Help for hot flashes and night sweats — causes and natural solutions by Marcy Holmes, NP, Certified Menopause Clinician If you suffer from hot flashes or night sweats, you’re not alone. In fact, 85% of women in the US experience some form of hot flashes during perimenopause and in the year or two following menopause. What’s more is that up to 50% of women continue to experience them for years after menopause. Whether you get them all the time or just once in a while, hot flashes can be extremely disruptive to your life. They’re not only embarrassing and distracting, but can sometimes even be scary. We’ve heard women liken the experience to being trapped in a small room with the heat turned up the highest it’ll go. For many of us, the worst aspect of hot flashes is the sense of powerlessness over our own bodies. It’s true that during perimenopause, menopause, and while weaning off hormone replacement therapy (HRT), your body is going through a major hormonal transition. The good news is that this is a transition Mother Nature fully intends for you to make, and she’s built ample opportunity into the process for you to set the stage for improved health through the transformation. This begins with understanding the triggers for your hot flashes and night sweats and how to support your body more fully. Let’s take a closer look at the underlying causes of hot flashes and Women to Women’s core approach to minimizing them. How do I know it’s a hot flash? The symptoms associated with hot flashes vary from woman to woman. Some women feel hot all the time, while others experience flashes. Here are some physical and psychological symptoms associated with hot flashes and night sweats: • An intense feeling of heat in the face and upper body • Increased heart rate • Dizziness • Nausea • Headache • Perspiration • Weakness • Feeling suffocated • Anxiety • Flushed appearance or blotchy skin • Chills as the hot flash subsides What causes hot flashes? Whether you are suffering from hot flashes due to the natural fluctuation of your hormones during perimenopause and menopause or because of rapidly weaning off HRT, the physiology is very similar. A menopausal hot flash is essentially caused by a mix-up of signals between the brain and the body. As our hormones naturally shift during perimenopause and menopause, some women’s brains receive confused messages from their bodies and hot flashes result. The brain in particular is affected by fluctuations in estrogen that occur against a backdrop of relatively low levels of progesterone. During moments of extreme estrogen flux, the temperature-regulatory part of the hypothalamus misinterprets the message as a signal for elevated core body heat. It responds by sending “release heat” messages to the peripheral body. To release this heat, the body reacts within seconds by increasing its heart rate and dilating vessels to circulate more blood, as well as opening sweat glands. For some women, waves of anxiety wash over them, while others might feel heart palpitations. When it’s all over, the uncomfortable sensations and panic may have passed, but you’re left in a puddle of sweat. The sudden impulse to dispel the body of heat is a built-in mechanism to protect us from overheating in intensely warm situations, as in the throes of exercise, stress, or infection. But when a hot flash overtakes us, we are not truly overheating — the brain just thinks we are. This confusion between body and brain can be mighty uncomfortable, and can increase skin temperature by several degrees. The rash of flushing events and hormonal storms generally subside a couple of years into menopause. But some women continue to experience them well into their menopausal years. And for women trying to taper off HRT after menopause, hot flashes can return as a result of hormone withdrawal and subsequent fluctuation of estrogen. In all cases, the specific triggers for hot flashes and night sweats are as colorful and varied as women are themselves — which is why there is no one-size-fits-all solution. Why only some women suffer hot flashes Just as triggers vary, so do hot flashes in general. In fact, some of our mothers and grandmothers never experienced hot flashes or night sweats at all. Even today, many women in the world make a far calmer and cooler menopausal transition than those of us in the US. The reasons underlying these cultural differences are several-fold. The absence of hot flashes may be the result of a less erratic course of hormonal fluctuation during this stage of life, or because the brain simply doesn’t get its messages mixed up. A transition free of hot flashes may also be a result of better coping mechanisms for stress or having solid measures of support already set in place for the elevated demands placed on the body during this time of change. Although some women get off easier than others, on the whole it seems as though today’s menopausal women are suffering more from hot flashes than in the past. This is likely due to our changing world, stressful lifestyles, and how we support our systems emotionally and nutritionally. Women in midlife today are pulled in many directions — between caring for older and younger generations, full-time jobs, household demands, marital challenges and financial concerns, our plates are full of responsibilities. At the same time, the quality of our food supply and eating patterns are not what they once were. Diets high in refined carbohydrates and processed foods result in less resilience to otherwise normal hormonal changes in the menopausal years. But the good news is, no matter what your health foundation — or how severe your hot flashes and night sweats — your body has an amazing ability to heal when you learn to listen to its messages and take steps to provide it support. Flag your hot flash and night sweat triggers The first step in pulling the plug on your hot flashes is to identify and understand your triggers. Try tracking your hot flashes in a diary, journal. Are there certain times of the day when you are more prone to having a hot flash — or do your night flashes wake you at a particular time of the night? Are there foods that seem to set you off on a heat wave? Here are some of the triggers, including foods to avoid for hot flashes: • Sugar, foods that act like sugar in the system, and simple carbohydrates • Caffeine, nicotine, and stimulants in general • Alcohol (even one glass of red wine!) • Spicy foods and hot (temperature) drinks or foods • Hot places, such as saunas, hot tubs, showers and over warm bedrooms • Anxiety or stressful events or people • Exercise — or any type of activity — that heats the body up without allowing adequate cool-down time While some women see a clear correlation between their hot flashes and triggers, others find it more difficult to make these connections. Once you track your hot flashes for a week or two, you’re very likely to spot patterns in how, where, when and why you get them most. From there, a plan to address the triggers will be easy to develop. Help for hot flashes — Women to Women's three-pronged approach Most of the women we see at our practice and in our Personal Program take pride in their commitment to a natural, personalized approach to healthcare. For them, addressing their health issues by merely filling another prescription doesn’t hold the appeal it might for others. Antidepressant use, a solution conventional medicine is turning to for hot flash relief, is not a standard approach at our clinic. We’ve been practicing safe alternative solutions that effectively address the underlying causes of hot flashes and provide equivalent — if not superior — results for over 20 years. Our core approach to resolving hot flashes is embodied in our Personal Program and includes: 1) dietary and nutritional support; 2) lifestyle modifications; and 3) gentle, natural endocrine support. When help beyond this core approach is needed, women have a variety of additional alternative remedies available to them. But time and again we find that the majority of women — upwards of 85% — experience rapid and marked reduction in their symptoms (including the number-one complaint: hot flashes and night sweats) when using our approach. 1) Diet and nutritional support At Women to Women, experience has shown us that women get amazing results by giving their bodies the nutrition they need. Eating a balanced diet of protein, healthy fats, complex carbohydrates, and fruits and vegetables provides your body and brain with the building materials it needs to function and keeps signals from getting crossed. An easy way to add protein to your diet and help hormonal fluctuations is by eating whole, non-GMO soy foods. Remember that a balanced diet provides building materials to contribute to your hormones and neurotransmitters, both of which affect hot flashes and your overall sense of well-being. Adding a high-grade multi-vitamin-mineral complex and supplemental essential fatty acids like the ones offered in our Personal Program will bridge any gaps in your core nutrition and ensure the adequate supply of micronutrients your body needs for neurotransmitter and hormonal balance. With the proper building materials, you will find the passage through menopause to be a lot less bumpy. What’s more, providing your body with optimal nutritional support during times of hormonal change doesn’t have to be a complicated. For more information on how you can give your body the nutritional balance it needs, see our nutritional and lifestyle guidelines. 2) Lifestyle modifications, exercise, and stress reduction Though the connection may be intuitive to most women, stress is finally being recognized by conventional medicine as a major cause of hot flashes. A recent study done on over 400 menopausal women showed a direct correlation between anxiety and the severity and frequency of their hot flashes. An NIH study also demonstrated that deep paced breathing and relaxation exercises done through the day significantly decrease frequency and severity of flushing symptoms — further supporting the precept of stress as a major trigger. If you know that relaxing is what you most need to calm your hot flashes, you might try a behavioral therapy, such as meditation, the Emotional Freedom Technique, or biofeedback. Many women in our practice have found great success in emotional healing through the Quadrinity Process and stress relief through deep breathing, which can be done without a therapist. These therapies can help you to step back and put your life into perspective. At Women to Women, we feel that physical concerns, such as hot flashes and other menopausal symptoms, are not only physical in their root. Many times our health depends heavily on our emotional state. Just as certain foods and drugs can be toxic to your system, stress and negative emotion can also be toxic. Anger is an emotion that mind–body practitioners relate to problems with the liver (our detox organ), and in turn is often implicated with hot flashes. Learn to identify and channel negative emotions accordingly, and find ways to give yourself more time for relaxation and reenergizing. There is also little doubt that exercise is one of the best things you can do to calm your body and mind. Recent studies indicate that hot flashes are yet another health concern that exercise can help, principally by reducing anxiety. In a small study looking at the effect of exercise on overall menopause symptoms, exercise proved to reduce hot flashes, while those who did not exercise showed an increase in hot flashes. When it comes to exercise, however, we recommend you time your work-outs so they do you the most good. Many forms of exercise raise core body temperature and can thereby trigger hot flashes unless you provide ample cool-down time. So it’s best to avoid dashing off to undertake activities that are stressful or involve a high level of activity directly following your work-outs. Make a commitment to reducing stress, whatever form it takes in your life, even if you have to chip away at it one degree at a time. Whether that means setting better boundaries at work, home, or within your community, learn to value your own well-being enough to say no. Use your inner guidance to seek out and cultivate practices that will calm rather than stimulate your inner thermometer. 3) Gentle bioidentical hormonal support For decades, synthetic and equine forms of estrogens were the hormones of choice for easing hot flashes in menopausal and perimenopausal women. But when the 2002 Women’s Health Initiative results linked their use with higher rates of cancer, heart disease and stroke, conventional forms of oral estrogens and progestins fell rather sharply from grace. At Women to Women, we have supported the use of low-dose bioidentical progesterone and other forms of bioidentical hormones for well over 20 years with tremendous success. Given that bioidentical hormones replicate the very molecular configuration of the hormones produced in our own bodies, it stands to reason that the human body is better equipped to handle and utilize them safely and effectively than synthetic versions. Though there are relatively few US studies to date on bioidentical hormones, those published have been promising and only serve to affirm an intuitive sense that when it comes to hormones, that which is closer to nature is preferable to synthetic versions. We suggest topical application of low-dose bioidentical progesterone cream as the third component of our three-pronged approach, as estrogen is very often not needed in perimenopause (and can be considered later). Using a 2% micronized progesterone cream as you transition from perimenopause to post menopause or off of HRT might be just what your body needs to bring your changing hormonal tides back into balance. Because progesterone is a natural precursor in the body’s steroid pathway to many other hormones, including estrogen, your body can make from it what it needs to buffer erratic fluctuations in times of transition. (To learn more about HRT and bHRT concepts, read our articles on hormone replacement therapy and bioidentical hormones.) What’s next — for women who need extra help While we always recommend starting with the core approach outlined above, there is still a small group — even those who take impeccable care of themselves — who continue to experience hot flashes and night sweats. For these women, there are additional measures that can be combined easily with the health precepts you have already set in place. Without resorting to pharmaceutical products, some additional options for hot flashes include: increasing soy isoflavones to higher doses (the next best step), using black cohosh (Remifemin), trying acupuncture and Traditional Chinese Medicine (TCM), using detoxification or some herbal alternatives we’ll be discussing in the weeks to come. In Traditional Oriental Medicine, hot flashes are said to arise from the liver. As our principal organ of detoxification, the liver is implicated in various ways. We’ve found at our clinic that women often find relief from unremitting hot flashes on the detox supplements known as DIM or Oncoplex (derived from cruciferous vegetables). Milk thistle can also help. Heavy metals in the body can significantly compromise the liver’s ability to detoxify, a functionality that becomes so important in perimenopause and menopause. But as always, we encourage you to work with your healthcare provider to explore the best options for you. For severe hot flashes and menopausal symptoms that persist despite efforts to adopt the above measures, prescription-strength bioidentical HRT remains an option. The key is knowing what to ask your doctor for and continuing the core nutritional and lifestyle measures we’ve discussed. Many women use customized bioidentical HRT formulas from compounding pharmacies. Bioidentical hormones are also available in a selection of conventional pharmaceutical products under brand names, like Climara and Vivelle-Dot estradiol patches, EstroGel topical estradiol gel, Estrasorb topical emulsion, and Prometrium (bioidentical progesterone) capsules. These treatments have undergone standard FDA trials and are shown to have fewer probable risks than conventional equine or synthetic hormone products such as Premarin, Prempro, or Provera. Many conventional doctors are familiar with these products if you ask for them by name. Don’t let hot flashes get the best of you Your body is magnificent in its ability to restore balance — it just needs some help from you. Get to know what causes your hot flashes and use that knowledge to find a solution. You may have to try a few things or a combination approach before identifying what works best for you. Remember that supporting your body through nutritional and hormonal balance is both the key and an ideal starting point. Our Personal Program provides the core foundation of support that can often help reduce hot flashes or help you wean off HRT more comfortably. Our Nurse–Educators offer one-on-one guidance for your unique situation through optional telephone consultations. Whether your hot flashes are minimal or severe, we’re here to help every step of the way. Click here to learn more about the Personal Program or call us toll-free at 1-800-221-1130.