As many as 80 percent of American women who are going through menopause complain of hot flashes (or flushes), with some having severe episodes many times a day. These sudden feelings of intense heat are accompanied by sweating and a flushed face, followed by a cold, clammy feeling.
Hot flashes are not only uncomfortable, they can also be embarrassing. If they occur at night (“night sweats”), they can disrupt sleep, leaving you exhausted the next day.
Women often report that hot weather, caffeine, alcohol and spicy foods trigger hot flashes. Not surprisingly, the most common relief strategies are to seek a cooler place, remove clothing, use a fan and drink cold beverages. What else contributes to and alleviates hot flashes?
Some lifestyle factors make women more prone to hot flashes. Smokers, for instance, are at higher risk and have more severe hot flashes, possibly because smoking affects estrogen metabolism.
Even exposure to secondhand smoke may increase the risk. Though many women report that alcohol is a trigger, some research suggests that light drinking (one drink a day) doesn’t increase hot flashes.
It has long been thought that being overweight helps protect against hot flashes. Yet several studies have linked hot flashes to higher weight. Body fat produces some estrogen, which would be expected to lessen symptoms, not increase them.
On the other hand, excess fat hinders the body’s ability to dissipate heat. Overweight women may also experience changes in other hormones involved in body heat regulation. Losing weight may thus help lessen symptoms, as was seen in a 2010 study in the Archives of Internal Medicine.
Hot flash remedies
Hot flashes are associated with changing levels of estrogen, and this affects the body’s ability to regulate temperature. But they’re still not fully understood, making it difficult to design effective treatments. And in many cases, treatments have a strong placebo effect. Still, both prescription drugs and supplements are often recommended.
• Hormone therapy: Despite its potential risks, hormone therapy remains the best treatment for hot flashes. Ultra-low doses of estrogen, plus a synthetic form of progesterone, significantly reduced hot flashes in a 2007 study published in Climacteric. If you have severe hot flashes, talk to your doctor about possible hormonal options. You should take the lowest effective dose for the shortest possible time.
• Antidepressants: A large study in the Journal of the American Medical Association found that escitalopram (Lexapro) reduced the frequency and severity of hot flashes, compared to a placebo. Other antidepressants, such as fluoxetine (Prozac), paroxetine (Paxil) and venlafaxine (Effexor), are also sometimes used—in small doses. While antidepressants help many women, they are not as effective overall as hormone therapy in reducing hot flashes, and responses can be highly variable.
• Other nonhormonal drugs: Clonidine (Catapres, a hypertension drug) and gabapentin (Neurontin, used for epilepsy and shingles pain) may be somewhat effective. In one study, gabapentin decreased hot flashes by 51 percent, compared with 26 percent for the placebo. But because there are few studies testing these drugs for hot flashes and because they are not as good as estrogen, their use should probably be limited to women with severe hot flashes who can’t or don’t want to take hormones.
• Isoflavone supplements: Evidence is mixed for these estrogen-like plant compounds, often derived from soy or red clover. An Australian review of studies several years ago concluded that isoflavones may have a small to moderate benefit in decreasing frequency of hot flashes, but it also noted a strong placebo effect.
Meanwhile, a review from the independent Cochrane Collaboration concluded that there is no evidence that plant estrogens, overall, are effective. The long-term safety of isoflavone supplements is unknown, particularly regarding breast cancer risk (though recent research suggests that isoflavones may actually decrease recurrence of breast cancer in women with hormone-dependent tumors). You can try eating a serving or two of soy foods a day to reduce hot flashes.
• Black cohosh: Though this herb (found in Remifemin and other products) has been much studied, the evidence is still slim. Most studies have not been well-designed and have had inconsistent results. A 2010 Canadian analysis of nine studies found black cohosh beneficial in six of them. But some studies have shown it to be no better—or even less effective—than a placebo. Despite concerns that black cohosh may cause liver damage, no significant adverse effects were seen in a 2009 study in Menopause. If you want to try it, tell your doctor so he or she can monitor your liver function.
• Other supplements: Most other proposed remedies—evening primrose, dong quai, ginseng, ginkgo, kava, flaxseed, vitamin E, DHEA, valerian, wild yam and melatonin—have little or no published research to back their use, and some may have undesirable side effects or be harmful.
A well-designed study in Menopause in 2010 found that St. John’s wort decreased hot flashes after eight weeks, but some other studies have shown no benefit from this “herbal antidepressant.” If you take any supplement, tell your doctor, since many of them can interfere with medication.
Beyond drugs and supplements
• Acupuncture: Though most studies are of poor quality, there’s some evidence that acupuncture may help. On the other hand, some research has found that sham acupuncture also works, suggesting a placebo effect—which may not matter, as long as symptoms go away.
• Mind/body methods: A review in the American Journal of Medicine several years ago concluded that a relaxation technique involving slow deep breathing was beneficial. And a newer study in Menopause found that a mindfulness-based stress-reduction program helped women cope better with hot flashes.
• Exercise. Some women find that exercise helps, but according to a 2010 review, “there is little convincing evidence” that it has positive effects on menopause symptoms. Still, it’s worth trying, since exercise has many other health benefits.