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Put the Freeze on Hot Flashes

Hot flashes might be a topic played mostly for laughs ("Is it hot in here, or is it just me?"), but they’re a serious matter for menopausal women plagued by sudden, overwhelming sensations of warmth that leave them soaking wet and often embarrassed. The good news is that there are more options than ever. Start with simple lifestyle changes, and if those aren’t effective, work your way down the list.

Step 1: Eat a Healthy Diet and Get Plenty of Exercise

“Healthy lifestyle choices are a must—not only for surviving the symptoms and chaos of menopause, but also for improving the quality and longevity of your life,” says Rebecca Hulem, certified menopause clinician and author of Feelin’ Hot? A Humorous, Informative and Truthful Look at Menopause.

“Your diet should consist of lots of fruits and vegetables, plant-based proteins, lean meat and omega-3 fatty fish like salmon at least four times per week,” she says. And exercise is equally key. “Don’t make it difficult. Walk four to five times per week for at least 45 to 60 minutes, and do light weights for upper-body strengthening. Yoga is great for stretching, relaxation, concentration and balance.”

If you smoke, stop, as it is linked to an increased incidence of hot flashes, she points out. “Also include stress-reduction practices (yoga, mindfulness meditation, tai chi, etc.),” in your regimen, she says.

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Step 2: Make Simple Lifestyle Changes

Hulem recommends making these simple changes to minimize incidents. Avoid spicy foods, which can trigger hot flashes. Dress in layers, so you can peel off outer clothing when you start to feel warm, and keep in mind that cotton is cooler and more breathable than synthetics. Also avoid using hair dryers and taking hot showers. Some women also keep a fan on their desk at work or in their family rooms to get a cool breeze going when they feel a hot flash coming on.

To stave off night sweats, “avoiding alcohol within two hours of going to bed is so important,” says Hulem. “Our estrogen levels are at their lowest at 2 o’clock in the morning, and this is when we will most likely be awakened with night sweats. Alcohol, while it is metabolizing in our body, raises our body temperature, so it is a double whammy to have low estrogen levels and alcohol going on at the same time.”

Step 3: Try Deep Breathing

“If your hot flashes are mild and infrequent, slow, deep breathing helps remind yourself that hot flashes are common and will pass,” says Hulem.

Step 4: Opt for an Herbal Remedy

“If hot flashes are becoming more frequent, then you can consider over-the-counter products,” says Hulem. “The most effective herbal options are black cohosh and soy [isoflavone] products.” Both supplements are available in tablet and capsule form. Although there have been some promising studies on black cohosh’s effect on menopausal symptoms, including hot flashes, the National Institutes of Health do not yet officially recommend it.

As for soy, while previous research had mixed results, a new meta-analysis of 17 previous studies in Menopause: The Journal of The North American Menopause Society found that women who took soy isoflavone extracts had a 21 percent reduction in hot flashes compared with women who took a placebo. The analysis also found that when women did have hot flashes while taking soy, the hot flashes were less severe.

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Step 5: Talk to Your Doctor About Pharmaceutical Options

“If hot flashes are really impacting your day-to-day life, then talking with your health care provider [about prescription hormone replacement therapy] is the next step,” she says. “Pharmaceutical options are aplenty today, especially after the bombshell that was dropped by the Women’s Health Initiative study in 2002,” says Hulem. In 2002, the Data and Safety Monitoring Board of the Women’s Health Initiative, a large set of clinical trials, identified an increased risk of breast cancer, heart attacks, strokes and blood clots to the lungs and legs in women taking hormone replacement therapy. Determining that the overall risks outweighed the benefits, the Board recommended against taking hormone replacement therapy for the long term. Now women who do choose to take HRT take a much lower dose, and only for a few years, just until menopausal symptoms abate.

“Hormone replacement comes in every imaginable vehicle: pills, patches, vaginal rings, vaginal tablets, creams, gels, and sprays,” explains Hulem. “The dose of each hormone is much lower now but still very effective in reducing the symptoms of hot flashes, night sweats and vaginal dryness. Pharmaceutical options will work quickly to reduce symptoms (within two weeks), whereas taking over-the-counter products may take up to six to eight weeks before you see relief.

There are two types of hormone therapies: bioidentical hormones (BHRT), which are derived from plants and are chemically identical to those your body produces; and traditional hormones, which are synthesized chemically in a lab. But according to the Food and Drug Administration, there’s no evidence that bioidentical hormones are more effective than traditional hormone therapy.

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"FDA is not aware of any credible scientific evidence to support claims made regarding the safety and effectiveness of compounded 'BHRT' drugs. "They are not safer just because they are 'natural,'" says Kathleen Uhl, M.D., Director of FDA's Office of Women's Health, on the FDA website.

But, Hulem warns, “Hormones are not for every woman. The benefits and risks must be carefully discussed so that the woman understands her options.”

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