Hot Flashes 101: An Owner's Manual

Unless you have a prostate, chances are you’re dealing with hot flashes as they’re one of the most common symptoms of the menopausal transition. Here’s help handling the heat.

By Karen Asp
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Contrary to popular belief, hot flashes start well before menopause, usually in your 40s, and they tend to be worse early in the transition. “Hot flashes signal that your body is changing and menopause is on the way,” says Susan D. Reed, M.D., M.P.H., professor and vice chair of OBGYN and program director of the Women’s Reproductive Research Program at the University of Washington in Seattle. (Note: Menopause begins at age 51 on average, according to the North American Menopause Society.)

What are the Symptoms of Hot Flashes?

Hot flashes (called night sweats when you get them while you sleep — or are trying to anyway) include numerous symptoms like sudden feelings of warmth and redness, sweating, palpitations, and anxiety. And while they generally last an average of four years, they can linger into your 60s. The bad news? “Around 10 percent of women will have bothersome hot flashes until they die,” Reed says. 

Happily, there’s a larger cohort of women — about 20 percent — who will either get no or minimal hot flashes. And the severity of hot flashes among the women who get them will differ. Twenty percent of women will have severe hot flashes, while the remaining 60 percent will have moderate ones, says Mary Jane Minkin, M.D., clinical professor of obstetrics at Yale University in New Haven, Conn. 

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Why do we get Hot Flashes?

Experts are still trying to understand why we get hot flashes, and while they don’t know the exact mechanisms, there are some obvious culprits, starting with your brain. “When your brain senses that you’re not making as much estrogen anymore, it tells your ovaries to work harder,” Reed says. Trouble is, your reproductive center is located next to your hypothalamus, which controls your body’s temperature, and when the reproductive center goes into overdrive, it sends an accidental spray of estrogen into the hypothalamus. As a result, your thermoregulatory center gets turned on, giving you an increased feeling of warmth and, for some, a chill that follows. 

While this process happens in almost every woman, not every woman responds the same, hence the range of reactions to hot flashes. Often, where you fall on that spectrum depends on your physiology and your response to pain, Reed says.

Other variables can also affect the severity of a hot flash. For starters, heavier women tend to have worse hot flashes than average weight women. “With hot flashes, your body’s trying to dissipate heat to cool you, and when you’re heavy, extra insulation means you can’t get rid of that excess heat,” Minkin says. Hot flashes are also more severe in smokers than non-smokers, perhaps because of nicotine’s effect on the blood vessels. (Smokers, by the way, go into menopause one to two years earlier than non-smokers.) And for reasons that aren’t known, African-American women suffer more severe hot flashes.

When your brain senses that you’re not making as much estrogen anymore, it tells your ovaries to work harder. Trouble is, your reproductive center is located next to your hypothalamus, which controls your body’s temperature.

Susan D. Reed, M.D., M.P.H., professor and vice chair of OBGYN and program director of the Women’s Reproductive Research Program at the University of Washington in Seattle

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How to Treat Hot Flashes

Lifestyle changes can help manage hot flashes. Losing weight (if necessary) and quitting smoking are good starting points. Then, prioritize getting good sleep, which can be challenging, given that women in this stage of life are highly susceptible to difficulties sleeping. “If you don’t sleep well, which can impact your mood, you won’t tolerate hot flashes as well,” Reed says. Her studies, by the way, show that cognitive behavioral therapy can improve sleep symptoms related to menopause. At night, keep your room cool and consider buying a fan for under your sheets, which you can find online. And avoid common triggers for hot flashes, which include sitting in a hot room, eating spicy foods, drinking alcohol (it may help you fall asleep, but a few hours later, you’ll be up and flashing, Minkin says), and stress, Reed says. 

Yoga and acupuncture may even help. Although the jury is still out on whether they’re effective for hot flashes specifically, they have been proven to be good for your overall health and because they can’t harm you, they may be worth trying, Minkin says. 

Eating more soy may also prove useful. Asian women, after all, have fewer hot flashes than other populations, and it may be related to their higher soy diet, Minkin says. Yet there’s a catch: For your body to process soy, it has to produce something called equol, which up to 50 percent of Asian women naturally do. Yet only about 20 percent of Caucasian women have this ability, which may mean that soy is ineffective for some, Reed says. If you do want to see if soy will help your hot flashes, you need to eat about 75 grams a day. (Women with estrogen-positive breast cancer should consult their doctor before adding soy to their diets.) 

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Natural Remedies for Hot Flashes

Should you prefer to continue exploring the natural route, two herbal remedies said to help hot flashes include Remifemin, a German product made with black cohosh, and Relizen, a pollen extract from Sweden, Minkin says. Although Relizen is a newer product and hasn’t been around as long to study, both have science behind them to support their benefits for hot flashes.  

And if you’ve tried all of the above and nothing is working? Ask your physician about hormone therapy. While you might worry about its safety, “there are numerous estrogen preparations that are safe and effective,” Minkin says, adding that estrogen is the most effective drug for hot flashes. If you’re worried about hormones, or can’t take them, you can opt for non-hormonal therapies like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Although both are used for depression, they’re often given in lower doses to ease hot flashes, Minkin says. Another drug called Gabapentin, originally approved for seizures, can help fight hot flashes. And while not yet on the market, there’s another class of drugs called neurokinin 3 receptor antagonists that have proven effective against hot flashes. These neurokinin drugs seem to have almost the same efficacy as estrogen on hot flashes but are indicated for women with estrogen-positive breast cancer. Minkin hopes they’ll be available in the next year or two. 

The bottom line: “There’s something for everybody having hot flashes, so talk with your health-care provider,” Reed says. Just make sure you’re working with somebody who’s been trained in menopause management. Visit menopause.org to find names. 

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