Nonhormonal Therapies For Hot Flashes In Menopause
DANA G. CARROLL, PHARM.D., B.C.P.S., University of OklahomaTulsa College of Medicine, Tulsa, Oklahoma
Am Fam Physician. 2006 Feb 1 73:457-464.
Numerous reports in the medical literature and popular media have discussed the effectiveness of various nonhormonal agents in reducing menopausal hot flash symptoms. Data for these therapies are limited, and most of the studies have been conducted in women with a history of breast cancer. Selective serotonin reuptake inhibitors and venlafaxine have been shown to reduce hot flashes by 19 to 60 percent and were well tolerated by study participants. Soy isoflavones reduced hot flashes by 9 to 40 percent in some trials, but most trials showed no difference compared with placebo. Black cohosh and red clover also have had inconsistent results, with some trials showing benefit and some no difference compared with placebo. Soy isoflavones, black cohosh, and red clover were well tolerated in clinical trials. Other agents that have been used to alleviate hot flashes include belladonna/ergotamine tartrate/phenobarbital combination, dong quai, evening primrose oil, gabapentin, ginseng, mirtazapine, trazodone, vitamin E, and wild yam, but few data regarding their effectiveness have been published. Further randomized controlled trials are needed.
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Black cohosh may be effective for short-term treatment of hot flashes.
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Sociocultural Issues In Measuring Hot Flashes
Hot flashes occur worldwide, and starting in the 1970s, research documenting such occurrence increased substantially. A wide distribution of the prevalence of hot flashes around the globe continues to be examined, with reports, particularly in Asian countries, of prevalence less than that in the US and other Western countries . Interest in understanding these differences has raised questions about whether these differences are due to genetic, cultural, environmental, or lifestyle factors such as diet and exercise.
Research in Japan has provided particular insight. Japanese women have a high dietary intake of soy and it was hypothesized that this might explain why they have fewer hot flashes than women in the US, Canada, and Europe. Basic science research has established that isoflavones have estrogen-like activity . Interest in the relationship between the soy consumption of different populations and hot flash prevalence led to epidemiological studies comparing level of dietary soy intake and frequency of hot flashes in countries such as Japan, where an inverse association between soy intake and hot flashes has been demonstrated . Clinical studies of soy foods and soy isoflavones to treat hot flashes proliferated, with mixed results, although there was a tendency toward a beneficial effect .
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Physiological Changes During A Hot Flash
Thermography provides a visual snapshot of the skin surface manifestation of the pattern of thermoregulatory changes during a hot flash and provides insights into underlying physiological changes . One can see the skin areas that warm during the hot flash and cool as the hot flash subsides.
graphically illustrates some of the primary physiological changes that occur during a hot flash . Sensation is a subjective rating of the sense of hot flash intensity on a scale of 010 . At the onset of a hot flash, there is a sudden increase in sweating. Heart rate increases anywhere from 5 to 25 beats/min. Cutaneous vasodilation occurs and blood flow to the skin increases, evident in an increase in finger skin temperature. With the sudden and rapid increase in heat loss , internal body temperature drops. The forehead temperature also cools given the sweating and subsequent evaporative cooling that occurs. These physiological phenomena can be reliably measured in the laboratory . These are labor-intensive studies and are not appropriate for clinical trials of various hot flash treatments that involve ambulatory, free living individuals. For this purpose, portable monitors that record changes in sweating, as measured by changes in the electrical conductivity of the skin , are used to correlate subjective reports of hot flash occurrence with this objective physiological change.
Perimenopause Symptoms And Signs
Perimenopause describes the time period when a woman is approaching menopause. During this time is when symptoms and signs begin. Examples include, weight gain, vaginal dryness, mood changes, painful sex, and hot flashes.
The complex hormonal changes that accompany the aging process, in particular the declining levels of estrogen as a woman approaches menopause, are thought to be the underlying cause of hot flashes. A disorder in thermoregulation is responsible for the heat sensation, but the exact way in which the changing hormone levels affect thermoregulation is not fully understood.
Hot flashes are considered to be a characteristic symptom of the menopausal transition. They also occur in men and in circumstances other than the perimenopause in women as a result of certain uncommon medical conditions that affect the process of thermoregulation. For example, the carcinoid syndrome, which results from a type of endocrine tumor that secretes large amounts of the hormone serotonin can cause hot flashes. Hot flashes can also develop as a side effect of some medications and sometimes occur with severe infections or cancers that may be associated with fevers and/or night sweats.
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Causes Of Hot Flushes
Hot flushes usually affect women who are approaching the menopause and are thought to be caused by changes in your hormone levels affecting your body’s temperature control.
They can happen without warning throughout the day and night, but can also be triggered by:
- eating spicy foods
- some health conditions, such as an overactive thyroid, diabetes and tuberculosis
Hot Flushes And Sweats
Hot flushes and sweats are the most common symptoms of the menopause and can affect three out of every four menopausal women*. Characterised by sudden feelings of heat which seem to come from nowhere and spread upwards through the body, the chest, neck and face, hot flushes and sweats are probably caused by changes in hormone levels which affect the bodys temperature control. Women talked about their experiences of hot flushes and sweats, the effect on their life, and what they did to relieve the symptoms.Hot flushesSome women we talked with had either not had flushes at all, had noticed just occasional mild feelings of warmth lasting seconds, or had simply not been bothered by them. Others, however, had more intense hot flushes which happened throughout the day and night, lasting several minutes or longer and accompanied by sweating, dizziness, light-headedness and heart palpitations. One woman said she had about twenty hot flushes a day another flushed every ten minutes throughout the day .
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Supplements And Complementary Therapies
Some women try supplements and complementary remedies to ease their menopause symptoms. Its important to note that supplements come in many different preparations and their quality, purity and safety varies. There is some evidence that a few of them might have a benefit, but for others, the science is still unclear.
Some women claim that acupuncture or relaxation techniques help them with menopausal symptoms, but there is little evidence to support their use. Speak to your GP before trying a supplement or remedy, as some can interact with other medications you might be taking.
What Are The Risks Of Using Hormones For Hot Flashes
In 2002, a study that was part of the Women’s Health Initiative , funded by the National Institutes of Health, was stopped early because participants who received a certain kind of estrogen with progesterone were found to have a significantly higher risk of stroke, heart attacks, breast cancer, dementia, urinary incontinence, and gallbladder disease.
This study raised significant concerns at the time and left many women wary of using hormones.
However, research reported since then found that younger women may be at less risk and have more potential benefits than was suggested by the WHI study. The negative effects of the WHI hormone treatments mostly affected women who were over age 60 and post-menopausal. Newer versions of treatments developed since 2002 may reduce the risks of using hormones for women experiencing the menopausal transition, but studies are needed to evaluate the long-term safety of these newer treatments.
If you use hormone therapy, it should be at the lowest dose, for the shortest period of time it remains effective, and in consultation with a doctor. Talk with your doctor about your medical and family history and any concerns or questions about taking hormones.
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The Symptoms Of Menopause
There is no one single symptom thats commonly seen in all women as everyone has a different menopause experience. Some women have very few symptoms, while others have issues that affect their daily lives. Symptoms are usually the most troublesome during perimenopause and can include:
- Mild warm flashes or hot flashes with profuse sweating.
- Poor sleep quality.
- Anxiety, mild mood swings, flares of depression
- Brain fogginess.
- Body changes, including weight gain and
- Fat redistribution to the abdominal area, also known as the âmenopouch, and vaginal dryness and pain with sex
- Certain changes should be monitored, including rapid loss of bone and the development of atherosclerotic plaques in vessels and coronary arteries.
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Utilize Supplements And Herbs
Many people use black cohosh, a large plant from the buttercup family, to reduce hot flashes, although little evidence exists as to how effective it actually is. Still, some swear that black cohosh root provides effective relief from these and other symptoms of menopause, including headaches, heart palpitations, and anxiety.
According to the North American Menopause Society, despite the lack of definitive evidence, “it would seem that black cohosh is a safe, herbal medicine.” Some other herbs with anecdotal evidence of helping hot flashes include red clover, dong quai, and evening primrose oil.
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Soy And Other Plant Sources For Menopause Symptoms
Isoflavones are chemical compounds found in soy and other plants that are phytoestrogens, or plant-derived estrogens. They have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been determined to be much lower than true estrogens.
Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined.
There is also a perception among many women that plant estrogens are “natural” and therefore safer than hormone therapy, but this has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.
Adverse Effects And Dosage
Most of the studies reported transient, dose-related adverse effects. The most common adverse effects reported were insomnia or excitement, nausea, constipation, and anorexia.2,5,7 In the trials using venlafaxine for hot flashes there were no reported increases in blood pressure, which is a dose-related adverse effect commonly associated with this agent.6,8
The dosage and duration of these medications most appropriate in alleviating hot flashes is unknown however, regimens using low to moderate dosages seem to be as effective as those using high dosages and have significantly fewer reported adverse effects. Therefore, when using an SSRI or venlafaxine to treat hot flashes, it is prudent to initiate the medication at a low dosage and titrate to effect.
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Watch This Before Drinking Green Tea While Pregnant
Even though it’s safe, pregnant women should pay attention to the amount of green tea they drink, right? The reason is, although not as much as coffee, green tea still contains caffeine which, if consumed in excess, risks causing a number of health problems, including premature birth and low birth weight babies. Caffeine also has a diuretic effect that can trigger urine output. If it is not balanced with the consumption of water in sufficient quantities, this can increase the risk of pregnant women experiencing fluid deficiency to dehydration. In addition, consuming excessive amounts of tea, including green tea, can also decrease the absorption of iron and folic acid. Folic acid is one of the important nutrients needed for fetal development and plays a role in preventing neural tube defects or spina bifida.
Therefore, if pregnant women still want to drink green tea while pregnant, limit their intake and should not exceed three cups a day, okay? In addition, also limit the consumption of other foods and drinks that contain caffeine, such as coffee, chocolate, or soft drinks.
To reduce caffeine levels in green tea, pregnant women can apply the following green tea brewing tips:
- Brew the green tea bag for about 30 seconds.
- Discard the first brewed water.
- Brew the previously used green tea bag.
- Green tea is ready to serve and enjoy.
When To See Your Doctor
While hot flashes are common during menopause, some people get them intensely and often. In some cases, hot flashes are disruptive to a persons life and can greatly affect their well-being.
If your hot flashes are interfering with your day-to-day life or preventing you from getting a good nights sleep, talk to your doctor. There are some treatments that you might be able to try that can help control hot flashes.
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What Are Hot Flashes
Hot flashes, as mentioned earlier, can occur during all three stages of menopause perimenopause, menopause, and postmenopause.
They are defined by a sudden heightening of body temperature, which can be coupled with redness of the face, neck, and chest.
Some women sweat so profusely during hot flashes that they need to change their clothes, while others do not experience any sweating at all. Sometimes, after a lot of sweat has been released, cold chills will follow as a result of the body trying to cool itself down. Hot flashes normally occur very quickly and can arise out of nowhere.
Although cannabis may be able to help with hot flashes, removing layers of clothing when you feel a hot flash coming on, keeping a fan close by, and avoid certain triggers , all can also assist with minimizing hot flashes. With hot flashes, it is important to create a containment system that works best for you so that they are not as frustrating to manage when the time comes.
How To Prevent Hot Flashes From Taking Over Your Life
If you find that youre regularly struggling with hot flashes, its important to check in with a doctor to try to figure out whats going on. If lack of estrogen is the cause, your doctor will likely prescribe something to help increase the levels of the hormone in your body, like an estrogen supplement or antidepressant, Dr. Bohn says.
Other than that, you can try your best to wear light, loose clothes to bed, keep your house cool, and drink plenty of water, Dr. Wider says.
Theres only so much you can do to stop hot flashes altogether, but taking these steps should help limit how much you experienceand how severe they end up being.
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How To Stop Hot Flushes
- See your doctor to make sure there is no underlying medical condition causing your hot flushes, particularly if youâre also suffering from symptoms such as fatigue, weakness, weight loss or diarrhoea
- Check the listed side effects of all of your current medication. If hot flushes are listed as a side effect then discuss your prescription with your doctor. There may be a suitable alternative, or changing timing or dosage might help
- Keep a food diary. This will help you identify whether certain foods or ingredients are triggers
- Track when you have a hot flush. Write down where you were and what you were doing. This might reveal patterns or environmental factors that are causing them
- Make time for yourself. Scientists have identified a link between hot flushes and stress
- Exercise regularly
What Can You Do
Stay cool. At night, a “chill pillow” filled with water or other cooling material might help. Use fans during the day. Wear lightweight, looser-fitting clothes made with natural fibers such as cotton.
Try deep, slow abdominal breathing . Practice deep breathing for 15 minutes in the morning, 15 minutes in the evening, and when a hot flash starts.
Plant estrogens, found in soy products, may have weak estrogen-like effects that could cut hot flashes. Doctors recommend you get your soy from foods like tofu and edamame rather than supplements. Some studies suggest black cohosh may be helpful for 6 months or less. Botanicals and herbs may have side effects or change how other medications work, so ask your doctor first.
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Cancer And Cancer Treatment
Hot flushes are sometimes a lesser-known symptom of breast cancer, leukaemia, lymphoma or carcinoid syndrome . But hot flushes can also be caused by cancer treatment too, including chemotherapy and tamoxifen .
Seven out of ten women whoâve undergone treatment for breast cancer experience hot flushes.
How Long Do Hot Flushes Last
A hot flush can occur at any time of the day. It usually lasts several minutes, but on average they last around four minutes. You may have them a couple of a times of week or up to every hour. Hot flushes that happen at night are known as night sweats. You may carry on getting them for several years after your periods stop.
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