Hot flashes, or vasomotor flushes, are characterized by the feeling of heat and sweating, particularly around the head and neck. They are the most common menopausal symptom, affecting anywhere from 50 to 85 percent of women at some point during their climacteric years. Mainstream medicine considers hot flashes to be a result of declining estrogen levels at menopause. Indeed, hot flashes are seen in women with low estrogen; however, women with high estrogen levels or fluctuating estrogen levels also experience hot flashes. It is not uncommon for women to experience hot flashes during pregnancy, and also premenstrually.
Hot flashes often start just before or during the menstrual period during perimenopause. While hot flashes tend to go away a year or two after menopause, many women experience hot flashes post-menopausally. Depending on the intensity of a hot flash, some women may get accompanying headaches or feel dizzy, tired, weak, or lose sleep. Others experience heart palpitations or erratic heart beats. Many women flush, sweat and then become chilled afterward.
Night sweats are on a continuum with hot flashes. In Traditional Chinese Medicine, 3:00–4:00 A.M. is the most common time for night sweats, which may cause you to awaken, drenched with sweat. Solutions are the same as for hot flashes.
What Causes Hot Flashes?
Hot flashes occur when blood vessels in the skin of the head and neck open more widely than usual, allowing more blood to shift into the area, creating heat and redness. Researchers believe that this vascular shift is due to changes in neurotransmitter activity that are not full understood, occurring in response to erratic hormone levels.
Women with low progesterone but normal estrogen levels may experience hot flashes and night sweats. Other hormones may also play a role in causing hot flashes. Hot flashes also occur with low testosterone levels (even in men), high FSH (follicle stimulating hormone), surges of LH (luteinizing hormone), increased cortisol, increased stress hormones and low beta–endorphin levels. Even low levels of antioxidants in the body can contribute to hot flashes, which is another reason why a hormone-balancing diet rich in nutrients and low in refined carbohydrates is important to support the body during menopause.
Certain illnesses, such as anorexia nervosa, can cause hot flashes. Medications can also cause hot flashes. Over-the-counter medications for sinus and allergy trouble can have an adrenaline-like effect that can trigger hot flashes. Prior to menopause, I experienced hot flashes while taking GnRH to shrink my fibroid before having it surgically removed.
While researches continue to look at the underlying causes of hot flashes, one thing is certain: Every woman can learn to stay cool by paying attention to her own individual triggers. What seems to trigger a hot flash for one woman, may give another woman no trouble at all. Learning your triggers may be all you need to control your hot flashes. Here are some common triggers that you may want to experiment with. Remember to keep a journal to record your individual findings.
Hot flashes are most common in Western cultures. Some researches are quick to excuse the low incidence of hot flashes and other menopausal symptoms in non-Western cultures, such as Japan, to a diet typically high in soy foods. However, other non-Western cultures such as Hong Kong, Pakistan, and Mexico also report, on average, that only 10 percent or less of menopausal women have hot flashes.
In our culture 70 to 85 percent of women suffer from hot flashes, sometimes severely. I believe that this is, in part, because we have been led to believe that issues that arise premenstrually and perimenopausally are just hormonal, or that they exist in a universe that is completely separate from the rest of our lives.1 This is simply not true. By reducing our bodies’ signals to physical symptoms, we are "buying in" to the belief system that pervades Western medicine. If we don’t pay attention to the emotional issues that arise premenstrually and perimenopausally, our symptoms will continue to escalate until we pay attention to the signals our bodies are sending. These signals are usually related to a larger need that is not getting met.
While I am not discounting the direct physical effect of changing hormones, it is important to understand that uncomfortable symptoms, such as hot flashes, will be magnified and prolonged if a woman is carrying heavy emotional baggage. In general, women with a history of anxiety, panic attacks or depression are more troubled by hot flashes than women without these experiences.
If you’re hot and bothered, there are a number of ways you can control the severity and frequency of your hot flashes.
NOTE: Bioidentical progesterone is entirely different biochemically from the synthetic progesterone found in most conventional hormone replacement regimens and in birth control pills. It has far fewer side effects compared to the synthetic varieties.
I recommend that you read Minding the Body, Mending the Mind, by Dr. Joan Borysenko and Healing Mind, Healthy Woman, by Alice Domar, PhD and Henry Dreher.
I recommend black cohosh, 40 mg, twice per day. Formulas that contain high quality wild-crafted Dong Quoi, burdock, chasteberry, black cohosh, motherwort, and licorice can be very helpful, as can Traditional Chinese herbs. (These approaches are detailed in The Wisdom of Menopause, Chapter 6, "Foods and Supplements to Support the Change.")