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The Very Peri Resource Centre: Hot Flushes and Insomnia with Dr Ginni Mansberg.

Dr Ginni Mansberg is a GP, TV presenter, author and columnist. She has a General Practice in Sydney’s Sans Souci, where she has a clinical interest in women’s health and menopause. She also has a supervisory role in the Discipline of General Practice at the University of Notre Dame Sydney Medical School. She is author of 5 books, including bestseller The M Word- How to Thrive in Menopause and has worked extensively as a medical journalist and columnist.

In this session, Dr Ginni speaks about night sweats, hot flushes and sleep disruption during menopause — including how to treat them.

Here's what we learned from her chat. 

Why do women get hot flushes during Peri?

75 to 80 per cent of women who go through menopause and perimenopause will have some sort of hot flush.

In scientific terms, "This chemical called neurokinin B goes up enormously when you have menopause when your oestrogen levels are low," Dr Ginni explains.

"And then the neurokinin B goes in place with an NK3 receptor. So neurokinin B meets NK3 receptor and there are more of them, when you're in menopause.

"Now, those are sitting in the thermoregulatory system inside your brain, so you feel so much hotter."

Are there any treatments for hot flushes in Perimenopause?


"I'm really perplexed by the fact that so many women put up with it!" Dr Ginni says.

the most effective thing is Hormone Replacement Therapy. And what studies have shown is that, if you take HRT within 12 weeks, your neurokinin levels fall by threefold... But most of my patients find that very, very quickly after starting HRT, they actually get relief.

"Studies show it's somewhere between 96 and 98 per cent effective for hot flushes.

If you don't want HRT, there are other things that you can do.

"There are probably about six antidepressant medications that are pretty good, then you've got other medications. 

"So there's one called pregabalin which is actually used for nerve pain but that's sort of about 65% effective.

"The side effects are not always awesome for people 'cause you often need a lot of it and weight gain is one of the big side effects.

"There's another one called oxybutynin and I've used that a lot with women who've got breast cancer and can't have Estrogen Replacement Therapy or Hormone Replacement Therapy. And in studies that's around 75% effective.

"Hypnotherapy is actually recommended. So it's actually got a good, what we call a Cochrane Review — the ultimate of medical reviews and evidence. It's actually got some pretty good evidence for it.

Then there are practical techniques like wearing light clothing layers and using a fan.

Are there any treatments for insomnia in Perimenopause?

Of all people, somewhere between 10 and 15 per cent of people experience insomnia at any given time. 

During perimenopause, that goes up to 40-60 per cent.

But, before you reach for sleeping pills, Dr Ginni suggests you first reset your circadian rhythm (A.K.A. Your internal 24-hour clock).

Try creating a regular morning, night and meal routine and exercise daily. 

"Studies have shown that routine can actually help reset your circadian rhythm," Dr Ginni says.

Next, she suggests getting out into the sunshine first thing in the morning to switch off your melatonin in the morning.

"When you are going through perimenopause and menopause, what we know, is that your melatonin, your natural sleeping hormone levels, they fall, they collapse. And so that's a real problem.

"Then you have another set of sleep hormones called the orexins. Now, they're the opposite of melatonin. They keep you awake and they actually skyrocket during perimenopause and menopause and then your natural circulation of your cortisol, which normally is very low at night.

"But then peaks just before you wake up in the morning that's when you peak your cortisol during perimenopause and menopause, you're actually getting much high levels of cortisol during the night.

"So to combat all of those hormone things, I would start with your lifestyle stuff."

As a next resort, Dr Ginni suggest medication to aid sleep.

"I'm not talking about sleeping pills here," she says. "What I would prefer is melatonin because we wanna replace the levels that are really, really going down the tubes."

You can purchase melatonin supplements at the chemist.

"The other one is you've got orexins inhibitors.

"So we know that now on prescription from your doctor you can get an orexins inhibitor.

"We know that orexin levels are much higher in women who are going through Peri and so that those things can be really effective in helping you get a good sleep."

As always, Dr Ginni recommends usual sleep aids like lavender sprays, good quality pillows, incense, and speaking to your pharmacist about other suggestions. 


Information discussed in The Very Peri Audio Series is for education purposes only and is not intended to provide professional medical advice. Readers should seek their own medical advice, specific to their circumstances, from their treating doctor or health care professional.

Feature Image: Supplied.

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