Hot Flash Guide - Ellen Dolgen
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Hot Flash Guide

Have you ever had a hot flash at just the wrong moment? Maybe you’re having coffee with your girlfriend, and all of a sudden, 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 flash symptoms 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  Menopause Society. For most women, signs of menopause, like the heat wave, 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.

The Science of Hot Flashes

As we enter our 40’s and 50’s (sometimes even our late 30’s), levels of estrogen take a veritable nosedive. This reduction is believed to affect your hypothalamus, an area at the base of your brain that regulates body temperature. Basically, a lack of estrogen tells your brain that you’re overheated, causing your heart to pump faster, the blood vessels in your skin to swell, and your sweat glands to spew out so much sweat you look like you just left a Bikram yoga class. Every woman will experience different perimenopause and menopause symptoms.  If you learn to recognize how hot flashes affect you personally will be a great start toward finding relief.

Some hot flash symptoms are a sudden rush of heat – so hot that your face may actually become flushed – that may quickly subside. Others can be an all-day sweat session of intense perspiration. Some women have hot flash symptoms only in their upper body, while others, like me, experience them in their lower body. Some women experience hot flash symptoms daily, while others go weeks at a time without one or only experience them at night (usually referred to as night sweats). These can keep you up later at night than your restless teenage son on a caffeine binge.

Thankfully, these sweaty episodes typically decrease over time as you go through the perimenopause stage and into postmenopause. Still, there are a few hot flash symptom triggers that can affect the intensity, frequency, and duration that you should know about.

What’s a gal to do?  Here are your options:

  • Try reducing your caffeine intake, especially before bedtime.
  • Alcohol is another trigger – but don’t panic. Not everyone is affected by alcohol (so we’re not giving up cocktail hour, right?!)
  • Just about anything hot (except your lover, of course!): showers, weather, spicy food, and overheated bedrooms are common triggers.
  • The more refined sugar menopausal women consume, the more hot flashes they endure.
  • Now is as good a time as any to quit smoking! Smokers are more likely to have menopausal hot flash symptoms than nonsmokers, so get rid of that pack of cigs, and you may enjoy fewer hot flashes (and better overall health)
  • Hot flashes go skipping hand-in-hand with stress and anxiety, according to a six-year study in Menopause. In the study, the most stressed women were five times (I repeat, five times!) more likely than normally stressed ones to report hot flashes. Try meditation and/or yoga.
  • Speak to your Menopause Specialist about hormone therapy (HT). According to all research, this is a tried and true defense against hot flashes.  Base your decision on facts instead of fear.  Learn more about HT here.
  • There is one FDA-approved antidepressant for hot flashes. It is a low-dose form of paroxetine called Brisdelle.
  • Various selective serotonin reuptake inhibitors (SSRIs) have been approved for the treatment of hot flashes. SSRIs are antidepressants that affect the brain’s use of a neurotransmitter chemical called serotonin.
  • There are various medications often used “Off Label,” such as anti-seizure medications, medications that treat overactive bladder, and high blood pressure medications.
  • There is a new non-hormonal medication called VEOZAH (Fezolinetant) approved on May 12, 2023. It has a different mechanism of action for treating moderate to severe hot flashes. It targets the root cause, which is in the hypothalamus in the brain.  The hypothalamus is responsible for regulating body temperature. Veozah is supposed to block the neurokinin B (NKB) in our temperature control center to help reduce the number and intensity of hot flashes and night sweats. (Fingers crossed!)
  • Elinzanetant is an oral, dual neurokinin receptor antagonist currently in phase 3 trials. Stay tuned.
  • Herbal remedies such as black cohosh, red clover, phytoestrogens, primrose oils, maca, and bee pollen extract are available. It is important to note that some herbal supplement companies do not have very robust data on the effectiveness of herbal supplements. Menopause Society states, “No over-the-counter dietary supplement or herbal remedy has been found to be effective on menopause symptoms. Some supplements have estrogen properties, and some can cause clotting abnormalities or other side effects.   Do not use any supplements without the approval first of your Menopause Specialist.
  • Studies show that a low vegan diet with a 1/2 cup of soybeans a day can diminish hot flashes.  Learn more here: MENOPAUSE MONDAYS® Blog: Can Eating a Vegan Diet Diminish Your Hot Flashes?

If you’re sweating in your 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 for the help you deserve, you can chill out those hot flashes in no time!

Suffering in silence is OUT! Reaching out is IN!

Whether you flash, flush, or sweat, it doesn’t mean you should suffer in silence. Recognizing your own hot flash symptoms is the first step to feeling better. It may take some time to figure out what works best for you to alleviate them, but trust me, it’s worth the effort.


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