Are you experiencing a menopausal internal heat wave? If so, you’re not alone.
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.
Here is my definition of a hot flash: When your estrogen levels begin to decrease, they can trigger your body’s thermostat to signal that you are overheated. This causes your body to send out an all-hands-on-deck alert: your heart pumps faster, the blood vessels in your skin dilate to circulate more blood to radiate heat, and your sweat glands release sweat to cool you even more. Your body cools down when it otherwise wouldn’t, and you are left feeling miserable: soaking wet in the middle of a board meeting like me or in the middle of a good night’s sleep. If you have had your ovaries surgically removed and suddenly enter menopause, you can suffer severe hot flashes that start right after surgery. Regardless of how and when you begin flashing, these hot flashes can result in interruption of daily activities, difficulty sleeping, anxiety, feeling out of control or helpless, and a lack of intimacy. Oh, joy!
What is a woman to do?
Here are the latest treatment options for these often-debilitating heat surges:
Menopausal Hormone Therapy – According to all research, this is the most tried and true defense for hot flashes.
Antidepressants – There is currently only one FDA-approved for hot flashes. It is a low-dose form of paroxetine called (Brisdelle).
Anti-Anxiety Medications and Mood Stabilizers, also known as selective serotonin or serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs), can be effective. Many menopause specialists prescribe the following options for hot flashes, “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 are also medications 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 Drug
The FDA just approved VEOZAHTM (Fezolinetant) on May 12, 2023!!! Veozah is not a hormone. It has a different mechanism of action for treating moderate to severe VMS by targeting the root cause of hot flashes and night sweats where they begin, which is in the hypothalamus in the brain. The hypothalamus is responsible for regulating body temperature.
There is a balance in our brain between estrogen (a hormone made by our ovaries) and neurokinin B (NKB), a brain chemical. Our body relies on this balance to keep our internal thermostat in check. During menopause, our estrogen and NKB become unbalanced, and this causes our hypothalamus to tell our body that it’s hot when it is not. Veozah is supposed to block the NKB in our temperature control center to help reduce the number and intensity of hot flashes.
You may have heard of black cohosh, red clover, phytoestrogens, primrose oils, maca, and bee pollen extract.
We still do not have any robust data on the effectiveness of herbal supplements. Some supplements have estrogen properties, and 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. Patients are cautioned not to use any supplements without the approval first of their menopause specialist.
According to 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.”
- 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 flashes.
- Just about anything 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, and 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 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.
If you are 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 simple lifestyle changes, chart your symptoms, reach out to a good menopause specialist, and discuss the options above, you can get the help you deserve!
Your quality of life is an important part of that plan!
Remember: Suffering in silence is OUT! Reaching out is IN.
If you want to educate your employees, colleagues, or friends about menopause, look no further! Book Ellen for your next event.
Sign up for Menopause Mondays® Hot News Flashes.
Be sure to follow me on Instagram @menopause_mondays.
*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.