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, spicy food. Many women find that spicy food aggravates or even triggers hot flashes. However, some researches now believe that hot peppers can be great for combating hot flashes, as women in South American and Mexico rarely experience them.
• Hot drinks. Warm beverages can heat you up just enough to trigger a hot flash. If this is true for you, stick with cold or room-temperature drinks instead.
• Caffeine. Eliminate all caffeine (even decaffeinated drinks) for one week to see if caffeine is a trigger for you.
• Alcohol. Alcohol is a refined carbohydrate that acts like sugar in the body. It can cause an epinephrine release, which can trigger a hot flash. Red wine is particularly potent.
• White sugar. Sugar has also caused heart palpitations in some of my patients.
• Stress. Stress causes a hormonal chain reaction in the body that has been linked to increased number and severity of hot flashes. See Solutions for ways to combat stress.
• Hot weather. You can’t control the weather, but you can set your thermostat at a comfortable level; 70 degrees during the day and 65 at night may help keep you cool.
• Hot tubs and saunas. Hot tubs and saunas can cause your body temperature to rise and trigger a hot flash. It’s best to avoid these if you’re sensitive.
• Tobacco.
• Unexpressed anger. Keeping feelings of anger and shame bottled up can lead to a whole host of health problems. Identify the root of your anger and express it openly. You may want to keep a journal to help you uncover patterns.

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.

• Try estrogen replacement. Estrogen replacement is highly effective in cooling hot flashes, and is considered the "gold standard." I recommend only bioidentical estrogen at individualized doses. You may want to have your hormone levels tested before you begin using estrogen.
• Try natural progesterone cream. Two-percent bioidentical progesterone cream has been shown to decrease hot flashes in many women at a dose of one-quarter teaspoon per day on skin. I recommend one-quarter teaspoon once or twice per day, at least three weeks per month, or daily if periods have stopped.²

  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.

• Learn stress reduction techniques. Dr. Herbert Benson, author of the famous Relaxation Response and founding president of The Mind/Body Medical Institute has successfully taught women relaxation techniques and cognitive behavioral skills to help them ease the transition to menopause. His studies show that relaxation-based techniques help cool hot flashes in 90 percent of women without any hormonal therapy at all.

  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.

• Improve your diet. Many women also find relief when they improve their diets. (See The Wisdom of Menopause, Chapter 7, "The Menopause Food Plan.") Soy foods (a total of 45–160 mg of soy isoflavones per day) provide relief.
• Try herbal therapies. There are a wide variety of herbs used on their own or in combination with other helpful traditional herbs, including Angelica (Dong Quoi), burdock, chasteberry, motherwort, and licorice.

  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.")

• Check your emotional baggage. Determine what your hot flashes mean to you. Tapping into your body’s wisdom can help ease your symptoms significantly. Many women experience hot flashes when they are angry, especially if they don’t let their anger out. Vicki Noble, author of Shakti Woman: Feeling Our Fire, Healing Our World suggests that hot flashes are the body’s way of naturally cleansing what it no longer needs. If you have any doubts about your emotions, one of the best ways to figure out just how you feel about things is through keeping a journal.
• Establish a peer support network. Studies show that women benefit both mentally and physically from mutual support. Talking with other women about your experience can help alleviate some of the anxiety often associated with menopausal symptoms.