The Cold Facts About Hot Flashes

It may be winter, but menopausal women across the country are still sweating and disrobing. Hot flashes are hardly a new problem and you would think that, by now, someone would have come up with something better than a portable fan to fix it. But it’s not so easy, mainly because the exact cause of the flash is still not entirely understood. 


Hot flashes typically begin as a sudden sensation of heat on the face and upper chest that becomes generalized. It can be pretty intense (I call it the "furnace inside you"), lasting between 2 and 4 minutes and followed by profuse sweating. As if that weren’t enough, many women also have chills and shivering. Physiologically, a hot flash happens for the same reason that you sweat in a sauna … the body is trying to cool down. The difference is, you don’t really need to cool down, but your menopausal brain thinks you do. Let me explain.


The human body is meant to be roughly 98.6 degrees. If you go outside in the winter without your coat, you’re going to shiver to generate heat. You sweat when you exercise to cool the body down. The part of the brain that keeps your body at the right temperature is known as the thermoregulatory zone. But during menopause, the thermoregulatory zone gets too sensitive resulting in a hot flash even when the body doesn’t really need to cool down.


Hot Flash Solutions?

In the 1870s, “Lydia Pinkham's Vegetable Compound” was a popular remedy for virtually every gynecologic ailment including menstrual and menopausal related problems. Roving salesmen (the 1870 equivalent of the health food store clerk) would go house to house selling the stuff. The ads claimed the compound was a "positive cure for all those painful complaints and weaknesses so common to our best female population and is particularly adapted to the change of life."


No doubt, its 18% alcohol content had something to do with its efficacy—even proper ladies could remain happily inebriated while dealing with difficult menopausal symptoms. Another key ingredient in Pinkham's remedy was none other than black cohosh, an extract of dried underground roots derived from a plant used by native North American Indians. Today, black cohosh is one of the most widely used alternative therapies for treatment of hot flashes despite research questioning its effectiveness.

What Actually Works?

Estrogen therapy eliminates hot flashes, and it works well in even very small doses. But many women can't, or chose not to, take estrogen.


Selective Serotonin Reuptake Inhibitors (SSRIs) were serendipitously found to significantly reduce hot flashes in menopausal women years ago, but the drugs are only intended and FDA approved to be used as anti-depressants. Drugs such as Fluoxetine (Prozac), Paroxitene (Paxil) and Venlafaxine (Effexor), have all been found to be helpful in reducing flashes. Effexor is the most studied and seems to do the best job.


Also, an article was just published in JAMA showing that Escitalopram (commonly known as Lexipro), another of the SSRI antidepressants, also reduces the frequency of  flashes.


But drugs aren't the only available option; don't underestimate the value of exercise. Multiple studies demonstrate that women who work out regularly have fewer hot flashes due to exercise-induced endorphin production. Losing that extra weight and eliminating cigarettes also make a huge difference.


For those that decide to tough it out without drugs, be aware that the average woman can expect to experience moderate to severe hot flashes for about 5 years. And around 20% will continue to have flashes even longer (perhaps forever). And while Lydia Pinkham's Vegetable Compound is still available, I wouldn’t recommend it. After all, it no longer contains any alcohol.


By the way, the documentary, Hot Flash Havoc, is circling the country and is really worth seeing. It comes to Chicago on February 2 followed by a panel discussion with yours truly!  


Added to Women's Health, menopause on Wed 01/26/2011