What can you do about hot flashes?

Internal Medicine World Report, October 2007, Volume 0, Issue 0

During menopause, your body produces fewer natural hormones than it did in your youth. This is why your period stops, hence the word "menopause." This change in hormones is also the reason that many women get many symptoms common during menopause, although no one really understands why some do and some don't.

As many women know, hormone replacement therapy (also known as HRT) used to be the best treatment until a few years ago. In 2002, there was a lot of media publicity about a study referred to as the "Women's Health Initiative" (or just "the WHI"), which showed that using HRT to treat menopausal or postmenopausal symptoms was associated with more health risks than benefits.

Some of the risks were very serious, like cancer, stroke, and heart disease. This scared a lot of women away from treatments that were very effective at relieving the symptoms of hot flashes or vaginal dryness that many women get just before and after they reach menopause.

In the years since the results of the WHI study were first published, researchers have continued to study the results from the WHI study more closely, and realized that many of the hormone therapies could be used safely, if they are taken in small amounts"--"what physicians refer to as "low doses""--"and for a short period of time.

What Are the Symptoms of Menopause?

The most common symptom during menopause is "hot flashes," which can include different things for different women:

  • Redness of the face, upper neck, and upper body (called "flushing")
  • Sweating, including night-sweating; many women complain of waking up from sweating during sleep
  • Short periods in which your upper body and face feel warm or very hot, sometimes followed by chills.

Vaginal dryness is another common symptom of menopause. This can cause irritation and itching, and pain during intercourse (called "dyspareunia"). Vaginal dryness is usually treated with a vaginal cream that contains low doses of a type of estrogen called estradiol.

What Can I Do If I Get Hot Flashes?

Many women find that they can prevent hot flashes from happening or make them go away by just changing their lifestyle. Some of the things that really seem to help are getting more exercise, and losing weight if you're overweight.

You can also try avoiding "triggers"—the things that seem to cause hot flashes or make them worse, for example:

  • Warm or hot places
  • Alcohol (including beer, wine, and hard liquor)
  • Beverages with caffeine (including coffee, tea, and some soft drinks).

Deep, slow breathing and other relaxation techniques may also be helpful.

But for some women, these things don't work. If you still have intense hot flashes that wake you up from sleep during the night and then interfere with your life at work and at home, you may need some form of treatment.

Do Vitamins and Herbs Work?

There have been hundreds of studies on what is often referred to as alternative or natural therapies for hot flashes. But keep in mind that more research is needed before we know for sure what really works and what doesn't for hot flashes or for other symptoms. Here's what the researchers say today:

  • Soy foods and isoflavone supplements (from soy or red clover): Maybe they work, and maybe they don't. You'd have to eat these foods or take these supplements for several weeks to find out if they are going to help you. If you decide to try the isoflavone supplements, do not take more than 40 to 80 mg in one day.
  • Black cohosh: It may offer some relief if your hot flashes are not too severe. The usual daily dose is two 20-mg tablets of a 27-deoxyactein standardized preparation (check the label on the bottle).
  • Vitamin E: Again, it may work, and it may not. You'll have to take it for several weeks to find out. It usually comes in doses of 200 or 400 IU. It is safe to take up to 800 IU in one day. Higher doses are not recommended and may not be safe for you.

Which Hormone Treatments Are Safe?

Basically, treatments that contain a low dose of hormones (estrogen alone, or combined with progestin) are safe, if you use them for the shortest possible time that they are needed. You must consult with your physician to see if hormones are safe for you. Some women, especially those who have high risk for breast cancer, should not be using these hormones.

Women who have had a hysterectomy (their uterus was removed) can use almost any of these low-dose hormone treatments. But women who have not had this operation should use a treatment that has some form of estrogen plus some form of progestin. If a woman who has not had her uterus removed takes only estrogen, it can increase her risk of getting endometrial cancer. Adding progestin to estrogen helps avoid this risk.

And you should see your gynecologist every year if you're taking the combined hormones, to check for endometrial cancer.

Are Hormones Available in Forms Other than Pills?

In addition to pills, there are now 3 hormonal gels and 1 hormonal lotion that you can just rub on your body once a day.

There are also lots of patches that you stick onto your skin, which need to be replaced either every week or twice a week, depending on the exact one you're using.

There is also a "ring" that your doctor places inside your vagina, which works for 3 months.

The patches and the ring have the added advantage of treating symptoms of vaginal dryness in addition to hot flashes. Most of the patches also help protect against postmenopausal bone loss (osteoporosis) that increases your risk of breaking a bone.

Talk to Your Doctor

Although they are not as effective as hormones, other prescription drugs can be helpful. These agents include some antidepressants (called SSRIs and SNRIs) and the drugs clonidine (Catapres) and gabapentin (Neurontin).

Ask your doctor if one of these medications might be right for you.

Your doctor is the person who knows what is safe for you and what is not. Ask about any or all of these options. Don't order any of these treatments online unless you ask your doctor first. Your doctor will have to prescribe the treatment that is best for you.