Dr. Carolyn Dean, author of Hormone balance: A woman’s guide to restoring health and vitality,  shares her advice and medical knowledge about hot flashes. What are they? Why do they occur? How do you stop them?  Plus, the pro’s and con’s with bioidentfical and Synthetic Hormone Replacement therapy

Make sure to check out other articles on:

• Perimenopause: All the basics about perimenopause in one handy guide. What are the causes, symptoms, and natural supplements you can take if you have perimenopause? When does it occur and how long will it last?   
• Menopause: Get all the basics about menopause in one handy guide. What are the causes, short-term and long-term symptoms, and a natural approach to regulating your hormones?  
• Hormone Imbalance: Get all the basics about hormones. What are they? How hormones get out of balance? An overview of estrogen and progesterone and what happens when your hormones are out of balance.

Source: All excerpts from this blog except where noted are condensed and edited from – Dean, C. (2005). Hormone balance: A woman’s guide to restoring health and vitality. Avon, MA: Adams Media.

What are hot flashes

Is it hot flushes or hot flashes? A hot flash is more descriptive of the onset of this menopausal event. A sudden sense of heat occurs, mostly in the face and neck and also the upper chest, then the red flush comes like a severe blush from a major embarrassment. Hot flashes at night can cause drenching sweats that have you up at night changing nighties and sheets. The terms hot flash and hot flush are used quite interchangeably in most texts and there is usually no attempt to differentiate. Either way they are very common, occurring in up to 85 percent of women during their menopause.

Hot Flash Symptoms

Beyond the heat, the red flush, and the sweating, hot flashes may be associated with a rapid heartbeat, nausea, dizziness, anxiety, headache, weakness, or a feeling of suffocation. Some texts talk about an “aura” or an uneasiness that precedes the hot flash, as though the lights dim, the scary music comes, and suddenly you’re flashing. When I went into menopause very suddenly one year when I was under massive stress, I experienced a symptom I had never heard before. My “aura” was an incredible sense of impending doom that would descend on my body just before a hot flash burnt me to a crisp and then drenched me in sweat, followed by a chilling clamminess.

What causes hot flashes

In medical school I was taught that hot flashes occur because of low estrogen levels. But now I know that women have hot flashes in perimenopause, when estrogen levels are high. It is indeed a hormonal roller coaster for some. Dr. Fugh-Berman, however, reminds us that young girls do not have hot flashes that go along with their low estrogen, so it’s not specifically low estrogen that causes those symptoms but rapid cycles of falling and rising estrogen levels

While most experts readily agree that we really don’t know exactly what causes hot flashes, we do know that it is a “vasomotor reaction” to hormonal shifts. Vasomotor reaction means a nerve and muscle reaction that occurs in blood vessels, causing them to constrict or dilate.

Apparently FSH, which stimulated a developing egg and LH (luteinizing hormone) and which stimulates ripening follicles in the ovary to produce estrogen, can be elevated when hot flashes occur. Both these hormones become elevated with menopause. Research shows that neurotransmitters and erratic hormones can cause blood vessels near the surface of the skin, especially in the head, neck and chest, to become dilated, which creates heat, blushing, and sweating. Hormonal surges of cortisol can also create hot flashes.

Hot flashes after menopause

Women get hot flashes after menopause when estrogen is very low.

Hot flashes before period

Carolyn recounts a story from Dr. Jerilynn Prior and her first hot flash.

“She was still menstruating regularly with no sign of hormonal imbalance. Then one morning she woke up very early feeling very angry. She said her heart was pounding and her legs were twitchy and she was in full fight-or-flight mode. That changed abruptly into a wave of heat that left her weak and shaken. The next day her period started. This is a clear example of how hot flashes are related to a rapid drop in estrogen, which is what occurs to trigger the onset of menses”.

Why do we sweat so much with a hot flash?

The medical experts at breastcancer.org give the following explanation for hot flashes. They say the hypothalamus is in charge of regulating estrogen levels. It presides over body temperature, appetite, and sleep cycles as well as sex hormones. A diminished level of estrogen triggers the hypothalamus, which somehow confuses its thermostat and reads the message that the body is too hot. In order to get the body to sweat and therefore cool off, a dizzying array of signals are sent out that leads to the release of the adrenal hormone epinephrine (thus the feeling of impending doom) and other hormones that increase the heart rate, circulate more blood, dilate blood vessels on the skin, and cause the release of sweat from glands close to the skin. All these actions are designed to cool the skin, resulting in hot flashes and severe sweats. But in the meantime, these confused messages cause heat. Research shows a rise of skin temperature by as much as six degrees during a hot flash, which causes you to sweat—and then you are left in a puddle

How long do hot flashes last

• 3:39 Dr. Carolyn Dean answers in Youtube Video. 

Hot flashes at night

• 2:26 Dr. Carolyn Dean answers in Youtube Video. 

How to stop hot flashes?

Research tells us that our core temperature goes up just before a hot flash. That means turn up the air conditioning and don’t allow yourself to get overheated. For me, I couldn’t take my hot, Epsom salt baths for years and had to swear off the saunas that I also loved.

Track down other triggers that make you flash. Get a bright red notebook and jot down what you are eating, wearing, and stressing about when you get your hot flashes. Also give them a score—from 1 for fuzzy (as in warm and fuzzy) up to 10 for deadly, as in dynamite. Finding names for your flashes can help to distract you from the abuse they inflict on you. One hot flash trigger that took me time to identify was the cinnamon I put on my Crock-Pot cereal in the morning. Cinnamon is a hot spice, and it was revving me up, increasing the heat in my body and stimulating more hot flashes. Most spicy foods can do the same. Other triggers include sugar, smoking, alcohol, and caffeine (found in coffee, chocolate, diet pills, or pain pills).

Stress and Hot Flashes

As we’ve said, stress has a tremendous impact on everything about our health. And stressing is the worst trigger for flashes. For some women, hot flashes work like aversion therapy to stop stressful behavior. I know for me they did. Every time I took a nosedive into some primal fear or worry I’d trigger a hot flash, so I just don’t go there anymore! Stress from overwork and rushing can also increase hot flashes. Look at them as a reason to slow down and take some time for yourself.

Stress Busters

Here are some more ways to relieve stress:

• Sleep!—at least seven hours a night
• Relaxation exercises
• Deep breathing
• Meditation
• Yoga
• Visualization
• Tai Chi
• Body work—deep tissue massage, craniosacral therapy, lymphatic massage
• Biofeedback
• Self-hypnosis

Sleep

An additional word about sleep—it’s the most important stress buster of all. We all know what sleepless nights do to us. It’s the same for inadequate sleep. If you are trying to make your life work by cutting back on sleep you are putting too much stress on your body. During sleep is when your body is able to repair and restore. If you have always had a sleep problem you can take magnesium, calcium, and vitamin B complex and use herbal combinations of hops, valerian, skullcap, St. Johns wort, chamomile, and passion flower. A homeopathic medicine called Gelsemium can be used for insomnia due to worry. If you wake up at night and can’t get back to sleep because you can’t stop thinking about something or worrying, take a few pellets of Gelsemium 6X under your tongue.

Hot flash remedies

Now that you know what your triggers are, here are some survival tips.

• Wear layers of clothing, in natural fibers, so you can peel them off when necessary. Synthetics do not allow the skin to breathe.
• Keep a fan handy.
• Keep ice water nearby—either throw it over yourself of take a long drink to cool your skin and your core temperature!
• Deep breathing can reduce hot flashes by about 40 percent.
• Wear cotton to bed and use cotton sheets—you may not need a blanket!
• Take a cool shower at bedtime.

Exercise Your Flashes Away

Exercise is beneficial for more than just hot flashes and more than just menopause. It can reduce hot flashes, help you lose weight, condition your muscles, improve bone density, prevent heart disease, lower cholesterol, balance moods by increasing endorphins, reduce insomnia, decrease fatigue, increase sexual desire, and improve confidence.

Hot Flash diet

• Fenugreek contains phytosterols and is used for hot flashes.
• Motherwort relieves hot flashes, anxiety, insomnia, and palpitations, and strengthens vaginal tissue.
• Sage helps eliminate hot flashes, night sweats, mood sweats, headaches, indigestion, and joint aches.

Dang Quoi—Angelica sinensis

Dang quoi is a “female” herb, high in phytoestrogens, for all stages in a woman’s life—for pregnancy and delivery, perimenopause, and menopause. Dong quoi relieves hot flashes, but it works better for stressed women who suffer hot flashes but are generally chilly. It’s a nourishing herb containing many nutrients that works part of its magic by supporting the liver. It increases vaginal secretions as well as stimulating circulation to the face to convey a healthy glow. Dang qui thins the blood and Chinese practitioners use it instead of aspirin, without the side effects. It lessens heart palpitations, lowers blood pressure, and increases the circulation to prevent heart disease. It also relieves insomnia, joint pain, and nervous tension, common symptoms in menopause.

Dosage for dang quoi: Tincture: 10–40 drops of dang quoi root one to three times a day. Capsules: 500 mg, 2–3 per day.

Cautions: Don’t use if you are taking aspirin. Don’t use if you have heavy bleeding or fibroids; because dang quoi increases circulation, it could increase bleeding. Stop if you get breast tenderness.

Black Cohosh—Cimicifuga racemosa

Black cohosh has been used for relief of menopausal symptoms by Native Americans, possibly for thousands of years. Knowledge of the many uses of this plant was passed on to early settlers. It is one of the few herbs that can relieve vaginal dryness because of its mild estrogenic effects. It also tames hot flashes, and is a muscle and nerve relaxant to the extent that it reduces menopausal depression. It alleviates arthritic pains, improves digestion, and strengthens the pelvic muscles and thus helps prevent prolapse. The beneficial effects of black cohosh don’t stop there. Regarding heart and blood vessels, it dilates blood vessels and thins the blood, thereby increasing circulation and lowering blood pressure. The focus of recent research has turned toward its anticancer properties. A 1998 review of eight clinical trials of black cohosh found that it is a safe and effective alternative to Estrogen Replacement Therapy (ERT) and can be safely used by women who should not use ERT.[EN37] Dr. Tori Hudson says it’s considered a suitable natural alternative to Hormone ReplacementTherapy, especially for women at high risk for cancer.

Dosage for black cohosh: Tincture: 10–30 drops a day. Capsules: 500 mg, one to three times per day. Standardized extract capsules: 20 mg, 2 per day.

Drugs for hot flash

Antidepressents

I was surprised to find that as an alternative to synthetic ERT, doctors are prescribing a new breed of antidepressants such as Effexor for hot flashes and night sweats. They are not of the Prozac variety, but they do seem to have a high rate of side effects. However if your symptoms are severe enough, a trial of this drug might be warranted. Even so, Effexor only seems to reduce the symptoms of hot flashes by about 60 percent.

Here is a list of Effexor side effects and the percentage of people experiencing each effect.

• Nausea: 37%
• Headache: 25%
• Sleepiness: 23%
• Dry mouth: 22%
• Dizziness: 19%
• Insomnia: 18%
• Constipation: 15%
• Nervousness: 13%
• Raised blood pressure: 13%
• Fatigue: 12%
• Sweating: 12%

Bioidentifcal Hormones for hot flashes

Natural hormones are not squeezed out of plants with your kitchen juicer so they are not strictly natural. They go through a laboratory process to convert plant chemicals (soy and yam) into hormones that are bioidentical to the hormones produced in our bodies. Estradiol, estriol, estrone, progesterone, and testosterone can all be made by this process. Soy and yam are chosen because the chemical composition of one of their constituents is very close to the structure of hormones and can be converted to be biochemical identical to our body’s sex hormones.

Natural/bioidentical hormones are prescribed, usually by integrative medicine practitioners, after assessment of your hormonal status with saliva or blood testing. The prescription often contains two or three estrogens—a bi-estrogen or tri-estrogen (estridiol and estriol or estrone, estradiol, and estriol) and may also contain progesterone, and occasionally testosterone. A compounding pharmacy makes up the formula, which is individualized to the patient’s needs. Prescribing for the individual is far superior to the “one size fits all” method of synthetic hormone replacement. A word about compounding pharmacies: They often have a roster of doctors who use their services and may be willing to help you find a doctor who prescribes bioidentical hormones in your area.

Synthetic Hormone Replacement therapy

The FDA advised women and health care professionals that “menopausal hormone therapy is associated with an increased risk of heart disease, heart attacks, strokes, and breast cancer.” The warning emphasized that these products are not approved for heart disease prevention.

The FDA’s press release goes on to say that, “because there are few “proven” alternatives for the relief of hot flashes and vaginal atrophy, menopausal hormone therapies have an important role in women’s health. But, as it hastens to add, “It is very important that women realize that this beneficial therapy also carries significant risks. Our recommendation is that if you choose to use hormone therapy for hot flashes or vaginal dryness, or if you prefer it to other treatments to prevent thin bones, take the lowest dose for the least duration required to provide relief.” Labeling of hormones will also change and will “clarify that these drugs should be used only when the benefits clearly outweigh risks.”

How are synthetic hormones created?

Synthetic hormones are also produced in a lab but the starting molecules can be hydrocarbons—commonly called “coal tar derivatives”—and they are non-bioidentical. With the increasing demand for “natural” products, many synthetic hormones are now being derived from plant compounds—soy and yam—but have their chemical structure altered, making them non-bioidentical and patentable.

The pharmaceutical industry makes synthetic hormones non-bioidentical on purpose because you cannot patent a drug if it has the same molecular structure as a naturally occurring chemical in the body. Drug companies, however, can patent a synthetic drug that has a “similar” structure, and have a monopoly on the making and marketing of that drug for up to seventeen years. Drug companies may even say their drugs are plant-based or from natural sources to give the impression that they are just like your own hormones. But that is far from the truth. The underlying reason for making synthetic hormones is not for our benefit but because drugs must be synthetic to make a profit.

Patented drugs are not natural and the body cannot process them properly. For example, our body’s naturally produced hormones and compounded bioidentical hormones are metabolized by the liver in approximately four hours, whereas synthetic hormones are partially metabolized and circulate in the body for over fourteen weeks.

It is true that synthetic hormones do have a “therapeutic” action on the body, but they also have a host of side effects that may include cancer. We have somehow come to accept that we have to take the bad with the good when it comes to drugs.

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About Dr. Carolyn Dean – Medical doctor, Naturopath, Herbalist, Acupuncturist, Nutritionist, Lecturer, Author

Dr. Dean has been in the forefront of health issues for over 30 years. She graduated from Dalhousie Medical School in 1978, holds a medical license in California and is a graduate of  The Ontario College of Naturopathic Medicine – now the Canadian College of Naturopathic Medicine (CCNM) in Toronto. She served on the board of Governors of the CCNM for six years. Dr. Dean has authored or coauthored over thirty books, including How To Change Your Life With Magnesium, Future Health Now! Encyclopaedia, Death by Modern Medicine: Seeking Safe Solutions, The Magnesium Miracle, The Yeast Connection and Women’s Health, IBS for DUMMIES, IBS Cookbook for DUMMIES andHormone Balance.  Currently, Dr. Dean lives in Maui with her husband where she visits the beach most days, swims, snorkels and thoroughly enjoys her work and play – most days not knowing which is work and which is play!