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Menopause: Managing Hot Flashes
Most women experience hot flashes at some point before or after menopause, when their estrogen levels are declining. While some women have few to no hot flashes, others have them numerous times each day. If hot flashes are disrupting your sleep or daily life, you are no doubt looking for relief. Fortunately, you have a number of self-care and medical treatment options that can help you manage your symptoms.
- No matter how disruptive and frustrating they may be, hot flashes are not a sign of a medical problem. They are a normal response to natural hormonal changes in your body. Hot flashes usually subside after the first or second year following menopause, when estrogen levels stabilize at a low level.
- Tobacco use, heavy alcohol use, and stress tend to make hot flashes worse. By avoiding these risk factors, exercising regularly, and eating well, you can prevent or reduce hot flashes.
- The body-mind connection is a powerful element of hot flashes and emotional symptoms. Rhythmic breathing exercises (paced respiration), which help you meditate and relax, may reduce your hot flashes.
- Treatments that may either reduce or stop moderate to severe hot flashes include short-term, low-dose estrogen (hormone therapy), certain antidepressant and blood pressure medicines, and the herb black cohosh.
You can manage hot flashes by making certain lifestyle choices. You can also take daily medicine. Some measures help prevent or reduce hot flashes, and others can make you more comfortable when you're having a hot flash. If you are looking for additional treatment measures, you have a few options to choose from.
Lifestyle choices for preventing or reducing hot flashes
Eat and drink well, and avoid smoking.
- Limit your intake of alcohol.
- Drink cold beverages rather than hot ones.
- Eat smaller, more frequent meals to avoid the heat generated by digesting large amounts of food.
- Make healthy eating a priority.
- Do not smoke or use other forms of tobacco.
- Keep your environment cool, or use a fan.
- Dress in layers, so you can remove clothes as needed.
- Wear natural fabrics, such as cotton and silk.
- Sleep with fewer blankets.
- Get regular physical exercise.
- Use relaxation techniques, such as breathing exercises, yoga, or biofeedback. Using a breathing-for-relaxation exercise called paced respiration may reduce hot flashes and emotional symptoms.
Medical treatment options for hot flashes
- Short-term, low-dose hormone therapy (HT) can reduce or stop hot flashes and other perimenopausal symptoms by raising your body's estrogen level. Use the lowest dose needed for the shortest possible time and have regular checkups. This is because HT may increase the risk of blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia in a small number of women. Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.1 If you have a history of cardiovascular disease or breast cancer, avoid using estrogen for hot-flash relief—other options are available.
- Estrogen-progestin birth control pills (before menopause) can reduce or stop hot flashes and other perimenopausal symptoms by evening out fluctuating hormones. Don't use estrogen for hot-flash relief if you are older than 35 and smoke; have diabetes, cardiovascular disease, or breast cancer; or have a family history of breast cancer.
- Antidepressant medicine can reduce the number and severity of hot flashes by improving the brain's use of serotonin, which helps regulate body temperature. Side effects are possible. This type of medicine is a good choice if hot flashes, irritability, or mood swings are your only perimenopausal symptom.2
- Clonidine may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent.3 This type of medicine is a good choice if hot flashes are your only perimenopausal symptom, especially if you have high blood pressure.
- Gabapentin, an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes.2
- Black cohosh may reduce or prevent hot flashes, depression, and anxiety. As with HT, have regular checkups when taking black cohosh.
- Some women eat and drink a lot of soy to even out hot flashes and other perimenopausal symptoms. So far, studies have used many different soy sources and different measures of success, which are hard for experts to compare. Soy isoflavone (rather than soy protein) studies have shown the most promise for hot flash treatment.4
- North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257–271. Also available online: http://www.menopause.org/PSht12.pdf.
- Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.
- Burbos N, Morris EP (2011). Menopausal symptoms, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- North American Menopause Society (2011). The role of soy isoflavones in menopausal health: Report of the North American Menopause Society. Menopause, 18(7): 732–753.
Other Works Consulted
- U.S. Preventive Services Task Force 2012. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf12/menohrt/menohrtfinalrs.pdf.
Last Revised: January 17, 2013
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