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“Is it hot in here – or is it just me?”

Friday, June 12th, 2009

If you’ve ever gotten a hot flash, you know how odd it can feel. Usually, hot flashes don’t have a major impact on a woman’s life but some women suffer more than others. About 80 percent of women experience hot flashes and night sweats, which are short bursts of intense heat of the face and neck. Usually they begin in the early years of the transition to menopause and peak one or two years after the last menstrual period, remain for several years and then resolve over a period of time. I’ve had patients come in to see me feeling downright miserable due to pre-menopausal and menopausal symptoms. Some complain of waking up dripping wet at 2:00 a.m. with night sweats or feeling like tiny bugs are crawling all over them.

These symptoms will pass as your hormone levels adjust but what do you do in the meantime? Other than buying a small hand fan, there’s no single answer. Treatment has to be individualized for each woman. Avoidance of triggers, such as cigarette smoking, hot beverages, foods containing nitrites or sulphites, spicy foods and alcohol, may  help limit hot flashes. Blood pressure medications have been prescribed off-label with some success. SSRIs (selective serotonin reuptake inhibitors) such as Prozac® and Zoloft® or antidepressants such as Effexor® (venlafaxine) also offer relief.  Oral estrogens or transdermal estrogen patches have been found to be very effective in reducing the incidence and the intensity of hot flashes.  However, if estrogen is used, unless you have had a hysterectomy, an additional hormone, progesterone, must be added to the estrogen in order to decrease your risk of developing uterine cancer.  Relaxation techniques, such as deep slow breathing, may also help with hot flashes.

Some women think first of herbal remedies such as dong quai, evening primrose oil or red clover. However, I discourage my patients from using herbs as they’re often ineffective. Soy (a phytoestrogen or plant estrogen) has been touted as a remedy for hot flashes.  However, there is no conclusive evidence  for its benefit and there are no long-term safety studies. If you are convinced that you want to go the herbal route, I strongly urge you to discuss these remedies with your doctor beforehand. Don’t assume that because you get it over the counter, it’s safe. Herbs are not regulated through government health agencies and can have potent unintended effects, and may interfere with other medications or cause harmful interactions.

– Yvonne S. Thornton, MD, MPH