This piece was originally published on Elektra Health.
When you think of menopause, chances are hot flashes are one of the first symptoms that come to mind. Hot flashes are an extremely frustrating — yet common — side effect of menopause. Hot flashes can begin to seriously impede your life and disrupt your sleep and you shouldn’t just have to tough it out. Here are some tips to help you manage the symptoms.
Nutrition and diet
Food can help minimize hot flashes by supporting hormone health — specifically cortisol and insulin. Here are some specific foods that Elektra’s founding physician, Dr. Anna Barbieri, MD recommends.
Soy
Soy products like tofu contain isoflavone compounds (genistein & daidzein) that can help control hot flashes. Isoflavone works essentially by mimicking natural estrogen. Studies have shown benefits with isoflavone supplements and one small study suggests that dietary soy might also help.
Flaxseed
Like soy, ground flaxseed contains phytoestrogens and may help reduce hot flashes. The research shows conflicted results. But like dietary soy, there are other health benefits. Ground flaxseed is a great source of fiber and omega-3s. Add 1-2 tablespoons to smoothies, oatmeal, and yogurt. Make sure that it’s ground though! Consuming it in whole seed or oil form does not deliver the same benefits.
Legumes
Legumes, like chickpeas and lentils, are a weaker source of phytoestrogens and may help reduce hot flashes, although the magnitude of the effect isn’t clear.
While some food can be a beneficial tool in mitigating hot flashes and night sweats, other foods can actually trigger these symptoms.
Common food triggers
Spicy foods
Exercise caution when it comes to late-night dinners that bring the heat! They can also bring you the heat and cause full-body flushing.
Alcohol
While any alcohol can be a trigger, red wine is known to be particularly problematic. If you do choose to drink, try switching to white wine or a different beverage and enjoy your drink with food, earlier in the evening rather than right before bed.
Caffeine
The correlation between coffee and sleep is widely understood. Plus, the effect your cup ‘o Jo has on hot flashes can be just as bothersome. Try cutting down on caffeine if you find it triggers your hot flashes.
Symptom management
Here are some effective ways to manage and mitigate hot flash symptoms.
Paced breathing exercises
The North American Menopause Society recommends paced respiration (slow deep breathing sustained for a specific period of time) as a behavioral treatment for hot flashes. To start, try for five minutes twice per day, with a target rate of 6-8 breaths per minute. If that works, try to get up to 15-minute sessions. It might feel a bit odd and unnatural at first, but stick with it, and it will become like second nature.
Cognitive Behavioral Therapy (CBT)
CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries — that may be triggering or exacerbating hot flashes. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and a mindset to improve the hot flash experience (vs the hot flash itself). It’s ideal for those looking to address underlying causes while working toward long-term management.
Bedroom
When it comes to night sweats, it’s important to keep your bedroom cool. Right around bedtime, our body temperature drops 1-2 degrees, which signals to our internal clock that it’s time to hit the hay. In doctor-speak, this is what’s called “thermoregulation.” Try keeping your bedroom at a cool 60 – 67°F. Here are some other ways to keep cool at night:
- Cooling sheets made with bamboo, effectively wick moisture (read: sweat) from your skin
- Cooling mattress pad or blanket, or a heated blanket for your bed partner (look into one with dual controls to accommodate your partner)
- Cooling system for your bed that uses circulating water to maintain a consistent, cool temperature
- A fan! Simple, low-cost, and effective
Exercise
Although exercise does not directly reduce vasomotor symptoms, it’s beneficial for a slew of other symptoms that may indirectly affect hot flashes, such as sleep health and mood.
Supplements and over-the-counter solutions
Supplements and over-the-counter solutions can be effective in supporting your sleep health. We recommend talking to your healthcare provider first to ensure you’re using the right solution for you.
Low-dose contraceptives
Some providers advise perimenopausal women to take low-dose birth control pills as a way to regulate hormones that impact our cycles, and decrease risk of ovarian/uterine cancer, bone loss, and hot flashes.
Hormone replacement therapy (HRT)
The treatment with the highest reported rate of efficacy for hot flashes is estrogen-based hormone therapy, which comes in the form of a skin patch, gel, cream, spray, or pill. It’s proven to be effective and, as an added bonus, also helps with other symptoms of menopause like vaginal dryness and pain with sex. There are some downsides, so speak with your provider about what makes most sense for you.
Tissue selective estrogen complex
Tissue selective estrogen complex involves a combination of selective estrogen receptor modulators (SERMs) and estrogen, which is most often recommended to postmenopausal women for the joint purpose of vasomotor symptom treatment and osteoporosis prevention.
SSRIs/SNRIs
SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors. These neurotransmitters are typically used as antidepressants; however, they’re also effective in treating certain menopausal symptoms such as hot flashes. They work by regulating serotonin and norepinephrine.
Gabapentin
Gabapentin (Neurontin) is an anti-seizure medication also used to treat menopausal symptoms such as vasomotor symptoms and sleep disruptions.
Oxybutynin
Oxybutynin (Ditropan), a medication commonly used for urinary incontinence, has also been shown to be effective for hot flash treatment.
Sources
- “Treatment & Relief For Menopause & Hot Flashes”. Cleveland Clinic. Cleveland Clinic.
- Barnard, N. D. “Menopause”. PCRM’s Nutrition Guide for Clinicians. 3rd Edition. Physicians Committee for Responsible Medicine. 2020. Print.
- Niazi, A. K., & Niazi, S. K. “Mindfulness-based stress reduction: A non-pharmacological approach for chronic illnesses”. North American Journal of Medical Sciences. 3(1), 20. January 3, 2011.
- Burns, D. S., & Carpenter, J. S. “Paced Respiration for Hot Flashes?” The Female Patient. Web. July 2012.
- Norton, S., Chilcot, J., & Hunter, M. S. “Cognitive-behavior therapy for menopausal symptoms” Menopause. 21(6), 574–578. January 2014.
- Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. “Acupuncture in Menopause (AIM) study”. Menopause. 23(6), 626–637. March 2016.
- “Frequently Asked Questions About Menopause”. WebMD. WebMD. October 7, 2002.
- Pickar, J. H., Boucher, M., & Morgenstern, D. “Tissue selective estrogen complex (TSEC): a review”. Menopause. 25(9), 1033–1045. September 2018.
- “Nonhormonal management of menopause-associated vasomotor symptoms”. Menopause. 22(11), 1155–1174. November 2015.
- “Gabapentin — Uses, Side Effects, and More” WebMD. WebMD.
