Have you ever had a hot flash at just the wrong moment? Maybe you are having coffee with your girlfriend and suddenly you burst into a fit of heat and sweat. It can be strange, uncomfortable, and downright embarrassing! Don’t worry, you are not alone! Most women experience hot flashes during perimenopause and menopause; however, knowing this fact does not make the experience any more enjoyable.
About 75 percent of women report perimenopausal symptoms such as hot flashes, according to the North American Menopause Society. For most women, signs of menopause, like the heatwave, will last between six months and two years, but occasionally can stick around for 10+ years. Temps tend to hit record highs during the first two years of perimenopause, and while they are often less frequent during menopause, hot flashes are known to strike women even into their 70s. Many women on hormone therapy find when they stop using their hormones, those dreaded hot flashes reappear. What is a woman to do?
Searching for the most current, trusted information on hot flash remedies, I interviewed Dr. Rebecca Brightman who has been taking care of women in menopause for the past 31 years in practice. Dr. Brightman currently serves as Assistant Clinical Professor of Obstetrics, Gynecology, and Reproductive Sciences at The Icahn School of Medicine at Mount Sinai in New York City. She is a member of the International Society for the Study of Women’s Sexual Health (ISSWSH) and the North American Menopause Society (NAMS). She is brilliant and stunning! (You can find her on Instagram @rebeccabrightMD)
I asked Dr. Brightman to give us a full download on all the latest options to treat these often debilitating heat surges. Here ya go:
Menopausal Hormone Therapy – According to Brightman, this is the most tried and true defense. However, not everyone is a candidate or feels comfortable taking hormones. She further explained that for her postmenopausal patients she often titrates the dosage down as they age.
Antidepressants – There is currently only one FDA approved for hot flashes. It is a low-dose form of paroxetine called (Brisdelle). Brightman does not prescribe these for women who are on Tamoxifen or women with a history of anxiety and depression.
Anti-Anxiety Medications and Mood Stabilizers, also known as selective serotonin or serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs) can be effective. Brightman explained that using the following options for hot flashes would be done, “off label”. “Off-label” means the medication is being used in a manner not specified in the FDA’s approved packaging label or insert. FYI, this is done often.
- Venlafaxine (Effexor XR)
- Paroxetine (Paxil, Pexeva)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Desvenlafaxine (Pristiq)
The following categories of medications are often used “Off Label” for hot flashes:
- Gabapentin – (Neurontin, Gralise, others)
- Pregabalin (Lyrica)
Medications that treat Overactive Bladder
- Oxybutynin (Ditropan XL, Oxytrol)
High Blood Pressure Medications
- Clonidine (Catapres, Kapvay, others)
New Non-Hormonal Drugs
Also, promising is a new group of nonhormonal drugs currently in clinical trials which appear to show strong promise for treating menopausal hot flashes and other symptoms as effectively as hormones, Brightman says. These new drugs targeting the kisspeptin/neurokinin B/dynorphin (KNDy) neuron receptor complex. Stay tuned!
I asked Dr.Brightman about her thoughts on the most talked about herbal supplements: black cohosh, red clover, phytoestrogens, primrose oils, maca, and bee pollen extract.
Her initial response to my questions about the effectiveness of herbal supplements is that many of the herbal supplement companies do not have very robust data. Some supplements can have estrogen properties, some can cause clotting abnormalities or other side effects. There is the added concern that when used in combination with other medications, some herbal products could pose serious health risks. She cautions patients to not use any supplements without approval first of their Menopause Specialist. Her caution is also mirrored by the North American Menopause Society,
“No over-the-counter (OTC) dietary supplement or herbal therapy has been found to be effective on menopause symptoms. If you still want to try a dietary supplement for your hot flashes, you must continue only with the appropriate oversight of your healthcare provider. Because normal FDA regulations for prescription or OTC drugs do not apply to dietary supplements, demonstrating safety is not required before a dietary supplement is put on the market. Although a number of manufacturers do employ rigorous quality-control measures, many products are not monitored for purity or levels of active ingredients.”
There are a few hot flash symptom triggers that can affect the intensity, frequency, and duration that you should know about. Try some of these lifestyle changes to see if they help you:
- Try reducing your caffeine intake, especially before bedtime.
- Alcohol is another trigger, but don’t panic. Not everyone is affected by alcohol. Try reducing your alcohol intake and see if you see a reduction in your hot flash symptoms.
- Just about anything that’s hot (except your lover, of course!): showers, weather, spicy food, and overheated bedrooms are common triggers.
- Yoga, tai chi, and acupuncture help with sleep, mood, stress and may help with hot flashes.
- Keep a hot flash emergency kit – lots of cotton layers, water for hydration, and maybe an ice pack that cracks open when needed.
- Be mindful of your diet! Overweight and obese women who suffer from hot flashes can reduce the severity of their hot flashes if they lose weight through diet or exercise.
This is a lot of information to digest. You are probably wondering how in the world you are going to figure out what course of action is best for you. First and foremost, find a great Menopause Specialist like Dr. Brightman who is up on the latest information and studies! If you don’t have one, here are some helpful tips on how to find one: Menopause Mondays® How To Find A Menopause Specialist.
She did stress that together with these guidelines and an open conversation with her patients a specialist can create an individual health plan just for you. Your quality of life is an important part of that plan!
If you feel like you’re sweating in your own private sauna, do something about those pesky menopause symptoms! Hot flashes may feel like an unstoppable force of nature, but if you make some simple lifestyle switches, chart your symptoms, and reach out to a good Menopause Specialist and discuss the various options above so that you can get the help you deserve!
Remember: Suffering in silence is OUT! Reaching out is IN.
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*EllenDolgen.com does not recommend, endorse, or make any representation about any tests, studies, practices, procedures, treatments, services, opinions, healthcare providers, physicians, or medical institutions that may be mentioned or referenced.