Menopause

What are hot flashes?

Decreasing or fluctuating estrogen levels during menopause can affect neurotransmitters, substances in the brain that help control the body's core temperature. As estrogen levels drop, a woman many experience hot flashes: a sudden sensation of intense heat, particularly in the upper body, arms, and face. This sensation is typically followed by skin flushing in these areas and also by profuse sweating.¹

In addition to a feeling of mild warmth to intense heat radiating throughout the upper body and to her face, the following often accompany hot flashes:²

• a flushed appearance
• red, blotchy skin on the face, back, and arms
• rapid heartbeat
• perspiration
• feeling chilled as the hot flash subsides
• depression
• nervousness or anxiety
• insomnia
• loss of libido

Lasting between 30 seconds and 30 minutes, hot flashes can cause social embarrassment and can occur at any time, whether in the middle of a meeting, or in the middle of the night as night sweats. Just as the symptoms of hot flashes vary, so does the frequency with which they occur: some women experience them every hour while others have them only occasionally. Living with hot flashes is an adjustment women must make as they enter menopause: hot flashes may occur for a year or more before eventually subsiding.³

Who gets hot flashes?

It?s estimated that at least one half to two thirds of menopausal women experience hot flashes. In addition, hot flashes are more likely in women with low estrogen levels or low body weight, among women smokers, black women, women who have entered abrupt menopause (either surgically or through induced menopause), and women whose lifestyle is sedentary. Use of drugs such as serotonin receptor modulators and aromatase inhibitors is also believed to increase the likelihood of hot flashes.⁴

How can hot flashes be managed?

Hot flashes may be managed through changes in lifestyle and diet, as outlined below.⁵

Keep cool

Slight changes in the body?s core temperature can trigger hot flashes; therefore, it's important to keep cool by opening a window or by using a fan or air conditioner to help circulate air through a room. Dressing in layers allows you to remove clothing if you feel too warm. Sipping cool drinks may also help.

Exercise regularly

Regular exercise is vitally important during menopause and in the years beyond. Not only does exercise help lower blood sugar and stimulate bone tissue growth, aerobic activity helps alleviate hot flashes and it is also known to improve sleep. Brisk walking or other similar vigorous activity for 30 minutes daily is recommended.

Mind what you eat and drink

Hot flashes can also be triggered by hot and spicy foods, caffeine, and alcohol. It's important to note which foods trigger hot flashes and to consume them in moderation.

Relax

It?s important to relax. Many women claim yoga, mediation, relaxation exercises, and stress reduction techniques help diminish their symptoms. Deep rhythmic breathing, or paced respiration practiced twice daily has also been clinically shown to reduce hot flashes. Although they may not alleviate symptoms in all women, these techniques have been known to help sleep disturbances that often occur with menopause.

Quit smoking

Hot flashes appear to be more common among women who smoke.⁶ If you quit smoking, you may not only reduce your hot flashes, but you may also decrease your risk of other serious health conditions such as heart disease, stroke and cancer.⁷

Common treatments for hot flashes

For many women, lifestyle changes are all that?s needed to bring the symptoms of hot flashes under control. For others, however, medications, or dietary supplements may be necessary.

Although 10 percent of women claim their hot flashes are severe, only 10 to 20 percent seek medical attention. Of those who do seek treatment, estrogen replacement therapy is often recommended, although alternative treatments such as Bellergal or Clonidine are also available.⁸

Alternative treatments for hot flashes

Black cohosh

Used extensively in Europe to treat hot flashes, black cohosh is gaining popularity in North America as well, where the American College of Obstetricians and Gynecologists supports the use of black cohosh for up to six months in the treatment of menopausal symptoms. Nevertheless, the effects of long-term use aren't known and studies are currently being done to determine the effectiveness and long-term safety of black cohosh supplements.⁹

Soy

Another popular alternative treatment for hot flashes is soy. This is because soybeans—as well as chickpeas and other legumes—contain a type of phytoestrogen known as isoflavones which behave like the body's own estrogen. Scientists have demonstrated that women with a high amount of soy in their diet are less prone to hot flashes and other menopausal symptoms. In addition, researchers have noted that women whose diets are high in phytoestrogens—women in China and Japan, for instance—have a much lower incidence of heart disease and osteoporosis. As a result, there have been a number of studies over the years to determine the effect soy products may have on menopausal symptoms.¹⁰

While phytoestrogens in soy have been found to behave like estrogen in certain ways, there is a concern that eating high amounts of soy or that taking isoflavone supplements may increase the risk of cancer. It's important, particularly if you have had breast cancer, to talk to your doctor before choosing to supplement your diet with soy products.¹¹

Vitamin E

There is scientific evidence that between 400 and 800 international units of vitamin E provides some relief from mild hot flashes.¹²

Additional herbal supplements

Although there is no scientific evidence of their safety and effectiveness, other herbal supplements such as quai, licorice, chasteberry, evening primrose, and wild yam are also used in the treatment of menopausal symptoms.¹³ Evening primrose reportedly helps reduce breast tenderness, while wild yams, which contain a substance similar to progesterone, are often touted as a remedy for menopausal symptoms.¹⁴

The table below outlines the effectiveness of various remedies.

Agent	Hot Flash Reduction
Estrogen	50%–100%
Progestin	71%–90%
Soy	35%–45%
Black cohosh	27%–28%
Vitamin E	25%
Clonidine	37%–41%
Serotonin drugs* * Refers to selective serotonin uptake inhibitors such as fluoxetine (Prozac®) and sertraline (Zoloft®)	34%–65%

Source: Hot Flashes - What Can be Done? Health and Age. (2004)

Women considering "natural" or herbal supplements should exercise caution since all supplements have potentially harmful side effects and may interact with other medications or with other medical conditions. Women are therefore well advised to discuss the medications they are taking, as well as their potential side effects and any contra-indications with their doctor.¹⁵

Because hot flashes typically subside over the course of 1 to 5 years, women who have elected to take medications or supplements to ease their menopausal symptoms may need to periodically re-evaluate their need for them. If hot flashes are subsiding on their own, medications and supplements may no longer be necessary. What's more, because menopause is a natural transition, choosing to take nothing at all for hot flashes is a perfectly valid decision as well. The variety of medications and supplements available should not imply that a woman should take them, if she chooses not to.¹⁶

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1. Hot Flashes. DrDonica.com. (2003)
2. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
3. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
4. Hot Flashes - What Can be Done? Health and Age. (2004)
5. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
6. Hot Flashes. DrDonica.com. (2003)
7. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
8. Hot Flashes. DrDonica.com. (2003)
9. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
10. Complementary and Alternative Medicine. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
11. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
12. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
13. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
14. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
15. Complementary and Alternative Medicine. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
16. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)
17. Hot Flashes: Several Treatments to Choose From. Mayo Foundation for Medical Education and Research (MFMER). (1998–2004)