Hot Flashes & Night Sweats:
Why Are They Such A Big Part Of Menopause?
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. Hot flashes occur because of the unsteady and declining levels of estrogen characteristic of menopause. The prevailing theory suggests that this change in estrogen levels makes the part of the brain which regulates temperature, i.e. the thermoregulatory zone, more sensitive to various stimuli. Essentially, the brain tries to do its job by protecting us from overheating, but the drop in estrogen in menopause makes it overreact, causing hot flashes in its attempt to cool us off, even when there is no good reason to do so. Do not worry though - hot flashes of menopause are not caused by a rise in temperature, and your thermometer will not give you a fever reading during or after one.
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 60s and beyond.
Treatments For Hot Flashes: Hormones therapy, medications, and lifestyle adjustments
Hot flashes occur because of unsteady, declining levels of estrogen and progesterone.
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.
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, spray or 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. For most women, estrogen treatment is combined with another main female hormone, progesterone.
That said, this treatment approach may come with some downsides – including potential increase in risk of breast cancer, liver disease, and stroke – depending on your profile, medical history and more. According to the North American Menopause Society, hormone therapy’s benefits will outweigh the small risk increase in most healthy women, especially when started around the time of menopause. 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 as well as non-medication options, which we discuss below. These include certain types of antidepressants or anti-seizure medications such as gabapentin, 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 first. These include dressing in layers, keeping your home nice and cool, and avoiding typical hot flash triggers such as 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, as 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 integrative approach to hot flashes by considering a range of lifestyle changes and supplements or other complementary methods such as Traditional Chinese Medicine and acupuncture, before reaching for prescription medications. This advice should be individualized as well and is best received from an integrative physician, functional doctor, licensed naturopathic practitioner, qualified acupuncturist/traditional Chinese medicine doctor. If you go this route, you’ll likely leave with a list of dietary and lifestyle changes to make, and may need to obtain some supplements. 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 to have severe hot flashes if you are obese, stressed, depressed or anxious, or a former smoker. What is most important is that you receive care from a reliable and trusted person that can understand your situation, assess for interactions and recommend safe and effective treatments. We definitely recommend that you disclose and discuss any herbs or supplements you are using or considering with your general doctor or gynecologist as they will be able to guide you and assess for any risks or interactions.
Dietary Changes for Hot Flashes
Many alternative practitioners will take things a step further and give hot-flash specific recommendations, including advice like eating whole food based meals, consuming plenty of fiber rich foods, colorful veggies and fruits, healthy fats, and avoiding processed and sugary foods 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.
Integrative medicine doctors also often 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.” Before you load up on soy in your diet however, consider its source or how it is prepared. When it comes to soy, it is best to get organic products such as edamame or tofu, and fermented soy such as natto, miso, or tempeh. Finally, for those trying a specific anti-inflammatory diet, it actually may be more optimal to avoid soy altogether.
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, especially when combined with herbal agents. 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 20-40 mg of black cohosh twice daily, as well as adrenal support such as vitamin C along with adaptogenic herbs such as ashwagandha 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 soy isoflavones and other soy extracts, rhapontic rhubarb, vitamin B6, evening primrose oil, and Swedish flower pollen—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 change 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 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