The hot flash is perhaps the most notorious and widely recognized announcement that menopause is underway. For reasons doctors don’t fully understand, fluctuating estrogen levels interfere with your body’s vasomotor regulation. Technically known as thermoregulatory dysfunction, a hot flash represents a momentary malfunction of your body’s cooling mechanisms.

Dropping estrogen levels fool your body into acting as though it has become seriously overheated. It really hasn’t, of course, although you suddenly feel very hot. But your vasomotor regulation process has already misinterpreted the signals, and its response is in full swing. The first line of reaction is dilation of the blood vessels near your skin’s surface. Blood rushes into these vessels, causing your skin to flush. Because the blood is now closer to the outside, it cools. Then stage two hits: profuse sweating. Evaporating perspiration cools the skin, carrying away the heat brought to its surface.

Vasomotor regulation is the process by which the body maintains a stable temperature. Thermoregulatory dysfunction is the technical term for the hot flashes and chills that often occur during menopause.

Your body temperature hasn’t really changed, so all this cooling is for naught. Sometimes the result is that as soon as the hot flash passes, you feel chilled. Hot flashes can last a brief 30 seconds or a seemingly eternal 2 to 3 minutes. The more drastic a woman’s estrogen levels drop, the more severe her hot flashes tend to be. Women who enter menopause suddenly, such as those who have hysterectomies with the removal of ovaries, are often the most unfortunate in this regard. For more than half of the women who experience them, however, hot flashes are less extreme. Indeed, many women jokingly refer to them as power surges!

Coping with Hot Flashes

For most women, hot flashes occur over a three- to five-year period of time when estrogen levels are most volatile. With rare exceptions, hot flashes end when menopause is complete. Whether you choose to put up with the inconvenience, try natural remedies, or seek medical treatment, you can take some basic steps to minimize the intrusion that hot flashes make into your life and everyday activities.

  • Avoid potential trigger foods that can set off or intensify hot flashes. These include spicy foods, caffeine, and alcohol.
  • Wear clothing made from natural fabrics. These items breathe, allowing heat and moisture to escape. They also absorb moisture when you perspire.
  • Sleep on natural-fiber sheets. Put two sheets on your mattress, so you can peel one off if nighttime hot flashes cause enough sweating to dampen the sheet.
  • Eat smaller, more frequent meals of nutritious foods to keep your blood insulin and sugar balance stable. There appears to be a correlation between insulin and estrogen.
  • Let the little things go. Stress keeps your body in a state of alertness, which intensifies any experience it has. Reducing stress lets your body relax.

Medical Treatments

From a medical perspective, a single word summarizes the most effective treatment for hot flashes: estrogen. Not every woman who experiences hot flashes may need or desire estrogen replacement. For those who do, the typical choices are birth control pills (if premenopausal) or hormone replacement therapy (HRT). Natural micronized progesterone pills or vaginal cream can also help with hot flashes, and some women get relief from vitamin E supplements. Which is medically appropriate for you depends on your personal circumstances. These may include your age, how your hot flashes affect you, and whether you have a personal or family history of breast or uterine cancer. The chapters in Part 4, “hormone replacement therapy or No HRT (hormone replacement therapy), That Is the Question,” provide a comprehensive discussion of estrogen replacement.

Certain medications prescribed to treat depression appear to also reduce the frequency and severity of hot flashes, and your doctor might prescribe them to do so. These medications, such as Zoloft and Prozac, work by increasing the brain’s serotonin levels. This seems to enhance the body’s ability to produce estrogen, alleviating some of the signs of menopause.

Natural Remedies

A number of herbal remedies on the market claim to relieve hot flashes and other signs of menopause. Some work well for some women, especially those whose hot flashes are less severe. Natural remedies tend not to be as effective when estrogen fluctuations are dramatic, such as in surgical menopause. Foods containing soy have high amounts of substances called isoflavones. Isoflavones are phytoestrogens, estrogen hormones that come from plant sources. Isoflavones also lower blood cholesterol levels. Good sources of soy-based isoflavones are tofu, soy milk, soybeans, soynuts, and tempeh. Don’t expect to get much relief from soy sauce, miso, or most soy burgers, though. These products are highly processed and retain very little in the way of isoflavones.

Herbal remedies are becoming increasingly popular. Many women experience relief from substances such as dong quai (a Chinese herb) and black cohosh (used by early Native Americans). These and other herbal remedies can interact with other medications you might be taking, though, so always check with your doctor before taking them. Post, “Soy, Herbs, and Other Botanicals: Nature’s Menopause Miracles,” discusses herbal and other natural remedies.

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