By Michael Goodman, M.D.
Hot flashes are the most common bothersome symptom of menopause. Your hot flashes may occur during the day or at night (also known as night sweats). They may be mild and tolerable, moderate and troublesome, or severe and debilitating.
Hot flashes get better with time. While most women have hot flashes for a few years, some women have them for decades. It is not known why some women have severe hot flashes for many years, while others have no hot flashes, or mild ones that resolve quickly. If your hot flashes are mild or moderate, you may find relief by changing your lifestyle, or utilizing botanicals. If you have severe hot flashes, you may still benefit from lifestyle changes, but also may choose to take a nonprescription remedy or a prescription medication, including hormones.
Lifestyle changes: Researchers find that women with hot flashes have more sensitive thermostats in their brain, so are comfortable only in a small range of temperatures. Staying cool and reducing stress are the principal lifestyle changes to treat your hot flashes.
Avoid warm rooms, hot drinks, hot foods, alcohol, caffeine, excess stress and cigarette smoking. ”Layer” clothing.
To reduce stress and promote more restful sleep, exercise regularly, but not too close to bedtime. Meditation, yoga or tai chi, biofeedback, acupuncture, or massage also will lower your stress levels.
When a hot flash is starting, try “paced respiration” — slow, deep, abdominal breathing, in through your nose and out through your mouth. Breathe only 5-7 times per minute, much more slowly than usual.
Try different strategies to stay cool while sleeping. Dress in light, breathable nightclothes. Use layered bedding that can be easily removed during the night. Cool down with a bedside fan. Keep a frozen cold pack or bag of frozen peas under your pillow, and turn the pillow often so that your head is always resting on a cool surface. If you wake at night, sip cool water. Try different techniques for getting back to sleep, such as mediation, paced respiration, or getting out of bed and reading until you become sleepy.
Women who are overweight have more hot flashes, so follow a careful diet and exercise regularly to decrease bothersome hot flashes and improve your overall health.
Nonprescription remedies: Although many nonprescription remedies reduce hot flashes, it’s likely that this is due to the “placebo effect.” When nonprescription treatments are studied scientifically, they typically are as effective as a placebo. Even if relief is due to the placebo effect, you can expect your hot flashes to decrease by approximately 30% with most nonprescription remedies, such as soy or acupuncture.
Nonprescription products do not receive careful oversight from the government and generally are not studied carefully enough to know all potential risks and side effects, especially with long-term use. Consider purchasing products made in North America that follow good manufacturing practices.
Nonprescription options you may consider for hot flash relief include the following:
Soy: Eat one or two servings of soy foods daily (containing isoflavones). Low-fat varieties of tofu, tempeh, soymilk, or roasted soy nuts are good choices. Supplements containing soy isoflavones, such as Promensil, reduce hot flashes in some studies.
Herbs: Supplements containing certain herbs like black cohosh, such as Remifemin, decrease hot flashes in some studies.
Prescription therapies: The following prescription medications reduce hot flashes more than placebos in scientific studies.
Hormonal options: As hot flashes are “about estrogen” (or lack thereof), prescription hormone therapy with estrogen is the most effective treatment for hot flashes and the only government-approved treatment., Studies show that benefits often outweigh risks for healthy women under age 60 with moderate to severe hot flashes.
If it has not been a full year since your last period and you are a healthy nonsmoker, you may consider a combination estrogen-progestin birth control pill. This will provide contraception, hot flash relief, and regular periods.
Testosterone (a female hormone also!) can be helpful, especially relieving nighttime sweats, in women with lower testosterone levels. Make sure your doctor is savvy on which test to order (a “regular” testosterone test is worthless.
Nonhormonal options: When hormones are not an option, you may consider the following nonhormonal medications. They are more effective than placebos in scientific studies, though not as effective as hormone therapy.
Sleeping medications will not reduce your hot flashes but may help you sleep through them. Available both by prescription and nonprescription (such as Benadryl).
Certain drugs approved to treat depression reduce hot flashes in women without depression
Gabapentin (Neurontin) is a drug approved to treat epilepsy, migraine, and nerve pain, but it also reduces hot flashes And can help with sleep. It needs to be started slowly…
If in doubt or when you need specialized help, see a North American Menopause Society- Certified Menopause Practitioned (visit www.menopause .org for a list of practitioners near you!)