Hot Flashes
Hot flashes are arguably the single symptom of menopause that aggravates women the most. And treating hot flashes is the only use of hormones that does not have a well-proven alternative.
Some women never have hot flashes. Others have mild or infrequent flashes. The worst sufferers experience dozens of hot flashes each day. Severe hot flashes can make it difficult to get a full night's sleep which in turn can affect mood, concentration, and cause other physical problems.
Hormones for Hot Flashes
There are many years of research and clinical experience confirming that hormone therapy is an effective way to treat hot flashes. But recent research has shown that even short-term use for relief of menopause symptoms carries some risk. Although the breast cancer risk associated with taking hormones takes several years to show up in studies, the increased risk of heart disease and stroke emerges within the first year.
We recommend that women who experience troublesome hot flashes try non-hormonal therapies as the first line of treatment. If a woman chooses hormones, we suggest she take lowest dose that alleviates her symptoms for as short a time as possible. Women who have been taking hormones to relieve hot flashes can work with their health care providers to reduce the amount they are taking and find the lowest effective dose. Some women will find that they can taper down to nothing if they've lived past the hot flash stage of menopause which usually lasts between a few months and a few years.
Alternatives to Hormones
Although the research backing up alternative treatments for hot flashes is not as strong as the evidence showing the effectiveness of hormones for this problem, many women find ways to handle hot flashes that don't involve taking hormones. Women who want to try a non-hormonal alternative should remember that what works for one woman may not help another. If one strategy doesn't provide relief, try another.
Dietary strategies. Many women make dietary changes and use natural products to relieve hot flashes. Try avoiding caffeine, chocolate, spicy or hot foods and alcohol which often aggravate hot flashes. Some women have found that eating plant foods which contain natural estrogens (phytoestrogens) is helpful in reducing hot flashes.
Staying cool. Wearing clothes in layers - both during the day and at night - allows you to shed clothes quickly when your internal temperature rises. Make sure that the layer beneath the jacket you wear to work is something you won't mind showing if you need to take your jacket off during a meeting. Sleeping nude helps to dissipate the heat of night sweats, and several layers of light bedclothes can make it easier to cool off. Keeping a portable battery-powered fan with you can also help you cool down when a hot flash strikes.
Paced breathing. Two studies have found that slow, deep breathing reduced the frequency of hot flashes. In one study, this paced respiration decreased hot flashes by 39 percent and in the other by 44 percent. By comparison in this research, progressive muscle relaxation was not effective in relieving hot flashes.
Herbs. Some women get relief from hot flashes by taking black cohosh, but the studies assessing its effectiveness for this use have been contradictory. There are no published human studies on long-term safety of black cohosh in which it has been taken for longer than six months. We recommend that women who try black cohosh for treatment of hot flashes do not continue use beyond six months. There's been a small amount of research on dong quai, evening primrose oil, and red clover for alleviating hot flashes, and none of the studies have found significant effectiveness. Sage is also reputed to help hot flashes and night sweats, but it should not be used because it may cause seizures and other neurological problems.
Natural hormones. Estriol is a weak estrogen that can be used in high doses to treat hot flashes, but there is no evidence that it is safer than other forms of estrogen that have been shown to increase the risk of endometrial cancer and possibly breast cancer as well. There's also evidence to show that natural or micronized progesterone, often marketed in a cream, is effective in helping hot flashes.
Non-hormonal drugs. Venlafaxine, an antidepressant, and clonidine, a high blood pressure treatment, are two non-hormonal drugs that can relieve hot flashes. Neither drug has been evaluated and approved by the Food and Drug Administration for this use.
Source:
The Truth About Hormone Replacement Therapy: How to Break Free from the Medical Myths of Menopause, by the National Women's Health Network, Prima Publishing, 2002.
Resources
A Friend Indeed, a newsletter that provides information and support to women in menopause and midlife. AFI, Main Floor-419 Graham Avenue, Winnipeg, MB R3C OM3, http://www.afriendindeed.ca
Created: 2003