Hot Flashes & Night Sweats: Why Are They Such A Big Part Of Menopause?
”This sweater is a prison,” you think as you sit at dinner,
doing everything in your power not to tear your shirt to
pieces like the hulk in the middle of the restaurant. The
back of your neck is wet, your skin is hot to the touch,
you’re burning up and yet somehow also have the chills.
You, my friend, are having a hot flash.
One of the most infamous symptoms of menopause, hot
flashes are not as dangerous as they are frustrating. They
come out of nowhere and can greatly influence our
quality of life—and our love for long-sleeved shirts. But
what are hot flashes really? Is there anything we can do
to treat them with medication or natural remedies?
Hot Flashes 101: What they are and why they occur
Hot flashes are one of the most common symptoms of menopause, affecting up to 80% of women and causing symptoms like a sudden feeling of warmth spreading through your upper body and face, a flushed appearance, red or blotchy skin, rapid heartbeat, perspiration, and chills. They can occur anywhere from once or twice a week to as often as three times an hour.
Unfortunately, we don’t know the exact root cause but it’s theorized to be declining levels of estrogen. Strange things tend to happen in the body when hormone levels increase or decrease drastically. PMS is a great example of this. During your premenstrual week, estrogen, testosterone, and progesterone levels plunge, causing symptoms like irritability, fatigue, and anxiety. Hot flashes occur because of the unsteady and declining levels of estrogen and progesterone characteristic of menopause and perimenopause.
Hot Flashes Duration: How long do they really last?
Experts used to think that all women experienced hot flashes in the same way and that they lasted for about 6 to 24 months. Then, a study called the SWAN study—which followed over 3,000 women of different racial and ethnic backgrounds for over 22 years—completely dispelled that myth, validating many women who had been insisting their hot flashes lasted far longer than 24 months. Published in 2015, the SWAN study showed that hot flashes frequently last seven years and that the time, duration, and severity of hot flashes can vary greatly from woman to woman.
When we say greatly, we mean greatly. For some women, hot flash symptoms appear five to 10 years before their last period. Others don’t experience a single hot flash until after their last period, and some—about 25 percent—go through menopause and don’t have any hot flashes at all, which is totally normal. About one in four women are categorized as “super flashers.” These women experience hot flashes early in life that continue well beyond their final period—sometimes for 15 years or more. These women can continue to have hot flashes into their 70s and beyond.
Treatments For Hot Flashes: Hormones therapy, medications, and lifestyle adjustments
If you’re suffering from hot flashes—and especially
if you qualify as a “super flasher”—you’re almost
definitely open to the idea of a remedy or
medication that could relieve symptoms. When it
comes to medications for hot flashes, there’s good
news and bad news.
The treatment with the highest reported rate of
efficacy for hot flashes is estrogen-based hormone
therapy, which comes in the form of a skin patch,
gel, cream, and occasionally a pill. It’s proven to be
effective and as an added bonus, also helps with
other symptoms of menopause like vaginal dryness
and pain with intercourse.
That said, this treatment approach may come with downsides – including potential increase in risk of breast cancer, blood clots, heart disease, dementia, and stroke – depending on your profile, medical history and more. When used appropriately, this increased risk is very mild for some women—especially if hormone therapy is only used for only a short amount of time—but other women should avoid using hormones completely due to factors in their health history. Deciding to opt for hormone therapy (or not!) is a personal choice and something to discuss with a trusted healthcare provider. Many will suggest other treatment approaches first before turning to hormone therapy.
If you decide hormone therapy isn’t for you, there are other pharmaceutical options. These include certain types of antidepressants, blood pressure medications, and even anti-seizure drugs that can be used off label for hot flashes. Unfortunately, they have not been proven as effective as estrogen and also come with side effects best discussed with a medical practitioner.
If you’re interested in connecting with a medical practitioner to discuss further, the North American Menopause Society (NAMS) has a handy search tool to find a practitioner in your area.
If you’re suffering from frequent hot flashes, your doctor will most likely recommend practical tips that—admittedly—you could have thought of on your own. These include dressing in layers, keeping your home nice and cool, and avoiding hot beverages, caffeine, vigorous exercise in the heat, and spicy foods. It’s also worth keeping a diary of what you’re doing in the moments before you experience hot flashes, this can help you identify triggers and avoid them. According to the National Institutes of Health (NIH), it’s recommended you try lifestyle changes like these for up to three months before you consider medication.
An Integrative Approach To Hot Flashes
If you’re dressing in layers and already have the thermostat at 65 degrees, you might seek out a more Eastern approach to hot flashes by seeing an herbalist, integrative or functional medicine doctor, naturopathic doctor, or traditional Chinese medicine doctor. If you go this route, you’ll likely leave with a long list of dietary and lifestyle changes to make. This can feel like a lot of work—Aren’t you suffering enough already?—but research backs up the idea that women with healthier lifestyles suffer less from hot flashes and night sweats. In fact, the SWAN study showed that you’re more likely have had severe hot flashes if you are obese, stressed, depressed or anxious, or a former smoker. Another study published in Obstetrics and Gynecology established a connection between frequent hot flashes and higher cholesterol levels.
Dietary Changes for Hot Flashes
Many alternative practitioners will take things a step further and give hot-flash specific recommendations, including advice like eating regular meals and consuming plenty of protein and fiber to keep blood sugar stable throughout the day. Balancing blood sugar is key since progesterone and estrogen affect how our cells respond to insulin. During perimenopause and menopause, blood sugar can be less predictable.
Leading integrative medicine doctors also recommend eating soy during this time. Soy contains chemical compounds that are known to mimic estrogen and could help mitigate symptoms through similar mechanisms as estrogen hormone replacement therapy, but without the risks. Not a fan of tofu? We get it. Luckily, soy isn’t your only option. Lentils, chickpeas, and flaxseeds are also full of these “plant estrogens.”
Alternative Remedies for Hot Flashes
Acupuncture is another alternative option for hot flashes. The
research is somewhat conflicting here, but some studies do
show that acupuncture can reduce the frequency and severity
of hot flashes. An alternative medicine expert might also
suggest herbs for your hot flashes. Dr. Aviva Romm, a midwife,
herbalist, and Yale-trained medical doctor frequently suggests
hops for night sweats. Science agrees with her, with one paper
concluding: “Numerous clinical trials have documented
significant reductions in the frequency of hot flushes following
the administration of hop-containing preparations.”
Stress is also particularly important to identify, because hot
flashes can be triggered by living in a perpetual state of fight-
or-flight. To supplement the diet changes and to support your
adrenal health (i.e. what suffers most with high stress), Naturopathic Doctor and Licensed Midwife Dr. April Blake recommends 20 ml of black cohosh twice daily, as well as adrenal support such as vitamin C along with adaptogenic herbs as needed. As with any course of treatment, make sure to check with your Naturopathic Doctor first.
Other common herbs and supplements used for hot flashes include evening primrose oil and vitamin E—but the research is not definitive. For women experiencing anxiety during the hot flashes, you may consider an additional multi-vitamin and a multi-mineral.
With any course of treatment, Dr. Blake’s guiding philosophy is “start low and go slow,” and pay attention to how your body responds to the treatments. This means introducing one new supplement or diet changes at a time every three days. Listen to your body — it’s going through one of life’s biggest shifts, and doesn’t need any extra stress from an overly aggressive regimen or herbs or supplements. Three days should hopefully be enough to know whether the new routine sits with your system before adding another new item to the mix. As with most new treatments & diets, it’s unlikely that you’ll experience changes overnight, but be patient. If you’re not seeing results within 30-60 days, it may be time to try a new regime.
Finally, while we know that nothing can fuel a person’s rage quite like being told to “relax,” according to the NIH early-stage research suggests that mindfulness practices—like yoga, tai chi, and meditation—can improve menopausal symptoms like hot flashes. They are definitely worth a try, especially if hot flashes are chipping away at your quality of life.
Hot Flashes FAQs — North American Menopause Society
Hot Flashes — Mayo Clinic
Non-Hormone Treatment for Hot Flashes — Cleveland Clinic
Soy and Women’s Health: The Truth About Soy Benefits & Safety — Dr. Aviva Romm, M.D.
Hormone Therapy: Is is right for you? — Mayo Clinic