News & Perspectives

Natural Treatments for Menopausal Hot Flashes

There are 475 million menopausal women in the world today. And a staggering three-quarters of them are all too familiar with the passing (yet all too memorable) sensations known as hot flashes. These powerful and sudden heat surges, which usually affect the face, neck, and upper back, are short-lived. But they leave the complexion embarrassingly crimson, clothes and bedding sweat-soaked, and trains of thought in disarray.

"I had horrible hot flashes," wrote Lea, a postmenopausal woman, in an email to Ohio psychotherapist Belleruth Naparstek, who uses techniques like guided imagery to help women deal with menopausal symptoms. "They turned me bright red . . . steamed up my glasses . . . woke me up in the middle of the night, soaking wet."

And Lea's experience is not unusual. Lasting anywhere from a few seconds to several minutes or more, hot flashes may occur only occasionally as menopause starts, or can flare up every several hours for weeks or even years.

Confusion about Hormone Replacement Therapy

Until recently, hormone replacement therapy (HRT) was regarded as the most effective medical answer for women in mid-life like Lea, who were struggling with drenching hot flashes and other menopausal symptoms. Designed to literally replace what a woman was "losing" in terms of hormones during this transition in her life, the therapy contained either estrogen combined with progestin or estrogen alone.

In fact, HRT is still essentially unrivaled as the best way to quell hot flashes. And since its approval by the Food and Drug Administration (FDA) for menopausal hot flashes in 1976, HRT has been prescribed to approximately 40 million American women every year.

But now millions of those women are voluntarily going off HRT because of a spate of recent, and alarming, research findings. Prestigious and large-scale studies run by the National Institutes of Health, as well as findings published in major medical journals such as the Journal of the American Medical Association (JAMA), report that the risk of HRT to a woman's health is probably not worth the symptomatic relief it provides. A women taking HRT, it's now evident, is more likely to develop invasive breast cancer, blood clots, heart-related problems (heart attack, heart disease, stroke), and even dementia (in those age 65 and older) than are women who forgo the hormone replacement.

Shopping for Alternatives

As a result of these findings, health experts are currently advising women to take HRT only if their symptoms are severe, and to use it for as short a time as they can tolerate. Millions of women are listening, and are now searching for alternative ways to handle their hot flashes and other symptoms (heart palpitations, mood swings, vaginal dryness, sleep problems). Protecting postmenopausal heart and bones are issues, too.

"There is a new awareness among women that HRT is not risk-free, and they are concerned about it," explains Rachel Manber, an assistant professor of psychiatry and behavioral sciences at the Stanford University School of Medicine. "Exploring alternative options is timely and important." Manber herself is leading a Stanford study on acupuncture for menopausal hot flashes.

"The brain is incredibly complicated and thermoregulation--the body's temperature control setting--is so complex," marvels Robert Freedman, a professor of psychiatry and behavioral neurosciences at Wayne State University of Medicine in Detroit, who has studied hot flashes for more than 20 years. "I have to say," he adds, "that I am surprised we don't know more at this point about why hot flashes happen."

The little that experts do know after years of study is that a woman having a hot flash is experiencing a sensation of heat that results from blood vessels near the surface of the skin dilating (opening up) to cool the body. The face and neck often look flushed and become sweat-drenched as a result.

Thankfully, there are some intriguing--and effective--nondrug strategies for contending with such heat-generating events. The best of these include guided imagery, deep abdominal breathing, relaxation techniques, acupuncture, and certain dietary approaches. While it's often unclear exactly why these techniques work in turning down the heat, so to speak, it's also evident from their growing popularity that they do.

  • Guided Imagery

    As with hot flashes themselves, it's still largely a mystery as to why the mental pictures drawn during guided imagery actually work for reducing the duration and intensity of hot flashes. The process itself, which usually includes narration and specially selected music, encourages a deeply relaxed state and then the redirection of thinking to an imagined desirable health outcome.

    Some preliminary research is now beginning to support the use of guided imagery for hot flashes. A small pilot study done at the University Hospital in Linkoping, Sweden, describes the technique's effect on six postmenopausal women. After meeting once a week for hourly group relaxation sessions for 12 weeks, the women experienced a remarkable 73% reduction in hot flashes after six months. Other menopausal symptoms and ratings of well-being improved as well.

    Belleruth Naparstek, who produces a menopause-related guided imagery tape and CD for her "Healing Journeys" series, explains that "the soothing words, the narration, poetic images, the music--all take a woman down into her body." The imagery also provides a way of "marshaling imaginal support from a circle of women, of the generations of women that have come before. It's a chain of support. It almost fills a need for community."

    Naparstek adds: "Whatever it is that's making guided imagery work, it is also a calming agent. And we do know that women with calmer lives have fewer hot flashes. And those with increased stress have a higher intensity and frequency of hot flashes."

    And the technique can be individualized as well. Lea, the woman who wrote to Naparstek about her drenching hot flashes, described an effective visualization she created for herself. "I made up a visualization of being in a Native American sweat lodge," she writes. (In traditional Native American Medicine, such lodges are used to generate spiritual cleansing through sweat.) "Each time a hot flash started, I stopped and took a deep breath . . . relaxed . . . and then visualized myself in a sweat lodge! I perceived my higher self imparting knowledge and insight during these times."

  • Deep Abdominal Breathing

    For many women, the best approach for hot flashes may be as basic as tuning into their own breathing patterns. Professor Freedman at Wayne State has studied this deceptively simple approach intensively. By training the body to slow breathing down to 6 to 8 breaths a minute (inhalation and exhalation), rather than the average 15 to 16 breaths, Freedman says something key takes place in the body's thermoregulation (heat and cold) system.

    "We don't exactly know how this type of slow, deep breathing works for hot flashes," he says. "But it clearly does. Our studies show that it can reduce the frequency of hot flashes by about 50%."

    Freedman says that women trained to use this technique as soon as they feel a flash coming on are often able to abort it or at least reduce its severity significantly. The professor's published studies on the subject have involved women who were enduring at least six hot flashes a day, and who weren't using any other form of treatment. "The only time deep breathing definitely doesn't work," Freedman adds, "is during sleep--because to work, this technique requires conscious (awake) intervention."

    The goal of focused deep abdominal breathing, also known as paced respiration, is to expand belly breathing and decrease chest breathing. It can be learned in a yoga class, or even by sitting in an armchair. "Stand a book upright on your lap, and then watch as it rises and falls," Freedman instructs. "Allow air to fill your lungs completely, right down to the abdomen."

    To do this type of breathing effectively, you need to sit quietly and focus on your breath. It's a good idea to practice the breathing 15 minutes twice a day as a preventative measure, and whenever you feel a hot flash coming on.

  • Relaxation Techniques

    The key to what makes deep abdominal breathing so effective for hot flashes may well be linked to the fact that, as with guided imagery, it generates a profound level of relaxation. Harvard cardiologist Dr. Herbert Benson first described this absorbing calm in the 1970s as the "relaxation response." This physiological state provides a mental and physical "sigh of relief" that slows breathing and heart rate, reduces blood pressure and metabolism, and promotes rejuvenation and healing.

    Elicitation of the relaxation response has shown its power for hot flashes in a handful of small but fascinating studies. For example, intensity of hot flashes was lessened in a mid-1990s randomized, controlled study at the New England Deaconess Hospital's Mind/Body Medical Institute.

    The 33 participants in this study, all of whom were experiencing at least five hot flashes every 24-hour period, were randomized to follow one of the following three regimens: daily practice of the relaxation response, simply reading about menopausal symptoms, or sticking with standard care. After 10 weeks, those in the relaxation group not only had less intense hot flashes than the other groups, but also experienced a notable decline in depression and tension/anxiety.

    The practice of yoga and meditation may similarly generate a deep relaxation effect that eases hot flashes. Well-known author and famed women's health specialist Dr. Christiane Northrup counsels patients to do both for 20 minutes twice daily. "They significantly decrease hot flashes," she repeatedly has advised.

    Northrup, along with many others, is also a big champion of regular exercise (walking, swimming, dancing, for example), which can ultimately lower the heat by helping to regulate hormones, promote sound sleep, and stabilize mood. Swedish studies indicate that exercisers suffer fewer hot flashes than their sedentary counterparts. Of course, exercise (including weight training) also provides crucial heart- and bone-protective benefits as well.

  • Acupuncture

    "One thing that really works for hot flashes is acupuncture," explains Dr. David Edelberg, a Chicago internist and chief medical advisor of WholeHealthMD. A form of traditional Chinese medicine, acupuncture recently has become the focus of menopausal research. A pilot study in England, for instance, demonstrated that it can lessen the frequency and severity of hot flashes in women being treated for breast cancer with tamoxifen, a drug with very powerful side effects.

    And now researchers at Stanford University Medical Center in northern California have started recruiting menopausal women to confirm what many women say they already know: The deftly placed needles really do a lot to ease hot flashes. "Getting women involved in this trial has been really easy," confides Rachel Manber, who is running the pilot study. Many are interested. A visiting colleague from Israel, Dr. Yael Nir, reported "amazing" results after using acupuncture to defuse hot flashes, and encouraged Stanford's laboratories to check it out.

    The Stanford study will last a year, with participants undergoing 10 acupuncture treatments over a period of eight weeks. In the meantime, while women await the results, there is certainly no harm in trying this ancient therapeutic technique, provided that the practitioner is skilled in treating women's issues. If it's successful in this small group, Manber says they hope to proceed with a much larger, federally funded study.

  • Dietary Approaches

    The foods you eat (or don't eat) and nutritional supplements that you take can also make a significant difference in the intensity of your hot flashes. The latest findings indicate, for instance, that the lowly soybean holds promise for easing hot flashes.

    The fact that their diets are so rich in soy may largely explain why women in Japan, Korea, and China report fewer menopausal symptoms such as hot flashes. Soy contains natural plant estrogens called phytoestrogens; consuming a lot of soy may stimulate or possibly replace estrogens, hormones that are declining during menopause. (Flaxseeds contain similar phytoestrogens and are good to incorporate into the diet for the same reasons.)

    The American College of Gynecology (ACOG) has declared that soy can possibly be helpful for hot flashes when used in the short-term (meaning less than two years). However, they warn that, given the possibility that soy compounds may interact with estrogen, women with estrogen-dependent cancers may want to avoid soy products.

    An extra benefit is that soy may improve cholesterol levels (good for the heart) and even protect against thinning bones. Try to stick with soy in foods rather than extracts such as isoflavones (an extract available in supplement form), as supplements may not be as effective or safe, ACOG has said. Soy foods include tofu, soy milk, soy shakes, and edamame (soybeans).

    A 2002 review of complementary and alternative therapies for menopausal symptoms published in the esteemed Annals of Internal Medicine concluded that soy was "moderately beneficial" for treating hot flashes. The authors note, however, that only three of eight studies involving soy use of at least six weeks generated significant improvements in hot flashes.

    "In my practice, I find that women who eat a lot of soy definitely have fewer hot flashes," Dr. Edelberg says. "And on a personal note, I know that grande soy lattes eliminated hot flashes in my wife. Within a week, they were gone."

    While soy extract supplements were found to be only marginally useful, the Annals study found that, of all the herbs that were surveyed, the Native American herb black cohosh showed the most potential benefit for quelling hot flashes. Dr. Edelberg reports that black cohosh works about "50% of the time" in his patients. Long-term safety of the herb remains unclear, however. Until more is known, using black cohosh for no more than six months (and preferably for just two to three) may be the best approach.

    Finding What Works for You

    In the end, every woman experiences menopause--and hot flashes--differently. Dr. Edelberg emphasizes that whatever strategy a woman follows to cope with them, she needs to remember that hot flashes will become less intense with time, and to not get too discouraged about them. "This is simply a transitional part of life," he says reassuringly.

    Belleruth Naparstek also strikes a positive note, pointing out that that hot flashes can serve as a way, oddly enough, to celebrate. To reinforce this idea, she now includes as one of the healing affirmations on her menopause tape, the following upbeat sentiment for women to repeat: "I welcome the time that I can keep all the lush fluids of my body, and use them to nourish my own life."

    Other Strategies to Ease Hot Flashes

  • Limit spicy foods, caffeine, and alcohol, and stop smoking. All can alter the regulation of body temperature, and all are well-known hot flash triggers. Alcohol also affects mood, which can be shaky to begin with in women going through menopause.
  • Take lots of baths in tepid water. Be sure the water is just a little cooler than body temperature. If you want to experiment, try adding a little of the essential oil clary sage, which folk wisdom has long recommended for hot flashes.
  • Keep your surroundings as cool as possible. Warm environments can actually trigger hot flashes, so lower your bedroom temperature and keep fans strategically placed throughout your home or workplace during the day. Carry a pocket fan for easy access. Wear several light layers of clothes so that you can shed layers easily if necessary.
  • Try self-applied acupressure. Like having acupuncture, stimulating certain acupressure points can help reduce hot flashes. Doing acupressure is also a great stress-reducer. You press each point for only a minute or two. For instructions on how to do this, see acupressure points for perimenopause.

  • Date Published: 09/20/2005
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