There you are, sitting quietly and minding your own business when rather suddenly, you feel the heat. Your body reacts by flushing red, especially around the face and neck. Then the sweat starts pouring off you. That’s right: you are experiencing a hot flash.
About 80 percent of women report experiencing hot flashes during and after menopause; it’s not a pretty story. These experiences range from mild to severe and can come at any time of day or night. There are options for treating hot flashes, but treatment is not mandatory. No matter how disruptive and frustrating hot flashes may be, they are not a sign of a medical problem. They are a normal response to natural hormonal changes in your body.
Hot flashes are the result of lower levels of estrogen in the body. While the biochemical mechanisms are not well understood, we do know estrogen helps regulate body temperature. In fact, it is during the two years following menopause that hot flashes are most likely as that is when estrogen levels have bottomed out.
The frustration and discomfort of hot flashes mean many women opt to treat the symptoms. The first response, naturally, is what we all do when it gets hot: turn on the fan or crank up the air conditioner, lose some clothing and drink cold beverages. But that may not be enough. The most common and effective treatment for hot flashes is estrogen therapy. One study showed that ultra-low doses of estrogen and a synthetic form of progesterone significantly reduced hot flashes. Because of the potential risks associated with hormone replacement therapy (higher risk of blood clots, stroke, heart disease, breast and ovarian cancer) it is very important to take the lowest effective dose for the shortest possible duration.
For someone who chooses not to use estrogen therapy, or for severe cases, there are other options. While none are as effective, they do offer some help. For example, a number of drugs aimed at other conditions have provided some success in reducing hot flashes. These include Clonidine (for hypertension) and gabapentin (epilepsy and shingles pain). In one study, gabapentin reduced hot flashes by 51 percent versus only 26 percent by a placebo.
Isoflavone supplements provide plant-based, estrogen-like compounds often derived from soy or red clover. It is believed to have low to moderate success in reducing frequency of hot flashes, but there is also a marked placebo effect that shows up. Similarly, Black Cohosh, an herb, has shown slim evidence of usefulness. There is also concern for liver damage when taking Black Cohosh.
Some may turn to acupuncture and here, again, there is evidence it can help. Studies have also shown that “sham acupuncture” can give good results, too, suggesting a placebo effect.
Treating hot flashes is not required, but it may be desired. The choice of estrogen therapy will make the most difference, yet may not be the right choice for every woman. Choosing alternate therapies is one option. And whether the alternative treatment works inherently, or is simply ‘fooling’ you into feeling better via a placebo effect, does it really matter? Either way, the treatment has worked.
Editor’s note: Dr. Paul Martiquet is the medical health officer for rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.
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