Treatments for hot flashes vary in effectiveness

Without a doubt, the most frequent complaint of women in perimenopause or menopause is the hot flash. Defined as a mild to intense sense of warmth that extends from the upper body to the face and neck, the flash or flush is accompanied by intense body heat and ends with profuse perspiration and chills. The flash may last 30 seconds to 30 minutes, and is more frequent at night and in warm environments.

Fifty percent of menopausal women may experience hot flashes, which may occur once or multiple times a day and last for months or years. Heart palpitations, chest discomfort, anxiety, chills, sweats and insomnia may coincide with hot flashes. However, conditions such as heart disease can mimic these symptoms and shouldn't be ignored, so women should seek a medical evaluation.

The precise reason for a hot flash is not fully understood, but it's believed to originate in the area of the brain that's sensitive to decreasing levels of estrogen.

Many physicians and others specialize in treating hot flashes and menopause. In reality, though, the only consistent treatment is hormone therapy. Other treatments aren't doomed for failure, but most often the patient and her specialist will embark on a trial-and-error process to find an effective treatment. What works for one patient may not work for the next patient.

Treatment for hot flashes may include lifestyle changes such as diet and exercise; medical therapy including hormone therapy; dietary supplements; and/or antidepressant medications. All of these treatments have succeeded and failed in treating hot flashes.

Hormone therapy includes traditional estrogen and progesterone therapy and bioidentical hormones or "natural" hormones customized to the patient. Traditional hormone therapy, which has been approved by the U.S. Food and Drug Administration, was the proven method of care until the Women's Health Initiative study in 2002 found increases in heart disease, stroke, dementia, blood clots and breast cancer. Since then, however, new evidence has surfaced to reinstate hormone replacement therapy in short interval usage as the standard treatment of menopausal symptoms.

Some hormone therapies derive estrogen from natural sources such as soy. For those who want to stay totally "natural," bioidentical hormones have become more popular. They are compounded specifically for a patient based on an evaluation of her saliva to determine which hormones are lacking. While not FDA-approved, many women have found bioidentical hormones to be of great help in relieving hot flashes and other menopausal symptoms.

Be sure to do your homework, however, before embarking on any hormonal therapy.

Medications such as Paxil, Prozac, Effexor and Celexa, in small doses, all have been shown to ease the number and intensity of hot flashes. For women who cannot take estrogen, these medications work well, but can have side effects such as nausea, insomnia, dizziness and sexual dysfunction.

Unfortunately, most dietary supplementations, including vitamin E, soy, black cohosh and red clover, have not fared well in clinical studies. Their effect on hot flashes has not been shown to be any more successful than placebo. Still, there usually is no harm in trying these alternatives, and they do work for some women.

Perhaps the easiest way to treat hot flashes is lifestyle modifications. Exercise is at the top of the list and has been shown to decrease the number and duration of hot flashes. Walking for 30 minutes or so six to seven days a week can significantly reduce the number and intensity of hot flashes. The use of slow controlled breathing (deep breath in, hold for a few seconds, slowly exhale) a few times a day also can reduce the number of hot flashes.

Keep a diary of what you consume to find out which foods and beverages can trigger a hot flash. Alcohol, coffee, tea and spicy foods are all known to instigate flashes. Of course, tobacco use is associated with hot flashes, yet another reason to quit smoking.

In most cases a treatment plan designed by you and your doctor will result in at least a decrease in the number of flashes, if not total elimination. Be patient during the trial-and-error portion of your treatment. Remember that what works for one person may not work for another, and something as simple as lifestyle modifications or vitamin supplementation may be all that's needed to relieve your symptoms.

Be assured, there's no inherent health hazard for those suffering from hot flashes. Keep your doctor informed of treatments you have tried and those you think may be working best for you. Together you can improve your health and happiness.
Dr. James J. Cosgrove is chairman of the Department of Obstetrics/Gynecology at St. Francis Hospital in Wilmington.

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