Hot flashes are the most common symptom of the climacteric and occur in about 75% of perimenopausal and postmenopausal women in Western societies. Symptoms can persist for several years after menopause, sometimes up to 14 years (although the average is about 7 years) and for some women can interfere with daily activities and sleep. This article on menopause has more information about this topic.
Women will try, and stick to, a weight loss plan if it promises to ease their hot flashes.
Soy Isoflavones and hot flashes reduction
Soy isoflavones reduce hot flashes in some women but most women are not likely to notice any benefits. Black cohosh and red clover also have had inconsistent results, with some trials showing benefit and some no difference compared with placebo.
The benefits of soy in fighting hot flashes in women going through menopause remain a matter of disagreement. Dr. Rafael Bolaños of San Marcos University in Lima, Peru, searched the medical literature for clinical trials lasting at least 12 weeks in which soy products were compared with inactive placebo in menopausal women. Dr. Rafael Bolaños divided the studies into three groups based on the type of supplement used: concentrate of soy isoflavones, the estrogen-like compounds found in soy (3 studies); soy extract (6 studies), or soy dietary supplement (10 studies). Within each group, women using soy products showed significant improvement of their hot flashes compared to the women on placebo. The extract seemed to have the strongest effects, while soy isoflavones came in second place, and soy dietary supplements came in last. But because the various studies were so different from one another in terms of dosages used, outcomes measured, and other factors, firm conclusions can't be drawn from the current analysis. Menopause, 2010.
Clin Exp Obstet Gynecol. 2015. Soy isoflavones, inulin, calcium, and vitamin D3 in post-menopausal hot flushes: an observational study. The authors performed an observational, prospective, multicentric study on women in peri-/post-menopause treated or untreated with a product present on the Italian market, consisting in a mixture of calcium (500 mg), vitamin D3 (300 IU), inulin (3 g) and soy isoflavones (40 mg). This observational trial suggests a possible beneficial effect of a dietary soy supplement containing 40 mg of isoflavone/day plus inulin in the management of menopausal symptoms such as hot flashes.
Minerva Ginecol. 2015. Evaluation of the efficacy of a new nutraceutical product in the treatment of postmenopausal symptoms. The aim of this study was to test the action of a new product without phytoestrogens containing Cimicifuga racemosa (black cohosh), chasteberry (Vitex agnus-castus), hyaluronic acid, zinc and ginger (ElleN®) in two different groups of women: one with mild and the other with moderate/severe menopausal symptoms. All women received a dose of one tablet per day of ElleN® for three months. Results showed a significant reduction in the Kupperman Index in both groups. The treatment was particularly effective against hot flushes associated with night insomnia and anxiety.
Alfalfa supplements could offer some benefits.
Chinese herbal preparations
Menopause. 2013. A randomized, double-blind, controlled trial of a Chinese herbal formula Er-Xian decoction for menopausal symptoms in Hong Kong perimenopausal women. The Chinese herbal formula Er-Xian decoction is superior to placebo in reducing the frequency and severity of hot flushes and in improving menopausal symptoms in Hong Kong perimenopausal women. It is well tolerated, with no serious adverse events noted during the study period.
Weight loss may offer some relief
Overweight women who suffer from bothersome hot flashes may find some relief by losing some weight. Archives of Internal Medicine, online July 12, 2010.
The higher a woman's percentage of body fat at menopause, the more likely she is to experience symptoms such as hot flashes and night sweats. Fat can convert male hormones into estrogen, which could reduce hot flash symptoms. However, heavier women actually experience more vasomotor symptoms with menopause. It's possible that excess fat makes it more difficult for the body to dissipate heat. Weight loss -- especially loss of fat -- may help women going through menopause to reduce hot flashes and night sweats. American Journal of Epidemiology, 2008.
An exercise program has small positive effects on sleep quality, insomnia and depression, but has no major effect on hot flashes
Flaxseed and hot flashes
The objective of this study published in 1997 was to evaluate the tolerability and the effect of 6 weeks of flaxseed therapy on hot flash scores in women not wishing to receive estrogen therapy. To be included in the study, women had to have at least 14 hot flashes per week and to not be using estrogen or any hormones. Dr. Sandhya Pruthi, director of the Mayo Breast Clinic at the Mayo Clinic in Rochester, Minnesota, asked women to add 40 grams of crushed flaxseed daily to their diet. Most of the women added the flaxseed on yogurt or cereal or mixed it with orange juice or water. After six weeks, here was a fifty percent reduction in hot flash symptoms in the women who added flaxseed to their diet. However, half of the women had side effects which included to mild or moderate abdominal distention. Three out of tem experienced mild diarrhea, one experienced excess gas.
St. John's wort herbal
extract may be of benefit
Preliminary studies show that St. John's wort may be of benefit in some women.
Chinese medicine, acupuncture
Support Care Cancer. 2014. How long do the effects of acupuncture on hot flashes persist in cancer patients? Data from six prospective analyzed studies indicate at least 3-month effects after the end of acupuncture treatment for flashes in women with breast cancer and men with prostate cancer.
Drug and medication options
Nonhormonal therapies may offer some relief from hot flashes, but less so than estrogen. Concern regarding the adverse effects of estrogen and other hormones for treating hot flashes and other menopausal symptoms has led to a demand for nonhormonal options. However, the efficacy and adverse effects of these therapies remain unclear. A meta-analysis of 10 trials of antidepressants, 10 trials of clonidine (a blood pressure drug), 17 trials of isoflavone extracts derived from red clover and soy, and 6 trials of other prescription medications, including the anti-seizure drug gabapentin was done to determine if any of these options were effective in reducing hot flashes. According to the findings, antidepressants reduce hot flashes "by approximately one per day." This was observed for drugs such as such as paroxetine, venlafaxine, fluoxetine and citalopram. The antihypertensive agent clonidine also reduced hot flashes by about one per day, while the anti-epileptic gabapentin reduced hot flashes by approximately two per day. Estrogen normally reduces hot flashes by approximately 2 to 3 per day. The most common adverse effects of antidepressants are headache, nausea, insomnia/drowsiness, dry mouth, decreased appetite and dizziness. Side effects of clonidine include dry mouth, insomnia/drowsiness, headache and constipation. Sleepiness and fatigue are the most common side effects of gabapentin. Journal of the American Medical Association, 2006.
2013 - Brisdelle (paroxetine) has been approved by the U.S. Food and Drug Administration as the first non-hormonal treatment to treat hot flashes associated with menopause.
Estrogen - the benefit versus the risk
Q. I am 54, and a survivor of uterine cancer, having had early detection and a radical hysterectomy 2 years ago, leaving no reproductive organs behind. I was put on the Vivelle estrogen patch after the hysterectomy It's a little over two years later. I am feeling great. I am worried about some of the things I have been reading in regard to the estradiol replacement and stories of breast cancer. I know you don't have a crystal ball and cannot determine my journey with this but, would it be beneficial to bit the bullet and go through the flashes? Or, would it be beneficial I stay on it, doing a lower dose, still getting some estrogen to combat other things like aging, hair loss, skin changes, osteoporosis, etc.? I appreciate your thoughts.
A. This is a good question and a difficult one to answer. There is an increased risk for breast cancer and deep vein thrombosis (blood clot) in those who take estrogen but this has to be balanced with the symptoms of hot flashes and other unpleasant effects of estrogen shortage and the risk for bone thinning. I think the risk for breast cancer is much less when low dosages are used and especially when occasional breaks are used from the hormone. Therefore taking a middle of the road approach -- that is low dose estrogen with occasional breaks from use -- may be an one option to try. There are no easy answers and each person has to determine the balance, and pros and cons, for themselves. If the severity of the hot flashes is truly interfering with quality of life, then it is worth it to try low dosages of estrogen to reduce the symptoms.
Cause flash hot
The cause for hot flashes is still being evaluated but it is mostly due to changes in levels of hormones such as estrogen. The cause of hot flashes has been studied for more than 40 years. One possible explanation has to do with an individual’s tolerance for temperature changes. One line of research shows that women who have hot flashes have a lower tolerance for changes in the body’s core (innermost) temperature than women who don’t have hot flashes. It's possible that estrogen or testosterone may allow the body to have a higher threshold for changes in body temperature.
Although hot flashes accompany the withdrawal of estrogen at menopause, the decline in estrogen levels is not sufficient to explain their occurrence. Elevated sympathetic activation acting through central alpha(2)-adrenergic receptors contributes to the initiation of hot flashes, possibly by narrowing the thermoneutral zone in symptomatic women. They are then triggered by small elevations in core body temperature acting within this narrowed zone. A relaxation-based method, paced respiration, has been shown to significantly reduce objectively measured hot flash occurrence by about 50% with no adverse effects. In studies of physical exercise, however, investigators did not find positive effects on hot flashes, possibly because exercise raises core body temperature, thereby triggering them. Other studies say the parasympathetic nervous system -- part of the autonomic nervous system, which regulates unconscious bodily functions such as heart rate and breathing -- isn't working as efficiently as normal during a hot flash.
For women in midlife, an earlier age of onset of vasomotor symptoms – hot flashes and night sweats – is linked to impaired endothelial function.
Risk of osteoporosis
Dr. Carolyn J. Crandall of the University of California, Los Angeles found that women with hot flashes and night sweats-known collectively as vasomotor symptoms-had lower bone mineral density (BMD). And the more hot flashes they had, the thinner their bones. Because hot flashes peak as bone density declines, and both menopausal symptoms and loss of bone density have been linked to low estrogen levels, Dr. Carolyn J. Crandall looked into whether there might be any relationship between the two. A total of 2,213 women participating in the Study of Women's Health Across the Nation, in which researchers are following a multi-ethnic group of US women through menopause were evaluated. At the beginning of the study, participants were 42 to 52 years old, and had either not yet undergone menopause or were in early perimenopause. Women having vasomotor symptoms had significantly lower BMD than women who didn't have these symptoms, no matter what their menopausal stage. Menopause, 2009.
Hot Flash natural therapy questions
Q. I love your newsletters. Do want to comment as a 55 year old who is finally through menopause, that besides the black cohosh (I didn't use the St. John's Wort), I found progesterone cream, pharmaceutical grade, very helpful for mood and hot flashes.
What herb works for hot flashes?
At this time there does not seem to be an herb that works for hot flashes as well as estrogen. However, some women find partial relief from exercise, and the use black cohosh, red clover, phytoestrogens or a combination. The effects of the herbs are much more subtle than estrogen. The natural depression treating herb St. John's wort, is another dietary supplement to consider.
While looking for information about melatonin, I came across your website. I was very impressed with the detailed research and references presented. I thought you might be interested in the "good side effects" I found from melatonin. I started taking 0.3 mg melatonin) twice a week to help me sleep. Because I am now sleeping soundly, I have more energy than I did previously. Melatonin has also, amazingly, greatly reduced hot flashes (both number and intensity) and my nasty cravings for anything with sugar.
Have you heard of Amberen, a natural treatment for
menopause? What do you think of the ingredients, it has ammonium succinate. It
also claims to have smart molecules.
I have not heard of Amberen and do not know which ingredients it has although a claim such as "smart molecules" makes me skeptical in trusting the claims.
I have been taking 'bulk' evening primrose oil now for about 9 years and it has totally eradicated my hot flushes. I have regular check ups and am very healthy with no side effects. You will be surprised at the amount I take (6 x 1,000 mg) 3 times a day (yes you heard it correctly - 18 tablets a day). Once I was in a health food shop and mentioned that taking some EPO was not doing much to improve my hot flushes (I was waking up several times a night and suffering many during the day). The girl behind the counter said 'oh, you need to take a lot more than what is recommended on the jar if you want to improve your hot flushes'. That simple comment was the trigger for me to experiment, so I started building up the number of tablets and after quite a period of time, found that 6 tablets 3 times a day took my hot flushes away totally and allowed me to sleep through the night. I had an ischemic attack about 10 years ago and was put on blood thinners. I don't need to take blood thinners anymore, because EPO now acts as a natural blood thinner, so this is a secondary advantage to taking evening primrose oil.
I had a hysterectomy a few weeks ago, due to severe endometrosis. I feel better already after surgery, but the hot flashes come every 30-60 minutes. Despite what pop psychologists think, there's no "emotional trigger", they come every 30-60 minutes even when I'm asleep!
My hot flashes are 100% gone at this time taking 50 mg of pregnenolone and 10 mg of DHEA each day.
My comment: These doses are very high and could potentially lead to many side effects.
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Genistein Rich Soy concentrate ( SoyLife )
Black-Cohosh Root Extract ( CimiPure )
Dong Quai Root Extract
Licorice Root Extract
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