Hot flashes — Discover remedies for hot flashes, an uncomfortable symptom of menopause.
You're sitting in a meeting when you feel it happening. Your forehead dampens with perspiration, and your face flushes bright red. As the familiar wave of heat creeps through your body, you self-consciously glance around the room and wonder if anyone else notices. And you brace yourself for what's becoming an all-too-common and uncomfortable occurrence: You're having a hot flash.
Hot flashes can occur at any time — in the middle of the night or in the middle of the produce aisle at the grocery store. And they're common. More than half of all women experience hot flashes during menopause.
For some women, lifestyle changes are enough to bring hot flashes under control. For others, medicines or dietary supplements seem to help. Learn more about what you can do to manage your hot flashes, as well as benefits and drawbacks to some common remedies.
What are hot flashes?
When you're having a hot flash, you might experience:
- A feeling of mild warmth to intense heat spreading through your upper body and to your face
- A flushed appearance with red, blotchy skin on your face, neck and upper chest
- A rapid heartbeat
- Perspiration
- A chilled feeling as the hot flash subsides
Hot flashes can last from 30 seconds to as long as 30 minutes, but most subside within a few minutes. The frequency of hot flashes varies. You may have them every hour or have them only occasionally. Nighttime hot flashes — or night sweats — can wake you from a sound sleep. During menopause, some women experience hot flashes for a year or more.
For mild hot flashes: Start with diet and lifestyle changes
If your hot flashes are mild — you have just a few a day and they don't interfere with your normal activities — you may be able to manage them with lifestyle adjustments. For example:
- Keep cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove clothing when you feel too warm. Open a window or use a fan or air conditioner to keep air flowing through a room. If you feel a hot flash coming on, sip a cold drink.
- Get active. Daily exercise is important during the menopausal years. If you aren't already exercising regularly, now is the time to increase your physical activity and add regular aerobic exercise. With your doctor's OK, try brisk walking — or a similarly vigorous exercise — for 30 minutes or more on most days of the week.
- Watch what you eat and drink. Hot and spicy foods, caffeinated beverages and alcohol can trigger hot flashes. Avoid any foods or drinks that increase your hot flashes.
- Relax. Some women find relief through meditation, relaxation exercises, stress-reduction techniques or yoga. Even if these approaches don't quell your hot flashes, they may provide other benefits — such as easing the sleep disturbances that tend to occur with menopause.
- Practice paced respiration. 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.
- Don't smoke. Smoking is linked to increased hot flashes. By not smoking, you may reduce hot flashes as well as your risk of many serious health conditions, such as heart disease, stroke and cancer.
Some pilot studies have suggested that acupuncture may ease hot flashes. But in a 2006 Mayo Clinic trial, medical acupuncture was no more effective than sham, or mock, acupuncture.
What about dietary supplements?
Evidence is mixed regarding the effectiveness of dietary supplements for easing menopausal hot flashes. Anecdotal reports suggest that some women find relief from nonprescription remedies — such as black cohosh, soy, red clover or vitamin E — but most clinical trials haven't found them to be any better than a placebo.
- Black cohosh. Black cohosh — an herb used extensively in Europe for treating hot flashes — has become increasingly popular among women with menopausal symptoms in the United States, but few scientific studies prove its benefit. The North American Menopause Society supports short-term use of black cohosh for treating menopausal symptoms, since it seems to have a low risk of side effects when used for less than six months. The exact effects of longer term use aren't known, but studies are under way.
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Soy and red clover. Soy and red clover are two common sources of isoflavones — plant-derived, estrogen-like compounds that have weak effects similar to your body's own estrogen. Scientists have observed that women who have an abundance of soy in their diet — such as women in Asian countries — are less likely to report hot flashes and other bothersome menopausal symptoms. This has led to studies to evaluate more specifically what effect soy products might have on menopausal symptoms.
Although some women find that adding isoflavones to their daily diet helps control hot flashes, clinical trials have yielded unimpressive results. In general, researchers have observed only a modest decrease, if any, in hot flashes for women who regularly consume soy products or isoflavone supplements.
Because of the estrogen-like behavior of isoflavones, there's some concern that isoflavone supplements increase cancer risk. If you've had breast cancer, talk to your doctor before supplementing your diet with isoflavone pills or red clover. Experts generally consider whole foods containing soy or isoflavones to be safe when consumed in moderation.
- Vitamin E. Vitamin E — ingested in doses up to 400 international units (IU) daily — provides relief from mild hot flashes for some women. However, scientific studies haven't proved its overall benefit in relieving hot flashes, and more recent reports have questioned its safety for cardiovascular health when taken in higher doses long term.
You may have heard of — or even tried — other dietary supplements, such as dong quai, licorice, chasteberry, evening primrose oil and wild yam (natural progesterone cream). Although some women swear by these remedies, scientific evidence of their safety and effectiveness is lacking.
It's also important to consider herbal supplements with a dose of caution. Just because manufacturers claim their products are natural doesn't mean they're safe. All supplements have potentially harmful side effects — and supplements may interact with medication you're taking for other medical conditions. Always review what you're taking with your doctor.
For moderate to severe hot flashes: Prescription medication options
If you experience at least seven or eight hot flashes in an average day and diet and lifestyle changes aren't helping, your doctor may recommend a prescription medication.
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Estrogen therapy. Estrogen therapy is the most effective treatment for hot flashes. Because estrogen therapy is associated with potentially significant health risks — including blood clots, cardiovascular disease, stroke and a slight increase in the risk of breast cancer when estrogen is taken along with progesterone — it's recommended in the lowest effective dose for the shortest amount of time needed to relieve symptoms.
The risks of estrogen for women early in menopause may differ from those for older women. The risks may vary based on the type, dose and combination of estrogen and progesterone as well. If you experience moderate to severe hot flashes and you haven't had blood-clotting problems, breast cancer or ovarian cancer, estrogen therapy may be an option for you. Your doctor can help you weigh the pros and cons.
- Progesterone therapy. As an alternative to estrogen, some doctors occasionally prescribe progesterone alone to control hot flashes. One such medication is megestrol acetate, a hormonal treatment used in the past for breast cancer that also helps reduce hot flashes.
If the risks of estrogen or progesterone therapy outweigh the benefits for you, your doctor may suggest a medication originally developed to treat depression, seizures or high blood pressure. Although the Food and Drug Administration (FDA) hasn't approved any of these medications to treat hot flashes, some women find them helpful.
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Antidepressants. Low doses of certain antidepressants may decrease hot flashes. Venlafaxine (Effexor XR) is one such medication. Antidepressants from a class of medications known as selective serotonin reuptake inhibitors (SSRIs) — including paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa) and others — have been found to relieve hot flashes in some small clinical trials.
Many doctors now consider these antidepressants the treatment of choice if you can't — or choose not to — take hormone therapy. However, these medications aren't as effective as hormone therapy for severe hot flashes and may cause unwanted side effects, such as nausea, dizziness or sexual dysfunction. Talk with your doctor about whether the benefits outweigh the potential side effects for you.
- Gabapentin. Gabapentin (Neurontin) is a medication approved for treating seizures and pain associated with shingles. It's also increasingly used to treat various other types of pain. Some studies have found that gabapentin also is moderately effective in reducing hot flashes. It's sometimes prescribed for menopausal hot flashes when other treatments don't work or aren't an option. Side effects can include drowsiness, dizziness, nausea, imbalance when walking and leg swelling.
- Clonidine. Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes. Side effects such as dizziness, drowsiness, dry mouth and constipation are common, sometimes limiting the medication's usefulness.
Re-evaluate your options regularly
Menopause is a natural transition. If hot flashes don't interfere with your normal activities, you may decide that treatment isn't necessary. If you choose to take medication or a supplement to help ease your symptoms, periodically re-evaluate your need for continuing it. For most women, hot flashes fade over time — making medication or supplements unnecessary.
Last Updated: 06/29/2006
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