Hot flashes experienced by women around the time of menopause are usually described as a sudden onset of a warm feeling in the face, neck, and chest, which can last from a few seconds to several minutes. For some women, they are accompanied by nausea, headache, insomnia, fatigue, perspiration, and/or palpitations, all of which may increase discomfort and anxiety. Some women may feel cold afterward.
When hot flashes are severe, frequent, or occur during the night (known as night sweats), they often disrupt a woman’s quality of life, affecting her sexual, family, social, and work life. Hot flashes are the chief menopause complaint that leads women to seek medical treatment. Some begin experiencing hot flashes when the menstrual cycle is still regular or just becoming irregular — usually just before a period, but the range of patterns varies from woman to woman and for the same woman at different times over her menopausal transition.
Several options are available to relieve hot flashes and improve a woman’s quality of life:
Fix No. 1. Make some lifestyle changes. Some strategies that may help to reduce hot flashes include: weight loss if a woman is overweight, regular physical exercise (at least 30 minutes of aerobic exercise four times a week, but note that exercise can also trigger hot flashes in some women). Try a relaxation technique called rhythmic breathing or paced respiration—taking low, deep, abdominal breaths in through the nose and out through the mouth. Avoid any personal triggers such as smoking, spicy foods, hot foods or beverages, caffeine, and alcohol. Also steer clear of diet pills, saunas, very hot showers, and emotional situations that cause intense stress or anxiety.
Fix No. 2. Keep cool. The idea is to keep your core body temperature low. Turn down the thermostat by using a ceiling fan or air conditioning. Keep a portable fan at work and by the bed. Dress in layers; wear cotton, linen, or rayon, and avoid wool, synthetic clothes, and silk. Stick to open-necked shirts. Wear cotton nightclothes, get a bigger bed if you and your partner are on different “heat planets,” and take a cool shower before bed. Keep ice water at hand to cool down from the inside.
Fix No. 3. Complementary/alternative medicine options. Many women continue to try nonprescription remedies or natural solutions, such as soy foods and isoflavone supplements (from soy or red clover), black cohosh, vitamin E, and acupuncture. No data suggest these remedies are consistently effective. Safety should always be considered, so remember to discuss these with your healthcare provider first.
Fix No. 4. Nonhormonal prescriptions. When women are unable or do not wish to take hormone therapy, “off-label” nonhormonal prescription therapies that are government-approved for other medical conditions have shown some success in improving hot flashes. These drugs must be prescribed and adjusted carefully by your healthcare provider and include gabapentin (used to treat epilepsy and migraine), certain blood pressure medications, and some low-dose antidepressants (paroxetine, fluoxetine, or venlafaxine).
Fix No. 5. Hormone therapy. Menopausal hormone therapy (HT) that is "systemic" (pill, skin patch, topical gel, topical spray) is the most effective option for the relief of hot flashes. We also know that lower hormone doses than used in the 1990s provide good relief of hot flashes. Sometimes birth control pills are prescribed. Although birth control pills contain higher doses of estrogen and progestogen than conventional HT, they are a good option for women who still require contraception or control of irregular periods. These hormone options should be discussed with your healthcare provider.
Note: Some medical conditions can also cause hot flashes, such as thyroid disease, infection, or even cancer. Some drug therapies, such as tamoxifen (for breast cancer), raloxifene (for osteoporosis), and gonadotropin-releasing hormone agonists (for endometriosis) may cause hot flashes. If you have unusual symptoms, consult your healthcare provider to rule out other potential causes of hot flashes.
For more information, visit the North American Menopause Society’s web page.