Among the myriad of perimenopausal and menopausal symptoms, hot flashes seem to be among the most troublesome.  This post will address this burning issue (burning, get it?).  Ahem, yes, well what causes hot flashes?

What causes hot flashes is a question that even the experts continue to debate!  Although why hot flashes occur is not fully understood, it is generally agreed it is related to decreasing estrogen in the body.  There are hot flashes and then there are HOT FLASHES.  Some women have just a few and can live with them and some have frequent and severe flashes and are totally incapacitated by them.  Some women may not experience hot flashes at all.   Many women learn to recognize certain things which trigger hot flashes or make them more severe and frequent.  Stress, alcohol, spicy foods, hot foods, warm temperatures are common triggers to hot flashes.  Some medications or cancer treatments may cause hot flashes or make them worse.  Hot flashes may start years before the actual menopause (remember, that is 12 months after the last menstrual period)  and some women may continue having hot flashes ad infinitum!  Experts estimate an average of 6 years of hot flashes. (But I know someone who shall remain nameless who is going on 10 years)

Many women may be able to lessen hot flashes by avoiding triggers mentioned above.  Dressing in layers and keeping homes cooler is a common sense solution.  Slow, controlled deep rhythmic breathing, known as paced respiration, practiced twice a day can decrease hot flashes. Take a slow, deep breath, hold it for a few seconds, and exhale just as slowly. Paced respiration may also help relieve a hot flash when started as the hot flash begins.  Herbs have not been shown in studies to be particularly helpful and may have side effects.  Herbal supplements are not well regulated and some brands may not have very much of the herb in them at all.  Although Black Cohosh has been shown to help some women with hot flashes, long term effects are not known.  It has been associated with irregular uterine bleeding and is not recommended to be used longer than 6 months.

For those women whose hot flashes are disrupting their ability to function, estrogen therapy may be a saving grace.  HT has gotten a bad rap since the Women’s Health Intitiative (WHI) stopped a study of  women on estrogen and progestin therapy (EPT) in 2001 after they had a larger than expected number of cardiovascular complications.  The women in the study who had a history of hysterectomy and were on estrogen therapy (ET) alone, without progestin did not experience these side effects.  Women with a uterus and taking estrogen need progestin to prevent cancer from forming in the lining of the uterus.  Since that time there has been a better understanding about how EPT effects heart and blood vessels in women in different age groups.  There is evidence that women starting EPT in perimenopause or within 5-10 years of reaching menopause do not have the same risks on EPT as women starting at an older age.  It also appears that it is the progestin in combination with the estrogen which may contribute to a slight increase in breast cancer, but only after 5 years of use.  Clinicians and researchers are looking at different ways to give progestin to minimize this risk.  HT is considered by menopause experts to be reasonably safe for many women and can dramatically improve quality of life for those who suffer severe symptoms.  Some women are not good candidates for HT because of health conditions such as a history of blood clots, heart disease or breast cancer.  For those women, relief can sometimes be found in non-hormonal medications such as clonidine, gabipentin or effexor.  Beware of individually compounded bioidentical hormones.  There is no evidence that these are safer or more effective than FDA approved products.

written by Deborah McBain, CNM MSN