Expert Advice: Hot Flashes in Perimenopause and Menopause

Dr. Tori Hudson, ND, is a member of Pharmaca’s Integrative Health Advisory Board and Medical Director of A Woman’s Time Clinic in Portland, Ore.  

The number of women who are affected by hot flashes in the United States is remarkable. About 75 percent of women experience them at some point, and 15 percent are severely affected by them. Hot flashes and nightsweats in perimenopausal and menopausal women are often referred to clinically as vasomotor symptoms.

Hot flashes are the most common symptom associated with the menopausal period and the second most common symptom, next to irregular menses, during the perimenopausal period. We still do not understand the physiology of hot flashes, nor can we project the average age of onset, triggers, duration, frequency, or why they are prominent in some cultures and absent in others.

Hot flashes are sudden, transient episodes that range from simply feeling warm or overheated to intense heat and perspiration. Women tend to describe a wave-like sensation over the body, particularly in the upper torso, face and head. If the hot flashes occur at night, alongside potentially drenching perspiration, we call them night sweats.

The occurrence of hot flashes is highest in the first two years of postmenopause, although information is scarce on the total time over which hot flashes are experienced. Hot flash frequency is variable, and ranges anywhere from several episodes in a year to every hour throughout each day. Women with surgically induced menopause often report particularly persistent, more intense and more frequent hot flashes. One large study determined that for most women, hot flashes last about two years, although some women experience them for 5-10 years. As many as 15 percent of women may still report hot flashes 16 years after menopause.

The clearest explanation for hot flashes is that they appear to be the body’s response to a sudden but transient downward resetting of the body’s thermostat, which is located in the hypothalamus. This temporary alteration of the set point would cause the sensation of intense heat and flushing. What we don’t know is what initially triggers this event.

A logical correlation between low estrogen levels and hot flashes exists. Estrogen levels have been found to be lower in premenopausal women with hot flashes than in those without hot flashes. But there are some contradictions in the low estrogen theory. For example, prior to puberty, girls have low estrogen levels, but not hot flashes. Hot flashes are also reported during pregnancy, when the estrogen level is high. As a result, some researchers believe that hot flashes are due to an imbalance in beta-endorphins and other opiates in the brain that in turn may influence the temperature regulation center. Estrogen and progesterone may alter the activity of these naturally occurring opiates, and it is possible that lower levels of estrogen and progesterone cause a withdrawal of opioids, triggering a hot flash.

Interestingly, not all cultures report the same incidence of hot flashes or other menopausal symptoms. For example, Japanese and Indonesian women report far fewer hot flashes than do women from Western societies. Mayan women in the Yucatan do not report any symptoms at menopause other than menstrual cycle irregularity. Many researchers have attributed these differences to biological, psychological, social and cultural factors.

Keep in mind that there are other causes of hot flashes, including thyroid disease, epilepsy, infection, insulin-producing tumors, pheochromocytoma, carcinoid syndromes, leukemia, pancreatic tumors, autoimmune disorders or allergic disorders.

Natural therapies are very well suited for hot flashes and/or nightsweats, and simple changes and awareness can often make a difference. For example, hot flashes can be aggravated by warm drinks, hot weather, stress, salt, alcohol and spicy foods. Women who have more body fat may have fewer hot flashes than lean women. Increasing the soy foods in the diet may decrease hot flashes. In addition, increasing intake of essential fatty acids–through nuts and seeds especially–can aid in other menopause-related concerns such as reducing calcium loss and improvinge calcium absorption while also being protective against heart disease.

There are also many medicinal plants and dietary supplements that have shown benefits in improving hot flashes and/or nightsweats.

Black cohosh is the most well studied herb for hot flashes, and has been included in more than 100 studies. Although not all studies show benefit, it often shows at least a 50 percent reduction in hot flashes. Black cohosh is also considered safe in breast cancer patients because it does not increase estrogen levels and has actually been able to inhibit breast cancer cells in the test tube.

A combination of black cohosh and St. John’s wort has been able to improve not only hot flashes but menopausal mood changes as well.

A special maca root extract has several studies showing significant benefit in reducing hot flashes.

Kava is a good choice when the hot flashes are occurring alongside anxiety symptoms.

There are also over-the-counter natural progesterone creams that have shown excellent benefits in reducing hot flashes.

Other research has been done on the benefits of red clover, pine bark (pycnogenol), fish oils,  siberian rhubarb, kudzu and at least one combination herbal product (dong quai +licorice + wild yam + burdock + motherwort).

In addition to these natural therapies, numerous prescription hormone replacement therapy medications are available. They come in all sizes, combinations and delivery methods.

One of the areas Pharmaca specializes in is preparing customized doses, combinations and delivery methods according to the patient’s needs. Whether the hormones are synthetic, semi-synthetic or bioidentical (when the hormone is chemically identical to the hormones the body makes), they come with both potential risks but many benefits. To best understand the benefits and risks for you, educate yourself and talk with a practitioner or pharmacist with expertise in menopause.

When searching for symptom relief, there are excellent dietary supplements to utilize for hot flashes in the perimenopause transition and in menopause. Usually, you should feel improvement within one month. If not, consider moving on to another option until you find something that works well for you.

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