Hot flashes: Up to 75 percent of women in the menopause transition experience them (and their extra-annoying nighttime equivalent, night sweats). This trademark symptom of the years surrounding your last menstrual period can range from a mild feeling of warmth to an intense wave of heat that makes you feel as though your skin is on fire. Hot flashes can truly be a flash, lasting a brief minute or two and occurring every once in a while, or they can recur regularly, sometimes lasting up to a seemingly unbearable 30 minutes. Although this nuisance does subside in time (we promise!), a recent study found that moderate to severe hot flashes continue for an average of nearly five years after menopause, and some women will have them for another five years after that. But while each woman’s experience is different, these heat spells are one of the most common symptoms many of us notice during menopause.
So what causes hot flashes? Fluctuating estrogen may mess with your internal thermostat, causing your blood vessels to dilate more frequently. The result is these out-of-the-blue heat waves.
Now that you’re caught up on all of the not-so-great news, you’re probably eager to find out what you can do to ease your symptoms. Because the frequency and severity of hot flashes vary a lot from woman to woman, there’s no one-size-fits-all approach to relief. It’s important to listen to your body to find treatments that work best for you and your lifestyle. And, fortunately, there’s a range of remedies that can help you handle the heat. From hormonal therapies to hormone-free prescriptions to natural treatments, explore your options to find the best approach for you:
Hormone Replacement Therapy
The most common treatment for hot flashes is combination hormone therapy using low doses of estrogen and progesterone to replace the ones your body is making less of now. “Hormone replacement therapy is incredibly effective for relieving hot flashes, night sweats and disrupted sleep, and it lowers the risk of osteoporosis,” says Cindy Geyer, M.D., medical director at Canyon Ranch in Lenox, Mass. There may be risks associated with combination therapy: A particular form of hormone therapy (conjugated equine estrogen and medroxyprogesterone by mouth) was associated with higher risk of heart disease, stroke, blood clots and breast cancer in the large Women’s Health Initiative study. “However, newer studies suggest that short-term use of combined hormone therapy (usually defined as less than five years), especially when delivered through the skin via a patch, is safe for many women,” Dr. Geyer says.
Whether or not to take hormones is an individual decision, and one that’s best made with your doctor, who should reassess the treatment every six months. Read our article Considering Hormone Replacement Therapy to learn more about the pros and cons, more safety advice and the best form of hormone therapy for your situation.
Hormonal Birth Control
“In perimenopause, you have higher highs and lower lows of estrogen during your cycle than before,” Dr. Geyer says. Hormonal birth control such as low-dose oral contraceptives or a progesterone intrauterine device (IUD) can even out those big swings and reduce your symptoms. Of course, it also protects you from getting pregnant until you reach menopause.
A prescription to help your mood may also cool hot flashes. A University of Pennsylvania study found that menopausal women who were given escitalopram for eight weeks experienced significantly fewer and less severe hot flashes than those on a placebo. It’s unclear why these types of antidepressants, also known as selective serotonin reuptake inhibitors (SSRIs), reduce hot flashes, but they provide an alternative for women who are not candidates for hormone therapy. The only SSRI currently FDA-approved for easing hot flashes is paroxetine.
Blood Pressure Aids
Clonidine, a patch or pill typically used to treat high blood pressure, may also be useful for hot flashes. One study of women with a history of breast cancer showed that the drug reduced hot flashes by 15 to 20 percent compared to placebo. The drug may work by easing the overreaction of blood vessels in menopausal women.
Recognizing your own hot flash triggers (coffee, for example) can go a long way toward improving how you feel about your symptoms, even if you opt not to change those habits. “When my hot flashes were the most intense, I chose to continue my morning coffee, but it meant I would spend the first few minutes at work standing in front of the air conditioner!” Dr. Geyer says. “Keeping your sense of humor and realizing that the hot flashes do tend to diminish over time helps.”
Some women find relief from hot flashes by using integrative treatments:
- Breathe Deeply. You already know that taking slow, deep breaths has a calming effect. When you’re more relaxed, your heart rate drops a bit, and that can make it easier to ride out a hot flash and minimize its severity. Research shows that simply breathing slower and deeper (six to eight breaths per minute) for 15 minutes daily—a technique known as paced respiration—can reduce the frequency of flashes by up to 50 percent.
- Chill Out. You might want to sip your drinks on ice, since hot beverages like coffee and tea can trigger hot flashes. Maintaining a lower ambient temperature in your home or office will help keep you cool, so use a fan or air conditioner or open a window. And you might want to go easy on spicy foods and alcohol; both cause blood cells to dilate, which can trigger hot flashes.
- Snack On Soy. Soy-based foods such as tofu, miso and soy milk contain estrogen-like compounds called phytoestrogens that mimic some of estrogen’s effects. When you eat these foods, bacteria in your digestive tract may convert these phytoestrogens into another estrogen-like compound called S-equol. Women who produce this compound have fewer and less intense hot flashes, Japanese studies have found. And here’s a bonus: S-equol may also help maintain bone density and reduce muscle and joint pain. If you’re concerned about the effects of soy, a recent study found that soy foods are safe even in women who have had breast cancer, although Dr. Geyer advises against taking soy supplements.
- Get Physical. Regular, moderate exercise, like aerobics and strength training, can also keep your symptoms in check. Only five percent of highly active women experienced severe hot flashes, compared with 15 percent of women who did little or no exercise, according to a study of around 800 menopausal women. Researchers believe this may be because regular exercise activates neurotransmitters in your brain that regulate body temperature.
- Give Yoga a Try. Getting your om on may minimize menopause symptoms. In a small study of women who reported four or more hot flashes a day, doing 90 minutes of yoga weekly for two months reduced the number and severity of hot flashes by one-third. Scientists suspect that yoga may activate the parasympathetic nervous system, which controls our unconscious physiological responses, including sweating.
- Experiment with Acupuncture. In one study, women who had 10 acupuncture sessions reported fewer hot flashes than those who received placebo treatments. The participants also reported sleeping better and experiencing less pain than those who got no needling sessions. It’s not clear how the alternative treatment helps, but the needles may trigger the release of feel-good brain chemicals like endorphins and serotonin.
- Think Cool. You probably know that dressing in layers can help you prepare for hot flashes when they strike—especially in places where you can’t control the temperature. Simply imagining yourself in a cool environment may help you avoid discomfort, too. In one study, women who visualized images associated with coolness—say, snowcapped mountains or a chilly rain shower—during hypnotherapy saw a big drop in their flashes. Visualization may stimulate areas of the brain identical to those activated by actual events, making you feel cool when picturing a frosty winter morning instead of feeling the heat from your flash. The more personal the images, the better the results, so summon up an experience when you felt truly chilled.
And, finally, some encouraging words for flash sufferers: Women who have hot flashes and night sweats early in the menopause transition may be at lower risk for heart attack, stroke and death, research in the journal Menopause notes. Scientists suspect that the fact that blood vessels respond well to hormonal changes during hot flashes is a sign of healthy vascular function. Thank goodness for silver linings.