Hot Flashes and Some Remedies

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January 16, 2014

Over the years, my patients have gotten older and almost half of my practice now is comprised of women over forty which explains why I often fall behind my schedule by the middle of the morning or afternoon.   Being 40-50 is a fairly tough decade of life, when the “women’s hormones” start changing.  An office visit for a “40 and up” woman rarely lasts 15 minutes.  There are just too many issues for me to wrap it up in fifteen minutes. 

Several years before reaching menopause, women have many vague complaints and symptoms. Moodiness, lack of libido, and hot flashes are among the most common complaints from my patients.  Menopause, by definition, is the cession of menstrual cycles for a year.   As a woman enters her menopause years, her estrogen (hormone) becomes lower and lower, responsible for these symptoms.

My OBGYN boot campers would tell you how many lengthy consults we perform for women near menopause. In my office, my nurse Roxanne alerts me with the chief complaint of “Peri-menopausal Consult” which, in layperson’s terms, is a warning of “You will be in the room with this patient for a long time, so go to the restroom first!”

Sometimes, peri-menopausal women even bring their spouses to my office to “witness” our conversations. I believe my patients want their spouses to hear me telling them how “normal” all these symptoms were, that they are not simply experiencing “acute psychosis” as their spouses believe.  When the ovaries “shut down” in a woman, it can be like a werewolf facing a full moon! 

Husbands, however, should be reassured that they will be able to find their “gentle wives” again, as long as they understand the menopause process and its irritating symptoms especially hot flashes.  Menopausal symptoms are worse in the first five years.

Hot flashes can prevent a woman from sleeping well.  This lack of deep sleep, in return, can cause a woman to be irritable and moody.  Hot flashes during the day, on the other hand, can interrupt work and meetings, and in many cases, can cause embarrassment and discomfort as the women may be “drenched” in sweat.  One of my patients told me how terrible she felt when she, an executive, started sweating profusely in the middle of an important presentation!  She couldn’t bring herself to tell her audience she was experiencing her usual hot flashes but she worried that the men in the meeting thought she was nervous!

There are several ways to relieve the hot flashes that plague many of us menopausal women.  Some are supported by scientific evidence while others are noted anecdotally by “observation” were not necessarily studied scientifically.  Some traditional treatments later were shown lead to a placebo effect while others are considered to have real effects but are considered “risky” by the FDA.  Below are the more popular treatments of hot flashes:

1.  Estrogen Hormone Replacement: Many gynecologists would agree with me that ERT  probably is the most effective treatment for hot flashes. Estrogen used for the treatment of hot flashes comes in patches, spray, or oral pills. You should discuss with your physician your method of choice. It usually takes about two weeks to a month for the hot flashes to subside significantly. 

In 2002, the WHI study showed a small increase in breast cancer incidence in those      on combined Estrogen Replacement Therapy, causing a sharp drop in the use of Estrogen. Since then, ERT is used only if the patients complain of menopausal symptoms, and even then, only following careful counseling from the gynecologists.  Since then, several studies have shown that short-term use of ERT, however, does not seem to elevate breast cancer risk.

Estrogen vaginal cream, on the other hand, does not help relieve hot flashes, as its absorption rate in the blood stream is low.  It is used mainly for vaginal dryness.

 2.  Peroxidene: the first non-hormonal medication, recently approved by the FDA, for the treatment of hot flashes.  Brisdelle, the brand name for this product, at 7.5mg per day has shown to effectively reduce symptom of hot flashes. This medication, in a higher dose such as 30mg per day is used to treat some psychiatric disorders such as depression and Obsessive-Compulsive Disorder. 

 3.  Fosteum Plus: a prescription medication consisting of Calcium (500 mg), Phosphate (70 mg), vitamin D3 (400 IU), vitamin K2 (90 mcg), Genisten (27 mg) and Citrated zinc Bisglycinate (20 mg)                                                                                                               

This product is not FDA approved for the treatment of hot flashes.  Fosteum, for years, has been used to improve bone density.  By the way, Fosteum is not considered a soy product.  

4. Soy Milk: several years ago, NIH made an observation that Soy milk was probably among the most effective over-the counter treatments to relieve some hot flashes. How many cups of soy milk and for how long? Nobody knows the answer. 

Soy pills, on the other hand, can be concentrated with estrogen and should be used with care. Estrogen use, without being balanced by a hormone called progesterone, can increase a woman’s risk for uterine cancer. Only women who have had a hysterectomy should take estrogen alone. 

5.  St John Wort: an herbal supplement often used to treat depression. Many scientists believe this supplement gives a placebo effect for hot flashes.

6.  Black Cohosh: can be found over-the-counter under different names including Remifemin.  It has been found to help with menopausal symptoms but the relief may be limited to about six months.

7. Helpful tips to reduce hot flashes: wear layered clothes, limit the use of a hair dryer, drink plenty of cool fluids, avoid spicy foods in the evening. 

I hope these tips will help relieve some hot flashes and I welcome comments from my boot camping friends and our readers, especially if they have additional tip to share.

Stay cool,