Got hot flashes? Here’s what helps

Suddenly, your face, neck, and chest feel hot, maybe you’re turning a bit red, and yep, the sweating kicks in, too. During the day they’re called hot flashes. If they disrupt your sleep, they’re known as night sweats. 

Hot flashes often begin during perimenopause (the years leading up to menopause). They can be mild and last just a few seconds, or they can be more intense and last up to 10 minutes. For most people, hot flashes go away gradually over a few years. But if hot flashes are causing you discomfort or keeping you from sleeping, there are lots of things you can do to help right now.

Lifestyle changes can make a big difference

If your symptoms are mild to moderate, experts recommend a few changes to help reduce the number, and severity, of hot flashes: 

  • Dress in layers.
  • Carry a portable fan. 
  • Sip cold drinks.
  • Turn the thermostat down at bedtime or sleep with a fan.
  • Sleep in socks. It might sound counterintuitive, but keeping your feet warm can help lower your core body temperature.
  • Avoid or cut back on alcohol, spicy foods, and caffeine. 
  • Keep your bedroom cool. Try sleeping under a fan or consider getting a bed fan, a device designed to keep your bed cooler.
  • If you smoke, consider cutting back or quitting. Studies show that smokers tend to have more hot flashes. (We know quitting is a huge and difficult lifestyle change. Please talk to your doctor for support.)
  • Move toward a healthy weight for you. Women who are overweight tend to suffer more from hot flashes, so weight loss can help. Talk to your doctor about healthy ways to lose weight.
  • Try mind-body practices such as yoga, meditation, and relaxation breathing. A regular practice may help reduce hot flashes, and relaxation breathing can help when you feel a hot flash coming on. 

Estrogen is the most effective treatment for hot flashes

If your hot flashes are severe, lifestyle changes can help, but you may also want to look into prescription medications. Estrogen is the most common prescription for hot flashes, and it’s shown to be highly effective. As your natural estrogen levels drop, prescription estrogen can help keep hot flashes at bay, while also reducing other menopause symptoms.

If you’re in perimenopause, your doctor may suggest a low-dose birth control pill. If you’ve reached menopause (it’s been at least one year since your last period), hormone replacement therapy (HRT) helps with hot flashes as well as vaginal dryness, mood changes, and bone loss. If you have a uterus, your doctor will recommend a combination of estrogen and progesterone (progesterone helps protect you from uterine cancer). If you’ve had a hysterectomy, your doctor may recommend estrogen-only HRT. 

HRT has been associated with some health risks, including blood clots, strokes, and some types of cancer. Studies show that risks are low for younger women (women in their 50s, or younger women who’ve experienced menopause early). For added safety, experts recommend using the lowest dose of HRT that works for your symptoms, and limiting HRT use to a few years. Be sure to talk to your doctor about your health risks as you’re deciding whether to use HRT. 

There are estrogen alternatives to treat hot flashes, too

If you’d prefer not to take hormones, or if you have health risks that conflict with hormone therapy, there are a few prescription medications that were developed for other conditions, but have good track records for managing hot flashes, including:

  • Fezolinetant, an FDA-approved non-hormonal treatment
  • Very low-dose antidepressants (lower than the dose used to treat depression)
  • Gabapentin, an antiseizure and nerve pain medication
  • Clonidine, a blood pressure medication
  • Tamoxifen, a medication for treating breast cancer

Some herbal remedies may help, but others make big claims without proven benefits

If you’ve been researching hot flashes, you’ve probably seen ads for herbal supplements. While they make a lot of appealing claims, it’s important to know that supplements aren’t regulated by the FDA the same way that medications are, so there isn’t as much research about their safety and effectiveness. Supplements can also interact with other medications, so it’s always a good idea to check with your doctor first. 

Here’s what we know about some common natural supplements for hot flashes:

  • Black cohosh: Studies of this herb show mixed results. While there isn’t a lot of evidence that it’s effective, black cohosh has a good safety record.
  • Red clover: Controlled studies of red clover extract don’t show any conclusive evidence that it reduces hot flashes, but some women say it has helped them. Studies haven’t found any serious side effects in humans, though some studies in animals suggest that red clover could be harmful to hormone-sensitive tissue. 
  • Dong quai: This herb has been used in Traditional Chinese medicine for more than 1,000 years. So far, clinical studies have not shown benefits for hot flashes. Avoid dong quai if you have fibroids or a blood clotting disorder or if you take medications that affect blood clotting. 
  • Ginseng: Some studies show that ginseng can help with mood and sleep problems, but it hasn’t been shown to help with hot flashes.
  • Kava: There’s no evidence that kava helps reduce hot flashes, but it has been associated with liver disease. The FDA has issued a warning about this danger.
  • Evening primrose oil: Though there isn’t a lot of research, studies of evening primrose oil haven’t found benefits for hot flashes. But studies have shown troubling side effects including inflammation, nausea, problems with blood clotting, and an increased risk of seizures in people taking antipsychotic medications. 

If you’re struggling with hot flashes, you don’t have to figure it out alone. Reach out to your provider for support.

Reviewed by the Ovia Health Clinical Team

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