Hot flushes are a sudden unpleasant sensation of burning heat spreading across the face, neck and chest, followed shortly after by sweating and a feeling of being cold and clammy. In extreme cases, hot flushes cause a drop in blood pressure and dizziness. This page highlights some of the possible medical interventions and provides some useful lifestyle and nutritional tips which may help you cope with this tedious symptom.
Causes of Hot Flushes
Women entering the menopause often experience troublesome hot flushes due to a drop in oestrogen production from the ovaries. Women with cancer may experience premature menopause induced by chemotherapy or surgery, yet those with breast cancer are denied oestrogen replacement therapy because of concerns about potential recurrence. Drugs such as tamoxifen or aromatase inhibitors are also known to exacerbate vasomotor symptoms, as well as other menopausal issues such as weight gain, joint pain and vaginal dryness [Thomas, Love]. Men with prostate cancer, treated with drugs or surgery which lower their testosterone, also suffer from hot flushes and night sweats. Occasionally, bone hardening drugs (bisphosphonates) can exacerbate the intensity and frequency of hot flushes.
Standard medical management
For women without breast cancer, the most successful medical treatments are oestrogen hormone replacement therapies (HRT). When lifestyle measures have failed, these are certainly worth considering, but they do increase the risk of breast cancer if taken for more than 10 years. For women with breast cancer, progesterones such as megestrol acetate and cyproterone acetate help, but they can cause fluid retention, weight gain and increased risk thromboembolism [Loprinzi]. In women, the anti-depressant venlafaxine helps to reduce intensity [Loprinzi] but has no effect on men [Quella, Vitolins]. Published research has shown that trying different hormone drugs may help (e.g. switching from tamoxifen to aromatase inhibitors or even switching between different brands) [Thomas].
Lifestyle and self-help strategies
The situations which trigger or exacerbate a hot flush can vary between people; you may find it useful to keep a diary to note when you experience one so that you can identify any pattern. If you know when to expect hot flushes, you can be better prepared. Otherwise, here are some practical tips which may help.
Clothes & environment
- Smokers suffer significantly worse hot flushes – giving up will help you
- Before entering a warm room, take off your coat or warm clothing
- Avoid wearing polyester or other man-made fibres
- Try wearing layers of clothing that can be taken off or put on as your body temperature changes
- Use layers of bedclothes (natural fabrics are better) which you can remove as required
- Carry water vapour sprays or moist wipes to help lower your skin temperature
- Use pleasant-smelling oils such as peppermint for its cooling properties or lavender for its relaxing effect
- Carry a handheld fan to use as soon as a flush starts
- Place a small electric fan on a desk to help lower your skin temperature
- Take plenty of cool baths and showers
- Regular saunas help some people (making sure you cool down afterwards)
Regular gentle exercise may help reduce hot flushes. Choose an activity that you enjoy and feel comfortable with. It’s important to try to exercise at least three times a weak at an intensity which gets you hot and sweaty before making sure you cool down properly afterwards.
Stress can increase the number and intensity of hot flushes. Being anxious about hot flushes could make your symptoms worse. Knowing what to expect and being prepared will help you feel more in control and ease your anxiety. Relaxation therapy can reduce stress and flushes. Hot flushes usually come and go over short periods, so try to relax and wait for the sensation to pass. You may find it helps to imagine yourself in a cool place, for example by the sea, when you feel a hot flush coming on. It may also help to know that although hot flushes are uncomfortable for you, other people are unlikely to notice them happening.
Standard and electroacupuncture have been extensively investigated, and a number of RCTs have reported that they help ease the severity and frequency of hot flushes at a level equal to venlafaxine. Its benefits appear to last up to 2 years.
Diet and Nutrition
- Some people report that spicy foods trigger hot flushes, while others say they can help
- Avoid overeating large meals or eating too fast as this stimulates sweating
- Sugary foods and drinks can cause swings in blood glucose
- Hot drinks can be a trigger – open a window, take your coat & scarf off
- Being overweight can make it more difficult to regulate body temperature
- Avoid stimulants such as caffeine
- Drink plenty of healthy fluids, particularly if you are sweating a lot
- Avoid too much alcohol
- Avoid alcoholic drinks with a high sulphite content (some wines and ciders)
Black cohosh (Actaea racemosa): This has been used for the treatment of hot flushes and other menopausal symptoms for many years (Zierau 2002). In Germany, it is approved as a non-prescription drug for premenstrual and menopausal ailments due to its phyoestrogenic effects [Bodinet, Blumenthal 1998]. Although systematic reviews summarising the clinical efficacy of black cohosh have concluded that there appears to be a minor benefit for menopausal patients, there is a paucity of research focusing on its use among cancer patients [Borrelli, Smith].
Evening primrose: Many people have found that taking evening primrose oil helps with hot flushes, although it may take several months before any improvement is noticed. Evidence from clinical trials is lacking apart from an underpowered, small trial which reported a minor benefit [Farzaneh]. Apart from the calorie content, it is regarded as generally safe.
Vitamin and mineral supplements Vitamin E, selenium and vitamin B6 have provided relief for some people. Again, evidence is lacking, and minerals and Vitamin E did not help vasomotor symptoms among women investigated in one trial [Barton].
Soya and other phyto-oestrogen-rich foods: Phytoestrogens are natural polyphenol chemicals found in plants such as soya beans, chick-peas, lentils, whole grains, peanuts and flaxseed. They are similar in structure to the female sex hormone oestrogen. Studies show that women whose diets are high in phyto-oestrogens have a lower incidence of hot flushes and other menopausal symptoms [Greendale]. Diets high in phytoestrogens are safe, and two large studies from the USA and China have demonstrated that, by suppressing the oestrogen receptors on hormone-sensitive cells and reducing the risk of abnormal growth and potential change into cancer, they are associated with a lower risk of breast cancer relapse [Boyapati].
Despite the benefits of these whole foods, concentrating them into capsules has not demonstrated prospective benefits in the five RCTs conducted so far [quella, van patten, MacGregor, Faure]. Furthermore, some safety concerns have been raised over phytoestrogenic extracts following a study from New York which reported that blood taken from women receiving a high dose soy extract supplement (genistein) increased markers of proliferation (growth) when added to breast cancer cells grown in a laboratory. Another study found that a phytoestrogenic isoflavones supplement altered uterine wall thickness in primates [Foth]. Although low to moderate rises in blood phytoestrogens are helpful, too high a concentration overrides the beneficial effect. Until further studies are performed evaluating the cancer risk of these supplements, they are best avoided.
Non-phytoestrogenic polyphenols (Pomi-T): The benefits of polyphenol-rich foods (teas, spices, green vegetables etc.) have been highlighted throughout this blog as their anti-inflammatory and antioxidant properties help a wide range of conditions. Unlike phytoestrogenic substances, they are generally regarded as safe, particularly those studied in large randomised studies such as the Pomi-T trial. This particular supplement includes concentrated broccoli extract which contains indole-3-carbinol, a substance known its effect on oestrogen metabolism. Although no randomised trials have reported a positive effect on hot flushes, a number of users are anecdotally reporting an improvement.
“After watching a TV program featuring Pomi-T some months back, I thought I would give it a go, simply to help get rid of free radicals. After taking it for a short while I noticed that I no longer had ANY hot flushes. I racked my brain trying to work out why this had happened, as I hadn’t taken any prescribed medication for this. The only change I had made was taking Pomi-T twice daily. I was amazed and thought I would stop them and see what happened. Within a day or two, the flushes came back, oh boy! I started the Pomi-T immediately and within two days they had completely stopped again. Over the six months I have taken them, I have not had a single flush. I would never at the outset have thought for one moment this would have happened. I cannot thank you enough, flushes are debilitating and this truly has transformed my life”.
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