Post menopause hot flashes

Dealing with Menopausal Hot Flashes and Night Sweats

Adding natural foods and supplements to your diet on a long-term basis may help reduce hot flashes and night sweats. Research has been mixed about how effective these supplements are for treating hot flashes and night sweats, but some women have found relief using them.

Because these products may have significant side effects or interact with other medications, you should consult your doctor before taking them.

Here are a few you might want to try:

  • eating one or two servings of soy per day, which has been shown to decrease how often hot flashes occur and how intense they are in some studies
  • consuming black cohosh supplement capsules or black cohosh food-grade oil, which can be used for short-term treatment of hot flashes and night sweats (however, it can cause digestive distress, abnormal bleeding, or blood clots and shouldn’t be used if you have a liver problem)
  • taking evening primrose supplement capsules or evening primrose food-grade oil, which is used to treat hot flashes (but can cause nausea and diarrhea and shouldn’t be used by those taking certain medications, such as blood thinners)
  • eating flax seeds or taking flaxseed supplement capsules or flaxseed oil, which is also called linseed oil, to help reduce hot flashes

You can also talk to your doctor about prescription therapies or over-the-counter (OTC) supplements that can help you find relief. They may suggest:

  • hormone replacement therapy (HRT) using the lowest dose necessary for the shortest period
  • gabapentin (Neurontin), which is an antiseizure drug used to treat epilepsy, migraines, and nerve pain but can also lessen hot flashes
  • clonidine (Kapvay), which is a blood pressure drug that can reduce hot flashes
  • antidepressants like paroxetine (Paxil) and venlafaxine (Effexor XR) can help hot flashes
  • sleeping medications, which don’t stop hot flashes but can help prevent you from being woken up by them
  • vitamin B
  • vitamin E
  • ibuprofen (Advil)
  • acupuncture, which requires multiple visits

Postmenopausal women who report consistent hot flashes and night sweats have an increased risk for developing diabetes compared with those not reporting vasomotor symptoms (VMS), according to study findings published in Menopause.

Researchers assessed a total of 150,007 postmenopausal women who participated in the longitudinal Women’s Health Initiative from 1993 to 2014. Specifically, investigators evaluated correlations between VMS, including the timing of these symptoms (early /late ) as well as their severity and duration, and incident diabetes at a mean 13.1-year follow-up.

As most of the patients included in this analysis were healthier at baseline compared with the general population, the findings from this study may be difficult to apply to patients with other comorbidities. Also, rather than relying on medical records, most of the cases of diabetes were self-reported, which may have presented data error.

The transition into menopause may represent the “optimal time for clinicians to discuss future diabetes risk and assist patients in decision-making around symptom management,” particularly as timely management of VMS can decrease future risk.

Reference

Gray KE, Katon JG, LeBlanc ES, et al. Vasomotor symptom characteristics: are they risk factors for incident diabetes . Menopause. doi: 10.1097/GME.0000000000001033

Is it normal for hot flashes to last long after menopause begins?

Ask the doctor

Menopausal symptoms such as hot flashes may last for years after menopause begins. But there are treatments that can offer relief.

Image: iStock

Updated: October 5, 2015Published: September, 2015

Q. I’m 62 years old, and my last menstrual period was at age 51. My doctor told me that my hot flashes would end after “about three to five years,” but I still have them. Am I unusual, and what can I do?

A. I wish you were unusual, but unfortunately your experience with hot flashes is surprisingly common. I say “surprisingly” because I was taught in medical school and read in the textbooks that menopausal symptoms, when they occurred at all, lasted about three to five years. And therefore that’s what I and my colleagues told our patients. But after about 20 years in practice, I had heard from many patients who were more than five years past menopause that they still were having hot flashes. My colleagues were hearing the same thing. So it seemed the textbooks were getting it wrong.

In fact, in the past decade, a number of studies have confirmed that for some women, menopausal symptoms can last a long time after menopause. A Swedish study of 430,000 women published in 2002 found that 15% of women age 66 and 9% of women age 72 still were bothered by hot flashes. A 2008 U.S. study found that 30% of women still had hot flashes 10 to 19 years after menopause, and so did 20% who were more than 20 years past menopause. A 2011 study of more than 8,000 Latin American women found that more than 60% reported these symptoms 12 years after menopause.

A 2015 study of over 3,000 women from all over the United States reported that among women who began to experience hot flashes before their menstrual periods stopped, the hot flashes persisted in nearly 70% of them 12 years after menopause. And here’s an anecdote: I recently received a letter in which a woman asked what could be done for her hot flashes, which continued to plague her—at age 92!

What to do? Tell your doctor that many studies show that your continued hot flashes are not unusual, and ask what treatments are available. In my opinion (it’s a controversial area), hormone therapy is generally the best option for the first 10 years following menopause. But you are 11 years out, and that’s when the heart disease risks of hormone therapy begin. So I’d ask about other treatments, such as a drug called clonidine (Catapres, Jenloga), the SSRI drugs used for depression, and two drugs used to treat seizures and nerve pain—gabapentin (Horizant, Neurontin) and pregabalin (Lyrica). (I am not saying that hot flashes are a sign of depression or seizures, just that medicines used to treat those problems also are effective against hot flashes.) I’m optimistic that your doctor can find a treatment that relieves, and possibly eliminates, the hot flashes

Disclaimer:
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New long-term research shows that hot flashes continue, on average, for five years after menopause. More than a third of women can experience hot flashes for up to ten or more years after menopause.

A recent study evaluated 255 women in the Penn Ovarian Aging Study who reached natural menopause over a 16-year period. The results indicate that 80 percent reported moderate to severe hot flashes, 17 percent had only mild hot flashes, and three percent reported no hot flashes.

Hot flashes are momentary episodes of heat that can occur with other symptoms including sweating and flushing. Changing hormone levels after cessation of menses are believed to cause hot flashes as well as other menopausal symptoms including insomnia, anxiety, joint and muscle pain, and memory problems. Hormone therapy repletes the hormones estrogen and progesterone the body stops making during menopause, and it has been proven an effective treatment for hot flashes.

Although hormone therapy is highly effective, it is not recommended for all women. In addition, concerns about health hazards linked to hormone therapy have made some physicians hesitant to prescribe it, or to adhere strictly to recommended duration guidelines; current guidelines suggest that exogenous hormones should not be taken for more than five years. This new research on the long-term persistence of hot flashes suggests that women should collaborate with their physicians to determine the risks and benefits of different hormonal and nonhormone therapies available for menopausal symptoms. Women should be able to individualize their treatment to appropriately minimize the the symptoms they may have, no matter how severe or how persistent. To learn more about the variety of treatments available for menopausal symptoms, visit Northwestern’s Menopause website here

Coping with cancer

About treatment for hot flushes

Hormone replacement therapy (HRT)

The only way to completely stop hormonal symptoms is to take hormones to replace the ones your body is no longer producing. But if you are having cancer treatment that stops you producing hormones, you can’t have hormone replacement therapy (HRT).

Doctors recommend that you don’t take HRT if you have had a hormone dependent cancer such as breast cancer. Even if you have finished treatment there is concern that HRT may
increase the risk of the cancer coming back.

Medicine versus the placebo effect

There are a number of different medicines that your doctor might prescribe to help reduce and control hot flushes. But before taking any of these, there is something important to bear in mind.

When researchers want to find out how well a treatment works in a trial, they sometimes test it against a dummy treatment, or placebo. The people taking part in the trial don’t know whether they are taking the new treatment or the placebo. Many of us feel better when taking something that we think will help.

In nearly all trials looking at treatment for hot flushes, people taking the placebo said that their flushes were reduced by about a fifth (20%). It is important to bear this in mind when we are looking at other treatments. If a treatment reduces hot flushes by 20% or less, it may not be better than a placebo.

Treatments your doctor may suggest

Vitamin E

A trial of 120 women who had had breast cancer compared vitamin E with a placebo. They found that vitamin E reduced the number of flushes by one a day. When asked the women said they did not prefer the vitamin E over the placebo. Vitamin E did not cause many side effects, so the researchers suggest it is worth trying as a first treatment.

We need more research to find out how well vitamin E really works and more about side effects.

Anti depressants

Some anti depressant medicines such as venlafaxine can help to reduce the number and severity of hot flushes.

In women who have had breast cancer, anti depressants can reduce hot flushes by just over half. But doctors don’t recommend some types of anti depressant, such as paroxetine or fluoxetine, for women taking tamoxifen. They may interfere with how well tamoxifen works.

Remember that all drugs have some side effects. Anti depressants can cause a dry mouth, headaches, feeling sick, and loss of appetite.

Gabapentin

Gabapentin is a type of anti epileptic drug. It controls fits (seizures) but it can also help to reduce hot flushes.

In trials for women with breast cancer, it reduced their hot flushes by about half (50%). It also helped with reducing the severity of hot flushes and how long they lasted. Pregabalin is very similar to gabapentin which might also reduce hot flushes.

Side effects of gabapentin include dizziness and drowsiness. Some women also develop a rash and fluid retention. We need more research to confirm how well these drugs work and find out more about side effects.

Clonidine

Clonidine is a drug used for a variety of conditions, including high blood pressure.

It can reduce the number of hot flushes women have but it doesn’t reduce their severity or how long they last. You can have clonidine as a tablet or wear a patch on your skin.

Side effects include dizziness, a dry mouth, constipation, drowsiness, and difficulty sleeping.

Progestagens

Progestagens such as megestrol acetate (Megace) are hormones.

Doctors only consider prescribing progestagens to women who have had a hormone dependent cancer if they have severe hot flushes and no other treatment is working.

There is no long term research to show whether they are safe to take for people who have had hormone sensitive breast cancer.

Progestagens can reduce hot flushes by more than 80%.

Side effects can include:

  • skin rashes
  • fluid retention
  • dizziness
  • a dry mouth
  • an increased risk of blood clots
  • headaches
  • vaginal discharge
  • vaginal bleeding (withdrawal bleeding)

Folic acid

Researchers are looking into folic acid as a possible treatment for post menopausal symptoms.

The FOAM trial is looking at this for women who have had breast cancer or womb cancer, or who have not had cancer. The researchers want to find out if folic acid helps to control hot flushes. They will also collect blood and urine samples to see what happens to folic acid in the body.

Cognitive behavioural therapy (CBT)

The word cognitive describes the mental process that you use to remember, reason, understand, solve problems and make judgements. The word behaviour describes your actions or reactions to something.

CBT aims to help you change how you respond to certain situations or emotions. It helps you understand how your thought patterns may be contributing to your feelings of depression or fear.

This therapy also teaches you how to calm your body and mind. It helps you to control your feelings, think more clearly and generally have a more positive outlook.

CBT research

Researchers have tried CBT to see if it can help women who have hot flushes and sweats.

One study found that CBT can reduce the effect of hot flushes and night sweats for women who have had breast cancer treatment. The reductions in sweats and flushes continued after the treatment ended. It helped women to feel better, sleep better, and have a better quality of life.

You can ask your doctor or breast care nurse whether CBT is available in your area.

Complementary therapies for hot flushes

Researchers have looked at a number of complementary therapies as treatments for hot flushes in menopausal women. There is some information about using them after breast cancer.

Acupuncture

Acupuncture has been researched as a treatment for hot flushes in women. A small study compared acupuncture with the anti depressant venlafaxine. The treatments worked equally well at reducing hot flushes in women with breast cancer. This was only a small study and we need further research to confirm how well both treatments work.

Soy

Soy has been tried for hot flushes because women in Asia have fewer hot flushes than women in western countries. People in Asia tend to eat more soy than people in the West.

There are mixed results from research, with some trials showing that it reduced hot flushes and others showing no difference.

There is also some concern about the safety of soy for women with hormone dependent cancers because soy contains plant oestrogens. At the moment there is not enough evidence to suggest that women who have had breast cancer should take it.

Black cohosh

Black cohosh is a native plant of North America. In Germany it is used to treat menopausal symptoms. It is thought to have oestrogen like effects on the body.

Evidence from research is mixed. Some trials found that it helped to reduce hot flushes in women and others did not. But an overview of all the trial results found that it did not reduce hot flushes in women.

Red clover

Red clover is a plant that contains plant oestrogens. Some trials have found that it reduces hot flushes but others have not. There is also some concern that it could increase the risk of cancer coming back in people with hormone dependent cancers because it contains oestrogens.

Other complementary therapies

Ginseng, Angelica sinensis (Dong quai) and Evening primrose oil have been looked at as treatments for hot flushes. There is currently no evidence to show that they work.

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