Hot flashes are one of the most common menopausal vasomotor symptoms, affecting more than 80% of menopausal women. Of these women, 65% will experience hot flashes for over two years and 36% for more than five years (12). With appropriate management, individuals may find relief from hot flashes. This article will discuss considerations for evaluating and managing hot flashes, focusing on those associated with hormonal changes during the perimenopausal and menopausal periods of a woman's life.
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What Are Hot Flashes?
Hot flashes are sudden, episodic sensations of heat felt on the chest, neck, and face. They are often accompanied by sweating and reddening of the skin. Hot flashes vary in duration and intensity but typically last one to five minutes. They can be very uncomfortable and disruptive to daily activities and sleep, especially if they occur frequently.
What Do Hot Flashes Feel Like?
Hot flashes are often accompanied by sweating, heart palpitations, headache, weakness, fatigue, and anxiety. These episodes' duration, intensity, and frequency will vary between individuals. (10)
Regarding perimenopausal and menopausal hot flashes, the frequency and severity tend to increase during the perimenopausal transition. Hot flashes can occur several times per week or up to ten times daily and generally last less than five minutes. Menopausal hot flashes can persist for months to years after a woman's final menstrual period, on average lasting 1.2 years after onset. (12)
What Are the Possible Causes of Hot Flashes?
Various hormones and neurotransmitters may influence hot flashes through their role in central thermoregulation. The hypothalamus is a part of the brain responsible for regulating body temperature. It contains receptors that are sensitive to changes in estrogen levels. As women go through menopause and perimenopause, their estrogen levels naturally decline. Estrogen plays a role in maintaining the stability of the hypothalamus and its control over body temperature. With decreasing estrogen levels, the hypothalamus can become more sensitive and reactive to minor changes in body temperature. It may misinterpret the body as being too hot, even when it's not, triggering a response to cool down. In response to the misinterpreted overheating signal, the hypothalamus sends signals to dilate blood vessels and increase blood flow to the skin's surface. This can lead to a sudden rush of warmth, reddening of the skin, and sweating. (20)
Serotonin and norepinephrine may also play a role in hot flashes. In addition to regulating mood and emotions, serotonin regulates body temperature. Fluctuations in serotonin during menopause may contribute to the occurrence of hot flashes. This is supported by the fact that selective serotonin reuptake inhibitors (SSRIs), which increase the availability of serotonin in the brain, are often prescribed to help manage hot flashes. Norepinephrine plays a role in the "fight or flight" stress response. Research has documented rising plasma levels of norepinephrine metabolites, which trigger peripheral dilation of blood vessels, before and during hot flashes (12).
Hot flashes can be triggered or exacerbated by various factors, including stress, hot weather, smoking, spicy foods, drinking caffeinated and alcoholic beverages, and tight-fitting clothing.
In women of any age, it is important to rule out pathologies that can cause hot flashes as a symptom. The differential diagnosis for hot flashes includes:
- Allergies and anaphylaxis
- Carcinoid tumors
- Drug and alcohol use
- Food sensitivities (6)
- Infection
- Medication side effects
- Pheochromocytoma
- Systemic mastocytosis and mast cell activation syndrome
- Thyroid disorders
Functional Medicine Labs to Test for Root Cause of Hot Flashes
If your doctor suspects a medical condition other than (peri)menopause as the cause of hot flashes, they may order a combination of tests to investigate. Depending on your history and symptoms, this may include a complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid panel, tryptase, histamine, urinary metanephrines and catecholamines, and allergy testing.
Hormone testing can provide valuable information regarding how the body synthesizes, metabolizes, and eliminates hormones from the body. Various functional medicine tests are available to provide an in-depth analysis of hormone imbalances that may contribute to hot flash severity and frequency.
Female Hormone Panel
Female sex hormones, including estrogen, progesterone, FSH, and LH, are used to track the perimenopausal transition and diagnose menopause. Blood testing provides a snapshot of hormonal balance at the time of the blood draw. However, this type of testing cannot provide insight into hormone fluctuations throughout the menstrual cycle or how the body's detoxification systems metabolize the hormones.
Therefore, a popular functional medicine test panel is the DUTCH test, which uses salivary and urinary samples to measure the metabolites of sex and adrenal hormones. This test can detect dysfunctional hormone metabolism and stress responses that may contribute to hot flashes. This test also measures organic acids, which may indicate nutritional and neurotransmitter imbalances known to contribute to hot flashes and other menopausal symptoms.
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Conventional Treatment for Menopausal Hot Flashes
According to the American Academy of Family Physicians, there is insufficient evidence to suggest that lifestyle modifications alone effectively manage hot flashes. Instead, they recommend considering hormonal and nonhormonal options for managing hot flashes in menopausal women. Estrogen is often used to help manage hot flashes and should be combined with progesterone in women with intact uteruses. Hormone replacement is used in the smallest effective dose for the shortest possible duration. Other non-hormonal pharmaceutical options for managing hot flashes include low-dose SSRIs and gabapentin. (9)
Integrative Medicine Protocol for Menopausal Hot Flashes
In addition to bioidentical hormone replacement (HRT) and natural supplements to support balanced estrogen and progesterone levels, an integrative approach may also incorporate nutritional, stress management, and sleep hygiene modifications to address the imbalances in the body and environmental factors that may contribute to hot flashes.
Therapeutic Diet For Menopausal Hot Flashes
Adherence to a Mediterranean-style diet is associated with a decreased risk of hot flashes. The Mediterranean diet, inspired by the traditional eating habits of Mediterranean countries, emphasizes a high consumption of fruits, vegetables, whole grains, legumes, nuts, and healthy fats like olive oil. It limits the consumption of unhealthy fats and sugars, which may increase the risk of hot flashes. (8)
Foods to Consider Including in Your Diet to Support Hot Flash Management
Various foods have been shown to help support hormone balance and may reduce hot flash intensity and frequency. Soy-based products, such as tofu, tempeh, and edamame, contain isoflavones and other phytoestrogens that may help manage hot flashes. Other phytoestrogen-rich foods can help support the body by mimicking estrogen's effects. Flaxseed, oats, seeds, and legumes are all rich in phytoestrogens. Traditional Chinese medicine (TCM) practitioners may also encourage eating cooling foods, like cucumber, radish, and watermelon, to help maintain the body's temperature balance. (18)
Foods to Consider Limiting to Support Hot Flash Management
Conversely, avoiding and limiting certain foods may help manage hot flashes. Coffee and alcohol may increase hot flash severity and can intensify other symptoms that accompany hot flashes, such as increased heart rate and anxiety. Having high blood sugar, insulin resistance, and hypertension can increase the risk of hot flashes during menopause; reducing intake of processed foods and sweetened beverages may help stabilize blood sugar levels and support normal blood pressure. (6, 18)
Supplements to Consider for Supporting Menopausal Hot Flash Management
Certain supplements and herbs are commonly used in functional medicine to support the management of hot flashes associated with menopause.
Black Cohosh
Black cohosh (Cimicifuga racemosa or Actaea racemosa) has been studied since the 1950s for its potential to support the management of menopausal symptoms. Many studies suggest that black cohosh may help reduce hot flash symptom scores. At the end of a six-month trial, black cohosh was found to be more effective than fluoxetine (an SSRI) in managing hot flashes and night sweats in postmenopausal women.
Dose: 40-80 mg daily
Duration: 12 weeks
PhytoEstrogen Herbal™
This powdered formula by Vitanica offers a phytoestrogen-rich blend of botanical herbs, soy isoflavones, and flaxseed lignans. As discussed in the nutrition section, phytoestrogens are plant-derived chemicals that may activate estrogen receptors and exert weak estrogenic effects in the body. One systematic review, including 15 randomized control trials, concluded that phytoestrogens may effectively reduce the frequency of hot flashes in menopausal women without serious side effects. (4)
Dose: 1 level scoop mixed into a liquid of choice 1-2 times daily
Duration: 12 weeks
Vitamin E
As estrogen levels decline during perimenopause, oxidative stress may increase. Vitamin E, an antioxidant, may help neutralize this oxidative stress. Some studies suggest that Vitamin E may improve hot flash severity and frequency. (19, 21)
Dose: 400-800 IU daily
Duration: at least four weeks
When To Retest Labs
The timing of a reevaluation may vary depending on the route of management that the patient pursues. Many functional doctors may recommend monitoring hormones one month after initiating bioidentical hormones, but may postpone follow-up until three months for a natural management plan utilizing natural supplementation and lifestyle modifications.
Learning More About Hot Flashes
- Case Study: Joan's Remarkable Journey of How She Achieved a Dramatic Reduction in Menopausal Hot Flashes and Night Sweats
- Live Class: Using DUTCH TEST Plus to help your patients glide into The Other PMS ™️: Perimenopause/Menopause Syndrome
- Bootcamp: Connecting the Dots on Female Hormones: From PMS to PCOS using the DUTCH Complete Test
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Summary
Hot flashes are a vasomotor symptom common during perimenopause and menopause. A protocol using diet and natural supplements can be used therapeutically on its own or complementary to conventional management to help support the quality of life of those affected by hot flashes.
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