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Hot flashes are one of the most common menopause symptoms women encounter, and also among the most bothersome. What can you do to find relief?

"Even though I'd never had one before, I instantly knew what it was," Anna, who has since left the perimenopause behind and entered calmer menopausal waters, said. "A sudden wave of heat, complete with the kind of dripping sweat I hadn't experienced since I'd gone fruit-picking in Greece in my twenties — except it was actually winter, and it seemed to be targeting my upper body. It was then I understood why they're called hot flashes." 

Hot flashes are among the most common perimenopause symptoms out there and they can, unfortunately, go on for years. They go by a different name — night sweats — if they strike while you were meant to be snoozing, perhaps because they have all the same nasty characteristics as well as often waking you up. 

Hot flashes: Did you know?

  • Likely caused by changes in your circulation and hormone levels, hot flashes — accompanied by red, blotchy skin, sweating, and sometimes a fast heartbeat — plague over half of US women approaching the menopause. 
  • One fifth of menopausal women never experience hot flashes, and some get off "easy", experiencing hot flashes for just a little while. 
  • The younger you are hot flashes pop up, the more likely they are to stick around for a while. 
  • Hispanic and black women are more likely to experience hot flashes for a long time than Asian and Caucasian women. 
The bad news is that women who experience hot flashes can't do anything to make them stop altogether. There's good news, too, mind you — some proactive lifestyle changes can reduce their frequency and make hot flashes less intense. What do you need to know to be as free from this "evil" as you can be?

Don't want hot flashes? It's time to re-examine your diet during the perimenopause!

Diet-related things that may make hot flashes worse include:

  • Consuming larger quantities of sugar
  • Eating spicy foods — no surprise, really, when you consider that they naturally induce a feeling of heat
  • Being overweight or obese

Besides eating a relatively bland, but wholesome and healthy, diet in which you shun processed foods, many women swear by plant estrogens like isoflavones. They are seen as a natural kind of mini hormone replacement therapy, and some women say they find they have fewer hot flashes when they include isoflavones in their daily routine. If you want to try this, stock up on foods like:

  • Soybeans (including soy milk, tofu, and edamame) 
  • Chickpeas
  • Lentils
  • Flaxseed
  • Beans
  • Fruits
  • Vegetables
  • Wholegrains
Soy, lentils, and chickpeas are seen as the most potent phytoestrogens available in foods. Black cohosh, also used as a herbal remedy for premenstrual syndrome and to induce labor, is also full of these plant estrogens, and there is some research to back the idea that it helps fight hot flashes up. If you are interested in trying this, talk to your doctor first as black cohosh can have side effects and is not safe for everyone. 

Hormone replacement therapy fights hot flashes — but is it safe?

Hormone replacement therapy is the most effective way to combat hot flashes, and for women who haven't had a hysterectomy, that means both estrogen and progesterone, while women who don't have a uterus can take estrogen-only HRT. If you choose to try HRT, the general recommendation is to use it for the shortest time possible, and no longer than five years. This is because hormone replacement therapy does come with some risks:

  • The Women's Health Initiative study, which came out in 2002, found that using hormone replacement therapy leads to a small but significant increase in the risk of developing breast cancer, but also suffering from a heart attack, stroke, and even dementia. 
  • While combined hormone replacement therapy seems to increase the risk of breast cancer when it's taken for more than five years, this risk does not appear to apply in women who use estrogen-only HRT. 

Beyond hormone replacement therapy: What are the treatments for hot flashes?

While some women — like those who had breast cancer in the not-too-distant past — aren't candidates for hormone replacement therapy, others, having heard about the potential risks, simply do not want to use HRT. These women can consider non-hormonal treatments that help against hot flashes. Some are prescribed by your doctor, in some cases off-label, while others are available over the counter. It is important to note that not all of the OTC products you come across are approved by the FDA, and some may be dangerous. 

Your doctor may prescribe you the following medications to help you find relief from hot flashes:

  • Certain antidepressants, like venlafaxine(Effexor), paroxetine (Paxil), fluoxetine (Prozac), or Brisdelle (especially effective against hot flashes), usually in very low doses.
  • Duavee, which helps fight hot flashes as well as osteoporosis, is FDA-approved to treat menopause symptoms.
  • Gabapentin (Neurontin) is an anti-seizure medications that is often prescribed for other reasons, including diabetic neuropathy, restless legs syndrome, and hot flashes.
  • ​Clonidine (Catapres) is a hypertension drug that may or may not relieve hot flashes. 
Women who are interested in more natural remedies may turn to black cohosh, but also evening primrose oil, ginseng, dong quai, acupuncture, and vitamin E supplements. While many of the herbal remedies used in the treatment of menopause symptoms have been used for a long time in traditional medicine, keep in mind that they haven't been subjected to the same rigorous testing as pharmacological treatments. They can both have side effects and interact with prescription and over the counter drugs you may be taking. For this reason, it's always wise to ask your doctor about any alternative treatment you are interested in before you begin using it.

Lifestyle changes — safe 'home remedies' to fight hot flashes

Certain proactive lifestyle changes — or "life hacks", as they may be called these days — can also play a role in keeping those hot flashes under control. The added bonus is that they're completely safe!

  • A fan can help you cool down — take a portable one with you, and sit in front of a bigger one if you're at home when a hot flash strikes.
  • Choose to wear natural fibers like cotton or linen, try loose-fitting options, and consider layering so you can easily remove extra clothing if you experience a hot flash.
  • Did you know overweight and obese women are more prone to hot flashes? Maintaining a healthy weight, or working on shedding some pounds, may help. 
  • Limit alcohol if you find it triggers hot flashes, as it does for some women. Caffeine can do the same thing, so consider cutting down on coffee as well.
  • If you're still smoking, quit. Not only will it benefit your general health, you may also find the severity and frequency of your hot flashes reduces.
  • If you are bothered by night sweats, you can consider a cooling pillow to help.
  • Yoga, abdominal breathing techniques, and meditation may not reduce the frequency of hot flashes, but can help you get through them more easily.
  • Definitely don't shun exercise, but consider going walking or jogging at night, when it's cooler, or working out in an airconditioned gym. 

  • American College of Obstetricians and Gynecologists. Practice Bulletin No. 141: Management of menopausal symptoms. Obstet Gynecol 2014, 123:202-216
  • American College of Obstetricians and Gynecologists (2001, reaffirmed 2010). Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin No. 28. Obstetrics and Gynecology, 97(6, Suppl): 1-11.
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