes sure weren't pleasant.
In fact, they contributed to the sleepless night and anxiety without question.
We'll look at the connection for hot flashes with anxiety below.
It's the strangest thing if you haven't been there.
All of a sudden, you start to heat up out of nowhere!
Worst yet, you wake up on fire and sweating.
Of course, if you're new to perimenopause, this is disconcerting by itself and you start to worry something is really wrong.
Hot flashes and night sweats (shared pathway) are the most common complaint of perimenopause and menopause so rest assured, you're in good company.
Roughly 80% of women experience them during this period.
Most women never do anything for them since they're relatively safe.
Keep in mind that perimenopause can actually start a few years before you lose your period.
Check out our perimenopause versus menopause review for the when's and why's of this wonderful period.
Meanwhile, we're going to drill down to what actually causes these bizarre changes in temperature.
We'll then look at what CBD does in these pathways to get some relief as well as look at other options that help.
We'll cover these areas:
What causes hot flashes and night sweats during perimenopause
Serotonin and hot flashes or night sweats
The opioid system and hot flashes or night sweats
Can CBD help with perimenopause hot flashes or night sweats
How much CBD to take for perimenopause hot flashes or night sweats
Best CBD for perimenopause hot flashes or night sweats
Grab a cold glass of water and let's get started.
What causes hot flashes and night sweats during perimenopause
This is basically the effect of a loss in estrogen.
You know...the hormone that's just for making babies??
It's tied into almost every major system of our body including brain, bone, heart, muscle, gut and more.
One particular place of interest for our discussion is the hypothalamus.
The hypothalamus is a small part of the old "reptilian" brain which acts as a master regulator of various bodily functions.
One of them….body temperature!
Research is pointing to this area as the main focal point for hot flashes and night sweats:
The underlying cause for HFs is abnormality in hypothalamic thermoregulatory mechanisms.
Basically, the system is sending blood flow to the extremities which feels like heat especially in the feet, hands, face, neck, and skin.
Here's the curious part.
Estrogen is definitely affected as estrogen replacement helps significantly with both hot flashes and night sweats. (see review of estradiol or Siberian Rhubarb for more detail).
That being said…
There is no correlation between serum estrogen levels and the frequency and severity of HFs.
Some clues come from the trajectory of both during this period.
- Hot flashes and night sweats come on with perimenopause
- They peak towards the end of perimenopause
- They subside going into menopause
This speaks to flux or change in estrogen being the culprit as opposed to levels.
As researchers confirm:
Thus, the rate of decline of estrogen levels rather than actual decrease may be more important in causation of HFs.
Silly researchers...they clearly aren't up to date that estrogen can fall and RISE dramatically during perimenopause as FSH tries to get one more egg.
So, chaotic estrogen is front and center.
Let's look at downstream effects from this since estrogen is a powerful regulator across many systems.
We'll follow the pace of research on what's actually driving downstream hot flashes and night sweats.
Serotonin and hot flashes or night sweats
Serotonin is a powerful messenger in the brain and it's directly tied to estrogen.
In fact, estrogen has its foot on the lever for both creation (see tryptophan and serotonin) and removal (MAO) of serotonin.
It basically controls the range (upper and lower) of serotonin.
In case you didn't notice, estradiol has gone off reservation during perimenopause before settling into a very low stable level during menopause.
This has a host of effects from anxiety and depression to poor control of body temperature.
When women have their ovaries removed, serotonin levels go down.
Maybe more importantly with those same women for our discussion..
Estrogen replacement alleviates hot flashes and restores serotonin concentrations.
Interestingly, it may be that lower serotonin leads to increased norepinephrine.
Norepinephrine is our alert and energetic neurotransmitter.
Clonidine blocks it's function and has been shown to reduce hot flashes without affecting estrogen levels so this is an interesting clue.
The basic theory is as follows:
Decrease in serotonin results in an increase in levels of norepinephrine which disturbs the hypothalamic thermostat.
SSRI and SNRIs (Serotonin and Norepinephrine) drugs show some effect on hot flashes although estradiol supplementation was more effective and avoids the nasty side effects (see CBD versus SSRI for serotonin here).
That's old news really.
The new research focuses on our opioid system of all things.
The opioid system, kisspeptin, neuropeptide, dynorphin, and hot flashes or night sweats
You're probably thinking...opioid system?
Isn't that just for pain?
The players in this system have powerful effects across many different systems.
Look...perimenopause is primarily a story of hormones...progesterone and really estrogen.
If you keep pulling back the curtains, you find chemicals like kisspeptin which initiate the cascade of hormone choreography.
Why do some women get hot flashes while others do not?
New research is pointing to the opioid system in the hypothalamus as the cause.
It may be the body's sensitivity to various hormones that affect the complicated dance:
Baseline estrogen levels were similar, yet the mean percentage of days with hot flashes was significantly higher in group 3 (26%) than in group 1 (9%) or 2 (11%).
In the group with hot flashes, their bodies were not responding correctly to estrogen:
Further, the LH level in group 3 was higher than in group 1 or 2, indicating the failure of negative feedback of estrogen on the pituitary secretion of LH.
This system in the hypothalamus may be the link between hormones like estrogen and the net effects of perimenopause and menopause:
Evidence exists that these NKB neurons are a key link between the endocrine changes of the menopause and vasomotor symptoms.
It's complicated but the basic theory is that neurokinin 3 levels increase as estrogen drops.
Neurokinin is part of the opioid system and higher levels are tied to many issues linked to perimenopause.
To test it, researchers blocked neurokinin 3 activity:
By day 3 of treatment with MLE4901, HF frequency reduced by 72% (95% CI, −81.3 to −63.3%) compared with baseline (51 percentage point reduction compared with placebo, P < 0.0001); this effect size persisted throughout the 4-week dosing period.
A 72% reduction in hot flashes and night sweats!
Again, this all leads us back to the hypothalamus, our master controller.
All these opioid operators function is a little part of it called (get ready for it)...the infundibular nucleus.
The function of the arcuate nucleus relies on its diversity of neurons, but its central role is involved in homeostasis.
Homeostasis is a fancy word for balance. In this case, balance of hormones and body functions.
When you take out estrogen, it no longer keeps a check on two other hormone LH and FSH.
In fact, levels of those two are usually used to officially say you're in menopause as they rise.
Here's the problem.
When all this was worked out by evolution from 40,000 to 400 million years ago, women weren't living till 50!
Estrogen goes away but the rest of the system that relied on estrogen as a brake keeps going.
In fact, without estrogen, it becomes too active!
This open-loop condition is accompanied by increased GnRH gene expression and cellular hypertrophy of a subpopulation of neurons within the human infundibular nucleus, the homologue of the arcuate nucleus in other species.
That's why blocking neurokinin 3 can drop hot flashes by 72%
Again, you're now privy to the immediate future of research to bring relief to millions of women.
This is really state of the art research on perimenopause and menopause now.
We wrote an entire review of low dose naltrexone which may have an ability to reset the opioid system here.
Also, our review on Siberian Rhubarb which is a safe substitute for estradiol supplementation and has direct and powerful effects on hot flashes.
That being said, some estradiol is very important for the entire body as you'll see in our estradiol review here.
Next up CBD. How does it work with these pathways?
Can CBD help with hot flashes and night sweats?
First, the hormone connection has to be addressed.
Check out our reviews on estradiol, Siberian Rhubarb, and even metformin (due to its ties with ovarian cysts - a telltale sign of hormone imbalance).
What about CBD?
First the serotonin connection.
Remember how estradiol governs serotonin levels and this neurotransmitter is key to body heat regulation?
What does CBD do with serotonin?
Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain.
Big shocker...both are affected by serotonin.
The keyword there is "modulate".
This is the real power of CBD.
Serotonin levels are so critical that you don't want to directly boost or lower it in one direction.
You can get nasty things like Serotonin syndrome (see CBD versus SSRI for serotonin syndrome).
I've been there and it almost broke me.
If CBD had the same effect, you would see overdoses and very nasty side effects at higher doses.
Those don't show in the research (for CBD isolate mind you).
You'll see "modulate" or "normalize" serotonin levels throughout the research.
That's an upstream driver (estrogen to serotonin) for hot flashes and night sweats.
What about the complicated hormone disconnect?
This gets more complicated.
We need research on exact interactions between CBD (or endocannabinoids) and the entire tachykinin (players in the opioid system) family.
For example, we saw above how estrogen acts as a brake on LH and FSH.
Estrogen leaves the scene and their numbers explode higher.
As a result, they drive neurokinin 3 up which is directly implicated with hot flashes (among other things).
Is there a role to play for CBD there?
As it turns out, the endocannabinoid system that CBD bolsters is intimately tied to this entire system.
Let's go to the initial step in this runaway process...GnRH (gonadotropin-releasing hormone).
This is the precursor for both LH and FSH.
What do endocannabinoids do there?
In perifusion experiments, CBs block the pulsatile release of GnRH
Ah ha. Remember, it's the pulses of GnRH which estrogen constraints (both to stimulate and inhibit).
The inhibitory effect of estrogen on GnRH secretion and GnRH gene expression has been shown in vivo studies in several mammalian species.
In fact, this all happens in the...hypothalamus. Hmmmm.
And the system that CBD supports (endocannabinoid system - ES):
These lipids, in turn, could bind to CB receptors on neighboring cells and perhaps, GnRH neurons, to exert feedback control over GnRH function.
We're talking about two very complicated systems.
Let's see if we can break it down to mirror what estrogen naturally does since we're losing its effect.
We'll try to simplify one key interaction in this puzzle:
- Estrogen increases anandamide levels
- Anandamide decreases GnRH
- Lower GnRH means less FSH and LH
- Less FSH and LH means less neurokinin 3
Goodness...are you dizzy yet?
Like we said...one of these systems is ridiculous but watching how they interact requires AI.
So...boosting anandamide (by blocking its degrader...FAAH) would be good for hot flashes.
What does CBD do there?
CBD (center) increases circulating anandamide by inhibiting the catabolic enzyme FAAH and transporter AMT.
That's actually from a study of stroke prevention as this upregulation of anandamide by blocking FAAH is key to many results of CBD.
The net effect:
Cannabinol and cannabidiol lowered not only circulating testosterone levels but also levels of LH and FSH.
Again, we look forward to direct studies on hot flashes and night sweats but we see CBD in a complementary role to estradiol or Siberian rhubarb.
Some practical questions.
How much CBD to take for hot flashes and night sweats.
We don't have good research on this yet.
Sleep help is showing at around 160 mg and clearly, hot flashes or night sweats figure into that.
Our real focus (mine included since I'm in the middle of perimenopause) is CBD's ability to support the hypothalamus since it's bearing the brunt of this change.
This may come down to CBD's benefit for stress response:
Research into ECS's role in the stress response has revealed a significant influence on the hypothalamic-pituitary-adrenal axis, the control of reproduction by modifying gonadotropin release, fertility, and sexual behavior.
Remember that the hypothalamus goes into hyperdrive without estrogen.
This may be the key to CBD's benefit for women in perimenopause:
CBD reduced the activity of the left amygdala-hippocampal complex, hypothalamus, and posterior cingulate cortex while increasing the activity of the left parahippocampal gyrus compared with placebo.
Based on this, even smaller levels at 30-100 mg might be supportive.
Test at about 25-30 mg to see how your body responds.
You can hold it under your tongue up to 60 seconds to speed up its availability (generally within 10-15 minutes) and then swallow.
This a great way to test for hot flashes since it's easy to gauge the effects.
Always work with your doctor or naturopath for any supplements!
What about the best CBD to take for hot flashes and night sweats?
Best CBD for hot flashes and night sweats.
First, the bare minimum requirements still apply:
- Organically grown in the US at an FDA registered farm
- CO2 processed (cleanest option)
- 3rd party tested for:
- No THC
- No pesticides
- No heavy metals
- No bacteria
- No mold
- No solvents
This is a starting place.
We actually test Indigo Naturals twice since our entire family uses it.
There's another important factor.
We focus on CBD Isolate for a reason (as opposed to full-spectrum that's pushed everywhere out there).
We tried 3-4 of the biggest brands when we first started and had bad responses.
It turns out those were histamine responses because they went away with CBD isolate.
This is incredibly important for women in perimenopause when allergic and histamine response is at an all-time high!
All that plant material in full-spectrum CBD is going the wrong direction and you're probably going to feel it.
Histamine is intimately linked with estrogen's pathway.
Again, if you've had any bad results from CBD, try isolate. It should be night and day as we found out the hard way.
Be well. Be informed. Be empowered.
Let's take care of each other!
This glimpse into perimenopause is just the beginning. 'Dre's Story' offers our complete, research-rich journey into hormones, tools to feel better, and safety. The full Perimenopause Toolkit with new additions can be found Here. Please review so other can learn. Feeling better starts with understanding what is happening.
Get specific links for CBD and Perimenopause symptoms and questions here.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.