- Home
- » Guides
- » Hot Flashes
Hot Flashes
Feeling the heat
As a woman matures, she has many joyous prospects to look forward to in life: family, career, home, personal growth. But one event she will not likely look forward to is the experience of hot flashes that frequently accompany the perimenopausal and postmenopausal years.
Hot flashes usually happen at a time in a woman's life when she may be facing physical and psychological changes. Feelings of fear, uncertainty, and loss of control may complicate these uncomfortable episodes. Whatever emotions a woman is feeling, her sensitivities about entering into this time may be mixed and many. The ups and downs of hot flashes may remind a woman of the wider scope of this midlife transition.
Of course, hot flashes are a natural phenomenon and should not cause any woman to cringe. Fortunately, as our society's awareness of menopause and women's health issues increases, so does our ability to treat them. Many methods for dealing with hot flashes have been developed in recent years that have helped women effectively overcome this natural phenomenon of the female life cycle.
Detailed Description
Hot flashes occur in 80% to 85% of menopausal women. Hot flashes usually indicate the beginning of menopause, but they can happen before a woman stops menstruation. Menopause begins on average at age 52, but some women have hot flashes or other symptoms of menopause earlier. Virtually all women enter menopause by age 58 but usually not before age 40.
Hot flashes are marked by a sudden sensation of warmth, especially in the upper body and face. Flushing and sweating followed by chills can also happen. Though most hot flashes last only minutes, they differ in quality and intensity from woman to woman. For example, some women have frequent and intense hot flashes that include night sweats. These women often wake up in the middle of the night feeling very hot and drenched with perspiration.
To understand hot flashes, it helps to understand the two main stages of menopause: perimenopause and postmenopause. Perimenopause happens when ovarian function begins to decline. Although a woman may continue to have periods, the ovaries may not actually release an egg for fertilization. During perimenopause, estrogen production decreases and symptoms such as hot flashes begin. Postmenopause is the period following menopause. Hormone levels stabilize, slowly diminishing during postmenopause, a period that accounts for more than one-third of a woman's life.
How Common Are Hot Flashes?
Currently more than 30 million women in the United States are of menopausal age (between ages 40 and 58).
Possible Underlying Causes
The biological mechanism of hot flashes involves a response of the blood vessels. An increase in the release of gonadotropin-releasing hormones (GnRH) from the hypothalamus in the brain is believed to trigger hot flashes by affecting the adjacent temperature-regulating area of the brain.
To understand the causes of hot flashes, it helps to understand the causes of menopause. Menopause itself has three main causes:
- Physiologic menopause happens when a woman's monthly periods (menses) naturally end, after the body's supply of eggs (oocytes) is depleted and ovarian hormone production (most notably estrogen production) declines. It is a natural consequence of growing older and signals the end of a woman's reproductive ability. One year after her last period, a woman is said to be postmenopausal.
- Surgical menopause happens abruptly after the removal of the ovaries as a result of disease. Hot flashes related to surgical menopause are usually the most severe, probably because of the sudden chemical shift the body endures.
- Medical menopause happens as a result of the medical treatment of endometriosis (abnormal growth of the endometrium uterine lining, outside the uterus) with drugs such as danazol or GnRH analogues. It can also happen with the medical treatment of breast cancer with anti-estrogen medications or with cancer chemotherapy. Medical menopause may be either reversible or permanent.
Triggers of Hot Flashes
A decrease in estrogens is the predominant trigger of hot flashes. However, several substances-- including caffeine, nicotine, and alcohol-- can cause the onset of hot flashes due to their effect upon the circulatory system. Stress can also lead to hot flash episodes. Even a warm room can bring on hot flashes. Fluctuating sensations of hot and cold are disruptive to a woman's sense of well-being, control, even relationships.
Diagnosing the Underlying Cause
Though chronic heat intolerance may indicate another problem needing medical attention, for women, hot flashes normally mean the beginning of menopause. Other medical conditions such as hyperthyroidism, lymphomas, pheochromocytoma, and systemic mastocytosis can also cause flushing. If you believe that your hot flashes are not related to menopause, you should consult your doctor for a complete evaluation of your symptoms. Do not attempt to diagnose yourself with a medical condition-- even if your symptoms match those typical of a certain disorder. If your symptoms concern you, the best thing to do is to seek medical advice.
Diagnostic Procedures
Your physician may perform diagnostic tests to determine whether you have entered menopause. Elevated levels of follicle-stimulating hormone (FSH) and decreased levels of 17-B estradiol can confirm a low-estrogen state or menopause. For women who may be experiencing early menopause, your doctor may consider testing your thyroid-stimulating hormone (TSH), calcium and phosphorus levels, and may also conduct a cosyntropin stimulation test to investigate other endocrine conditions.
Goals of Treatment
Around the time of menopause, your body undergoes a number of important changes due to the decrease of estrogen production. A low-estrogen state can make you more vulnerable to future osteoporosis or heart (coronary artery) disease. You and your doctor may decide to use hormone replacement therapy, including estrogen. But estrogen supplements may not be appropriate for you. Many alternatives exist, including a class of promising new drugs called SERMs (selective estrogen regulating modulators). Your doctor will advise you as to the medication that best suits you.
Estrogen boosts HDL (good cholesterol) levels. Therefore, estrogen replacement therapy is a commonly used treatment to help prevent coronary artery disease. Estrogen also decreases calcium levels. Adequate calcium intake from natural and supplemental sources is important (usually about 1,500 mg daily). Doctors frequently suggest calcium supplements to help reduce the chance of osteoporosis.
General health measures are also in order to treat menopausal changes and the hot flashes that accompany them. These include a regular exercise program, avoiding smoking, and reducing alcohol and caffeine intake.
Usually you can only partly control hot flashes, especially when menopause begins. Most women find a method or combination of methods for coping with the discomfort of hot flashes after a process of trial and error. The following sections outline possible strategies for overcoming hot flashes.
Treatment Options
Estrogen replacement drugs include the following:
- Transdermal estrogens:
- Alora
- Climara
- Estroderm
- FemPatch
- Oral estrogens:
- Estrace
- Estratab
- Menest
- Ogen
- Ortho-est
- Premarin
- Estrogen/progesterone combinations:
- Combipatch-transdermal
- Prempro
- Premphase
- Synthetic progestins:
- Amen, Provera, Cycrin, Curretab (medroxyprogesterone)
Second choices
- Catapres (clonidine)
A new class of medications is being introduced called SERMs (Selective Estrogen Receptor Modulators). The first one to market in the United States is Evista (raloxifene), which the FDA approved for the prevention of osteoporosis in postmenopausal women.
Special Diets
Increased calcium intake is the most important dietary modification to consider. In addition to supplements, consume foods high in calcium more frequently. Low-fat and nonfat dairy products, leafy green vegetables, and canned fish with bones are all high in calcium. Postmenopausal women should have a total of 1.5 g (1,500 mg) of calcium per day. Calcium tablets that contain small amounts of boron, a metal element, improve ovarian hormone production.
Supplements
- Vitamin E: Some women say it helps minimize hot flashes. About 800 mg/day is the recommended amount.
Herbs
- Black cohosh: A centuries-old herbal remedy for hot flashes. Like soy foods, black cohosh contains phytoestrogens, making it a natural form of hormone replacement. Commission E, the German panel of doctors, pharmacists, and herbalists that judges the safety and effectiveness of herbs for the German government, endorses black cohosh for hot flashes and vaginal dryness.
- Soy isoflavones: A supplemental form of the natural plant estrogen found in tofu and other soy products. Try about 50 mg/day.
Relaxation
Several studies show that deep relaxation minimizes hot flashes. For example, British researchers treated some women with hormone replacement therapy, and instructed others in a relaxation regimen which included meditative deep breathing, progressive muscle relaxation, and cognitive therapy, a psychological technique. After three months, both groups reported about the same relief from hot flashes. [1]
1 Hunter, MS and KLM Liao. "Evaluation of a 4-Session Cognitive Behavioral Intervention for Menopausal Hot Flashes," abstracted in Mental Medicine Update 4:3, 1995.
Self-Care Measures
- Eat tofu. Soy foods contain plant estrogens (isoflavones) that are a natural form of hormone replacement therapy (HRT). HRT minimizes hot flashes, and so does a diet high in soy foods. In one study, Italian researchers gave 104 menopausal women either a daily placebo or soy powder (60 g), and asked them to keep track of their hot flashes. After three months, the women taking the soy powder reported significantly fewer hot flashes. Natural medicine experts suggest eating two to four ounces of tofu a day.
If you don't like tofu, you can take isoflavones in supplement form. Natural medicine experts recommend 50 to 100 mg a day. - Wear layers of clothing. This will help you adjust your own levels of warmth as the need arises. At night, use several lightweight covers rather than one heavy cover. Remove them as needed.
- Quit smoking. Compared with nonsmokers, women who smoke are more bothered by hot flashes.
- Exercise regularly. Many studies show that exercise helps cool hot flashes. For example, Swedish researchers surveyed 900 women about their menopausal symptoms and exercise habits. As their time spent exercising increased, the women's hot flashes decreased, with 30 minutes or more of daily exercise producing the most benefit. Any form of exercise helped, including walking, running, aerobics, and yoga.
When To Call the Doctor
Consult your doctor if:
- Your periods (menses) stop
- You are having hot flashes
It is always advisable to consult with your gynecologist or primary physician to discuss the natural course of menopause and the changes your should expect from your body at this time in your life.
Websites & Organizations
Advocate Health Care System Support Center
2025 Windsor Drive
Oak Brook, IL 60523-1586
Phone: 800-3-ADVOCATE (800-323-8622)
American Medical Association
515 North State Street
Chicago, IL. 60610
Phone: 312-464-5000
The Foundation for Better Health Care
6 East 32nd Street
New York, NY10016
Phone: 212-835-2146
Fax: 212-545-1378
The Institute of Endocrinology and Reproductive Medicine
3280 Howell Mill Road NW, Suite 205
Atlanta, GA 30327
Phone: 404-355-1066
Fax: 404-352-3666
Pharmaceutical Information Network
Planned Parenthood Federation of America
810 Seventh Avenue
New York, NY 10019
Sources & Further Reading
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw Hill, 1996.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Albertazzi, P. et al. "Effects of Dietary Soy Supplementation on Hot Flashes," Obstet. and Gyncol., 91:6, 1998.
Avis, NE, Crawford, SL, McKinlay, SM. "Psychosocial, Behavioral, and Health Factors Related to Menopause Symptomatology." Womens Health. 3(2):103-20. Summer 1997.
Clark, JA, Wray, N, Brody, B, Ashton, C, Giesler, B, Watkins, H. "Dimensions of Quality of Life Expressed by Men Treated for Metastatic Prostate Cancer." Soc Sci Med. 45(8):1299-309. Oct 1997.
Dennerstein, L, Dudley, E, Burger, H. "Well-being and the Menopausal Transition." J Psychosom Obstet Gynaecol. 18(2):95-101. Jun 1997.
Frishman, GN. "The Hot Flash: Pathophysiology and Treatment." R I Med. 78(5):132-4. May 1995.
Hammar, M. et al. "Does Physical Exercise Influence the Frequency of Postmenopausal Hot Flushes?" Acta Obstet. Gynecol. Scandinavia, 69:409, 1990.
Hunter, MS and KLM Liao. "Evaluation of a 4-Session Cognitive Behavioral Intervention for Menopausal Hot Flashes," abstracted in Mental Medicine Update, 4:3, 1995.
Lucerno, MA, McCloskey, WW. "Alternatives to Estrogen for the Treatment of Hot Flashes." Ann Pharmacother. 31(7-8):915-7. Jul-Aug 1997.
McGuffey, EC. "Treating Hot Flashes." Am Pharm. NS35(1):14, 17. Jan 1995.
McQuaide, S. "Women at Midlife." Soc Work. 43(1):21-31. Jan 1998.
Mohyi, D, Tabassi, K, Simon, J. "Differential Diagnosis of Hot Flashes." Maturitas. 27(3):203-14. Jul 1997.
Rousseau, ME. "Women's Midlife Health. Reframing Menopause." J Nurse Midwifery. 43(3):208-23. May-Jun 1998.
Wilbur, J, Miller, AM, Montgomery, A, Chandler, P. "Sociodemographic Characteristics, Biological Factors, and Symptom Reporting in Midlife Women." Menopause. 5(1):43-51. Spring 1998.