Hot Flashes

What are hot flashes?

A sudden flare of heat, sweating and discomfort: Hot flashes are a common and uncomfortable vasomotor symptom of menopause. There are many symptoms that you might experience during menopause (the transitional phase when your menstrual cycle stops), ranging from vaginal dryness and urinary urgency to insomnia and mood swings. But, for many people, hot flashes are one of the most frequent symptoms of menopause.

Hot flashes can be different for everyone. Some people might not really notice hot flashes, while others may have hot flashes that disrupt normal daily life. Not only can the severity of hot flashes vary, but the length of time you have hot flashes can be different for each person.

The reason hot flashes happen isn’t really clear. However, there are ways to manage them and improve your life during this time of transition.

At what age do hot flashes start?

Hot flashes are a symptom of menopause that can happen as you go through this transitional phase of life. On average, menopause happens in your late 40s to early 50s. This can vary depending on each person.

Do hot flashes go away after menopause?

Just like many other aspects of hot flashes, the length of time they last can vary from person to person. You might only experience hot flashes for a little while during menopause, but not the entire time. Your hot flashes could end once you’re post-menopausal. In other cases, they could last for the rest of your life. Hot flashes that last a long period of time often become less severe as time goes on.

What does a hot flash feel like?

Even though different people might experience them slightly differently, hot flashes usually feel like a brief sensation of heat throughout your body. When you have a hot flash, you might become flush and start sweating. After the heat, you might feel chilled.

Hot flashes not only feel different for each person, they can also last for different amounts of time and vary in severity. What might be a short inconvenience for one person could be intense heat for another.

What can trigger a hot flash?

A trigger is something that can set off a hot flash. There are actually a lot of things in your normal life that could trigger a hot flash. Triggers of hot flashes can include:

• Hot weather.
• Heat.
• Smoking.
• Caffeine.
• Alcohol.
• Spicy foods.
• Tight clothing.
• Stress.

Avoiding things that trigger your hot flashes can often mean watching what you eat. Spicy foods, caffeine and alcohol are just a few things that can cause you to experience hot flashes.

Hot flashes can also be triggered by heat. You might experience more hot flashes when the weather is hot or even when you get overheated by an activity. Be careful when you’re working out to make sure you don’t get too hot as this could lead to a hot flash.

How do I treat a hot flash?

Hot flashes may seem like an inevitable symptom of menopause that you just need to deal with. But there are treatment options to improve your hot flashes. If you have hot flashes, particularly hot flashes that disrupt your daily life, reach out to your healthcare provider to learn more about your treatment options.

In general, there are two categories of treatment options for hot flashes: prescription medications and over-the-counter (non-prescription) therapies. Some prescription medications are used as off-label treatments to help reduce hot flashes. Using a product “off label” means that it’s not FDA-approved for the treatment of hot flashes, but is often used because it can be safe and effective as a treatment option.

It’s important to talk to your healthcare provider about any treatment option and discuss the pros and cons. Your provider is aware of your medical history and other medications. Some treatment options may not be safe to take with your other medications or other medical conditions.

Prescription medications are typically considered to be more effective than over-the-counter treatments. These medications can include:

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) boosts your hormone levels and can relieve some of the symptoms of menopause. Your provider will consider whether your uterus is in place or has been removed when prescribing hormone replacement therapy. They’ll prescribe:

• Estrogen and progesterone, if you still have your uterus.
• Estrogen, if you’ve had surgery to remove your uterus (hysterectomy).

Non-hormonal medications

Certain antidepressants, called selective serotonin reuptake inhibitors (SSRIs), can reduce how often you have hot flashes and how bad they are. These medications include:

• Venlafaxine (Effexor®): This medication has been proven to be effective in several well-designed studies. Some common side effects of this medication include nausea, changes in bowel habits, headaches (temporary side effect for most) and elevated blood pressure (at high doses).
• Desvenlafaxine (Pristiq®): This is a newer medication than venlafaxine, so there are fewer studies available. Common side effects include nausea, changes in bowel habits, headache (temporary side effect for most people) and elevated blood pressure (at high doses).
• Fluoxetine (Prozac®): This medication improves hot flashes. Some side effects include nausea, changes in bowel habits, decreased sex drive and insomnia. This medication should be avoided if you’re taking tamoxifen.
• Paroxetine (Paxil®, Brisdelle®): This medication has been FDA-approved to treat hot flashes. Common side effects include nausea, changes in bowel habits, decreased sex drive, dry mouth and weight gain (not common). You should avoid taking this medication if you’re taking tamoxifen.
• Escitalopram (Lexapro®): If you’re also experiencing insomnia with hot flashes, this medication tends to be more effective for sleep. Common side effects can include nausea, changes in bowel habits, decreased sex drive and an abnormal EKG (this is not common).
• Gabapentin (Neurontin®): This medication tends to be effective for sleep in people with hot flashes who also have insomnia. Common side effects include fatigue, dizziness, nausea, disorientation, swelling and weight gain.
• Clonidine (Catapres®): This medication relieved hot flashes in some people. Healthcare providers use it less frequently than other options. Common side effects can include dry mouth, drowsiness, fatigue, constipation and low blood pressure.

Over-the-counter therapies

Non-prescription, herbal and over-the-counter therapies are another treatment option for hot flashes. These therapies can include:

• Evening primrose oil: There’s only one well-designed study for this treatment option, and it shows that this therapy isn’t effective. Common side effects can include nausea, diarrhea and headache.
• Black cohosh: Some small, short-term studies have suggested benefits with this therapy, but most studies don't show that it works. A common side effect is mild stomach upset. It’s safe for up to six months only due to possible estrogen-like effects. Liver toxicity has also been reported.
• Soy (plant estrogen): This treatment option is also referred to as phytoestrogens. For the most part, results from clinical studies show that phytoestrogens aren’t effective for treatment of hot flashes. This is generally safe when you consume it in foods. In supplements, consistency of dose and quality can be a concern. Supplements are not recommended for breast cancer survivors.
• Acupuncture: Individual trials have reported some benefits of acupuncture, but larger studies haven’t shown any improvement over placebo procedures. Some people do report benefits with acupuncture, so it’s possible that more well-designed studies are needed to determine just how effective this treatment option is. This option is uncomfortable for some and often costly. It’s generally well-tolerated, but it can require multiple appointments.
• Vitamin E: One study showed that this treatment option was effective. However, the improvement seen in this was only one less hot flash per day compared to placebo. Side effects include a 13% increased risk of heart failure. It might also increase the death rate in those who use high doses for a long time. A higher risk of prostate cancer has also been shown, but this applies only to people designated male at birth (DMAB).

Are over-the-counter herbal products (botanicals) safe to use when treating hot flashes?

While consuming small amounts of soy isoflavones is generally safe in your diet, adding them through supplements may be harmful to people with a history of estrogen-dependent cancer, like breast cancer, and possibly to other people as well. More research is needed to determine the safety and effectiveness of botanical treatments. For example, ginseng, dong quai, wild yam, progesterone cream, reflexology and magnetic devices are sold to help menopausal symptoms, but there are no good studies demonstrating their safety or how well they work. The best thing to do is talk to your healthcare provider before you start any new supplement or treatment for your hot flashes.

How do I know if a product to treat hot flashes is safe or legitimate?

In general, it’s always a good idea to talk to your healthcare provider before starting a new medication or supplement. Sometimes, a product might seem safe on the surface, but it might not be a good option for you when you factor in other medications you take or other medical conditions you might have. Your provider will discuss each of these factors with you and make sure it’s a safe product for you.

Ask yourself a few simple questions when you’re considering a new treatment for hot flashes:

• What’s the treatment?
• What does it involve?
• How does it work?
• Why does it work?
• Are there any risks?
• What are the side effects?
• Is it effective (ask for evidence or proof)?
• How much does it cost?

Also, when you’re trying to determine whether or not a product is what it says it is, consider how it’s being promoted. Advertising can give you clues about the product. Be cautious of products that are promoted through:

• Telemarketers.
• Direct mailings.
• Infomercials.
• Ads disguised as valid news articles.
• Ads in the back of the magazines.

Additional red flags to look for can include:

• Big claims: If products claim to be a "cure" for your condition or give outrageous claims, be cautious.
• Source: Be wary if the product is only offered through one manufacturer or purchased only through a healthcare provider’s office.
• Ingredients: Make sure all of the active ingredients are listed and don’t trust "secret formulas."
• Testimonials: Remember that only people who are satisfied with a product give testimonials and that they may be getting paid for their endorsement.

The best and safest thing to do is talk to your healthcare provider before starting any new product for your hot flashes.

Are there any lifestyle changes I can make to help with hot flashes?

Making small changes to your normal lifestyle can sometimes help limit the number and severity of your hot flashes. Dressing in layers, reducing the temperature in your home, using a fan and drinking cold beverages can all be small ways to help with hot flashes. If you have obesity, you might have more bothersome hot flashes. Maintaining a healthy body weight may be helpful. Another lifestyle change that can help improve your hot flashes is not smoking or using tobacco products. Smoking contributes to the increased cardiovascular risks of being postmenopausal. People who smoke and/or use tobacco products also tend to experience more hot flashes.

Exercise is another lifestyle change that often helps menopausal people. This is not only a great way to maintain a healthy weight, but people who lead sedentary lives seem to experience more hot flashes. Just remember to watch the temperature when you work out. Getting overheated can trigger a hot flash, so it’s best to try and exercise in a cooler environment.

Are there foods that can help with my hot flashes?

Many people try to add more plant estrogen into their diets to combat the hormonal changes that go along with menopause. The thought is that adding plant estrogens can help with your hot flashes. Plant estrogens, such as isoflavones, are thought to have weak estrogen-like effects that might reduce hot flashes.

Examples of foods with isoflavones include:

• Soybeans.
• Chickpeas.
• Lentils.
• Flaxseed.
• Grains.
• Beans.
• Fruits.
• Red clover.
• Vegetables.

In general, soybeans, chickpeas and lentils are considered to have the most powerful plant estrogens. Keep in mind though, the effects of these foods won’t be as strong as human estrogen.

Try working natural foods into your diet rather than supplements. Also, remember that only crushed or ground forms of flaxseed are likely to help as compared to the whole seed or seed oil forms.

What foods have high amounts of isoflavones?

Certain foods have higher amounts of isoflavones than others. These foods include:

How do I cope with mood swings, fears and depression?

Many people experience a wide variety of symptoms during menopause, not just hot flashes. Mood swings, depression, anxiety and fears are all possible symptoms you might experience throughout menopause. It’s alright if you have these symptoms. Menopause is a time of extreme change and transition for your body. If you feel overwhelmed by any of these symptoms at any point, reach out to your healthcare provider. There are ways to help you feel better.

There are also a few ways you can cope with mood swings, depression and fear during menopause at home. These things include:

• Finding a self-calming skill to practice, like yoga, meditation or slow, deep breathing exercises.
• Avoiding tranquilizers, if possible.
• Engaging in creative outlets (hobbies) that foster a sense of achievement.
• Staying connected with your family, friends and community.

Another symptom of menopause that you might experience is painful intercourse. If you find that sex is uncomfortable or painful, there are things you can do to make it better. Try using a vaginal water-based moisturizing lotion or lubricant during intercourse. These are sold without a prescription. Common names include Astroglide® and KY liquid®. It’s recommended that you avoid Vaseline® as a lubricant because it could lead to yeast infections.

Can I prevent hot flashes at night (night sweats)?

Hot flashes can also interfere with your sleep. You might hear this referred to as night sweats or even insomnia. There are a few environmental and lifestyle changes you can make that can help you sleep better each night. These changes include:

• Keep your bedroom cool to prevent night sweats.
• Avoid using sleeping pills.
• Exercise daily.
• Avoid caffeine and alcohol at night.
• Take a warm bath or shower at bedtime.
• Try milk products at bedtime or during the night (but avoid products that contain caffeine).