“OMG – not another Hot Flash! Will they ever stop? Please – help me make them stop!”
This is the beginning of a very common conversation in my office. Until about 10 years ago, many women used post-menopausal estrogens, which really helped, so this was a less common complaint. Then came the publication of the Women’s Health Initiative in 2003, which pointed out the increased rate of heart attacks, strokes and breast cancer in women who used estrogens. While there are valid criticisms of this study, the fact remains that many women have chosen not to use estrogens – and this has meant lots of hot flashes.
What’s a hot flash? The lack of estrogen causes changes in the brain thermostat within the hypothalamus. Blood vessels in the skin dilate, making the skin feel hot, but resulting in cooling of the body – that’s why hot flashes are accompanied by sweats, and are followed by a chill as the perspiration and radiated heat cause a cooling effect.
Who gets hot flashes? Most women. If you don’t, keep it to yourself – your friends will disown you! Risks factors include: obesity, smoking, lack of excercise, and ethnicity – African-Americans have them worse than Caucasians, and Asians have them the least.
Triggers: Spicy foods, hot temperature, feeling emotional, stress, caffeine, alcohol, tight clothing, and cigarette smoke. For some, a high sugar intake. We like to simply say, “Heat brings on heat.” Frankly, I look at this list and think “What a great Saturday night!” Clearly, avoiding triggers takes a concerted effort to change one’s lifestyle.
In addition to avoiding triggers, what other lifestyle changes can diminish flashes? Keep cool – layer clothing made of natural fibers such as cotton, layer bedding with several light blankets rather than one heavy comforter, open the windows, use air conditioners and ceiling fans. Drink plenty of fluids. Get daily aerobic exercise. Put a gel insert inside your pillowcase. Lose weight. Quit smoking. Avoid/diminish caffeine and alcohol at night. Try slow-breathing exercises such as yoga or tai chi. Acupuncture and hypnosis have demonstrated effectiveness for many.
Non-prescription supplements: many of my patients seek ‘safe and natural’ over the counter products to help with their hot flashes. While many compounds have not been tested, some of the more popular supplements have been evaluated, sadly with disappointing results.
According to the Mayo Clinic: “People often assume that ‘natural’ products cause no harm. However, all supplements have potentially harmful side effects, and supplements can also interact with medications you’re taking for other medical conditions. Always review what you’re taking with your doctor.
Dietary supplements commonly used for menopause symptoms include:
Plant estrogens. Asian women, who consume soy regularly, are less likely to report hot flashes and other menopausal symptoms than are women in other parts of the world. One reason might be related to ingestion of estrogen-like compounds in soy, red clover and many other plants. However, studies giving soy to women with hot flashes have generally found no benefit. [Note: NOT recommended for breast cancer survivors.]
Black cohosh. Black cohosh has been popular among many women with menopausal symptoms. Studies of black cohosh’s effectiveness have had mixed results, and the supplement can be harmful to the liver.
Ginseng. While ginseng may help with mood symptoms and insomnia, it doesn’t appear to reduce hot flashes.
Dong quai. Study results indicate that dong quai isn’t effective for hot flashes. The supplement can increase the effectiveness of blood-thinning medications, which can cause bleeding problems.
Kava. Kava may ease anxiety, but not hot flashes. It can also damage the liver.”
Evening Primrose Oil. Can cause nausea, diarrhea and headache. The one well-controlled study published showed it was no more effective than placebo.
Vitamin E. Lessens hot flashes – by one flash per day. But it also raises the risk of heart failure by 13%. Might increase the death rate in long-term, high-dose users.
Prescription medications – these should be considered when the lifestyle suggestions are not sufficient for you to live your life in a reasonably comfortable manner.
Estrogens. These are highly effective, but as mentioned, may increase the risks of heart attack, stroke and breast cancer. You should discuss your individual health history and risk factors with your physician.
Low-Dose anti-depression medications. This includes Prozac, Sarafem, Lexapro, Paxil, Brisdelle, Effexor, and Pristiq. These are also quite effective. Adverse side effects can include: nausea, change in bowel habits, headaches, decreased libido, etc. Some are contraindicated in women taking Tamoxifen.
Blood pressure medications. Clonidine (Catapres) has been shown to be useful in some studies. Adverse side effects can include: dry mouth, drowsiness, fatigue and constipation. This is a reasonable choice especially for women with hypertension.
Anti-seizure medications. Gabapentin (Neurotin) has also been shown to be effective. Because it is sedating, it’s especially suited for those whose flashes keep them up at night. Adverse side effects can include: fatigue, dizziness, nausea, disorientation, and weight gain.
With so many therapies, please enlist the help of your gynecologist. I try to individualize therapy for each of my patients based on their individual health history, symptoms, and the success of any given therapy.
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