Technically, menopause is defined as the 12-month anniversary of a woman's last menstrual period. The menopause transition encompasses the period of time during which her body is experiencing menopausal symptoms, the most common of which is the hot flash. According to the North American Menopause Society, 95 percent of women experience hot flashes, and 86 percent have this experience on a daily basis. Since theories on what causes hot flashes vary, strategies on how to treat them vary as well. No single approach fits the needs of all women, but it is valuable to think of hot flashes as a sign of change instead of a symptom of illness.
Core Temperature Reduction
Hot flashes are the primary reason women seek treatment for menopausal symptoms. The experience feels like a sudden onset of fever and is accompanied by a flushing of the face and neck. For some women, perspiration of the face, neck and chest also occurs.
For many years, it was assumed that hot flashes occurred when estrogen production declined to a specific level. But Robert Freedman, M.D., of the Mayo Clinic, has disputed this theory with his work on core temperature variation published in the August 2005 edition of "Seminars in Reproductive Medicine." He found that the hot flash originates in a sudden but small rise in the body's core temperature. In menopausal women, the body sets a lower threshold for flushing, and for some women that temperature is very low. Freedman's team did not speculate on the cause of this difference between women who experience menopausal hot flashes and those few who don't.
Lowering the core temperature can be accomplished by drinking ice water, taking cool showers and wearing cool, cotton clothing. In addition, smoking cessation and losing weight, especially in the abdomen, also may lower core temperature, according to Freedman.
Blood Glucose Management
It is possible that fluctuating blood sugar levels may also cause hot flashes. In the September-October 2003 issue of "Nursing Research," researchers Sharon Dormire, R.N., Ph.D., and Nancy King Reame, R.N., Ph.D., documented a connection between hot flashes and low blood glucose levels. Their research suggests that a hot flash is the body's way of getting glucose into the brain when the levels fall too low. This suggests that hot flashes could be a benefit to some menopausal women, protecting them from the effects of low blood sugar.
Based on these findings, treatment of hot flashes would be best accomplished by eating small. frequent meals that contain protein to stabilize blood sugar, with the last meal of the day being a small bedtime snack.
Hormone Replacement Therapy
Hormone replacement therapy, or HRT, for menopausal women can be accomplished with estrogen and progesterone or, for women who have had a hysterectomy, with estrogen alone. The National Institutes of Health, the North American Menopause Society and the American College of Obstetricians and Gynecologists each have said HRT should used be only for decreasing hot flashes and other symptoms of menopause and only for as long as necessary.
HRT reduces the number and the intensity of hot flashes by up to 80 percent, according to the National Institutes of Health, but it also carries significant risks: The incidence of cerebral vascular accidents, or strokes, is higher in women using HRT. In addition, a report presented at the June 2010 meeting of the American Association for Cancer Research by Celia Byrne, M.D., indicates that HRT delays the beneficial decrease in breast density that occurs with natural menopause and may increase the risk of breast cancer in women with dense breast tissue.
Antidepressants
HRT is not the only treatment a physician can prescribe to help manage hot flashes. A group from the Mayo Clinic reports that 10 to 20 mg of Celexa, an SSRI antidepressant, reduced the rate of nighttime hot flashes significantly in 50 percent of the women studied. These findings were reported in the May 24, 2010, issue of the "Journal of Clinical Oncology."
Plant Estrogens
One way of treating hot flashes regardless of the cause may be to add estrogen-like chemicals naturally found in vegetables and legumes. For example, flaxseed, a phytoestrogen, contains a plant source of the female hormone estrogen. In 2007, Mayo Clinic researcher Sandhya Pruthi, M.D., found that women ingesting 40 g, or about 1.4 oz., of crushed flaxseed each day reported a 50 percent reduction in the frequency of their hot flashes and a 57 percent reduction in their intensity.
References
- National Institutes of Health: Facts About Menopausal Hormone Therapy
- "Seminars in Reproductive Medicine"; Pathophysiology and Treatment of Menopausal Hot Flashes; Robert Freedman; Aug. 29, 2005
- Menopause"; Estrogen and Progesterone Use in Postmenopausal Women"; Wulf H. Utian, M.D., Ph.D.; May 2010
- "J. of Clinical Oncology"; Citalopram for the Treatment of Hot Flashes; D.Barton, et al; May 2010
- "Nursing Research"; Menopausal Hot Flash Frequency Changes; S. Dormire, N.K. Reame; 2003
